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Reviews Small cell carcinoma of the long: Treatment in the community Diggs CH, Engeler JE Jr, Prendergast EJ, Kramer K. Dean Medical Center. 1313 Fish Hatchery Road, Madison, WI 53715. Cancer 1992;69:2075-83.

The results of nonprotocol treatment of 232 patients with small cell lung cancer seen by a group of community-based medical oncologists overa 13-yearperiodwereevaluated. Factorsassociated withimproved survival also were assessed. The following patient characteristics significantly improved survival: limited stage of disease at diagnosis, treatment of extensivefiut not limited) disease with regimens including etoposide and cisplatin, tumor resection, age younger then 70 years, radiation therapy to the chest, and female sex (extensive disease only). Comparison of the data from this study with published results of protocol studies showed similar outcomes.

New approaches to treating early lung cancer Roth IA. Department of lkvacicSurgery, Uniwrsityof Terar MDACC, Box 109. 1515 Holcombe Blvd.. Houston. TX 77030. Cancer Res 1992;52:Suppl:2652s-7s.

The survival from lung cancer has not changed over the past 15 years, despite the intensive application of combined modality therapy for advanced disease. Prevention and early diagnosis appear to be the most promising strategies for reduction of hmg cancer mortality. A Keystone Colloquium was held April 1 to 7, 1991, on the Biology of and Novel Therapeutic Approaches for Epithelial Cancers of the Aerodigestive Tract, to discuss recent basic and clinical research in this area. This paper summarizes the presentations relevant to lung cancer, including genetic mechanisms, growth factors, neuropeptides, growth and differentiation, carcinogen&s, chemoprevention, multidrug resistance, and immunology.

Miscellaneous Orthotopiclivertransplantationformetastasesofbronchialcatinoid tumor Le Hello C, Auvray S, letellier P, Segol P. Service de Medecine Intente, CHU, Avenuedela Cotede-NarreF-I4@0 Caen. Gastroenterol Clin Biol 1992;16:281-3.

We report the case of a 42 year old man in whom orthotopic liver transplantation was perfomxd successfolly for unresectable hepatic metestases of a bronchial carcinoid tumor. Prior to transplantation, somatostatintherapy, pulmonary lobectomy, andsystemicchemotherapy (streptozotocin and tluorouracil) were performed. After 9 months there were no signs of clinical or biological recurrence. Orthotopic liver transplantation might be indicated for unresectable and limited liver metastases of neuroendocrine tumor.

The cost of treating small cell lung cancer Rosenthal MA, Webster PI, Gebski VJ, Stuart-Harris RC, Langlands AO, BoyagesJ. WesfmeadHospital, Westmead, NSW2145. MedJ Aust 1992;156:60510.

Objective: To determine the cost of treating small cell lung cancer (SCLC)and toassessqoality-adjustedsurvivalin thesepatients. Design: Retrospective analysis. Setting: Westmead Hospital, a tertiary referral institution. Patients: Consecutivesampleof31 patientswithhistologically proved SCLC, treated between January 1987 and December 1987. Main outcome measures: The cost of investigation, hospitalisation, chemotherapy, radiotherapy and follow-up of patients overall and for those with limited and extensive disease respectively. Quality-adjusted survival was based on a Q-TWIST analysis. Results: The median overall costperpatientwas$14413 (range, $1188~$39598)forallpatientsand

forlimiteddiseaseandextensivediseasewas$18234(range,$l914-$39 598) and $13 177 (range, $1188~$32 798) respectively. The two major costswerehospitalisa~ion(42%)andchemothempy(l8%). Radiotherapy accounted for 11% ofall costs. The Q-TWiST analysis suggests that for patients with limited disease, quality-adjusted survival is similar to absolutesurvival. Conclusions: The tr&mentofSCLCatourinstitotion was expensive but the cost may be reduced by reduction in the duration ofhospitalisation, theuseof lessexpensive combination drug regimens, or theuseof ‘true’ outpatient chemotherapy. Despite intensive therapy, patients with limited disease maintained a reasonable quality of life.

Psychosocial issues in tbe treatment of patiens with lung cancer Bergman B. DepanmentofPttlmonary Medicine, Ren.stromskaHospital, P. 0. Box 17301, S-40264 Goteborg. Lung Cancer (The Netherlands) 1992;8:1-20

In recent years there has been a growing interest in evaluating psychosocial issues iu the treatment of lung cancer, as in cancer populations in general. New measures of quality of life, of which the EORTC Core Quality of life Questionnaire (QLQ-C30) is one of the most interesting, have emerged, offering the clinicians a possibility to adequately evaluate subjective end functional disease- and treatment consequences. However, there is a methodological incoherence in this research area, which is, in part, related to a failure among researchers in formulating the research question sufficiently precisely to allow the selection of appropriate measures. From a review of the literahxe on lung cancer, a few patterns of treatment outcomes are discernible. The impact of oncological treatment on functional states or quality of life is not likely to be beneficial in lung cancer patients without objective turnour responses or radical resections. In responders. relief of hlmour symptoms occurs more rapidly than do changes of functional status or psychosocial dimensions ofquality of life. Side-effects from chemo- or radiotherapy are reasonably well tolerated during periods of tomour control. Finally, studies of social functioning and social support of lung cancer patients receiving treatment *r-e warranted.

Primary tracheal neoplssms: Recognition, diagnosis and evaluation Zimmer W, Deluca SA. Deportmekt of Radiology. Ma.wochu.wffs Gxeral Hospital, Boston, MA. Am Fern Phys 1992;45:2651-7.

Primary neoplasms of the trachea are much less common than malignancies of the larynx and lungs. Tracheal neoplasms Fount for less than 0.1 percent of all neoplasms. Their importance lies in the fact that they may initially be m&diagnosed, resulting in a delay in diagnosis ranging from months to years. The most common benign tracheal neoplasms are hemangiomas, squamous papillomas and tibmmas. The mostcommontracbealmPlignancyissquamousceUca~cinoma.Symptoms of these lesions are usually related to airway obstruction and include wheezing, dyspnea and cough.