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was 7 months. Four out of l0 partial respon- ders failed in the C.N.S. and 6/10 includ+ ing 3 patients from C.R. failed in the chest in group I. Separately in groups II (23/33) and III (23/32) 70% failed in the chest and 25/65 failed in the C.N.S. in both groups. Four out of 17 in group II failed in bone as against 15/32 in group III. Analysis of data revealed that 75% of failures occurred within 12 months irrespective of the site of failures and the median survival following the occurran- ce of metastasis was 12 weeks and was in- dependent of the site of failure.
We feel more aggressive local therapy should be directed toward the primary lesion either after complete response or after incomplete response with no evidence of metastasis following chemotherapy. In the former situation local radiotherapy should be utilized and should be used prophylactically.
Long-Term Survival in Small Cell Lung Carcinoma (SCLC). Sculier, J.P., Klastersky, J. and the EORTC Lung Cancer Working Party, Institut J. Bordet, Brussels, Belgium.
The EORTC Lung Cancer Working Party con- ducted 2 successive trials in SCLC;2respec- tively with CAV: cigplatin (60 mg/m dl), adriamycig (45 mg/m" dl) and etoposide (120 mg/m- dl, 2,3) in 1979-1980 (Cancer 50: 652-958; 1982) and AVE: adriamyci9 (45 mg/m- dl),cyclophogphamide (I g/m- dl) and etoposide (80 mg/m - dl, 2,3) in 1981- 1982 (Cancer, in press). Patients charac- teristics were the following:
CAV AVE Number o f p a t i e n t s 4-T- Evatuable patients 36 62 Sex (H/Y) 3016 5319 Medlan age 57 (36-72) 59 (30-69) Median P.S. (garnofaky) 80 (60-100) 80 (60-100) Limited disease (LD) 14 34 Disseminated disease (DD) 22 28
Our results are shown below : CAV AVE
LD D D - - tota l LD D D ' - - t o t ~ l Evaluable patlents 14 22 36 34 28 62 Complete r e s p o n s e 10 b 16 7 3 10
(71Z) (27 I ) (44X) (21Z) ( I I Z ) (16Z) Per t /e l response 2 12 14 21 15 36
(14Z) (55Z) (39Z) (62Z) ( ISZ) (58Z) Median survival 80 54 60 58 35 45
(weeks) 2 y e a r s u r v i v a l 6 2 4 8 3 I I
(43Z) (gz) ( t l Z ) (24Z) ( I t Z ) ( tax) 2 year disease- 2 2 ~ 3 1 4 free survival (14Z) (9Z) ( I I Z ) (gz) (4Z) (6X)
In conclusion, our long-term survival rates are similar to those reported so far in the literature.
The Long Survival in Unresectable Small Cell Lung Cancer. Soresi, E., Borghini, U., Harari, S., DiNoia, C., LoCicero, S., Scoccia, S. Department of Pneumonology, E.O. Niguarda, Milan, Italy
1436 patients (pts) with unresectable lung cancer were registered in the ambu- latory of Pneumology Department of E.O.
Niguarda, from 1977 to 1981. Small cell lung cancer (SCLC) was observed
in 201 (14%) of these pts: 114 pts (56.7%) showed extensive dieease (ED) and 87 pts (43.3%) showed limited disease (LD). All LD pts and 47 (41%) only of ED pts underwent at least two periods of ¢hemotherapy (CT).
At first, only MACC trial was administe- red during the first three years, successively, in agreement with a trial of Oncological Divi- sion of S. Carlo Hospital of Milan, CAV alter- nate with CMC plus radiotherapy was carried out.
Conclusions: With the first trial the me- dian survival rate for LD pts was 11,2 months and 6,8 months for ED pts while with the second trial it was 11,4 and 7,9 moths for LD and ED pts respectively.
8 long survival (LS > 30 months) were ob- tained in the follow up of 87 LD pts with SCLC.
No significant-difference was noted eva- luating the results of the two CT trends.
At present 31,40,44,52 and 54 are respec- tively the months of survival in the 5 LS pts alive and in free disease. Results these data, in agreement with the international literature (5,10% of LS for LD pts) suggest to test new trends in SCLC management multimodel therapy, autotransplantation of bone marrow, reeearch of monoclonal antibodies, cellular kinetic in order to value the response of pts to the the- rapy, and the possibility of LS.
A Demonstration of Scintigraphy in Lung Can- cer. samuels, T.H., Chin-Sang, H.B., Vickar, D.K. Cameron, R.H., Fraser, L.E. Sunnybrook Medical Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5.
A visual overview of scintigraphy in lung cancer is presented with examples of normal and abnormal scans. The primary tumour, metasta- ses, certain peraneoplastic syndromes, treat- ment response and drug toxicity are displayed.
The major value of scintigraphy in the sta- ging of lung cancer is exemplified by the bone scan. Beyond its familiar role in demonstrating a spectrum of bony metastases (from a single focus to a "super" scan), the bone scanning agent can be utilized to reveal less common manifestations of lung cancer such as superior vena cave obstruction and hypertrophic pulmo- nary osteoarthropathy. Incidential extraskele- tal uptake may rarely demonstrate the primary tumour or extrathoracic metastases (eg. liver). Increased renal activity from hypercalcemia or displacement of the kidney by metastases may be identified on the bone scan.
Visceral metastases are shown on liver- spleen scans, and gallium scans. Mediastinal disease or a paraneoplastic coagulopathy may be reflected on a lung scan.
The pitfalls of interpretation resulting from thoracotomy and radiation are illustrated.
The role of MUGA scans in monitoring the po-