286 Abstracts/Lung Cancer I2 (1995) 265-329

Mehstasls in tongue from carcinoma of broochus: A case report Shehab Z. Desousa S, Pahor AL. Ciry Hospitol, Dudley Road, Birmingham BIS 7Q,? J Laiyngol tXo1 1994;108:1099-1101.

A case of ewcinoma of the lung with a metastasis on the tongue is presented. The ease is of interest because, although primaly carcinomas of the tongue are fairly common accounting for 50 per cent of all oral carcinomas, mctastatic turnour represents only one per cent of all malignant turnours of the oral cavity and of these only 0.2 per cent metastesize to the tongue.

~omcmp~y~dedfiwo~pllmoaorybiopsy~~ROTEX needle: Results from 890 patients with focal lung lesions Szolar DHM, Preidlcr KW, Kugln C, Hausegger K, Klein GE, Popper H et al. UniversitaIsklinik/ur Radiologie. Auenbruggerplatz 9, A-8036 Graz. Rofo Fortschr. Geb RontgCnstr Neucn Bildgcbendm Verfahren 1994;161:505-11.

Fluoroscopically guided transthoracic line needle biopsies were performed in 890 patients (380 female, 582 male, mean age: 56 years). In 795 patients (89.4%) the first biopsy was successful. The success rate of biopsy correlated closely with the size of the lesion and increased with larger size. Sensitivity in the diagnosis of malignant lesions was 94.6%, specificity 99.5%. Due to cytological, histological, and clinical confirmation of benign lung lesions in 300 patients (33.7% of all patients), the number of unnecessary diagnostic thoracotomics for benign disease could be reduced significantly. In 9 of 113 cases (8%) histological reclassitication of the cytologic results was necessary. Reclassification was not necessary in the differentiation between benign and malignant lesions and between small cell and non-small cell carcinomas. The overall complication rate was 24.7% (220 patients). Only 36 patients (4% of all patients) required chest-tube insertion. There were no fatal complications. Pcrcutancous tluoroscopicelly guided transthoracic tine needle biopsy of the lung, performed with the Rotex needle, is a time-effective, safe. and ellicient method for diagnosing focal pulmonary lesions.

Videotboracoscopy and video-assisted smail tboracotomy for tbe treatment of pulmoaary maligoancies Casadio C, Giobbe R, Cianci R, Molinatti M, Oliaro A, Maggi G. Department of Thoracic Surgery, University of ‘lirrin. via Genovo 3. 10126 Turin. J Cardiovesc Swg 1994;35:44S-8.

Video-assisted thoracic surgical procedures continue to be performed with increased frequency, the role of this new technique in the treatment of pulmonary malignancies or metastetic mediastinal adenopathics is not yet defined. Out of a series of 100 consecutive video-assisted thoracic operations, 22 patients resulted affected by a malignancy in the lung or in the subearinal lymphnodes: six patients had a primary lung cancer and were operated with a video-assisted small thorawtomy of 5 cm (three lobectomy and three segmcntcotomy) because of a vcty poor respiratory reserve. Nine patients received a video-assisted wedge resection of a nodule resulted et the frozen section a metastasis of a carcinoma: a smell thoracotomy of 8 cm was made and a hand entered the thoracic cage to obtain 8 careful palpation ofthc entire lung; five patients had enlarged lymphnodes only in posterior and inferior mcdiastinum, inaccessible by cervical mediestinoscopy or anterior mediastinotomy: thoracoscopic exploration obtained a useful mediastinal nodal sampling for these adenopathies. In selected cases video-assisted thoracic surgery can be used for resection or assessment of thorn&c malignancies.

Aeascdadcnocarciooataoftbchmg sxtmddIy treated by combiiation cl~~mothcrapy with cisplatbt and viadesii resulting ia a long swvival without recurreoceaod synch-s thyroidcancer Haiti S, Kimum Y, Oke2aki M. Division of IntemolMedicine. Chugoku Chuoh Hospital, Muhad Aid Association, Fukuyamo. Jpn J Chest Dis 1994;53:925- 30.

A combined chemotherapy with cisplatin (20 mgim’, day 1-S) and vindcsine (3 mp”m’, day 1 and 8) was administered for a 68-yearaId male patient with a low differentiated adenocarcinoma of the lung (T3NOMI) and pulmonary hypofimction. A&r completion of 3 courses, the lesion on chest radiographs became unnoticeable. Afler completion of 3 courses, the chest CT showed only a scar like shadow, Then a thyroid cancer was found and was resected Non- recurrent non small cell lung caneer following chemotherapy for a long time is uncommon. This patient has been well without recurrence of either tumor for 4 years and 7 months afler the initiation of chemotherapy.

Small cell long cancer presenting as a metastatic conjonctival tumor Gotoh T, Tsujimoto S, Hashimoto S, Arimoto T, Iwasaki Y, Hiramori N et al. Second Deparbnenf ofMpdicine, Kyofo Pr&~ural Yosanoumi Hospital, Kyoto. Jpn J Thorec Dis 1994;32:1120-4.

A 65-year-old man complaining of a let? medial ocular angle mass and hcmoptysis was admitted to our hospital. Chest radiography revealed a right hilar mess and bronchoscopy revealed widespread cancerous invasion of the carinn, both main bronchi, right upper lobe bmnchus, truncus intermedius, and middle lobe bronchus. Histological examination of 8 biopsied specimen revealed small cell carcinoma. Brain CT scan, abdominal CT scan, and bone scintigmm showed solitary brain, multiple liver, and multiple bone metestases. Partial response was obtained with three courses of combined chemotherapy with carboplatin and ctoposidc, and the ocular tomor until it was almost invisible to the unaided eye. However, complete response could not be obtained with additional hvo courses of combined chemotherapy, and the patient was discharged. Seven months after the first admission, he was readmitted with dyspnca and en enlarged (6 mm in diameter) lefi ocular mass. Histological examination of the resected mass revealed a small cell carcinoma that had metastasized to the conjunctival substantia prop&. He died of respiratory failure one month after readmission. Metastasis to the eye from primary lung cancer is uncommon and patients such as this we extremely rare. Although some cases of weal or orbital metastasis from lung cancer have been reported, we can find no other report of conjunctival metastasis from lung cancer.

Meawrable or assessable disease in luhg caocer trials: Does it matter? ktt JR, Su JQ, Krook IE, Goldberg RM, Kuglcr JW. NCCTWU. Plummer C- 402. 200 Firsf St SW Rocheste,: MN 55905. J Clin Oncol 1994,12:2677-g 1.

Purpose: The goals of this study were to analyze and compare the major clinical response rates and survival of patients with either measurable or assessable disease status to treatment with systemic chemotherapy. Pafienfs and Melhods: All patients had stage IIIB or IV non-small-cell lung cancer (NSCLC) and were enrolled onto three consecutive phase Ill clinical trials. Patients were stretitied by disease status (measurable or usesable) before randomization to systemic chemotherapy. The three trials were conducted in the setting of a multicenter cooperative oncology group. Composite data were obtained for the three trials. Major clinical responses, time to progression, and survival were analyzed and compared in patients with measurable or assessable disease using standard statistical methods. Resulrr: Four hundred hventy-six patients were enrolled onto the three trials from June 1981 through August 1990. Measurable disease was present in 236 patients (55%) and assessable disease in 190 (45%). Each study was well balanced for the number of patients with measurable or assessable disease on either treatment regimen. A major clinical response was observed in 71 patients with measurable disease (30%; 95% confidence interval [Cr], 24 to 36). Forty p&ems with assessable disease responded to treatment (21%; 95% CI, 16 to 28) (P = .04). The time to progression for all patients (P = .23) and for responders only (P = .lO) was not significantly different based on disease statlls. Overall survival and survival of responders only was not significantly different, but patients with assessable disease tended to do better. Using multivariate analysis, sex and disease status had a borderline influence on the major response rate (P = .05). Performance score (PS) was the only factor that was significantly correlated with survival. Conclusion: NSCLC patients with assessable disease have major clinical response rates, time to progression, and survival that are similar to those ofNSCLC patients with measurable discax. This study suppats the inclusion of patients with assessabledisease lung cancer in both phase II and III trials conducted in the cooperative group setting.

Preoperative evaluation of stage I and stage II wn-small cell hog cancer Hatter J, Kohman LJ, Mosca RS, Graziano SL, Veit LJ, Coleman M. Deparbnenf of Surgery. SUNY Health Science Cenfe,: 750 E Adorns Street. Syracuse, NY 13210. Ann Thorac Surg 1994;58:1738-41.

The appropriate preoperative evaluation for occult metastasis m patients with potentially resectable lung cancer remains controversial. The records of 265 patients with stage I and II non-small cell lung cancers who underwent resection with curative intent were reviewed to determine if there was a survival benefit of negative preoperative scanning to detect metestases. A minimum of 5 years of follow-up was possible for all long-term survivors. Patients having preoperative bone scans, brain imaging, and abdominal imaging had no increased survival over those without such evaluation (using Kaplan-Meier survivsl curves).

Abstracts/Lung Cancer 12 (1995) 265-329

Additionally, no difference was found in the time to first recurrence between these groups, and the site of recurrence was independent of a negative preopexalive sce.n for that location. These data, using patient outcame as the basis of our conclusion, support a policy of reserving expensive preoperative metastatic evaluations only for those patients with clinical evidence of metsstatic disease.

Prediftkm of probability of pneumooectomy for lung caocer using Tc- 99m MAA perfusion lung imaging Chen C-Y, Kao C-H, Hsu N-Y, Chcn C-L, Hsu C-P, Wang P-Y Division of Thoracic Surgery, Deparbnent of Surgery. Taichung Veterans General Hospital, 160 Taichung Harbor Road, Taichung. Clin Nucl Med 1994,19:1094-7.

Pulmonary perfusion scintigraphy with Tc-99m MAA was performed on 182 patients, on whom either pneumonectomy or lobectomy was performed, because of primary nonsmallccll lung carcinoma. Among them, 76 underwent pncumoneetomy, and 106 underwent lobectomy. The mean value of the perfusion fraction (PF) of the affected lung of the patients undergoing pneurnonectomy ~88 32.3 * 13.6% (range, 4%-50%) and was less than that of the patients undergoing lobectomy, 43.5 f 4.5% (range, 27%-50%). The difference was statistically significant (t-test, t = 6.82; P < 0.001). Among the 28 patients whose PF of the affected lung was equal to or less than 30%, 26 underwent pncumonectomy and only 2 had a lobectomy. Among the I54 patients whose PF of the sffccted lung was more than 30%. 50 underwent pncumonectomy and 104 had a lobectomy. These result suggest that ‘30%’ can be a cutoff value (Yates correction X2 test, X’ = 33.09; P < 0.001).

Pmgnostic signifiiaoce of tissue polypeptidespecific antigen (‘I’PS) in patientswith advaoced non-small ceil lung cancer Van der Gaast A, Schoenmakers CHH, Kok TC, Blijcnberg BG, Hop WCJ, Splinter TAW. Deporbnent of Medical Oncology, Univ. Hospital Rotterdam- Dijkzigt, DrMolewaterplein 40, 3015 CD Rotterdam, Eur J Cancer Part A Gen Top 1994;30:1783-6.

In this study, we evaluated the prognostic value of the turnour marker, tissue polypeptidc-specific antigen (TPS), in 203 patients with non-small cell lung cancer (NSCLC), and related this to several other known prognostic factors. TPS was significantly correlated with lactate dchydrogcnasc (LDH), gamma- glutamyltmnspeptid and alkaline phosphatase, and the median level of TPS in patients with stage 4 disease was significantly higher as compared to stage 3A and 3B discaPc. In the univariate analysis, performance status, stage of disease, LDH, alkaline phosphatase, a histology of undiffmntiated large cell carcinoma and TPS all had a statistically signiticant ass&&ion with survival. Multivariate analysis showed that stage of disease, performance status, histology and TPS were the most important prognostic factors. TPS has prognostic significance for survival in patients with advanced NSCLC, independent from performance states and stage of disease.

ClinkA evaluation of serum tissue polypeptidespecitic antigen (Tps) in non-small cell lung cancer Pujol J-L, Cooper EH, Grenier J, Purvcs DA, Lehmann M, Ray P et al. Service des Maladies Respiratoires, Hopital Amnoud de C%lleneuw, 34059 Montpellier Cedex. Eur J Cancer Part A Gen Top 1994;30: 1768-74.

M3 is an cpitope of the tissue polypeptide antigen detectable in the serum by immunoradiometric assay. This cpitope is referred to as tissue polypeptide- specific antigen (TPS). We examined the pretreatment TPS level of 160 non- small cell lung cancer (NSCLC) patients and 71 patients who suffered from non-malignant pulmonary diseases. The upper limit of normal values was 140 U/ I. Using this cutoff, the sensitivity and specificity were 36 and 90%, respectively. The TPS was significantly higher in NSCLC patients with an advanced swe, B mediastinal lymph node involvement or a poor performance status. This level w.ss significantly higher in the group of patients for whom the disease proved to progress during chemotherapy. In univariate analysis, patients with a high TPS level proved to have a shorter survival than patients with a TPS % 140 U/l. In Cox’s model analysis, performance status, stegc of the disease and serum TPS were the only significant prognostic variables. The low sensitivity ofTPS precludes its use for diagnosis. However. the pretreatment TPS level adds information to the management of NSCLC inasmuch as it predicts a low sensitivity to chemotherapy and a poor prognosis.

‘llte clinical signifhoce serum N-POMC level in lung cancer patients Li L, Luo W, Lu Z. Peking Union Medical College Hosp., Beijing 100730. Chin J Oncol 1994;16:2914.

Serum N-POMC level of 103 cases of lung cancer were measured in our hospital. The results were as follows: The lung cancer group, 50.5%. of paticnst has an N-PONC level above the normal upper limit. The percentages of the N- POMC levels above the normal limit in lung cancers, such as: squamous-cell carcinoma, adenocarcinoma, SCLC and undifferentiated carcinoma were 52.2%, 50.0%. 47.3% and 57.1%, respectively. There was no statistically significant difference of N-POMC levels among these kinds of lung cancers. Eleven of 18 eases of SCLC patients in stage W or IV. and 3 of 9 cases of SCLC patients in stage m had N-POMC levels above the upper normal limit. Could serum N- POMC be one of the indexes for assisting the diagnosis and prognosis of lung cancer needs further investigation. Cases with carcinoid, thymoma and ncumtibmma had higher N-POMC levelstoo Six pateints had Cushing syndrome.

Surriv~rarly~sofuntrePted~tieotsnithnoa-sm~ kmgcancer Vrdoljak E, Mist K, Sapunar D, Rozga A, Mnrusic M. School ojMedicinc, Clinical Hospital, Split and Zagreb Untiersily. Split. Chest 1994;106:1797- 1800.

The survival rate analysis of I30 patients with non-small-cell lung cancer who did not receive any specific anticancer therapy showed no statistically significant differences in the survival rates behuan various TNM combinations classified into stage groups II, III& IIIb. and IV, as proposed by Mountain in 1989 and adopted by the American Joint Committa on Cancer. Following these findings, based on survival probabilities, two distinctive staging groups could be distinguished. The tirst stage group we.8 composed of only the Tl , ZNO, MO combination, and the second of all other TNM combinations. In a purely biologic sense of tomor growth, the lymph node involvement appeared to be the crucial factor determining the length of survival.

Endoscopic criteliaofearly squamous cell carcinoma oftbe bronchus Akaogi E, Ogawe I, Mitsui K, Onizuka M, Ishikawa S, Yamamoto T et al. Institute of Clinical Medicine, Universi~ of Tsuhba. Tsukuba 305. Cancer 1994,74:3113-7.

Baclrground. Early lung cancer, not extending beyond the bronchial cartilaginous layer without regional lymph node involvement is considered curable by endoseopic laser therapy or limited surgery. The endoscopic criteria for early squamous cell carcinoma ofthe bronchus, however, have not yet been determined. Me&o&. For 44 resected lesions of roentgenographically occult bronchogcnic squamous cell carcinomas, the relationship between cndoscopic findings and the degree of histologic extent of tumor was examined. ResuL. The lesions were divided into three types: polypoid or nodular (PN), flatly spreading (FS), and mixed. Thirty-three lesions arising from the central bronchus included 7,19, and 7 of the PN, FS, and mixed types, respectively. In the central lesions, the degree of transmural invasion and the greatest dimension correlated, but the degree of intramural invasion of PN-type lesions was higher then that of the FS type. The PN-type lesions smaller than 10 mm and the FS type smaller than 15 mm in greatest dimension were found within the cartilaginous layer without regional lymph node involvement. All lesions of the mixed type were larger than 20 mm. Three of the lesions larger than 20 mm had regional lymph node involvement. All 1 I lesions originating in the Peripheral bronchus were of the FS type, and a lesion of only 5 mm in greatest dimension had extracartilaginous invasion. Conclusions. The ezdoscopic criteria of early squamous cell carcinoma ofthe bronchus may be applied to central PN lesions smaller than IO mm and central FS lesions less than 15 mm in greatest dimension. Any lesions of mixed type should be excluded from the criteria.

Indium-lll pentetmotide in tbe diagnostic work-up of patients witb broncho&c caniooma Kirsch C-M, Wn Pawel J, Gmu I, Tats& K. Nukiearmedtzinische Klinik Kltiikwm Groshadem, D-81366 Munchen. Eur J Nucl Med 1994;21:1318-25

In a prospective study we examined 38 patients with primary bronchogenic carcinoma to validate the use of iridium-I I I pcntetreotide (IPT) as a diagnostic tool. Ofthese 38 patients, 25 had small ccl1 lung cancer (SCLC) end 13, non-small cell lung cancer (NSCLC). The aim of the tidy was to investigate whether (a)