Thus, in our study, candidate patients were evaluated on the basis of spirometry, oximetry, arterial blood gases, chest radiograph and CT, chest MRI (after 1988), ventilation-perfusion scan (if FEV1 was <1 L), and echocardiography. Patients without medical contraindications whose tumor was clinical stage I according to Butchart et al and considered completely resectable were candidates for trimodality therapy if they had an Eastern Cooperative Oncology Group performance status of 0 or 1 and normal renal and hepatic function. Patients were excluded if they exhibited compromised cardiac function (ejection fraction <45%), preoperative partial pressure of C02 >45 mm Hg, room air partial pressure of 02 <65 mm Hg or predicted postoperative FEVj of <1 L, or mediastinal or transdia-phragmatie invasion on MRI.
The technical aspects of extrapleural pneumonectomy have been described in detail. Briefly, the operation involved en bloc resection of the lung, parietal pleura, and ipsilateral pericardium and diaphragm, with diaphragmatic and pericardial reconstruction. Any previous biopsy sites or thoracoscopy ports were also resected. canadian health&care mall

Chemotherapy was administered 4 to 6 weeks following extrapleural pneumonectomy. Before 1985, patients (n=9) received doxorubicin, 50 to 60 mg/m2, and cyclophosphamide, 600 mg/m2, for four to six cycles; after 1985, cisplatin (70 mg/m2) was added to the regimen.
External-beam radiotherapy (4 to 10 MV) was administered following chemotherapy, initially including the entire ipsilateral hemithorax and mediastinum to a dose of about 30 Gy, followed, if possible, by a boost dose (typically 50 to 55 Gy) to regions of previous bulk disease.
A recent analysis of this trimodality protocol in 120 consecutive patients undergoing extrapleural pneumonectomy at the Brigham and Women’s Hospital from 1980 to 1995 has been reported. To summarize, complete follow-up was available through February 1996, with a median follow-up of 15 months (range, 2 to 91 months). Median patient age was 56 years (range, 31 to 74 years), and the onset of symptoms occurred a median of 2 months (range, 0.5 to 27 months) prior to diagnosis. Eighty patients (67%) were current or former smokers, and 94 patients (78%) reported asbestos exposure. Presenting symptoms included chest pain in 61 patients (51%) and dyspnea in 88 (73%).