209

beam radiauon was also gwcn (h000 rads) to 16 patients ior curative

mtcnt and (3000 rads) to 9 patients for palliative mtcnt. Twenty

rccurrcnt dlseasc patients wcrc also trcdtcd, but they did not receive

cxtemal trradlation. An obstruction score (OS) was devcloped in an

attempt to quantitatc the improvement m intraluminal narrowing.

Patients trcatcd with curative mtcnt showed 66% Improvement after

Initial therapy. lmttal therapy for palliative patients showed an 84%

improvcmcnl and for rccurrcnt disuse patients, 64% of luminal mu-

rowmg was seen. Patlcnts who received laser m addition to brachyther-

apy showed a 70% reduction. A 67% improvement was seen m those

who did not reccwc lawr therapy. The entire group averaged a 69%

Improvcmcnt of narrowmg. Four comphcations, three minor, (I bron-

chospasm, and 2 cp~sodcs of trans~cnt intratrcatmcnt mcrcased ven-

tncular irritability) and one major (pneumothorax) wcrc noted. The

relatively short trcatmcnt times allowed most of the treatments to be

pcrlbrmcd on an outpatient basib and were well-tolerated by the

patients. Forty-four of the 45 paucnts cxperienccd significant sympto-

matlc lmprovcmcnt. The remote aftcrloading tcchniquc allowed im-

proved radiation protection for pcrwnncl.

Lung cancer: Value of computed tomography in radiotherapy

planning and evaluation of tumour remission

Fcyerabcnd T, Schmitt R, Richter E, Bohndorf W. KIinikfur Strahlen- lhempie, Universm Urology, .lo.\ef-Schneider-Stra.rse I I, D-8700 Wurzburg. Stmhlcnthcr Onkol 1990;166:405-IO.

434 CT cxammations ol 133 patients with histologically proven

bronchogcmc carcmoma (22 out 01 133 wth small cell lung cancer)

were analyscd before and after radiotherapy. The study evaluates the

USC ol’ CT fordetcrmining target volume, tumour volume and remission

rate: 1. Conccmmg detcrmmation of target volume conventional roent-

gcndlagnostic simulator methods are much inferior to CT aided plan-

nmg; as Ibr our patients changes of the target volume were ncccssary in

SO%, m 22% the changes wcrc crucial. This happcncd mom often in

MM-small ccl1 lung cancer than m small cell carcmomas. 2. The

response rate (CR + PR) after radiotherapy (based on the calculated

tumour volumes by CT) was 70 to SO’%. The rate of CR of the primary

was 45% (non-small ccl] carcmoma) and 67% (small cell carcinoma).

3. The cruual pomt for the evaluation of tumour remisston after

radlothcrapy IS the pomt of umc. One LO three months and lbur to nine

monthsallcr Irradiation WC Ibundcomplctc rcmlsslons tn 19% and 62%,

respectively. Hence, the cvaluatmn of trcatmcnt results earlier than

three months al’tcr radiotherapy may bc mcorrcct. WC deem it indlspcn-

whlc to use CT fordctcrmmatmn ortargct, calculation ofdose distribu-

two and accuratecvaluatlonoTtumourremissionand sidccflectsduring

and allcr lrradlatlon of paocnt\ wth bronchogcmc carcmoma.

Although shorter term improvement in surwval has been obtamed with

current treatment, the poor overall long-term results support studtes

exploring new approaches to curt and to palhation.

Time trends in the outcome of lung cancer management: A study of

9,090 cases diagnosed in the Mersey Region, 1974-86

Watkin SW, Hayhurst GK, Green JA. Deparrmen~ ofRadramn Oncol- ogy, University of Liverpool, Clamrbridge llospikzl. Lc~erpool L63 4LA Br J Cancer 1990;61:590-6.

The purpose or this paper is to describe temporal trends m the

treatment of lung cancer m the Mcrseysidc Region of England OVCT the

years 1974-86. A d&led analysts of 9,090 casts of hrstologically

confirmed turnour? showed that age at diagnow and histological type

wcrc important prognostic factors, wth the S year suwval of adenocar-

cinema, squamous carcinoma, undii~erentiated carcmoma and small

cell carcinoma after treatment being 22.50/u, 18.5%. 10% and 3.5%

respectively. An analysis of 74 1 cases of small cell carcmoma given

chemotherapy over the same period showed progressive Improvement

in 2 year survival from 2.5 to 7.5% (P < 0.001) and thts was shown to

bc closely associated with the increasing use of intravenous combma-

lion chemotherapy. The survtval of patients who underwent surgical

rescctlon m the three periods 1974-77.1978-81 and 1982.86 showed a

continuous improvement m median survwal from 13 to 30 months (PC

0.00 I). Overall survival curves of all treated casts showed a significant

lmprovcmcnt m median surwval from 8 to IO months and 5 ycax

wrwval from 12.5 to 17.5% (P = 0.001). With Improved staging

assessment, the value of surgical resection oT all hlstologlcal types IS

cmphaswd, and in the case of the small cell subtype, the increasing use

ol combmatton chemotherapy would appear to have paralleled an

mcreasc m median and 2 year .\urvival. These data support the argument

that wth appropriate cast selcct~on, there IS a survival benefit assoct-

atcd wth acuve trcatmcnt for lung cancer.

Failure of the perioperative PCV neoadjovant polychemotherapy

in resectable bronchogenic non-small cell carcinoma. Results from

a randomized phase II trial

Dauucnbcrg B, Bcnichou J, Allard P et al. Service de Pneurrrolog~ ef de Reanimuiion Respiralorre, Groupr Ilosprmkr. Puie-Salpetriere. 47

Boulevard de l’llopital. 7%Sl Pnris Cedex 13. Cancer 1990:65:2435- 41.

In 1985, the authors began a phase II study to awx the PCV

pxiopcratwc polychemothcrapy (cxplaun I00 mg/m:/ cyclophosphamtdc

600 mg/m”, vmdcsmc 3 mg/m’) m patlcnts with rcscctablc bomcho-

gcmc non-small cell carcmoma. Patients were randomizd to reccwc

c~lhcrtwoprcopcrat~vecoursc~~olPCVchcmotherapy,surgcry,andtwo

postopcrat~vccourscsofPCVchcmothcrapy(PCVgroup)or~mmcdiatc

wrgcr) (surgery group). A staging procedure usmg the CT scan was

pcrt’ormcd bcrorc randomlLation and, addlclonally, h&xc surgery in

the PCV group. Thcsc wcrc 26 randomwcd paGem\, I3 m each group.

In the PCV group, I I pattcnts agreed to rccclvc the two prcopcratlvc

courbc\ of chemotherapy. A rcsponsc has obscrvcd m llvc patuxts

(4% 1, and a progrewon was observed in four patlcnts (36%) leading

to a canccllalion of wrgcry m two ot” them. Postopcrauvc cart was the

\amc for each group. Although no death could bc rclatcd to chcmother-

spy, 11 was dcuded to stop entering new patients mto this trial hccausc

of the raw of prcopcrativc progrcsslon m the PCV group

Combined treatment modalities

Longevity in small long cancer. A report to the Lung Cancer SobcommitteeoftheUnited Kingdom Coordinating Committeefor

Cancer Research

Souhaml RL, Law K. Depurmrcnf of Otu ology. Unrversily Colk~e. Mnrrimrr Slreel. London WIP 7fN. Br J Cancer 1990;61:584-9.

An analysis of the long-term rcwlis of watmcnt of 3,681 palien&

w~thsmallcelllungcanccr(SCLC)~uprcscntcd.Thcdatawcrcobtained

from maJor ccntres m the UK who wcrc conductmg Ucatmcnt trials

durmg the period 1978. I986 and for whom complete computcrrecords

and follow-up were available. A total of 217 (5.9%) survived 2 years or

more. Two year survwal for paticnth prcsentmg with hmited dlscase

(LD) wa\ 8.5% and rorcxtcnsrvc dtscace (ED) 2.2%. Death from SCLC

contmued until 7 year\ alter dlagnosi\ but not thercaftcr. At this pomt owxall~urvival has3’1 (3.6’%LD, I .I% ED). Survlvalaftcr2 ycarswas

not al.fcclcd by mmal dlrcax cxtcnt, xx, thorax radlotherapy or

prophylactic. cramal madlation. Dcarh l’rom causes other than SCLC

contmucd throughout the pcrlod 01 observation. Vascular disease,

rcspuatory fadurc and second turnours wcrc the mam other causes of

death. The bcttcrsurvival in youngcrpatlcnts wa& mainly attr~butableto

fen deaths l’rom these other causes. Thcsc results mdlcatc that only a

small proportion 01 patlcnts wth SCLC arc cured by current treatment.

Multidisciplinary management of non-small cell lung cancer in the

community

Folman RS. Oncolo~j A.m( UZM.> of Bndgcporr, 15 Corporate Dr. 7iumbull. CTOhbll. Scmm Oncol 1990;17:Suppl 7:30-2.

A community-bared, multldisuplinary approach, mcorporatmg

chcmothcrapy may provide bcnerit to partemu wtth non-small cell lung

cancer. Drug-induwd cytorcduct~on may make it powhlc to perlbrm

surgery on paucnts hlthcrto mopcrdblc, and may Ihcllltalc radlothcrapy

m olhcrpat~cnl?, wlthrcgwnally advanced dwasc. Scvcral crItcrIamuq

bc met bcl’orc the mstitulion of this approach. The drugs %elcctcd must

bc cf~ccct~w m a malorlty of patlcnty and toxic wit clfcctr must he

wthm tolcrablc Itm&: candldatcs mu\t bc wccnzd iarclully with