We are now prospectively monitoring functional morbidity and use of analgesics, as these subjects are important parameters related to quality of life. Although the goal of cancer treatment should be tumor control and improvement of survival, optimal locore-gional treatment will reflect in better local relapse-free survival. Because the presence of distant metas-tases reflects the biological behavior of the primary tumor, a reduction of local failure rates does not guarantee a better overall survival rate. In that respect, SST is no exception.
The high morbidity of local tumor progression and local treatment failure (pain, nerve damage) does justify aggressive local treatment, and the main target should be local recurrence-free survival, even for those patients with a rather poor prognosis. Palliative radiotherapy alone can give local control of > 50%. Only a few arti-cles give information on the local control rate after combined radiation and surgical treatment Viagra in Australia for SST; their figures range from 40 to 86%, but neither this information nor the duration of follow-up is always clearly stated. Another point of criticism is that these groups are not homogenous; in some series, N2 status is included, and in others also concomitant chemotherapy.
In addition, some patients with probably negative prognostic factors, such as bad performance status, were also treated. In our series of 23 patients with good performance status, negative mediastinoscopic findings, no concurrent chemotherapy, high-dose radiotherapy, and resection resulted in a local control rate of 85%. Excluding the two patients with treatment-related mortality, the local control rate is 76%. These figures could probably be further improved with more aggressive surgery, such as vascular or spine resection and reconstruction. In our series, the number of patients is too small to study the positive influence of radiotherapy on resection margins and tumor necrosis, which could be the case.
In all our resected specimens necrosis was present, but the original pathology could not be studied because the diagnosis was made by brush or percutaneous fine-needle aspiration. As shown in the present study and confirmed by others, the overall survival of patients with SST remains poor because of the high distant relapse rate. Induction chemotherapy for stage IIIA and IIIB lung cancer seems to improve the survival figures.
