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104 Clinical assessment Deletion of 3(p14p23) in secondary erythroleukemia arising in long term survivors of small cell long cancer. Whang-Peng J, Lee EC, Minna JD, Abeloff MD, Bradley EC, Young RC, Longo DL. Division ofCancer Treafmenr, Naiional Cancer Insri- we, Bethesda, MD. J Nat1 Cancer Inst. 1988;80:1253-5. Cytogenetic studies were done on the leukemia cells of two patients with small cell lung cancer (SCLC) who developed erythroleukemia (acute non-lymphocytic leukemia, French-American- British M6) after combined modality chemotherapy and radiotherapy for their lung cancer. Surprisingly, both erythroleukemias exhibited the del(3)(pl4p23) predominantly found in SCLC. In four other patients who had secondary erythroleukemias associated with other cancers, no deletionsof3pwcre found.Thesefindingscouldbeaccountedforbyone of three possible mechanisms: (a an inherited recessive gene (anti- ) oncogene or tumor suppressor gene) in this region of 3p was uncovered by the combined modality therapy, (b) an inherited predisposition to damage of both chromosomes at 3~14 leads to SCLC and erythroleukemia after exposure to carcinogens and/or chemotherapy- radiotherapy, or(c) the finding of lineage specificity for the 3p deletion with the presence of the 3p deletion in SCLC and erythroleukemta suggests a common bone marrow precursor. Neuron-specific enolase in the diagnosis of small-cell lung cancer with pleural effusion: A negative report. Pettersson T, Klockars M, Froseth B. Fourth Department ofMedicine. Helsinki Universily Central Hnspilal. SF-00170 Helsinki. Eur Respir J 1988;1:698-700. We measured the concentrauon of neuron-specific enolase (NSE) and carcincembryonic antigen (CEA) in the serum and pleural fluid of 53 patlen& with pleural effusions, including seven patients with small-cell lung cancer (SCLC). High levels (above 12.5 *gl-‘) of NSE in pleural fluid were observed in five patients with SCLC (sensitivity 71%). However, pleural fluid NSE levels were also increased in five patients with other types of cancer and in four patients with non-malignant inflammatory diseases (specificity 80%). We conclude that although SCLC wthplcuraleffusioncan beassociatedwithelcvatedpleural fluid NSE actwity, this increase m enzyme levels is not specific for malig- nancy. Diagnostic significance of flow cytometric DNA analysis applied for the detection of cancer cells in bronchial washing fluid. Deinlein E, Sander U, Greincr C, Hornstein OP. Department ofDerma- tology, Universily of Mangen-Nurnberg, D-8520 Erlangen. Anal Nal Quant Cytol Histol 1988;10:360-4. Since both DNA aneuploidy and increased proliferatwe activity are important characteristics of malignant neoplasms, flow cytometric (FCM)analysiswasused toexamine thecellcontentin brochial washing samples obtained via fiberoptic hronchoscopy from 73 patients. The results were compared with the results of histology and conventional cytology. The patients included 30 with bronchial carcinomas, I2 with bronchopneumonia and 3 1 with no evidence of lung disease. Of the 30 patients with histologically confirmed lung cancers, 25 showed either aneuploid stem lines (19 cases) or high levels of proliferation (6 cases) as determined by analysis of cell-cycle stages The same rate of cancer cell detection was obtained by cytology. In the 43 cases with neither histologic nor clinical evidence of malignancy, FCM data yielded 5 false-positive results, as compared to 4 ermneous suspicions of cancer by cytology. From these data, it is concluded that FCM measurements ofbothDNAploidyandproliferativeactivitymaycomplementconven- tional cytology in the recognition of bronchial carcinomas. Peripheral carcinoid turnours of the long: A clinicopathological study. Abdi EA, Gocl R, Bishop S, Bain GO. Department of Medicine, University of Album, Edmonton, Al&z. J Surg Oncol 1988:39:190-6. Peripheral carcinoid turnours (PCT) of the lung are a distinct entity. These turnours arise from subsegmental or distal bronchioles, are usually well circumscribed and encapsulated, and contain varying amounts of spindle cells. Their histogenesis is from the Kultchitsky or newosecretory type of cells. Of 52 patients with carcinoid turnours of the lung, 11 (21. I W) had PCT. The mean age was 60.2 years, 9 out of 1 I patients were females, and about two-thirds of turnours were in the left lung (8 out of 13). No patient developed carcinoid syndrome. but three patients had nonspecific respiratory symptoms. Bronchoscopy was not helpful in diagnosing any of these cases. Four patients required a wedge resection of the lung; the other six underwent lobectomy. One patient had turnours detected incidentally at autopsy. Mean turnour size was 2.39 cm (range 1.O-5.0 cm): four tumours were 3.0 cm or larger in diameter. Three cases (27.3%) hadregional lymph node metastases, but no systemic metastasis was discovered. Apart from the patient who was discoveredto havecarcinoid tumoursatautopsy, all othersarealive and disease-free from 1to 6 years after surgery. ApilotstudyoftheFonctionalLivingIndex-Cancer(FLlC~scalefor the assessment of quality of life for m&static lung cancer patients. An Eastern Cooperative Oncology Group study. Finkelstein DM, Cassileth BR, Bonomi PD, Ruckdeschel JC, Ezdinli EZ, WolterJM.DivisionofBiostatisrics,Dana-FarberCancerfnstitute, Boslon, MA 02I15. Am J Clin Oncol, Cancer Clin Trials 1988;11:630- 3. Quality of life is an important factor in the assessment of cancer therapy, but it is difficult to define and measure. The Functional Living Index-Cancer (IXIC) was designed specifically for cancer patients under treatment. The Eastern Cooperative Oncology Group (ECOG) mounted a pilot study to assess the feasibility and sensitivity of the patient-onentedFLIC scale forassessment of quality of life. The results of this study show that the FLIC scores correlate with the functional status of patients on treatment: high scores on the FLIC prior to therapy were found to correlate wth good performance status (p = O.OOOl),and decreases in the FLIC score during therapy correlated with a decline in performance status (p = 0.0001). with poor performance status (p = 0X002), and > 5% recent weight loss (p = 0.004). However, there was poor compliance to completion of the instrument, indicating a need for future research mto this aspect of assessing quality of life in the cooperative group setting. Monoclonal antibody-mediated detection of lung cancer antigens in serum. Schepart BS, Margolis ML.DeparrmentofMicrobiologyandImmunol- ogy. Medical College of Pennsylvania, Phrladelphia, PA 19129. Am Rev Respir Dis 1988:138:1434-8. We assessed the ability of three monoclonal antibodies (MAbs) (5E8, 5C7, and lFl0) to detect tumor-associated antigens (TAAs) m the sera ofpatientssseeninconsultation by thePulmonary DiseaseSectionatthe Philadelphia Veterans Administration Medical Center from Septcmbcr through November 1987. Eighteen of the 61 sera were obtained from patients with histologically established lung cancer. Using a semiquan- titative enzyme-linked immunoassay @LISA), TAAs were detected by the MAb panel in the sera of 12 lung cancer patients, yielding a sensitivity of 67% with a 95% confidence interval of 44 to 84%. The frequency of TAA detection varied among cell types and stages of disease. There were eight false positives and 35 true negatwes, givmg a specificity of 81% with a 95% confidence interval of 67 to 90%. Two of the false positives came from patients with nonpulmonary mmors known to cross-react with the MAbs (laryngeal and gastric carcinoma). The panel was able to distinguish pattents with lung cancer from those without toa highlysignificantdegree(*gc’= 11.2 with 1 df,p<O.OOl). This study suggest that MAb-mediated detection of serum TAAs may bc useful in diagnosing and characterizing lung cancers.

Deletion of 3(p14p23) in secondary erythroleukemia arising in longterm survivors of small cell lung cancer

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Page 1: Deletion of 3(p14p23) in secondary erythroleukemia arising in longterm survivors of small cell lung cancer

104

Clinical assessment

Deletion of 3(p14p23) in secondary erythroleukemia arising in long term survivors of small cell long cancer. Whang-Peng J, Lee EC, Minna JD, Abeloff MD, Bradley EC, Young RC, Longo DL. Division ofCancer Treafmenr, Naiional Cancer Insri- we, Bethesda, MD. J Nat1 Cancer Inst. 1988;80:1253-5.

Cytogenetic studies were done on the leukemia cells of two patients with small cell lung cancer (SCLC) who developed erythroleukemia (acute non-lymphocytic leukemia, French-American- British M6) after combined modality chemotherapy and radiotherapy for their lung cancer. Surprisingly, both erythroleukemias exhibited the del(3)(pl4p23) predominantly found in SCLC. In four other patients who had secondary erythroleukemias associated with other cancers, no deletionsof3pwcre found.Thesefindingscouldbeaccountedforbyone of three possible mechanisms: ( a an inherited recessive gene (anti- ) oncogene or tumor suppressor gene) in this region of 3p was uncovered by the combined modality therapy, (b) an inherited predisposition to damage of both chromosomes at 3~14 leads to SCLC and erythroleukemia after exposure to carcinogens and/or chemotherapy- radiotherapy, or(c) the finding of lineage specificity for the 3p deletion with the presence of the 3p deletion in SCLC and erythroleukemta suggests a common bone marrow precursor.

Neuron-specific enolase in the diagnosis of small-cell lung cancer with pleural effusion: A negative report. Pettersson T, Klockars M, Froseth B. Fourth Department ofMedicine. Helsinki Universily Central Hnspilal. SF-00170 Helsinki. Eur Respir J 1988;1:698-700.

We measured the concentrauon of neuron-specific enolase (NSE) and carcincembryonic antigen (CEA) in the serum and pleural fluid of 53 patlen& with pleural effusions, including seven patients with small-cell lung cancer (SCLC). High levels (above 12.5 *gl-‘) of NSE in pleural fluid were observed in five patients with SCLC (sensitivity 71%). However, pleural fluid NSE levels were also increased in five patients with other types of cancer and in four patients with non-malignant inflammatory diseases (specificity 80%). We conclude that although SCLC wthplcuraleffusioncan beassociatedwithelcvatedpleural fluid NSE actwity, this increase m enzyme levels is not specific for malig- nancy.

Diagnostic significance of flow cytometric DNA analysis applied for the detection of cancer cells in bronchial washing fluid. Deinlein E, Sander U, Greincr C, Hornstein OP. Department ofDerma- tology, Universily of Mangen-Nurnberg, D-8520 Erlangen. Anal Nal Quant Cytol Histol 1988;10:360-4.

Since both DNA aneuploidy and increased proliferatwe activity are important characteristics of malignant neoplasms, flow cytometric (FCM)analysiswasused toexamine thecellcontentin brochial washing samples obtained via fiberoptic hronchoscopy from 73 patients. The results were compared with the results of histology and conventional cytology. The patients included 30 with bronchial carcinomas, I2 with bronchopneumonia and 3 1 with no evidence of lung disease. Of the 30 patients with histologically confirmed lung cancers, 25 showed either aneuploid stem lines (19 cases) or high levels of proliferation (6 cases) as determined by analysis of cell-cycle stages The same rate of cancer cell detection was obtained by cytology. In the 43 cases with neither histologic nor clinical evidence of malignancy, FCM data yielded 5 false-positive results, as compared to 4 ermneous suspicions of cancer by cytology. From these data, it is concluded that FCM measurements ofbothDNAploidyandproliferativeactivitymaycomplementconven- tional cytology in the recognition of bronchial carcinomas.

Peripheral carcinoid turnours of the long: A clinicopathological study. Abdi EA, Gocl R, Bishop S, Bain GO. Department of Medicine,

University of Album, Edmonton, Al&z. J Surg Oncol 1988:39:190-6. Peripheral carcinoid turnours (PCT) of the lung are a distinct entity.

These turnours arise from subsegmental or distal bronchioles, are usually well circumscribed and encapsulated, and contain varying amounts of spindle cells. Their histogenesis is from the Kultchitsky or newosecretory type of cells. Of 52 patients with carcinoid turnours of the lung, 11 (21. I W) had PCT. The mean age was 60.2 years, 9 out of 1 I patients were females, and about two-thirds of turnours were in the left lung (8 out of 13). No patient developed carcinoid syndrome. but three patients had nonspecific respiratory symptoms. Bronchoscopy was not helpful in diagnosing any of these cases. Four patients required a wedge resection of the lung; the other six underwent lobectomy. One patient had turnours detected incidentally at autopsy. Mean turnour size was 2.39 cm (range 1 .O-5.0 cm): four tumours were 3.0 cm or larger in diameter. Three cases (27.3%) hadregional lymph node metastases, but no systemic metastasis was discovered. Apart from the patient who was discoveredto havecarcinoid tumoursatautopsy, all othersarealive and disease-free from 1 to 6 years after surgery.

ApilotstudyoftheFonctionalLivingIndex-Cancer(FLlC~scalefor the assessment of quality of life for m&static lung cancer patients. An Eastern Cooperative Oncology Group study. Finkelstein DM, Cassileth BR, Bonomi PD, Ruckdeschel JC, Ezdinli EZ, WolterJM.DivisionofBiostatisrics,Dana-FarberCancerfnstitute, Boslon, MA 02I15. Am J Clin Oncol, Cancer Clin Trials 1988;11:630- 3.

Quality of life is an important factor in the assessment of cancer therapy, but it is difficult to define and measure. The Functional Living Index-Cancer (IXIC) was designed specifically for cancer patients under treatment. The Eastern Cooperative Oncology Group (ECOG) mounted a pilot study to assess the feasibility and sensitivity of the patient-onentedFLIC scale forassessment of quality of life. The results of this study show that the FLIC scores correlate with the functional status of patients on treatment: high scores on the FLIC prior to therapy were found to correlate wth good performance status (p = O.OOOl), and decreases in the FLIC score during therapy correlated with a decline in performance status (p = 0.0001). with poor performance status (p = 0X002), and > 5% recent weight loss (p = 0.004). However, there was poor compliance to completion of the instrument, indicating a need for future research mto this aspect of assessing quality of life in the cooperative group setting.

Monoclonal antibody-mediated detection of lung cancer antigens in serum. Schepart BS, Margolis ML.DeparrmentofMicrobiologyandImmunol- ogy. Medical College of Pennsylvania, Phrladelphia, PA 19129. Am Rev Respir Dis 1988:138:1434-8.

We assessed the ability of three monoclonal antibodies (MAbs) (5E8, 5C7, and lFl0) to detect tumor-associated antigens (TAAs) m the sera ofpatientssseeninconsultation by thePulmonary DiseaseSectionatthe Philadelphia Veterans Administration Medical Center from Septcmbcr through November 1987. Eighteen of the 61 sera were obtained from patients with histologically established lung cancer. Using a semiquan- titative enzyme-linked immunoassay @LISA), TAAs were detected by the MAb panel in the sera of 12 lung cancer patients, yielding a sensitivity of 67% with a 95% confidence interval of 44 to 84%. The frequency of TAA detection varied among cell types and stages of disease. There were eight false positives and 35 true negatwes, givmg a specificity of 81% with a 95% confidence interval of 67 to 90%. Two of the false positives came from patients with nonpulmonary mmors known to cross-react with the MAbs (laryngeal and gastric carcinoma). The panel was able to distinguish pattents with lung cancer from those without toa highlysignificantdegree(*gc’= 11.2 with 1 df,p<O.OOl). This study suggest that MAb-mediated detection of serum TAAs may bc useful in diagnosing and characterizing lung cancers.