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unresectable carcinomas of the lung. Pa-

tients who received megavoltage radiothe- rapy to a minimum tumor dose of 60 Gy be- tween 1978 and April 1983 were studied. Availability of body CT and physicians preference determined whether CT was used in pretreatment evaluation and treatment planning. All patients were at risk a mini- mum of two years after therapy.

The selection criteria resulted in the identification of 168 patients, 140 men and 28 women, from 31 to 87 years of age. The histopathologic diagnoses were squamous carcinoma -125, adenocarcinoma-34, large cell carcinoma-21, combined carcinoma-l, and unspecified-3. Fifty-three patients were in clinical stages I and II (40 medi- cally inoperable, 13 operated but unre- sectable) and 115 were in clinical stage III (MO). Eighty-five patients received radiation therapy without prior CT; 83 patients had CT before radiation therapy, 27 for diagnostic evaluation of the chest, and 56 specifically for treatment planning. There were no significant differences in major prognostic variables between the groups with and without CT. Seventeen per- cent of patients without CT were alive at two years, compared with 25% of patients with CT. Patients with only diagnostic CT had the same two year survival rate as those without CT. Sixteen (29%) of 56 patients who had CT for treatment planning were alive at two years. There may be a more favorable prognosis for patients who have CT based planning of definitive radiation therapy for carcinoma of the lung.

Radical Radiotherapy as Curative Treat- ment for Localised Carcinoma of the Lung. stout, R., Hancock, B. Christie Hospital, Manchester, U.K.

Surgery is the accepted treatment for localised non small cell lung cancer. A number of patients, although technically operable, are unsuitable for surgery because of age or concomitant medical con- ditions. Even today, patients may not be referred for potentially curative radio- therapy in the mistaken belief that treat- ment can only be palliative.

114 patients with localised lung can- cer were treated with radical x-ray-therapy between 1971-75. Patients with radiologi- cal evidence of involvement of the media- stinum were excluded. The primary tumour with a modest margin was irradiated to 50-55 G (5000-5500 rad) in 16 fractions over 22 days using standard Megavoltage beam-direction techniques. The maKimum volume was 9x9x9 cm. No conscious attempt was made to irradiate the regional lymph nodes.

The overall 5 year survival was 15%

and 18% when corrected for intercurrent

deaths. The results by T stage were as follows:

Patients Overall 5 year surv.(%) Corrected(%)

T1 14 36 45 T2 64 18 21 T3 36 3 3

NO unacceptable early or late morbidity oc- curred as a result of treatment.

Postoperative Radiation of Lung Cancer. (With 64 Cases Analyses). Zhiyi, Z. Rongfen, Z., Xiafang, Z. Department of Radiation Oncology Cancer Hospital of Shang- hai First Medical College Changhai, People's Republic of China.

Since January of 1973 to December of 1978, there were 64 patients of lung cancer in Cancer Hospital of Shanghai First Medical College who underwent postoperative radiation. The 3-yr and 5-yr survival rate were 45.3% (29/64) and 28.1% (18/64) respectively. AJC staging system does not seem to be a very important factor influen- cing survival rate. But for squamous cell carci- noma of lung, 3-yr survival rate were better than adenocarcinoma, 58% (18/31) and 35% (10/28) respectively.

Stage III in T 2 N M and T N M patients i- 0

w&th postoperative radiation 1 0 t ~ e r a p y cou ld im- p rove the 5-yr survival rate, but in T3N2M 0 and T N M patients none survived over five

i-3 l-t~e 1 years. On other hand, a large proportion of squamous cell carcinoma and adenocarcinoma patients after postoperative radiation therapy developed remote metastases. Thus we approve of giving chemotherapy as adjuvant treatment.

The Treatment of Malignant Mesothelioma With P32 Colloid and External Radiotherapy. A Phase II

Studyl 1 2 Helle , PIA., Baris , G.~ Caspers , R.J.L., van

der Pompe , W.B., Visser , A.G. i. Departments of Radiotherapy, Nuclear Medicine and Physics, Rotterdam Radio-Therapeutic Institute, P.O. Box 5201, Rotterdam, The Netherlands and 2. Department of Clinical Oncology, Academic Hospital, Univer- sity of Leiden, The Netherlands.

The prognosis of malignant mesothelioma pa- tients is poor. The main reason for failure is the inability to achieve local control with surgery or radiotherapy. In this study the value of the application of P32 colloid intrapleurally combined with external radiotherapy is assessed.

By the application of 15 mCi P32 colloid in- trapleurally, minimal tumor of less than 3 mm will receive a dose of about 290 grays. An even distribution of the colloid over the total pleu- ral surface was obtained. External irradiation with high fraction doses of ii x 4 Gy 3 times a week was added for the treatment of macrosco- pic disease, i.e., greater than 5 mm measured by CT scan.

All patients had u~ilateral disease, measu- ring less than 400 cm by CT scan, in addition to being histological proven malignant mesothe-

lioma.

147

Thirteen patients were treated with a median survival of ll months. Local control of greater than 12 months (as assessed by chest x-ray and CT scan) was achieved in 4/13 patients. No toxicity was observed with the exception of minimal, self-resol- ving oesophagitis.

Conclusion: in selected cases local control is achievable in malignant meso- thelioma with this kind of management. Fur- ther study is warranted.

Hearing Loss After Prophylactic Cranial Irradiation (PCI) in the Treatment of Small Lung Cancer (SCLC). ten Velde, G.P.M., Moonen, L.M.F., Anteunis, L.J.E., Blijham, G.H. State University of Limburg, Maastricht, The Netherlands.

PCI in complete responders (CR) in SCLC, especially in limited disease (LD) is an accepted treatment modality to reduce the incidence of brain metastasis. Except for severe progressive dementia no major side effects of this treatment have been repor- ted. From 1-1-1981 ill 1-1-1985 59 patients with SCLC, 39 LD, wer~ treated with cyclo- phospha~ide i000 mg/m-, adriamy~ine 50 or 45 mg/m and etoposide i00 mg/m x 3. 27 patients receiving CR after 3 or 5 courses of chemotherapy received PCI, 30 Gy in l0 fractions. 7 patients complained spon- taneously of hearing loss immediately after PCI; this was documented by audiogram in 3 patients and reversible in only i. Audi- tory assessment revealed conductive, high- frequency sensorineural as well as mixed hearing loss. Brainstem auditory evoked potentials attested a cochlear component but did not indicate neural involvement at this stage.

We subsequently conducted a survey among 7 institutions from the Netherlands Lung Cancer Group which together have treat- ed over 150 patients with SCLC in the past two years with the same protocol, Four phy- sicians indicated to have seen several patients complaining of hearing loss; an estimation of the incidence will be pro- vided.

It is concluded that non reversible hearing loss after PCI is a sometimes disabling complication secondary to PCI, possibly in conjunction with the admini- stration of chemotherapy (etoposide). Further prospective audiologic investiga- tions to assess the incidence and severity of hearing loss after PCI are necessary.

Late Effects of Prophylactic Cranial Irra- diation: Demonstration of Neurological and Phychological Abnormalities. Walker, R.W., Lazar, R.M., Gralla, R.J., Scher, H.I. Memorial Sloan-Kettering Can- cer Center, New York, N.Y. U.S.A.

Prophylactic cranial irradiation (PCI)

is included along with chemotherapy in most treatment plans of small cell lung cancer (SCLC). The efficacy of PCI in the prevention of clinical brain metastases has been esta- blished, but the possible long term effects of PCI have recently been questioned. We eva- luated 7 patients with SCLC 2~-7 years (mean 4.5) after treatment with PCI. All patients received a total of 3000 rad. 2 patients recei- ved 500 rad x 3 fractions, followed by 4 days rest, then 300 rad x 5 fractions. 5 patients received 300 rad x i0 fractions over 13-18 days. All patients had received prior chemo- therapy. 2 patients had neurological abnorma- lities; 1 had unilateral optic neuritis and the other dementia and communicating hydroce- phalus. 4 patienta had late CT scans done and all were abnormal. Neuropsvchological testing was performed on all patients and although on- ly 4/7 had verbal memory deficits, 7/7 had vi- sual memory deficits. Only 4 of these patients complained of mild memory difficulty. All patients had normal mean IQ's (verbal IQ=I06; performance IQ=I01). The evaluation included the following: the Wechsler Adult Intelligen- ce Scale, the Wechsler Memory Scale, the Ben- ton Visual Retention Test, the Boston Naming Test, Verbal Fluency, Finger Tapping, The Grooved Pegboard, and Trail-Making A and B. These data suggest that this decreased memory function may be a consequence of PCI. A pro- spective randomized study with and without PCI is necessary to further elucidate and confirm these findings.

Relapse Pattern After Complete Response to Combination Chemotherapy for SCLC Favors Pro- fylactic Cranial Irradiation (PCI). Thorud, E., H~st, H. General Department, The Norwegian Radium Hospital, Oslo, Norway.

During 1979-82 171 patients were treated with the combination of adriamycin, vincristin and cyclophosphamid (plus radiation therapy to the thorax for limited disease). No PCI was given.

The overall CR rate was 33% (42% for limi- ted disease and 21% for extensive disease). In 44 of patients with CR the first site of recurrence was documented. In 43% this was seen in the thorax, in 36% in the brain. The median duration of CR when recurring in the thorax was 9 months (for limited disease 12 months), and 4 months when the recurrence was in the brain.

The data presented indicate that PCI could improve the duration of CR. The trauma associ- ated with PCI as part of the initial treatment is probably much less than to experience symp- toms from early brain metastases followed by cranial radiation.

Good Quality Long Term Survival Without Pro- phylactic Cranial Irradiation (PCI) in Small Cell Lung Cancer (SCLC).

Evans, B.D., Weston, C.F.M., Smith, I.E.