Abstracts/Lung Cancer 13 (1995) 185-232 221

during the last twenty years by the Radiation Therapy Oncology Group @TOG). Initial studies demonstrated the dependence of local tumor control and survival on total dose of standard fractionation RT for unresectable NSCLC. Subsequent studies evaluated radiation dose intensification, employing altered fractionation RT administered as either hyperfractionated or accelerated fractionation RT. Altered fractionation schemes achieved total doses as much as 32% higher than standard RT to 60 Gy, which necessitated careful reassessment of acute and late treatment-related toxicity, These studies showed a survival advantage for hyperfractionation to 69.6 Gy, in favorable performance patients, compared to hyperfractionation to 60 Gy. Current dose intensification investigations include evaluation of 3-dimensionaU confonnal RT as a means of delivering high doses of standard Iiactionation RT with low toxicity. Treatment intensification utilizing combined chemotherapy (CT) and RT for NSCLC has also been evaluated. Recent studies have demonstrated improved local control and survival with induction CT followed by standard RT to 60 Gy. Current studies will evahiate the timing and sequencing of CT and RT and the combination of CT with altered fractionation RT. Hypoxic cell sensitizers and nonspecific immune stimulants, two noncytotoxic adjwants to RT, have shown no survival be&it. Biologic response modiflers, including recombinant interferon-beta, will also be evaluated as adjuvants to standard RT, based on interferon-beta radiosensitization observed in the laboratory and clinical investigations suggesting improved survival. Overall, RTGG studies have yielded small, but @artant, incremental improvements in treatment outcome for NSCLC, enhanced understanding of the pathophysiology of NSCLC, and provide a solid foundation on which to develop tiuure investigations.

Single fraction prophylactic cranial irradiation for small cell carcinoma of the lung Brewster AE, Hopwood P, Stout R, Burt PA, Thatcher N. Manchester Lung Tumour Gtwup. Department of Radiotherapy, Christie Hospital, Manchester A420 4BX. Radiother Oncol 1995;34:132-6.

The effectiveness of a single 8-Gy fraction prophylactic cranial irradiation regime was assessed in 106 patients with small-cell carci- noma of the lung. .All patients had limited stage disease and received combination chemotherapy consisting of either cisplatin or carboplatin with ifosfamide, etoposide, and vincristine (VICE). Cranial irradiation was administered 48 h after the first cycle of chemotherapy and was well tolerated. Actual Z-year survival was 35% and cranial relapse occurred in 22% of those patients who achieved complete remission. This compares favourably with a cranial relapse rate of 45% incomplete remitters previously reported with the same chemotherapy regime after a minimum follow-up of 2 years where PC1 was not used. Formal psychometric testing was performed retrospectively on a series of 25 long-term survivors of whom 14 were taken from this reported series. Whilst 75% of patients were impaired on at least one test with 68% performing badly in the most complex task, this was not associated with clinically detectable neurological damage and the patients did not complain of memory or concentration difficulties, In conclusion, single fraction PCI, when used with platinum based combination: chemo- therapy, appears tobe equally effective but may be less neurotoxic than the more standard fractionated regimes.

Factors causing radiation pneumonitis and the CT findings in lung cancer cases Sanka Y Department ofRadiology, Osaka Medical College, Osaka 569. Jpn J Lung Cancer 1995;35:7-15.

By using chest CT, we investigated the factors and CT findings of

radiation pneumonitis. In 70 cases which were treated by radiotherapy with a total dose of over 30 Gy and followed up over 2 months after radiotherapy, radiation pneumonitis was detected in 49 cases (70.0%). There was no signitIcant correlation between the occurrence Of radiatiOn

pneumonitis and the size of the radiation field. Combined chemotherapy was not related to the occurrence of radiation pneumonitis. However, there was a higher incidence of radiation pneumonitis in cases with over 4 courses of chemotherapy. In 25 cases with diffuse lung disease, radiation pneumonitis was detected in 22 cases (88.00%) and extended beyond the radiation field in I2 cases. Diffuse lung disease had significant intluence on the occurrence of radiation pneumonitis. We found various CT findings of radiation pneumonitis, including ground glass appearance, patchy, reticular, honeycomb and subpleural increased density. We investigated the clinical usefulness of 3-D imaging using helical scan CT. 3-D CT imaging was useful to observe the extent of radiation pneumonitis and to follow changes in CT findings.

Combined treatment modalities

The combined treatment with surgery and chemotherapy: Primary approach to small cell lung carcinoma (SCLC) Cui S, Li H, Gu Y Department of Thoracic Surgery, Henan Pmvincial Hospital, Zhengzhou 450003. Chin J Oncol 1994;16:432-4.

Forty cases of small cell lung carcinoma (SCLC) treated with surgical and chemotherapeutic combined therapy were reported. There were 28 males and I2 females in the group, most with history of more than 2 months, ranging in age of 27 - 66 years old. Cough, bloody sputum, low fever and chest distress are the main clinical manifestation. The small cell undifferentiates carcinoma was contirmed by tiberbron- choscope examination and pathology in all patients. Single lobectomy was performed in 20 cases, lobectomy of the upper and middle lobe in 9 cases, (sleeve resection of the lobarbronchus in 3 cases), and total pneumonectomy in 7 cases. Iwo cases were of stage I, I8 were of stage II, and 20 were of stage III a. Twelve patients received chemotherapy after operation, and 28 patients underwent the ‘chemotherapy -operation - chemotherapy’ treatment model. Adriamycin (or CDDP), cytoxan, vincristin, and dexamethasone were used for the chemotherapy procedure. The I, 3,5-year survival rate of chemotherapy after operation and chemotherapy - operation - chemotherapy group were 70%. 45%, 30.5% and 54% 30% and 22%. respectively. It is demonstrated that the long-term survival rate could be elevated in SCLC patients treated with chemotherapy after surgical operation, and the chance of operation also could be elevated by preoperative chemotherapy. The resection rate was 93% in the preoperative chemotherapy group.

Immunotherapy with the use of tumor-infiltrating lymphocytes and interkukin-2 as adjuvant treatment in stage III non-small- cell lung cancer: A pilot study Ratto GB, Melioli G, Zino P, Mereu C, Mirabelli S, Fantino G et al. Istihrto Patologia Chirqica, Universily of Genoa, Male Benedetto XK 16132 Genova. J Thorac Cardiovasc Surg 1995;109:1212-7.

This study assesses the feasibility and toxicity of adoptive immuno- therapy with tumor infiltrating lymphocytes and recombinant interleukin-2 in 29 patients underwent resection for stage III non-small- cell lung cancer. In five patients cultures yielded no growth of tumor infiltrating lymphocytes. In the remaining patients (stage IIIa, 14 cases; stage IIIb, IO cases) tumor infiltrating lymphocytes were in vitro expanded from surgically obtained tissue samples, including samples from both the tumor and surrounding lung. A number of tumor