Lung Cancer.pdf

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Thoracic Imaging Techniques 41 A B Figure 3–1. Non–small cell lung cancer manifesting as a hypermetabolic nodule on FDG-PET. CT scan (A) shows a small nodule in the right upper lobe (arrow). Note the emphysematous lung disease. Axial PET image (B) shows increased FDG uptake within the nodule (arrow) compared with the uptake in the mediastinum. These findings are suggestive of malignancy. M mediastinum, V vertebral body.
42 R.F. Munden and J.J. Erasmus (Gupta et al, 1992; Dewan et al, 1993; Patz et al, 1993; Knight et al, 1996; Gould et al, 2001). False-negative results are uncommon; however, at M.D. Anderson, serial radiologic assessment is performed for 2 years on all opacities with low FDG uptake that are not biopsied or resected. Low FDG uptake has a high specificity in the diagnosis of benign lesions and can substantially reduce the number of unnecessary biopsies and surgical resections performed. However, false-positive results can occur with infection and inflammation (e.g., lesions due to tuberculosis, histoplasmosis, or rheumatoid arthritis). Preliminary studies evaluating solitary lung opacities also suggest a possible role of FDG-PET as a prognostic indicator (Ahuja et al, 1998; Dhital et al, 2000). Patients with significantly increased FDG uptake in the primary lesion have a worse survival rate than that of patients with modest FDG uptake. The concentration of FDG within a nodule can be measured on attenuation-corrected, quantitative PET images. FDG uptake is usually expressed as the standardized uptake value, also referred to as the differential uptake ratio. This semiquantitative measure is calculated by dividing the mean activity of the nodule by the injected dose and multiplying the result by the body weight—i.e., Standardized Uptake Value Mean Activity of Nodule (mCi/mL) Body Weight (kg) Injected Dose (mCi) Image-Guided Transthoracic Needle Aspiration Biopsy Many lesions have indeterminate etiology even after comprehensive radiologic assessment. These lesions can be observed, biopsied, or resected. The choice of approach is usually subjective and based on the perceived probability that the opacity is malignant (according to clinical parameters such as the patient’s age and cigarette-smoking history as well as the radiologic features of the nodule). Advances in CT and cytopathology have led to an expanded role for image-guided transthoracic needle aspiration (TTNA) biopsy in the diagnostic evaluation of thoracic lesions. TTNA biopsy is now widely accepted as a safe, accurate procedure with a high yield in establishing the diagnosis of pulmonary and mediastinal masses. TTNA biopsy has been shown to frequently alter management in patients with lung cancer and, if the likelihood of malignancy is low, is the best initial diagnostic procedure (Klein and Zarka, 1997). In the case of peripheral opacities, TTNA should be used instead of bronchoscopy because TTNA is more likely to yield a diagnosis. Most radiographically visible lesions can be biopsied with a TTNA approach if biopsy is clinically indicated. TTNA biopsy has a high sensitivity for the diagnosis of malignancy, and even in the case of small lesions (10–15 mm in diameter) the yield is
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Lung Cancer Frank V. Fossella, MD R
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Page 5 and 6: Frank V. Fossella, MD Department of
Page 7 and 8: vi Foreword possible. Since the res
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Page 11 and 12: x Contents Chapter 7 Surgical Treat
Page 13 and 14: xii Contributors Joe B. Putnam, Jr.
Page 15 and 16: 2 J.B. Putnam, Jr., F.V. Fossella,
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Page 41 and 42: 28 F.V. Fossella history and physic
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92 Y. De Jesus and G.L. Walsh Figur
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94 Y. De Jesus and G.L. Walsh Recov
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96 Y. De Jesus and G.L. Walsh Figur
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98 Y. De Jesus and G.L. Walsh KEY P
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100 Y. De Jesus and G.L. Walsh Jenn
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102 W.R. Smythe nation for these su
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104 W.R. Smythe patient reports of
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106 W.R. Smythe bar or limited lung
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108 W.R. Smythe hospitals for 149 p
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110 W.R. Smythe Figure 6-1. Postsur
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112 W.R. Smythe nant neoplasms has
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114 W.R. Smythe Future Directions F
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116 W.R. Smythe Henschke CI, McCaul
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7 SURGICAL TREATMENT OF LOCALLY ADV
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120 S.G. Swisher Treatment Options
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122 S.G. Swisher Initial Assessment
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124 S.G. Swisher Figure 7-1. Region
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126 S.G. Swisher Table 7-2. (contin
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128 S.G. Swisher upper paratracheal
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130 S.G. Swisher is performed only
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132 S.G. Swisher chance for long-te
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134 S.G. Swisher Pancoast tumors th
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136 S.G. Swisher A B Figure 7-2. Do
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138 S.G. Swisher a combination of t
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140 S.G. Swisher Dartevelle PG, Cha
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8 NONSURGICAL TREATMENT OF EARLY-ST
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144 R. Komaki morbid conditions pre
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146 R. Komaki and 26 patients had c
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148 R. Komaki Around 1998, by using
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150 R. Komaki Table 8-5. Survival a
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152 R. Komaki A total of 610 patien
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154 R. Komaki tially obstructed air
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156 R. Komaki report of Radiation T
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9 TREATMENT OF PATIENTS WITH ADVANC
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160 R. Zinner chemotherapy, in pati
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Table 9-1. Chemotherapy in Older Pa
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164 R. Zinner results of additional
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Table 9-3. Third-Generation-Agent M
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Table 9-4. Third-Generation Agents
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Table 9-5. Third-Generation Platinu
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Table 9-6. Comparisons between Diff
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174 R. Zinner may play an important
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Table 9-8. Third-Generation Cisplat
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178 R. Zinner wards higher survival
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180 R. Zinner KEY PRACTICE POINTS
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182 R. Zinner DeVore RF, Fehrenbach
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184 R. Zinner Perng RP, Chen YM, Mi
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10 TREATMENT OF LIMITED-STAGE SMALL
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188 R. Komaki Age is not a signific
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190 R. Komaki lished between 1979 a
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Table 10-1. Complete Response Rates
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194 R. Komaki twice daily to a tota
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196 R. Komaki Intergroup study 0096
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198 R. Komaki Figure 10-1. Survival
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200 R. Komaki cisplatin with concur
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202 R. Komaki KEY PRACTICE POINTS
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204 R. Komaki tients (Pts) with lim
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206 R. Komaki Wagner H, Kim K, John
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208 G.R. Blumenschein, Jr. recurs a
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210 G.R. Blumenschein, Jr. syndrome
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212 G.R. Blumenschein, Jr. toxicity
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214 G.R. Blumenschein, Jr. the year
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216 G.R. Blumenschein, Jr. is chara
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218 G.R. Blumenschein, Jr. new cyto
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12 PALLIATIVE CARE IN PATIENTS WITH
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222 J.B. Putnam, Jr. therapy. Patie
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224 J.B. Putnam, Jr. tion—includi
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226 J.B. Putnam, Jr. rates were 47%
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228 J.B. Putnam, Jr. Dyspnea The ma
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230 J.B. Putnam, Jr. Small-bore cat
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232 J.B. Putnam, Jr. A B Figure 12-
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234 J.B. Putnam, Jr. C D Figure 12-
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236 J.B. Putnam, Jr. B Figure 12-3.
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238 J.B. Putnam, Jr. KEY PRACTICE P
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240 J.B. Putnam, Jr. Rendina EA, De
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242 A.A. Vaporciyan, J.F. Kelly, an
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14 PREVENTION AND EARLY DETECTION O
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258 E.S. Kim and F.R. Khuri A secon
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260 E.S. Kim and F.R. Khuri Smoking
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262 E.S. Kim and F.R. Khuri Reversa
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264 E.S. Kim and F.R. Khuri yet to
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266 E.S. Kim and F.R. Khuri nation
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268 E.S. Kim and F.R. Khuri Methodo
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270 E.S. Kim and F.R. Khuri have be
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272 E.S. Kim and F.R. Khuri the tre
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274 E.S. Kim and F.R. Khuri changes
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276 E.S. Kim and F.R. Khuri KEY PRA
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278 E.S. Kim and F.R. Khuri Hong WK
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15 MOLECULAR EVENTS IN LUNG CANCER
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282 W.N. Hittelman, J.M. Kurie, and
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300 Index Anterior spinal column re
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302 Index Cardiac murmurs, 104 Card
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304 Index Diagnosis. See also under
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306 Index Growth. See Tumor growth
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308 Index Magnetic resonance (MR) i
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310 Index p16 gene, 285 p19 arf gen
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312 Index Pulmonary resection (cont
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314 Index Squamous metaplasia, 263-
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316 Index Vitamin A, 262 Vocal cord
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