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the results of similar series already in the literature. It appears as though surgi- cal therapy confined with preoperative radiotherapy is the best treatment for ope- rable patients with superior sulcus tumours (T^N. or less). However, radiotherapy can £ afford appliation and, in the occasional patient, long term survival.

Alternating Combination Chemotherapy (CT) in Small Cell Lung Cancer (SCLC) With a Randomized Trial of CT Alone VS CT Plus Radiotherapy (RT) in Limited Disease (LD). Kimura, I., Ohnoshi, T., Hiraki, S., Kawa- hara, S., Tamura, M. Department of Medicine, Okayama University Hospital, Okayama 700, Japan.

In 1982-84, 76 patients with SCLC were treated with alternating chemotherapy consisting of a four-drug ~OMP combination (cyclophosphamide2270 mg/m-, i.v. day 1-5 ; oncovin, 1.42mg/m , i.v. day i; methotrex- ate 6.5 mg/m 2, p.o. day 1-5; and procarba- zine 65 mg/m , p.o. day 1-5) and a three- drug V~/q combination (VP-16, 140 m~/m , p.o. day 29-32; adriamycin 40 mg/m-, day 29; and nidrgn, a water-soluble nitrosou- rea, 40 mg/m- i.v. day 29). Forty patients with extensive disease (ED) received CT alone in a one arm study, and 36 patients with LD were randomized to receive either CT alone or CT plus RT. The RT dose was 4,000 rads to the chest between CT cycle I and II, 20 fractions over 4 weeks. The table shows the therapeutic results.

2-yr disease-free MST

Stage No CR([) CR+PR(%) (mo) % ProJected Actual

CT ED 40 14(35) 33(83) 10 CT LD 18 10(56) 15(83) 14.5 23 1/9 CT+RT LO 18 11(61) 16(89) 12 16 1/10

Major toxicity was myelosuppression but was well tolerated. One patient given CT plus CT died of pneumonitis.

Our conclusions are: (L) alternating CT appears beneficial compared to COMP histo- rically, however, modality advantages should be clarified in randomized trials, and (2) in LD patients chest RT in addition to intensive CT did not affect response rate, survival or pattern of recurrence.

Evaluation of Thoracic Sequelae in Long Term Survivors (LTS) After Combined Chemo- therapy and Radiotherpay for Treatment of Limited Small Cell Lung Cancer (L.S.C.L.C.) Baldeyrou, P., Le Chevalier, T., Ruffie, P., Arriagada, R. Institut Gustave-Roussy, Villejuif, France.

Patients treated for LSCLC since 1980 by alternating radiotherapy (RT) and che- motherapy (CT), and alive disease-free after 30 months of follow-up are being evaluated for thoracic complications.

The assessment includes clinical examina-

tion, quantification of dyspnea using Borg sca- le, C.B.C. and chemistries, chest x-ray,, fi- beroptic bronchQscopy, ECG, cardiac ultrasono

graphy, spirometry, flow/volume curve, TLCO in steady state, compliance and exercice testing.

Among the first six evaluated patients, the following results were found: one patient is symptom-free, 4 present a mild and 1 a severe shortness of breath. Four patients have a pul- monary grade I fibrosis and 2 a grade II fibro- sis on chest-x-ray. Fiberoptic bronchoscopy was normal in 1 patient and demonstrated seg- mental (4) or proximal (i) post therapeutic bronchial stenosis. Cardiac ultrasonography was normal in 3 patients and showed a minimal pericardia1 effusion in 3.

Compliance and TLCO in steady state were significantly decreased in 5/6 patients.

In exercise testing, only one patient was able to develop an effort > i00 watt.

This complete respiratory assessment is necessary to evaluate the complication rate and degree in LTS after treatment of LSCLC.

Superfractionated Radiotherapy With Chemothe- rapy in Limited Oat Cell Carcinoma of the Bronchus. Ian Hodson, D., Malaker, K., Meikle, A.L., Levitt, M. The Manitoba Cancer Foundation, Win- nipeg, Manitoba, Canada.

The unique cellular kinetics of oat cell car- cinoma (OCC) suggest that superfractionation of the radiotherapy (SFR) i.e. more than one daily treatment, might be more effective than conventional daily treatment in loco-regional control.

Between June 1980 and October 1982, 27 pa- tients (pts) with limited OCC were treated by SFR and combination chemotherapy. Initially this consisted of procarbazine, vincristine, cyclophosphamide and cis-chloronitrosourea (POCC) but, because of myelosuppresion, this was changed after 7 pts to adriamycin. Cyclo- phosphamide and etoposide (ACE).

In both studies the radiation was given with i00 cGy per fraction with 4-6 hours be- tween fractions and the primary lesion recei- ved 50 Gy in 50 fractions over 20 days, the mediastinum 35 Gy in 35 fractions over 15 days. In the initial study, the entire affec- ted lung and liver received 20 Gy in 20 frac- tions over i0 days; in the second study the whole lung irradiation was omitted.

There were 18 males and 9 females treated with a median age of 60 yrs, range 29-77 yrs. Overall, a complete regression (CR) rate of 74& was achieved with a median survival of 12 months and 5 pts survived 2 yrs or longer. No pt developed acute radiation penumonitis or hepatitis and, although most pts developed transient dysphagia, no pt required hospitali- zation for nutritional support.

SFR can be combined with aggressive combina- tion chemotherapy leading to a high CR rate, but it remains to be proven in a prospective

randomized fashion whether this approach is