1
s39 Radiotherapy and integrated treatment of lung cancer. Botrero G, Novella V, Spinoglio G. U.S.S.L. n.70. Ospedule Civile, II DivisionediChirurgia, 1SlOOAlessandria. MinervaMed 1988;79: 275- 9. The results of lung cancer treatment are often disappointing. In order to optimise the use of the therapeutic means at our disposal each clinical case should be assessed on a multidisciplinary basis with regard to the stage and type of the tumow. The fundamentals of radiotherapy technique are presented as are the concepts of integrated radiation, chemical and surgical treatment for the two basic groups of microcyto- mas and non microcytomas. Combined Treatment Modalities Preoperative radiotherapy in the combined treatment of lung can- cer patients. Trakhtenberg AK, Kiseleva ES, Pitskhelauri VG et al. PA. &men, Research Institute of Oncology, Moscow. Neoplasma 1988;35:459-65. The results of a cooperative study on combined treatment and preoperative radiotherapy in 478 lung cancer patients were analyzed. Intensivefractionatedradiolherapywasgivenatdosesof4GyforS&ys, the total dosage thus attaining 20 Gy. 218 patients received combined treatment, 260 patients were treated only surgically. A comparison of the 5-year survival rates of Stage 1 and II patients did not show any advantage in favor of the used therapeutic modality. The combined treatment with preoperative radiotherapy, however, improved the sur- vival rates of Stage III patients with non-small cell lung cancer. The 3- year rate in these patients was 49.4% and the 5-year rate was 29.2%. while those found in the patients treatedonlysurgically were28.1% and 15.8,respectively. In all patients with regional metastases the effective- ness of the treatment was higher when the combined method was employed. Innovative and future approaches to small cell lung cancer treat- ment. Beck LK, Kane MA, Bunn PA Jr. Division of Medical Oncology, University of Colorado Cancer Center, Denver, CO 80262. Semin Oncol 1988;15:300-14. As the unique properties of SCLC cell biology become further elucidated, therapeutic strategies which take advantage of these phe- nomena are becoming more common. Bone marrow stimulation with recombinant CSFs is sure to reduce the toxicity of standard dose chemotherapy and may allow for the useof higher chemotherapy doses. Clinicaltrialstoassesswhetherthiswillprolongsurvivalareinprogress. Immunodulation using cytokines to restore normal antitumor processes by augmenting normal functioning of the elements of the immune system and enhancing SCLC susceptibility to immune surveillance by increasing expression of major histocompatibility antigens looks en- couraging.InvivoefficacyofantigrowthfactorreceptorMoAbhasbeen demonstrated in murine models, and growth factor toxin conjugates have shown specificity in vitro. Growth factor conjugates topharmacol- ogic agents which spcifically inhibit links in the signal transduction pathway stimulating proliferation seem feasible. Meanwhile MoAbs may prove extremely useful in purging micrometastases from bone marrows for transplantation and also in improvement of histologic and imaging diagnostic techniques. SCLC treatments of the future are likely to beelegantspecifictherapiesof moderate tolow toxicityandincreased efficacy compared with the nonspecific cytotoxic approaches in stan- dard use today. Other Treatment Modalities Specific active lung cancer immunotherapy: Immune correlstes of clinical responses and an update of immunotherapy trials evalu- ations. HoliinsheadA,TakitaH, StewartT, Baman S.DeparfmentofMedicine. George Washington University Medical Center, Washington, DC 20037. Cancer 1988;62:1662-71. The mechanisms of action of the specific active immunotherapy of solid tumors have not been defined. In an attempt to characterize some of these mechanisms, we report controlled studies of humoral immune responses and cell-mediated immune (CMI) responses in lung cancer patients with Stage I and Stage II adenocarcinoma and squamous cell cancer receiving pure tumor-associated antigen (TAA) specific active immunotherapy or combination immunochemotherapy. At 5 to 6 months postimmunotherapy, the humoral immune response measure- mentsare predictive of response to therapy/survival in early lung cancer patients,permittingdecisionsas towhethertocontinuethempy.Patients with adenocarcinoma respond to combination chemoimmunotherapy by showing stronger or earlier responses to tests of immunity. Cell- mediatedimmunitytoTAAat 17to24monthswasfargreaterinpatients receiving immunotherapy or immunochemotherapy compared with control patients, and also correlated with early humoral immune re- sponseand with 5-year survival. Here wereportafurther subsetanalysis of Stage I and Stage II lung cancer patients in a successful Phase III US specific active immunotherapy trial as substantiating the experience with Stage I patients in a successful Phase II Canadian trial. We analyze failures and suggest additional therapies, especially a chemoimmunoth- erapy trial indicated by our analyses of humorocellular immune vari- ables reported here. Radioimmunotherapy of transplanted small cell lung cancer witb “‘I-labelled monoclonal antibody. Yoneda S, Fujisawa M, Watanabe I, Okahe T, Takaku F, Homma T, Yoshida K. Pulmonary Medicine Clinic, Saitama Cancer Center, Komwa 818. Br J Cancer 1988;58:292-5. Monoclonal antibody TSF-4 has previously been shown to react selectivelywithhumansmaBcelllungcancer(SCLC).Weevaluatedthe use of 1311-labelled TFS-4 for the treatment of established human SCLC transplanted in nude mice. The specific accumulation of theantibody in the transplanted tumour was recorded by both scintigraphic and biodis- tribution studies. Administration of 200 ?? Ci “iI-labelled TFS-4 inhib- ited turnour growth when compared with the same radiation dose of the control monoclonal antibody. The therapeutic effect was dose-depend- ent and complete disappearance of the tumour was observed transiently in one out of the three animals following the administration of 500 ?? Ci ‘311-labelled TFS-4. Therapeutic in vivo and in vitro effects of argon dye laser and hematoporphyrin derivative in lung cancer. Von Hardenberg D, Yamaguchi Y, Fijisawa T, Ogawa T, De Vivie ER. Centre for Surgery, Departmenr of Thoracic. Heart and Vascular Surgery. Universitar Coningen, D-3400 Golringen. Thorac Cardiovas~ Surg 1988;36: 15-9. In clinical and experimental study the therapeutic efficacy of argon dye laser irradiation with hematoporphyrin derivative (HpD) was evaluated in lung cancer. A total of 14 lung cancer cases including 12 squamous cell, 1 adeno- and 1 small cell carcinomas were irradiated superficially 48 hours or more after iv. injection of 3 mg/kg of HpD

Preoperative radiotherapy in the combined treatment of lung cancer patients

Embed Size (px)

Citation preview

Page 1: Preoperative radiotherapy in the combined treatment of lung cancer patients

s39

Radiotherapy and integrated treatment of lung cancer. Botrero G, Novella V, Spinoglio G. U.S.S.L. n.70. Ospedule Civile, II DivisionediChirurgia, 1SlOOAlessandria. MinervaMed 1988;79: 275- 9.

The results of lung cancer treatment are often disappointing. In order to optimise the use of the therapeutic means at our disposal each clinical case should be assessed on a multidisciplinary basis with regard to the stage and type of the tumow. The fundamentals of radiotherapy technique are presented as are the concepts of integrated radiation, chemical and surgical treatment for the two basic groups of microcyto- mas and non microcytomas.

Combined Treatment Modalities

Preoperative radiotherapy in the combined treatment of lung can- cer patients. Trakhtenberg AK, Kiseleva ES, Pitskhelauri VG et al. PA. &men, Research Institute of Oncology, Moscow. Neoplasma 1988;35:459-65.

The results of a cooperative study on combined treatment and preoperative radiotherapy in 478 lung cancer patients were analyzed. Intensivefractionatedradiolherapywasgivenatdosesof4GyforS&ys, the total dosage thus attaining 20 Gy. 218 patients received combined treatment, 260 patients were treated only surgically. A comparison of the 5-year survival rates of Stage 1 and II patients did not show any advantage in favor of the used therapeutic modality. The combined treatment with preoperative radiotherapy, however, improved the sur- vival rates of Stage III patients with non-small cell lung cancer. The 3- year rate in these patients was 49.4% and the 5-year rate was 29.2%. while those found in the patients treatedonlysurgically were28.1% and 15.8, respectively. In all patients with regional metastases the effective- ness of the treatment was higher when the combined method was employed.

Innovative and future approaches to small cell lung cancer treat- ment. Beck LK, Kane MA, Bunn PA Jr. Division of Medical Oncology, University of Colorado Cancer Center, Denver, CO 80262. Semin Oncol 1988;15:300-14.

As the unique properties of SCLC cell biology become further elucidated, therapeutic strategies which take advantage of these phe- nomena are becoming more common. Bone marrow stimulation with recombinant CSFs is sure to reduce the toxicity of standard dose chemotherapy and may allow for the useof higher chemotherapy doses. Clinicaltrialstoassesswhetherthiswillprolongsurvivalareinprogress. Immunodulation using cytokines to restore normal antitumor processes by augmenting normal functioning of the elements of the immune system and enhancing SCLC susceptibility to immune surveillance by increasing expression of major histocompatibility antigens looks en- couraging.InvivoefficacyofantigrowthfactorreceptorMoAbhasbeen demonstrated in murine models, and growth factor toxin conjugates have shown specificity in vitro. Growth factor conjugates topharmacol- ogic agents which spcifically inhibit links in the signal transduction pathway stimulating proliferation seem feasible. Meanwhile MoAbs may prove extremely useful in purging micrometastases from bone marrows for transplantation and also in improvement of histologic and imaging diagnostic techniques. SCLC treatments of the future are likely to beelegantspecifictherapiesof moderate tolow toxicityandincreased efficacy compared with the nonspecific cytotoxic approaches in stan- dard use today.

Other Treatment Modalities

Specific active lung cancer immunotherapy: Immune correlstes of clinical responses and an update of immunotherapy trials evalu- ations. HoliinsheadA,TakitaH, StewartT, Baman S.DeparfmentofMedicine. George Washington University Medical Center, Washington, DC 20037. Cancer 1988;62:1662-71.

The mechanisms of action of the specific active immunotherapy of solid tumors have not been defined. In an attempt to characterize some of these mechanisms, we report controlled studies of humoral immune responses and cell-mediated immune (CMI) responses in lung cancer patients with Stage I and Stage II adenocarcinoma and squamous cell cancer receiving pure tumor-associated antigen (TAA) specific active immunotherapy or combination immunochemotherapy. At 5 to 6 months postimmunotherapy, the humoral immune response measure- mentsare predictive of response to therapy/survival in early lung cancer patients,permittingdecisionsas towhethertocontinuethempy.Patients with adenocarcinoma respond to combination chemoimmunotherapy by showing stronger or earlier responses to tests of immunity. Cell- mediatedimmunitytoTAAat 17to24monthswasfargreaterinpatients receiving immunotherapy or immunochemotherapy compared with control patients, and also correlated with early humoral immune re- sponseand with 5-year survival. Here wereportafurther subsetanalysis of Stage I and Stage II lung cancer patients in a successful Phase III US specific active immunotherapy trial as substantiating the experience with Stage I patients in a successful Phase II Canadian trial. We analyze failures and suggest additional therapies, especially a chemoimmunoth- erapy trial indicated by our analyses of humorocellular immune vari- ables reported here.

Radioimmunotherapy of transplanted small cell lung cancer witb “‘I-labelled monoclonal antibody. Yoneda S, Fujisawa M, Watanabe I, Okahe T, Takaku F, Homma T, Yoshida K. Pulmonary Medicine Clinic, Saitama Cancer Center, Komwa 818. Br J Cancer 1988;58:292-5.

Monoclonal antibody TSF-4 has previously been shown to react selectivelywithhumansmaBcelllungcancer(SCLC).Weevaluatedthe use of 1311-labelled TFS-4 for the treatment of established human SCLC transplanted in nude mice. The specific accumulation of theantibody in the transplanted tumour was recorded by both scintigraphic and biodis- tribution studies. Administration of 200 ??Ci “iI-labelled TFS-4 inhib- ited turnour growth when compared with the same radiation dose of the control monoclonal antibody. The therapeutic effect was dose-depend- ent and complete disappearance of the tumour was observed transiently in one out of the three animals following the administration of 500 ??Ci ‘311-labelled TFS-4.

Therapeutic in vivo and in vitro effects of argon dye laser and hematoporphyrin derivative in lung cancer. Von Hardenberg D, Yamaguchi Y, Fijisawa T, Ogawa T, De Vivie ER. Centre for Surgery, Departmenr of Thoracic. Heart and Vascular Surgery. Universitar Coningen, D-3400 Golringen. Thorac Cardiovas~ Surg 1988;36: 15-9.

In clinical and experimental study the therapeutic efficacy of argon dye laser irradiation with hematoporphyrin derivative (HpD) was evaluated in lung cancer. A total of 14 lung cancer cases including 12 squamous cell, 1 adeno- and 1 small cell carcinomas were irradiated superficially 48 hours or more after iv. injection of 3 mg/kg of HpD