Abstracts/Lung Cancer 10 (1994) 395-430 427

pleuraldissemination. theauthorsdevelopcxipostoperuiveintrathoncic chemo- thermotherapy (PET). In this report, they present the long-term results for 3 1 conxcutive patients who underwent resection. followed by PICT for lung cancer with pleural dissemination behveen April 1985 and December 199 I. hfethodr. Among the patients, there were 26 cases ofaden-inoma. 3 casesofsquamouscellcarcinoma. and 1 caseeach of large and adenoqtamous cell carcinoma. Twenty-four of these patients had an initial diagnosis of pleural involvement at thoracotomy. The other seven patients had massive malignant effusion at the. time of the initial diagnosis. PICT was started berween days 10 lo 14 postoperatively. When possible. three courses of this procedure were administered ar intervals of S-7 days. Results. The S-year cumulative and 5- year local relapse-free survival rates were 24.6 96 and 76.3 46, respectively. The 3-year and 5-year cumulative survival rates for 14 patients without mediastinal lymph node involvement were 68.4% and 42.7 R. respectively. Those tates for 17 patients with mediastinel lymph node involvement were 22.7% and 096, respectively. The 3-year survival rare in the former group was significantly better than that in the latter group. Concf~~ionr. These results strongly suggest that in patients with pleural dissemination, PICT may be benelicial for regional disease control and improvement of survival, particularly for patients without mediastinal lymph node involvement.

Induction chemotherapy for locally advanced non-anal1 cell lung QnCW Shepherd FA. Toronto General Hospital. 200 Elizabeth St., Toronto. Ont. MSG 2C4. Ann Thomc Surg 1993;SS: 1585-92.

ThepoorsurvivalofpatientswithstageIIInon-smalIcelllungcancer haslrdtoarezvaluationoftheroleofsystemicchemoth~yadminis~red before operation. The results of 15 phase-11 pilot trials of induction chemotherapy (5 with chemotherapy alone; 4 with chemotherapy and radiotherapy: and 6 with chemotherapy and concurrent radiotherapy) arereviewedinthisarticie, andrecommendations forfunrrerandomixation studies are made. For most trials, only patients in stage IIIa were eligible, but five trials included both IIIa and IIIb patients. The studies employlxlavarirtyofchemoth~yandradothcrapyinductionprotocols. but no superiority could be demonstrated for the administration of chemotherapy and radiotherapy over chemotherapy alone. Response was observed in more than 50% of patients overall, although the complete clinical remission rate was always less than I5 96, and the pathologic complete response was usually less than 10%. After induction therapy, approximately 70 46 ofpatienu were eligible for a thoracotomy. and complete resection was possible in 60% of paticats. The median survival ranged from 8 to 32 months, with a median of approximately 1 I,+ years. Two-year to 3-year survival ranged from 25 96 to 30 46. The studies reviewed showed that induction therapy followed by surgical resection is feasible and is not associated with uncacceptable toxicity. The apparent survival benefit confed by such combined modality treatment may be due to patient selection, and until randomized trih are undertaken, induction therapy and surgical intervention for locally advanced non-small lung cancer must be viewed as experimental.

Preoperative chemotherapy for stage Illa (N2) lung cancer: The Sloan-Kettering eqerience with I36 patienti Martini N, Kris MG, Flehinger BJ, GraIla RJ, Bains MS, Burt ME et al. Marrini. 1275 York Ave. New York, NY lOQ21. Ann Thorac Surg 1993;55: 1365-74.

From 1984 to 1991. 136 patients with histologically confirmed non- small cell lung cancer and stage IIIa (N2) disease rfzceived two to three cycles of MVP (mitomycin + vindesine or vinblastine + highdose cispladn) chemotherapy. All patients had clinical N2 disease, defined as bulky mediastinal lymph node metastases or multiple levels of lymph node involvement in the ipsilateral mediastinum or subcarinal space on

chestroentgenograms, computed tomographic scans, or mediastinoscopy. The overall major response rate to chemotherapy was 77% (105/136). Thirteen patients had a complete nsponse and 92 patients had a partial but major response (>50%). The overall complete resection rate was 65% (89/136)withacompleteresecdonrateof78% (82/105)inpatients wllh a major response (0 chemotherapy. There was no histologic evidence of Nmor in the resected specimens of 19 patients. The overall survival was 28% al 3 years and 17% at 5 years (median. 19 months). For patients who had complete resection, the median survival was 27 months and the 3-year and 5-year survivals were 41% and 26%. respectively. ‘Ihere were seven treatment-related deaths. five of which were postoperative deaths. To date. 33 patients, all of whom had complete resection, have had no recurrence aher treatment. These results demonstrate that (1) preoperative chemotherapy with MVP produces high response rates in stage IIIa (N2) disease. (2) high complete resection rates occur after response (0 chemotherapy. and (3) survival is longest in patients who have a complete resection atier major response to chemotherapy.

Current treatment of unresectable lung cancer Jatt JR. noruric Dis. /Inrerttal Medicine Div., Mayo Clinic Rochester, Rocfwster, MN. Mayo Clin Proc 1993;68:603-11.

The treatment of choice for most cases of non-srna&cell lung cancer &surgical resection; however, which patients with stage IIIA diseeseare surgical candidates is debatable. For many patients with stage IIIA or IIIB disease, the preferred modality is thoracic radiotherapy. In several randomized prospecctive trials, the addition of chemotherapy to thoracic radiotherapyprcducedasignitican~ butclinicallysmallswivaladvantage over radiotherapy alone. For patients with stage IV lung cancer, no curative treatment or ‘standard therapy’ is available. Accordingly, many patients are offered investigational agents in phase I or II clinical trials. Small-cell lung cancer has a 60 to 90% late of initial response 10 available chemotherapeutic agents. Patients with limited di- are generally given combination chemotherapy and thoracic radiotherapy, approximately 50% of whom have a complete clinical remission. Patients with extensive di- (spread beyond one radiation port) also have a high rate of initial response to chemotherapy, but only 20 to 40% have a complete remission and few survive for 5 years. New agents are being tested in previously uncrrated patients with extensive small-cell lung cancer. Promising new chemotherapeutic agents for lung cancer are being studied in clinical trials. Currently, only 1% of patients with lung cancer in the United States are enrolled in prospective clinical trials. Primary-care physicians are urged to encourage their patients to consider participation in approved prospectiveclinical trials at reputable medical centers, in an effort to discover new, effective agents with novel mechanisms of action. Information about such studies is available through Physician Desk Query (PDQ) or the cancer hodine (1-800-G CANCER).

Altcsneting chemotherapy and twice-daily thoracic radiotherapy in limited- stage snail-cell lung cancer: A pilot study of the Eastern Cooperative Oncology Group Johnson DH, Turrisi AT, Chang AY, Blum R, Bonomi P, Ettinger D et al. 1956 Vanderbilt Clinic, Nmhville, ??V37232-5536. J CIin Oncol 1993: 11: 879-84.

Purpose: This pilot study was undertaken to determine the efficacy and feasibility of alternating cisplatin and etoposide with multiple daily fractions of thoracic radiotherapy (TRV in patients with limited-stage small-cell lung csncer (SCLC). Patients aad Methodx Thirry-four SCLC patients received four coursea of cisplatin (30 mg/m*/d x 3) plus aloposide ( 120 mg/d/d x 3) (PE) every 3 weeks. TRTwes administered twice daily ( 1.5 Gy Per fraction) for 5 consecutive days in the week after cycles 1, 2, and 3 of chemotherapy (total TRT dose. 45 Gy). Patients