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EFPBCT OP PImSTunY TunoB STAQB Am OP CHQIOTBERAPY- RAuIoTRERAPY (CT-WC) IW non-SWAI& CRLL LUWO CAWCBR (WSCLC)~eisman.HD. A.Lisbona.MD.L.Olsonr

rooert.So.D.C MoBggeg.Dillman.MD.S.Seaaren. pro, HR.Green. &JJ) iewish General Iiospital,McGill University, Montreal Canada and CALGB, Lebanon N?I, USA

Cancer and Leukemia Group B (CALGB) protocol 8433 compared chest RT (6000 cGy)with CT-RT in selected pts-with stage III- NSCLC.Iill pts were performance status O-l and had weioht loss < S%.Althouah the study showed significan: failure-free and overall survival favoring CT-RT,there was no stratification for prestudy TWM etage.We reviewed pretreatment CT- scans from 129 of the 180 ots on urotocol.Reviewers were unaware of which traatment-each patient had received.S2% and 84% of pte in the 2 arms had measurable disease.We found the treat- ment arms balanced with respect to stage III substage. (58% of RT arm, 65% of RT-CT arm were IIIa).Pts with IIIa had superior survival to pts with IIIb(16.5 mo vs 10.5 molfo-0.00451. Survival wae suoerior in the CT- , ._ RT arm within eaih of these stages-(17.2 mo vs 10.7 mo in IIIa, p=O.l6, 12.0 mo vs 6.9 mo in IIIb,p=O.O89).CT scanning may be used to categorize patients into the 2 stage III substages and those with IIIa have a better prognosis than those with IIIb.The combination of chemotherapy-radiotherapy was superior to chest radiotherapy alone, in each of the stage III substages. Further studies in this population should stratify for stage III substage.

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APPLICATION OF POSITRON EMISSION TOMOGRAPHY IN THE STAGING OF LUNG CANCER

M.V. Knapp, L.G. Stnu~. H. Birchoff, U. Habukom, D. BnnachekY, I. Doll, W.J. Lorcnz, G. van K&k. Cnmun Cancer Research Center, Hrideber& Tlinic for Thoncic Diieasu, Heidelbq, Germany

The feasibility as well as potential application of positron emission tomography (PET) with F-18 deoxyglucose (FDG) for thoracic imaging has been established in previous studies. The promising results encouraged clinical studies to evaluate the benefit of diagnostic PET studies in comparison to surgical results. 65 patients were studied with PET in the course of diagnostic evaluation of newly detected, indetermined lung tumors prior to invasive staging. Surgical resection was performed in 25 patients. T-classification for TNM staging was compared between the current diagnostic methods, PET and invasive staging. Ihe final T-state was determined by bronchoscopy (49%), surgery (38%) and thoracoscopy (2%) or clinically (11%) of all 65 patients. The PFX T-staging agreed in 98% with the invasively continued T value. This results give PET the highest degree of accuracy in non-invasive T-staging. In the detection of tumors, PET correctly identified 63 of 65 patients by classifying 53 of 54 as malignant and 10 of 11 as benign lesions. We can conclude that FDG PET studies are of great clinical value in the staging of lung tumors if the more conventional technique including CT and MIU present ambiguous tindmgs.

Prognostic Factors in Small Cell Lung Can- cer (SCLC). RECPAM analysis on 1,651 pts treated in Copenhagen during 1973 - 1987.

K Bsterlind, A Ciampi, P Dombernowsky, M Han- sen, OP Hansen & HH Hansen. Finsen Institute, Herlev, Hillersd & Bispebjerg hospitals, DK- 2100, Copenhagen, Denmark, & Montreal Chil- drens Hospital, Montreal, QuQbec, Canada. Multivariate analyses of pretreatment prog-

nostic factors in SCLC have proven the impor- tance of stage disease, performance status (PS), LDH, alkaline phosphatase & hyponatre- mia. Among such analyses are our own on 074 pts & 777 pts, prospectively included in con- trolled trials during 1973-81 & 1981-87, re- spectively. Most multivariate analyses have been based on Cox's proportional hazards mo- del. Knowing the Cox coefficients enables calculation of an index, i.e. a point on a prognostic scale. In contrast RECPAM (recur- sive partition and amalgamation) grows a tree, a hieratical system in which a sequence of clinical meaningful questions lead to pro- gnostic subgroups. RECPAM analysis of our two data set led to the same prognostic factors as mentioned above. Data on all factors were necessary to identify the good risk group, while I> 2 x upper level LDH' and 'PS >2' led directly to the poorest group, and staging of these 15% of the pts was unnecessary. Thus, a prognostic system based on RECPAM is econo- mic and it supports our natural stepwise cli- nical decision making.

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A MULTICENTRE CONSENSUS MODEL FOR PROGNOSTIC FACTORS IN SMALL CELL LUNG CARCINOMA (SCLC).

U. Sagman, E. Maki, E. Ledesma, R Feld, and the Consensus Group for Prognostic Factors in SCLC. A consensus model for prognostic factors in SCLC was developed by analysis of pooled data from 6,386 patients managed at six centres in North America and Europe. Factors identified as statistically significant in univariate log rank analysis in all six data sets included the following: extent of disease; site(s) of metastasis; mediastinal involvement; sex; age; performance status; hemoglobin, white blood cell count, platelet count; serum alkaline phosphatase, lactate dehydrogenase and sodium. Employing the statistical methodology of recursive partitioning, a prognostic model was developed based on data derived from 1429 patients managed at centres in Canada and Denmark. From that model, the variables selected to define the resulting four prognostic groups include: extent of disease; sodium; performance status; serum lactate dehydrogenase; age; and sex. Further analysis will test the applicability of the model to patients from other centres in the study. Comparative statistical analysis will test the possible advantage of using recursive partition over the Cox multivariate approach. We are also investigating how to deal with centres missing information on a given variable. Adoption of a new consensus model for prognostic factors in SCLC may improve on the design, conduct and interpretation of clinical trials, as well as the prognosis of individual patients.