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717

mFTIK~A6EIllER-lR-~MNrIN FATIENTswnH~MEDsr~xNs4kL-ELLw6uylIR(N5a_c). Ratto G.B., Melioli G., Meres C., Fantin, G., Tassara E., Verna A., f’mte M. Istituto Patolqia Chiruqica, hivet-sity of &rca, Italy.

Adoptive Innwwtherapy (AI) with twr infiltrating lqnphocytes (TIL) and Interlwkin-2 (IL-Z) has mqed as a new mxN of treatment capable of nrxliatirg the regression of cancer. In this study AI was firstly used as the initial tt-eainent in 3 patients with NXLC involving supt-aclavicular nodes. TIL cells her-e obtained fran the rmwed supraclavicular n&s and then reinfused intravenously (range: 12-40 bilion cells). IL-2 was adninistenxi subxtatwwsly at escalating doses for 2 w&s, and then at reduced doses for 2-3 tis. MI evidence of tuner regression was recorded; patients died 5 to 9 scnths after surgery. Follcwirg such deceiving eqwiexe, w tested AI as adjuvant treainmnt in 53 patients ti urrdewnt surgery for MaCs clinically classified as stage IIIa. They were randomized ard assigned to the AI arm or the chsldlxtlwapy arm. Median survival was 11 ranths in the chan.$Uttwapy group and 13 in the AI group. There was no significant difference between the two Groups; however, vhen curves were plotted at 9 months of follcwup, survival was significantly better in the AI - (p 0.051. Three patients ti received innwnotherapy and 1 ti had chescRXttwapy, rmmin alive and disease-free at 24 to 30 months after surgery.Pninprowd pet-fonssnce statuswas found in patients receiving AI, as carpared to those vrho had chencf#tl-wapy. In conclusicn, AI is not indicated as initial treabsent in patients with advanced stage NXLC. Hrxwer, m used as adjwant therapy, AI may offer sass advantages with respecttochard(Xtherapy.

ALTWWATltD APPROACE WlTE LOCAL IRRADIATION ATW COMBINATION CEEMOTEEU?Y INCLUDING CISPLATIN OR CARROPLATTN, EPIltDllICIN, AND BTOPOSIDE lN JNTERMEDIATE STAGE NON-SMALL CRLL LUNG CANCER_ P. Come&, G. Scq+, A. Dqonte, G. MuseHa’, C. Ana&*, A. Mdorlno”, C. Curdo”, R. Casmtti, G. Com&. Dqarhomts of Medial Oswolog, md ‘B~diothmpy, NaUonaJ Tmnor IasUt&, Naples, Ita& Dklrlons of llsoradc Sur8ery of “Mowldi 8d “Asalai Hoqit&, Naples, Italy.

FWy-tight consecu!ivc pa&Its with stage IIrA or IlEi non-small cell hang cancer were seated with four courses of combination chunothempy and rhree cycles of local bradSon. Cbcmotbcrapy included a platirmm compound (CDDP 60 m&m or CBDCA 300 mgkpn) iv. on day 1, epintbicin (50 mgkqm) iv. on day 1. and ctoposidc (100 mgkqm) iv. on days 1 tbrougb 3. A courst of radtothempy consisted of 5 coosecutk Raclion (3 G@aclion, 1 Rsction a day) for a total dosage of 15 Gy. Each COUTSC of chomotborapy was altcmatcd cvcry two weeks with a course of inndkfion so that ihe whole treatment was carried out in 13 w&s. Fifty-linw out of 58 patio& wore nrplusblc for rosponsc: 7 of tbun showed a complete ciinical remission, pad 25 reached a pardal response, giviag an ovoraU rcsponsc rate of 60% (95% CL, 46%.74%). Four rcspondcr pa!knts ware subsequently surgicrfly resected aad the complete disappearance of any residual tumor cells was hktologkaUy &cum&cd No difkncc in rcsponsc was observed between CDDP- (16~26 = 62%) and CBDCA-treated patients (16/27 = 59%). and no correlation was found botwccn rcsponsc and cithcr stage or histology. A less severe leukopenia and vomitiug was registered among patients enrolled in the CBDCA-Arm. Mcdiao freedom from progression and ovoraU smvival time were 28 and 39 weeks. respectively. Responder palients had a @iticantty Iongcr m&an duration of smvival (49 wks) as compared to non- responders (15 wks) @ = 0.005). The aitmuned chemoradiothempy treatment obtaiocd a high rcsponsc rate with substaatial toxicity. This approach did not seem to signiticandy improve the prognosis of patients. In this se&g, the admiukmition of CBDCA instead of CDDP appeared more casiiy toloratcd by the patients.

718

PROGNOSTIC FACTOES OF THE RESECTED p-N2 DISEASES WITH INDUCTION CHEMOTHERAPY FOR PRIMARY BRONCHOGENIC CARCINOMA. T. Mori', K. luchi', K. Furuse', M. Kawahara', T. Yasumitsu' *, Y. Kotake**, M. Takada", V. Kusunoki", H. Tada"'. N. Takifuji"', M. Fukuoka"'. National Kinki-Chuo Hospital for Chest Diseases*, Osaka Prefectural Habikino Hospital, Osaka City General Hospital***, Osaka, Japan.

From May, 1989, 40 patients with positive N2 metastases of lung cancer confirmed by mediastinoscopy were treated by CMV (Cis-platinl20 mg/m2 day 1, Mitomycin 8 mg/m2 day 1, VDS 3 mg/m2 day 1.29. 2 cycles).

PR 9, HR 15, NC 15, PD 1; 35 patients were resected. Follow up time were between 2 years and 4 year 1 months.

Response rate were higher in the advancd stages than early stage of c-TNN.

The patients of down-stage is 4 to p-NO, 3 to p-N1 while only one case to P-TONO. Relapse sites were local rn 5 cases, distant in 17 cases.

Survival of the patients (Groups I) with the induction chemotherapy were compared to the 145 compatible N2 patients (Group C) resected in the same periods in Kinki-Chuo Hospital.

Three year survival rate is 38.4% in Group I versus 33.7% in Group I vs 31.1% in Group C (p=O.76) of male patients, 68.5% in Group I vs 40.5% in Group C (p=O.O94) of female patiens. Female patients survived (68.4%) more than male patients (24.2%) at 3 year, p=D.ODE.

Curability (p=O.O031) and tumor size (p=D.O4D) were other prognostic factors by multi-regression analysis, while there were no significant difference in the histological type, age, Brinkman index and response rate.

In conclusion, female, curable resection and smaller tumor size were better significant prognostic factors in case of the induction chemotherapy for confrrmed p-N2 lung cancer patients in our series.

719

MULTI-DISCIPLINARY TREATMENT OF LOCALLY AND REGIONALLY ADVANCED NON-SMALL CELL LUNG CANCER UNIVERSITY OF MIAMI EXPERIENCE. KS SRIDHAR MD, RJ THURER MD, I-IT CI-IATOOR MD, FJ BEATTIE MD. UNIVERSITY OF MIAMI SCHOOL OF MEDICINE/SYLVESTER COMPREHENSIVE CANCER CENTER, MIAMI, FL.

An intensive multimodality therapy protocol incorporating neoadjuvant chemotherapy was initiated in July 1985 for patients with either borderline resectable or unresectable non-small cell carcinoma of the lung. Fifty patients were entered. Thirty-five patients entered till March 1991 were evaluated. The median age was 58 years (17-74). Histology was squamous in 15, adenocarcinoma in 11, large cell in 6, and adenosquamous carcinoma in 3. Initial stages were IIIA in 19 patients, IIIB in 14 and II in 2. All patients tolerated preoperative chemotherapy with 5-FU, etoposide and cisplatin (FED). The response to chemotherapy was complete response in 2 (6%). and partial response in 22 (63%). ‘D&@-two patients underwent surgery. 26 patients were rendered disease free including two found disease free at surgery. Fifteen underwent pneumonectomy, 14 lobectomy and 3 biopsy only. Interstitial radiation therapy was used in 7 patients. ‘lk median survival of patients all patients was 19 months, those who underwent incomplete surgical resection was 12 months and patients rendered disease free at operation 21 months. Thirteen patients rue alive and free of disease, including 5 patients alive longer than 5 years. Only patients who responded to chemotherapy and also had compete resection survived more than 2 years. Aggressive neoadjuvant therapy with FED, followed by resection, brachytherapy, post-operative radiation therapy and adjuvsnt chemotherapy can be safely accomplished with encouraging survival in Stage III patients.