[Comparative assessment of the effectiveness of treatment for patients with lung cancer].

A total of 4218 lung cancer patients received therapy from 1965 to 2004. Patients' population analysis shows no statistically significant changes in sex, clinico-anatomical forms or morphological type structure. The first 30 years analyzed showed a gradual increase in the number of patients receiving radical treatment (46.7, 67.2 and 82.4% for each decade), in 1995-2004 this value dropped to 34,0%. For each of the decades studied was evident an increase in the number of patients over 60 years receiving radical treatment. The third decade (1985 to 1994) was characterized by statistically significant increase of 5-year overall survival among patients receiving radical treatment (49.0% compared to 36.2%, 37.6% and 46.0%) mostly due to an increase in I and IIA stage patients compared to other periods (67.9 versus 52.3, 56.5 and 51.6%). The adjuvant tele-irradiation (total focal dose 45-55 Gy, conventional fractioning) in patients receiving radical surgical treatment for metastatic lung cancer with mediastinal lymph nodes involvement (N2) lead to statistically significant increase in 5-year overall survival from 14.7 to 19.7%.

[Anesthetic management in endotracheo-bronchial surgery for central bronchial and tracheal tumors].

The article summarizes the experience of anesthetic management in rigid bronchoscopy endobronchial surgery. Induction intravenous anesthesia followed by high tidal-volume mechanical ventilation proved to be more effective, than inhalation anesthesia with injector or high-frequency ventilation, although these methods are safe and effective in patients with compensated respiratory failure. The use of controlled hypotonia with mean arterial pressure of 60-70 mm Hg leads to decrease of blood loss and hypoxemia prevention without impairment of hemodynamics.

[Optimization of treatment methods of surgical complications in lung cancer].

The present report analyses the immediate and long-term results of treatment of surgical complications in 998 patients with lung cancer. There were complications in 37,5% of the cases, with a fatality rate of 14,7%. The most frequent complications were as follows: postoperative empyema with bronchopleural fistula (41,3%), bleeding (12,0%), pneumonia (9,8%), pulmonary arteries embolism (8,1%) and heart rhythm disorders (8,1%). Adjuvant and neoadjuvant treatment does not increase the rate of surgical complications as compared to just surgery alone (p = 0,1). Postoperative empyema with bronchopleural fistula requires intensive therapy, affects the quality of life of patients but does not decrease survival rates as compared to patients at the same stages of disease with uncomplicated course (p = 0,001). Timely drainage of pleural cavity accompanied by its adequate sanation does not differ (p = 0,1) from usage thoracoplasty (MS 29,9 months to 33,2 months).

[Use of autofluorescence bronchoscopy and spectrometry in the diagnosis of central lung cancer].

The paper evaluates the available data as well as our own on use of autofluorescence bronchoscopy in conjunction with spectrometric examination. We used qualitative and quantitative assessment of images obtained by conventional and autofluorescence (ClearVu Elite) means in real time. Our double-stage study evaluated sensitivity and specificity of autofluorescence bronchoscopy in diagnosing lung cancer as well as constructed spectrometric curves (ROC) and areas under them (AUC). Endoscopy was used in 171 patients with central lung cancer. Autofluorescence bronchoscopy established high sensitivity--94.74% (95%CI: 80.9-99%) and sufficient specificity--79.95% (95%CI: 75.8-83.6%). Application of a wide range of spectrometric coefficients contributed to high specificity thus reducing the number of biopsies as well as the injury from the treatment. The AUC for a best predictive index was 0.89 (99%: 0.83-0.95).

[Application of automated quantitative cytometry in diagnosis of lung cancer].

The paper deals with evaluation of the literature data and our experience with automated quantitative cytometric examination of sputum for diagnosis of lung cancer and, in particular, early one. This novel procedure uses measurement of quantitative indices which characterise tumors-induced alterations. The LungSign computerized system was employed to scan cellular nuclei. The results were evaluated by linear discriminative analysis with the aid of ROC-curves and underlying areas. The procedures were run in 248 cases and its sensitivity was significantly higher that of a standard cytological one (36.6% and 13.3%, respectively; p = 0.033), albeit a slight decrease in specificity (93.7% and 100%, respectively; p = 0.003). Automated quantitative cytometric indices varied significantly in cohorts of patients with confirmed (-0.275871) and false (-1.24990) diagnosis of lung cancer (p = 0.0001).

[Results of treatment of lung cancer complicated by postoperative pleural empyema].

An evaluation of the literature and our own experience with surgical and combined treatment of lung cancer complicated by postoperative pleural empyema established the following incidence rates in 2.4% of patients: postpneumonectomy (4.2%), particularly on the side (57.4%), and in tumor stage III cases (70.6%). Bronchal stump failure (89.7%) was the main cause of postoperative pleural empyema while the risk doubled (4.5-6.0%; p < or = 0.05) after neoadjuvant therapy. Both immediate and end results were worse in postoperative pleural empyema than in similar uncomplicated cases: 12 month survival--43.8% vs. 71.1%; 3-year--18.8-36.8%; 5-year--10.4-26.3%. Also, postoperative pleural empyema patients stayed in hospital longer.