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Because one pathologist reevaluated tissues, changing histologic clas- sifications were not responsible for secular trends; now were the results influenced by referral bias inasmuch as the study was population based.

Therapeutic advances in small cell lung cancer. ArriagadaR, Le Chevalier TJnsritut Gusfave-Roussy, F-94805 Villejuif Cedex. Presse Med 1988;17:1851-6.

Small cell lung cancer is one of the most chemo- and radiosensitive adult solid malignancies. The effects of treatment should be evaluated according to standardized rules to ensure reproducibility. Recent ran- domizedclinical trials haveshownthatcombinedchemo-andradiother- apy can improve survival. A 5.year survival rate of 20 per cent can be obtained for an initially limited disease. However, further improvement of results requires optimized drug combinations and multimodality approaches as well as a better integration of new biological concepts in therapeutic trials.

Changing concepts in the management of patients with lung caocer. Hansen HH, Kristjansen PEG. Deparmen~ of Oncology, Finsen Insti- We, Rigshospikzler, 2100 Copenhagen. Med J Aust 1988;149:77-84.

The trials of the treatment of lung cancer have demonstrated that there havebeenonlymodesttherapeuticachievementsinthelasttwodecades, and these have occurred almost exclusively in patients with small-cell lungcancers.Themanagementofpatients withlungcancerstillremains one of the most critical problems in medicine today. Ideally, patients with inoperable non-small-cell lung cancers should be included in clinical trials that test new systemic treatmenl modalities such as new antitumour agents, biological modifiers, and so on. The development of less toxic and more effective systemic treatment both for small-cell lung

cancers and non-small-cell lung cancers 1s most important. It is to be hoped that in-vitro assay techniques to test new antineoplastic com- pounds will evolve in terms of the reliable prediction of clinical responsiveness, thus accelerating this development.

Lung cancer in Australia. McLennan G, Roder DM. Deparrmem of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA 5000. Med J Aust 1989;150:206-13.

Lung cancer is the leading cause of death of cancer in Australian men and the third leading cause in Australian women. Efforls are being made to reduce the incidence of this disease by smoking-cessation pro- grammes and improved industrial hygiene, and these measures need to beencoaragedstmnglybyall sectorsofthecommunity. Onapopulation basis, insufficient evidence is available to justify screening procedures fortheearlydetectionof lungcancerin ‘at-risk’gmups.Cureispossible by surgical resection in early cases. Improvements in therapeutic results with traditional cancer treatments largely have reached a plateau, but a number of newer therapies, and combinations of standard therapies, currently are being evaluated. Of particular interest is concurrent radiotherapyandchemotherapyin localizednon-small-celllungcancer; laser ‘debulking’ in conjunction with radiotherapy in non-small-cell lung cancer, and biological response-modifying agents in non-small- cell lung cancer. It is important that data be collected adequately to define epidemiological changes and to evaluate treatment results (in- cludingrepeatbronchoscopy,tassesslocalcontroloftumour),andthat the quality of life is recorded and reported in the evaluation process. Finally, phase-III studies in lung-cancer treatments require adequate numbers of subjects to enable meaningful conclusions to be reached. In most instances, this requires cooperation among centres to achieve objectives within a reasonable study period.

Miscellaneous

Psychosocial personality traits and cigarette smoking among bran- chial carcinoma patients. KulessaCHE, Blohmke M, JagschitzP, StelzerO, Cooper CL, Eysenck HJ. fnslilute of Social and Occupational Medicine, University of lfeidelberg, 6900 Heidelberg. Stress Med 1989537-46.

In a multicenue study, the Eysenck personality questionnaire (EPQ) was administered to patients in the diagnostic prccess for lung diseases, who later on turned out to have lung cancer or other chest diseases. The study was controlled by a group of healthy persons. The most important results of the survey are relatively low values for extraversion in the

carcinoma group (BCA) and relatively high scale values for exvaver- sion both in the healthy (GKG) and in the sick (KKG) control groups. Higher neuroticism scale values are shown by younger carcinoma patients (BCA) in comparison with healthy (GKG) and patient control group persons (KKG). However, psychoticism scale values show just small differences between BCA on the one hand and the control groups (GKG and KKG) on the other. Finally the authors discuss whether the results of the study are more supportive of Cooper’s svess hypothesis than of Eysenck’s constitutional hypothesis as explanation for an important partial cause of carcinogenesis.