1
206 Abstracts/Lung Cancer I3 (199s) 185-232 phmning in 54% (38 of 70 patients) versus 27% (19 of 70 patients) for TI-201 imaging. If treatment planning was based on CT, Ga-67 scintigraphy added more information in 19% (13 of 70 patients) versus only 3% (2 of 70 patients) for Tl-201 imaging. We conclude that Ga-67 scintigraphy is more useful than Tl-201 imaging in the initial evaluation of NSCLC. Both are inferior to x-ray CT imaging for staging purposes and determining the local extent ofthe disease. Galliumd7 scintigraphy was necessary in some patients for proper radiation therapy treatment planning and adds more useful information to the x-ray CT imaging, Thallium-201 imaging did not add more information to Ga-67 scintigraphy in any patient. Detection of oligoclonal T lymphocytes in lymph nodes draining from advanced non-small cell lung cancer Meta M, Ponte M, Gustella M, Semino C, Pietra G, Ratto GB et al. Servizio di Citometria, Centm di BiotecnoiogieAvanzate, 1st. Nazionale Ricerca Cancro. Male Benedetto Xc: IO, I-16132 Geneva. Cancer Immunol Immunother 1995; 40:235-40. Despite the combined use of surgery and chemoradiotherapy, the poor prognosis of advanced non-small-cell lung cancer (NSCLC) requires the definition of new therapeutic approaches. The presence of T lymphocytes, with peculiar phenotypic, functional and molecular characteristics within the tumour, suggested the possible use of these cells, expanded in vitro, in protocols of adoptive immunotherapy. We have described how a population of oligoclonal T lymphocytes, derived from advanced NSCLC, can be expanded in vitro and has the capability of lysing autologous cancer cells. What is more important, we observed that patients with advanced NSCLC, treated with TIL expanded in vitro and recombinant interleukin-2, seemed to have a disease-free period longer than that of patients treated with conventional chemoradiotherapy. In an attempt to find new sources of specific lymphocytes for immunotherapy, we describe the analysis of the phenotypic, functional and molecular characteristics of T lymphocytes, derived from lymph nodes draining advanced NSCLC. In this paper we show that these cells, have restriction patterns ofT cell receptor B chain similar to those detectable in the population of infIltrating T lymphocytes. This finding suggests that T cells derived from draining Iymph nodes of advanced NSCLC have peculiar characteristics and can be a suitable source of effector cells for protocols of adoptive immunotherapy in lung cancer treatment. The iocidence of airflow obstruction in bronchial carcinoma, its relation to breathlessness, and response to bronchodilator therapy Congleton J, Muers ME Regional Caniiothoracic Unit, Killingbeck Hospital, Leeds. Respir Med 1995;89:291-6. Breathlessness is a common symptom in patients with primary bronchial carcinoma and is often not well-controlled. Most patients are ex- or current smokers, and therefore are at high risk for co-existing chronic obsbuctive pulmonary disease (COPD). The incidence of airRow obstruction in patients with bronchial carcinoma, its relation to breathlessness, and response to bronchodilator therapy was examined prospectively. Fifty-seven consecutive patients attending our outpatient clinic with bronchial carcinoma diagnosed in the preceding 12 months were studied (22 female, 35 male, mean age 68.4 years). Spirometry was performed and breathlessness rated. Those with airflow obstruction (FEV,:FVC < 65% and FEV, < 70% predicted) and who judged themselves to have moderate or severe breathlessness, were offered a trial ofbronchodllator therapy. The response to regular inhaled fenoterol and ipratropium bromide by metered dose inhaler (MIX) and large volume spacer, and to regular nebulized salbutamol and ipratropium bromide was assessed by home peak flow recordings, spirometty and two subjective scores: (a) rating of breathlessness on a simple four- point scale, and (b) activity score of the St George’s Respiratory Questionnaire. There was very strong association between aifflow obstruction and breathlessness. Twenty-eight patients (49%) had aifflow obstruction, and we had breathlessness ratings on 26 of these patients of whom 18 (69%) had rated it as moderate or severe. Only four of the patients with airflow obstruction and breathlessness were using bronchodilator therapy. There was no significant difTerence in the mean age, time from diagnosis, tumour site, or smoking history between the groups with, and without, airflow obstruction. There was no association between cell type and the presence of airflow obstruction. Seventeen patients accepted the offer of a trial of bronchodilator therapy, of whom 15 patients remained well enough to complete it. Home peak expiratory flow rate (PEFR), rose from 233 I min-’ to 247 I min-’ with MDI bronchodikuors, and to 256 I min’ with nebulizedbronchodilators. Mean FEV, rose from 1.18 I to 1.31 1 following 2 weeks of MD1 bronchodilators, and to 1.35 I with nebulized drugs. For the group, there was no additional benefit from nebulized drugs over the MDI. Eight patients showed objective improvement PEFR and/or FEV, increasing by > 15% of baseline. Nine patients felt that their breathing had hccn helped ‘quite a lot’ or ‘a great deal’, but four patients had not experienced objective benefit. Breathlessness rating improved significantly following bronchodilators, falling from 2.53 pre-treatment to 1.87 following MD1 use, and to 1.79 with nebulized drugs. There was no significant improvement in mean activity scores. We conclude that untreated airflow obstruction is commonly present in patients with bronchial carcinoma, is strongly associated with breathlessness, and that these patients may benefit from simple bronchodilator treatment. Bronchogenic carcinoma in 13 patients infected with the human immunodegciency virus (HIV): CIinical and radiographic findings Gruden JF, Webb WR, Yao DC, Klein JS, Sandhu JS. Department of Radiology, San Francisco General Hospital, IO01 Potretv Avenue, San Francisco, CA 94110. J Thorac Imaging 1995;10:99-105. Bronchogenic carcinoma is a cause of parenchymal or bilar masses with or without mediastinal adenopathy in HIV-seropositive smokers. Lung cancer can occur earlier than the more commonly recognized opportunistic infections and in patients not known to be HIV seropositive. Tumor cell types do not diIIer markedly from those expected in HIV-seronegative young lung cancer patients, but are oRen poorly differentiated; patients with high-grade malignancies fare poorly independent of their degree of immunocompromise at diagnosis. Computed tomography (CT) scans not only add important information with regard to disease distribution and preferred means of diagnosis, but also result in the detection of new sites of disease with respect to the plain radiography in many patients. Because lung cancer often occurs before the diagnosis of AIDS, the association may not be suspected in some cases; poorly differentiated, rapidly growing tumors in young smokers may raise the suspicion of underlying HIV infection. Videothorscoscopic staging and treatment of lung cancer Roviaro GC, Varoli F, Rebuffat C, Vergani C, Maciocco M, Scalambra SM et al. Divisione di Chirwgia Generale, Ospedale S. Giuseppe, Universita di Milano, Ma San l&tore 12, 20123 Milano. Ann Thomc Surg 1995;59:971-4. Videothoracoscopy, routinely performed as the initial step of an operation, opens interesting opportunities for both the operative staging and treatment of lung cancer. Vuleosurgical maneuvers ensure thorough exploration of the cavity, thus avoiding unnecessary exploratory thoracotomies, confirming resectability of the lesion by open or, in

Detection of oligoclonal T lymphocytes in lymph nodes draining from advanced non-small cell lung cancer

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206 Abstracts/Lung Cancer I3 (199s) 185-232

phmning in 54% (38 of 70 patients) versus 27% (19 of 70 patients) for TI-201 imaging. If treatment planning was based on CT, Ga-67 scintigraphy added more information in 19% (13 of 70 patients) versus only 3% (2 of 70 patients) for Tl-201 imaging. We conclude that Ga-67 scintigraphy is more useful than Tl-201 imaging in the initial evaluation of NSCLC. Both are inferior to x-ray CT imaging for staging purposes and determining the local extent ofthe disease. Galliumd7 scintigraphy was necessary in some patients for proper radiation therapy treatment planning and adds more useful information to the x-ray CT imaging, Thallium-201 imaging did not add more information to Ga-67 scintigraphy in any patient.

Detection of oligoclonal T lymphocytes in lymph nodes draining from advanced non-small cell lung cancer Meta M, Ponte M, Gustella M, Semino C, Pietra G, Ratto GB et al. Servizio di Citometria, Centm di BiotecnoiogieAvanzate, 1st. Nazionale Ricerca Cancro. Male Benedetto Xc: IO, I-16132 Geneva. Cancer Immunol Immunother 1995; 40:235-40.

Despite the combined use of surgery and chemoradiotherapy, the poor prognosis of advanced non-small-cell lung cancer (NSCLC) requires the definition of new therapeutic approaches. The presence of T lymphocytes, with peculiar phenotypic, functional and molecular characteristics within the tumour, suggested the possible use of these cells, expanded in vitro, in protocols of adoptive immunotherapy. We have described how a population of oligoclonal T lymphocytes, derived from advanced NSCLC, can be expanded in vitro and has the capability of lysing autologous cancer cells. What is more important, we observed that patients with advanced NSCLC, treated with TIL expanded in vitro and recombinant interleukin-2, seemed to have a disease-free period longer than that of patients treated with conventional chemoradiotherapy. In an attempt to find new sources of specific lymphocytes for immunotherapy, we describe the analysis of the phenotypic, functional and molecular characteristics of T lymphocytes, derived from lymph nodes draining advanced NSCLC. In this paper we show that these cells, have restriction patterns ofT cell receptor B chain similar to those detectable in the population of infIltrating T lymphocytes. This finding suggests that T cells derived from draining Iymph nodes of advanced NSCLC have peculiar characteristics and can be a suitable source of effector cells for protocols of adoptive immunotherapy in lung cancer treatment.

The iocidence of airflow obstruction in bronchial carcinoma, its relation to breathlessness, and response to bronchodilator therapy Congleton J, Muers ME Regional Caniiothoracic Unit, Killingbeck Hospital, Leeds. Respir Med 1995;89:291-6.

Breathlessness is a common symptom in patients with primary bronchial carcinoma and is often not well-controlled. Most patients are ex- or current smokers, and therefore are at high risk for co-existing chronic obsbuctive pulmonary disease (COPD). The incidence of airRow obstruction in patients with bronchial carcinoma, its relation to breathlessness, and response to bronchodilator therapy was examined prospectively. Fifty-seven consecutive patients attending our outpatient clinic with bronchial carcinoma diagnosed in the preceding 12 months were studied (22 female, 35 male, mean age 68.4 years). Spirometry was performed and breathlessness rated. Those with airflow obstruction (FEV,:FVC < 65% and FEV, < 70% predicted) and who judged themselves to have moderate or severe breathlessness, were offered a trial ofbronchodllator therapy. The response to regular inhaled fenoterol and ipratropium bromide by metered dose inhaler (MIX) and large

volume spacer, and to regular nebulized salbutamol and ipratropium bromide was assessed by home peak flow recordings, spirometty and two subjective scores: (a) rating of breathlessness on a simple four- point scale, and (b) activity score of the St George’s Respiratory Questionnaire. There was very strong association between aifflow obstruction and breathlessness. Twenty-eight patients (49%) had aifflow obstruction, and we had breathlessness ratings on 26 of these patients of whom 18 (69%) had rated it as moderate or severe. Only four of the patients with airflow obstruction and breathlessness were using bronchodilator therapy. There was no significant difTerence in the mean age, time from diagnosis, tumour site, or smoking history between the groups with, and without, airflow obstruction. There was no association between cell type and the presence of airflow obstruction. Seventeen patients accepted the offer of a trial of bronchodilator therapy, of whom 15 patients remained well enough to complete it. Home peak expiratory flow rate (PEFR), rose from 233 I min-’ to 247 I min-’ with MDI bronchodikuors, and to 256 I min’ with nebulizedbronchodilators. Mean FEV, rose from 1.18 I to 1.31 1 following 2 weeks of MD1 bronchodilators, and to 1.35 I with nebulized drugs. For the group, there was no additional benefit from nebulized drugs over the MDI. Eight patients showed objective improvement PEFR and/or FEV, increasing by > 15% of baseline. Nine patients felt that their breathing had hccn helped ‘quite a lot’ or ‘a great deal’, but four patients had not experienced objective benefit. Breathlessness rating improved significantly following bronchodilators, falling from 2.53 pre-treatment to 1.87 following MD1 use, and to 1.79 with nebulized drugs. There was no significant improvement in mean activity scores. We conclude that untreated airflow obstruction is commonly present in patients with bronchial carcinoma, is strongly associated with breathlessness, and that these patients may benefit from simple bronchodilator treatment.

Bronchogenic carcinoma in 13 patients infected with the human immunodegciency virus (HIV): CIinical and radiographic findings Gruden JF, Webb WR, Yao DC, Klein JS, Sandhu JS. Department of Radiology, San Francisco General Hospital, IO01 Potretv Avenue, San Francisco, CA 94110. J Thorac Imaging 1995;10:99-105.

Bronchogenic carcinoma is a cause of parenchymal or bilar masses with or without mediastinal adenopathy in HIV-seropositive smokers. Lung cancer can occur earlier than the more commonly recognized opportunistic infections and in patients not known to be HIV seropositive. Tumor cell types do not diIIer markedly from those expected in HIV-seronegative young lung cancer patients, but are oRen poorly differentiated; patients with high-grade malignancies fare poorly independent of their degree of immunocompromise at diagnosis. Computed tomography (CT) scans not only add important information with regard to disease distribution and preferred means of diagnosis, but also result in the detection of new sites of disease with respect to the plain radiography in many patients. Because lung cancer often occurs before the diagnosis of AIDS, the association may not be suspected in some cases; poorly differentiated, rapidly growing tumors in young smokers may raise the suspicion of underlying HIV infection.

Videothorscoscopic staging and treatment of lung cancer Roviaro GC, Varoli F, Rebuffat C, Vergani C, Maciocco M, Scalambra SM et al. Divisione di Chirwgia Generale, Ospedale S. Giuseppe, Universita di Milano, Ma San l&tore 12, 20123 Milano. Ann Thomc Surg 1995;59:971-4.

Videothoracoscopy, routinely performed as the initial step of an operation, opens interesting opportunities for both the operative staging and treatment of lung cancer. Vuleosurgical maneuvers ensure thorough exploration of the cavity, thus avoiding unnecessary exploratory thoracotomies, confirming resectability of the lesion by open or, in