S23

Clinical Assessment

A pilot studyofthe Functional Living Index-Cancer (FLIC)scalefor the assessment of quality of life for metastatic lung cancer patients. An Eastern Cooperative Onculogy Group study. Finkelstein DM, Cassileth BR, Bonomi PD, Ruckdeschel JC, Ezdinli EZ, WolterJM. DivisionofBiosratisrics. Dana-Farber CancerInstitute, Bosfon, MA 02115. Am J Clin Gncol, Cancer Clin Trials 1988;11:630- 3.

Quality of life is an important factor in the assessment of cancer therapy, but it is difficult to define and measure. The Functional Living Index-Cancer (FLIC) was designed specifically for cancer patients under treatment. The Eastern Cooperative Oncology Group (ECGG) mounted a pilot study to assess the feasibility and sensitivity of the patient-oriented FLIC scale for assessment of quality of life. The results of this study show that the FLIC scores correlate with the functional status of patients on treatment: high scores on the FLIC prior to therapy were found to correlate with good performance status @ = O.OOOl), and decreases in the FLIC score during therapy correlated with a decline in performance status (p = O.OOOl), with poor performance status @ = O.OOOZ), and > 5% recent weight loss (p = 0.004). However, there was poor compliance to completion of the instrument, indicating a need for future research into this aspect of assessing quality of life in the cooperative group setting.

Deletion of 3(p14p23) in secondary erythroleukemia arising in long- term survivors of small cell lung cancer. Whang-Peng J, Lee EC, Minna JD et al. Division of Cancer Trearmenr, National Cancer Insritute, Bethesda. MD. J Natl Cancer Inst 1988;80:1253-5.

Cytogenetic studies were done on the leukemia cells of two patients with small cell lung cancer (SCLC) who developed erythroleukemia (acute non-lymphocytic leukemia, French-American-British M6) after combined modality chemotherapy and radiotherapy for their lung cancer. Surprisingly, both erythroleukemias exhibited the de1(3)(p14p23) predominantly found in SCLC. In four other patients who had secondary erythroleukemias associated with other cancers, no deletionsof3pwerefound.Thesefindingscouldbeaccountedforbyone of three possible mechanisms: (a) an inherited recessive gene (anti- oncogene or tumor suppressor gene) in this region of 3p was uncovered by the combined modality therapy, (b) an inherited predisposition to damage of both chromosomes at 3~14 leads to SCLC and erythroleukemia after exposure to carcinogens and/or chemotherapy- radiotherapy, or(c) the finding of lineage specificity for the 3p deletion with the presence of the 3p deletion in SCLC and erythmleukemia suggests a common bone marrow precursor.

Diagnostic significance of flow cytometric DNA analysis applied for the detection of cancer cells in bronchial washing fluid. Deinlein E, Sander U, Greiner C, Homstein OP. Department ofDerma- tology, Universiry of Erlangen-Nurnberg, D-8520Erlangen. Anal Quant Cytol Histol 1988:10:360-4.

Role of tumor-infiltrating lymphocytes in the host defense mecha- nism against lung cancer. Yasumoto K, Takeo S. Yano T et al. Second DeDartmenr of Surnerv. Faculty of Medicine, Kyushu University, Higashi-ku, Fuku& 8‘i2..j Surg Oncol 1988;38:221-6.

Since both DNA aneuploidy and increased proliferative activity are important characteristics of malignant neoplasms, flow cytometric (FCM)analysiswasused toexaminethecellcontentin brochialwashing samples obtained via fiberoptic bronchoscopy from 73 patients. The results were compared with the results of histology and conventional cytology. The patients included 30 with bronchial carcinomas, 12 with bronchopneumonia and 3 I with no evidence of lung disease. Of the 30 patients with histologically confirmed lung cancers, 25 showed either aneuploid stem lines (I9 cases) or high levels of proliferation (6 cases) as determined by analysis of cell-cycle stages The same rate of cancer cell detection was obtained by cytology. In the 43 cases with neither histolonic nor clinical evidence of malignancv, FCM data yielded 5 false-positive results, as compared to 4 erroneous suspicionsbf cancer by cytology. From these data, it is concluded that FCM measurements ofboth DNAploidy andproliferativeactivity maycomplementconven- tional cytology in the recognition of bronchial carcinomas.

Tumor-infiltrating lymphocytes (TIL) and tumor-associated macro- phages (TAM) were recovered from 22 patients with primary lung cancer. The TIL did not exhibit any cytolytic activity against various target cells. The average percentage of TIL recovered was 6.7 ?? 1.3% in patients without recurrence, as compared to 3.6 ??0.6% in those with recurrence within 2 years after complete resection of lung cancer (P<O.OS). The average cytostatic activity of TAM was 38.5 ??6.8% in patients without recurrence, although it was 25.2 ??4.6% in those with recurrence within 2 years after complete resection Cpc0.I). The activity of macrophage activating factor (MAF) induced by TIL was also higher inpatients showing norecurrence. A significantpositivecorrelation was observed between MAF activity induced by TlL and the cytostatic activity of individual TAM. These results suggest that antitumoractivity of TAM may be controlled by specifically sensitized TIL through lymphokines.

A new versatile transbronchial cytology needle for the staging and diagnosis of bronchogenic carcinoma. Gittlen SD, Erozan Y, Wang KP. Pulmonary Division, Johns Hopkins Hospital. BalGmore, MD 21205. Chest 1988:94:561-5.

Neuron-specific enolase in the diagnosis of small-cell lung cancer with pleural effusion: A negative report. Pettersson T, Klockars M. Froseth B. Fourth Departmenr of Medicine, Helsinki University Cenfral Hospital, SF-001 70 Helsinki. Eur Respir J 1988;1:698-700.

We measured the concentration of neuron-specific enolase (NSE) and carcinoembryonic antigen (CEA) in the serum and pleural fluid of 53 patients with pleural effusions, including seven patients with small-cell lung cancer (SCLC). High levels (above 12.5 ??g.l-i) of NSE in pleural fluid were observed in five patients with SCLC (sensitivity 71%). However, pleural fluid NSE levels were also increased in five patients with other types of cancer and in four patients with non-malignant inflammatory diseases (specificity 80%). We conclude that although SCLC withpleuraleffusioncan beassociated withelevatedpleuralfluid NSE activity, this increase in enzyme levels is not specific for malig- nancy.

Anew versatile transbronchial needle, the modified type 2B retract- able needle, was used for the staging and diagnosis of bronchogenic carcinoma. Itcombines the advantages of its predecessors, the fixed type IA needle and the retractable type 2A needle, such as convenience of usage and the added ability to sample peripheral as well as central lesions. The new modified type 2B retractable needle provides better protection of the airways and bronchoscope than the fixed type 1A needle and eliminates the type 2A needle’s requirement for total removal of the guidewire before aspiration. The new type 2B needle was compared with either the original fixed type 1A or the retractable type 2A needle in 20 patients at 34 tmnsbronchial sites and found a similar diagnostic yield. The modified type 2B retractable needle was the most versatile needle of those studied and can be used for transbronchial needle aspiration of both central and peripheral lesions.