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median age of 59 years (range 28-79). 8 patients had primary breast tumours, two

were colonic adenocarcinomas, two were renal carcinomas and 2 were squamous car- cinomas (one vulval and one laryngeal). 2 were lymphomas (one histiocytic NHL and one nodular sclerosing HD). There was one each of malignant melanoma, cystadeno-car-- cinoma of the ovary, adenocarcinoma of the stomach, extensive intra-abdominal carci- noma of undetermined origin, testicular seminoma and acute myeloid leukaemia. The median delay from primary diagnosis to presentation for bronchoscopy was 2.7 years (range 0-ii) and most patients were dead within one year of bronchoscopic diagno- sis.

Breast canser, rather than renal or co- lonic malignancy is then the com/nonest tumour to metastaSise to the bronchi in this fashion, but other rarer tumours can also present with this diagnostic problem.

All patients had chest x-ray abnormali- ties, i0 pts had pleural effusions, either proven or presumed malignant. This asso- ciation has not previously been noted but amy be due to the relationship between the bronchial and pleural blood supplies.

Treatment of Pleuritis Carcinomatosa of Primary Lung Cancer With Intrapleural Ad- ministration of 0K-432. Tatsumura, T., Sugiyama, S., Koyama, S., Tsuda, M., Murakami, A., Kasajima, M., Yamamoto, K. Department of Surgery, Toya- ma Medical and Pharmaceutical University, Toyama, Japan.

Direct intrapleural administration of a streptococcal preparation (OK-432) for the treatment of pleuritis carcinomatosa of primary lung cancer has been studies. The present series, comprised of 26 cases, which included 19 treated and 7 non-treat- ed patients. Of the 19 in the treated groups, were in stage III and 12 in stage IV, while all the cases in the non-treated group were in stage IV. Adenocarcinoma was the most frequently noted pathologic fin- ding in this series. OK-432 at a dose of 10-50KE and adriamycin (10-50 mg) were con- comitantly given intrapleurally. In the control of pleural effusion, continuous thoracic drainage was applied to 6 of the 19 cas~s; for the remainder, thoracentesis, either direct or ultrasound guided-was used for the administration of the regimen and/or aspiration of the accumulated ef- fusion. Positive therapeutic results were observed in 15 of the 19 cases (79%), with complete regression of the pleural effusi- on noted in 12, and partial regression in 3 cases, However, 4 of the cases, all in terminal stages, showed no response to the

treatment. The overall mean survival time for the response group was 13.5 months,

3 months in the non-response patients, and

2.4 months for the non-treated group. In the response group the mean survival time for the patients in stage III was 19.9 months, and 8 months for those in stage IV. A recurrence of pleural effusion was noted in 5 patients, 1-2 months before their demise. In the present series the cases who showed prolongation of their survival time also received combined sy- stemic chemotherapy with cis-platinum, mitomy- cin C, adriamycin and 5-fluorouracil. Chest pain in 4 and fever in 6 patients was noted in those treated with intrapleural injection of OK-432.

Testicular Dysfunction After Chemotherapy For Lung Cancer. Ravez, P., Libert, P., Gr~goire, Y., Moury, D., Robience, Y.J. H6pital de Warquignies, Boussu, Belgique.

Gynecomastia in patients with lung cancer usually results from gonadotropin production by tumor. We observed a case of gynecomastia in a patient who was considered to be in complete remission after chemotherapy without any B hu- man chorionic gonadotropin detectable in his serum. Elevated follicle stimulating hormone and luteinizing hormone serum levels indicated testicular damage. This led us to practice a sexual hormonal screening in every patient re- ceiving chemotherapy for lung cancer at this moment. Three patients with small cell lung cancer were treated with a cisplatin, etoposi- de, adriamycin and cyclophosphamide regimen; out of 14 with non small cell lung cancer, i0 received cisplatin and etoposide and 4 mito- mycin and vindesine co,~sinations.

We found elevated FSH levels in 14 of the 17 patients (82%); elevated LH levels were found in 6/17 (35%), one of those presenting a marked decreased testosterone to estrogen ratio. The- se results suggest that chemotherapy does alter both leydig and sertoli cell function in a high percentage of the cases and that gynecomastia may be a consequence of treatment instead of a paraneoplastic syndrome. Since no prior chemo- therapy data is available in this series, a pro- spective study is now conducted to determine the testicular function toxic effects of the drugs cormnonly used in the treatment of lung cancer.

Intrapleural Administration of Cisplatin in Patients With ~lignant Pleural Effusion: Effect and Pharmacokinetic Evaluation. Yoo, J.Y., Fukuoka, M., Takada, M. Department of Internal Medicine, Osaka Prefectural Habiki- no Hospital, Osaka, Japan.

This study was made to evaluate the efficacy of intrapleural administration of cisplatin in patients with malignant pleural effusion.

In ii patients with malignant pleural effu- sion due to adenocarcinoma 9f the lung, cis- platin at a dose of 80 mg/m~ was administered

into the pleural space with closed tube thoraco- tomy. And the effect for the management of

187

pleural effusion and the pharmacokinetic behavior were investiagted, Pl~tinum con~

centrations in protein-free ultrafiltrates of plasma and pleural effusion were assay- ed by flameless atomic absorption spectro- photometry.

Nine out of II cases have been free of recurrent effusion for more than 2 months after treatment. Following intrapleural administration of cisplatin, the protein- free platinum in pleural effusion declined in a biphasic mode with a mean initial half life of 2.2 hours and a mean termi- nal half life of 65.9 hours. High concen- trations of protein-free platinum were a- chieved and maintained in pleural effusion after intrapleural administration of cis- platin. After intrapleural administration of cisplatin serum level rose to peak values of about 0.75 ug/ml at 0.5~2 hours and fell to undetectable values at 4 hours.

Severe to moderate nausea and vomi- ting were observed in all patients. Mye- losuppression occurred in only one pa- tient.

These suggest that intrapleural admi- nistration of cisplatin is useful for the management of malignant pleural effu- sion.

Necrotic Lung (NL) and Bronchopleural Fi- stula (BPF) as Complications of Therapy (Rx) in Lung Cancer (CA). Frytak, S., Pairolero, P.C., Lee, R.E., Arnold, P.G. Mayo Clinic, Rochester, MN 55905, U.S.A.

Aggressive radiation therapy (RoRx) + chemotherapy (CT) is utilized for inope ~ rable but "localized" lung CA and as sur- gical adjuvant Rx. Following such Rx, 6 patients (pts) developed NL and a BPF pre- ceeded by a prodrome of recurrent bronchi- tis with increasing refactoriness to anti- biotics, weight loss (WL), fever, and generalized debilitation. The time inter- val between end of RoRx and the prodrome ranged from 6-42 months (median-33). Pt characteristics were:

Pt. T~pe/Lobe RoRx(cG~)/Fracttons CT" k~. (lbs) AdenO/LUL 41DUO/IU x ~ 19

2 Adeno/RUL 5500/31 0 25 3 Adeno/LUL ?/ZO 0 ? 4 Squamous/RUL 4000/10 x OAF 14 5 Squamous/RUL,RL 5000128 0 20 6 5mal! ceI1/RUL 4000/10 x CAVE 40

Serial chest x-rays and computerized scans eventually showed cavitating lesions and bronchoscopy, purulent secretions. Delays in definitive Rx resulted from concern about the pts "guarded" CA progno- sis and misinterpretation of involved areas on x-rays and scans as showing CA.

Aggressive surgical Rx by a team of

thoracic and plastic surgeons utilizing

latissimus dorsi, pectoralis major and serra- tus anterior muscle flaps for restoration of chest wall contiguity and bronchial stump re- inforcement afforded successful Rx in 5 pts. Only 1 pt had residual disease.

Clinicians must be increasingly aware of NL and BPF in treated lung CA pts, and repidly employ these new surgical techniques following diagnosis.

x=split course; *C=Cytoxan, A=Adriamycin, P= Cisplatin, D=Dianhydrogalactitol, V=Vincristi- ne, E=VP-16.

Effect of Perioperative Blood Transfusion on Prognosis of Resected Stage la Lung Cancer. Pastorino, U., Valente, M., Lequaglie, C., Ca- taldo, I., Ravasi, G. Istituto Nazionale Tumo- ri, Milano, Italy.

The possibility of a nonspecific immuno- suppression determined by blood transfusions on kidney grafted patients has induced a se- ries of studies aimed at evaluating this po- tentially negative effect on cancer patients. A recent report from Mount Sinai Medical Cen- ter based on 165 resections for Stage Ia non- small cell lung cancer has shown a significant- ly lower relapse-free survival for transfused patients versus nontransfused (62% vs 76%, P 0.013).

In order to confirm this interesting fin- ding, we have retrospectively analysed our po- pulation of resected stage Ia non-oat lung can- cers (years 74/79). 285 patients were included in this analysis: 65 underwent penumonectomy (23%), 207 lobectomy (73%) and 13 sublobar resections (4%). Patients submitted to peri- operative blood transfusions were 156 (55%), without major differences of surgery (lobec- tomy 54%, pneumonectomy 64%) or tumor extent.

The cumulative survival at 8 years was 41% for transfused patients and 38% for nontrans- fused, relapse-free survival was respectively 37% and 35%; no differences were detectable stratifying for the amount of transfused blood or the extent of operation. Our experience does not support the hypothesis of an adverse prognosis related to perioperative blood trans- fusion.

Carcinoma of the Trachea Prolong Survival 8 Years After and Followed by Radiation. Prathnadi, P., Sorasuchart, S., Kattipatanapong, W., Narco, S. Department of Surgery, Patholo- gy and Radiology, Faculty of Medicine, Chiang Mai University.

A rare case of 22 year old woman, clinical symptom of asthmatic attack off and on found tumor mass by trachography and bronchography at trachea nearly completed occlusion of tra- chea lumen. Squamous cell carcinoma, poorly differented was pathological diagnosis.

Tracheal resection was performed with end to end anastomosis, the patient was recovered for one year and recurrence symptom suggested

recurrence tumor, radiation was further adjuvant