Abstracts/Lung Cancer 14 (19%) 377-408 403

having a much higher risk than those with upper lobe tumors. A critical volume effect and threshold dose were apparent in the development of high-grade pneumonitis. Conclusions: Three-dimensional therapy for lung cancer has been practically implemented at the Mallinckrodt Institute of Radiology and shows promising results in our preliminary analysis. The incidence of high-grade pneumonitis, however, warrants careful selection of patients for future dose escalation. Future dose escalation trials in lung cancer should be directed to volumes that limit the amount of elective nodal irradiation. However, the volume of necessary elective nodal irradiation remains unknown and should be studied prospectively. Dose escalation trials are indicated and may be facilitated by smaller target volumes.

Treatment of unresectable lung cancer with brachytherapy Aygun C, Blum JE. Radiation Oncology Afiliates, 9105 Franklin SquareDrive, Baltimore, MD 21237. World J Surg 1995;19:823-7.

Endobronchial brachytherapy is an evolving treatment modality. Although standard clinical indications and dosage schedules have not yet been established, the wide range of individual experience over- whelmingly demonstrates its efficacy in palliating lung cancer patients who generally have limited treatment options. Although the exact comphcatlon rate is not known, it appears to be low and the potential benetitsfaroutweigh therisks. Theroleofendobronchial brachytherapy for cure is less clear. For most instances ‘prolonged palliation’ would be a more suitable term than ‘cure.’ Further data is needed to clarify the proper place ofendobronchlal brachytherapy as a boost to external beam radiation therapy. The dose, fractionation scheme, and timing relative to external beam radiation therapy are based on institutional preference at this time. The historical evolution, treatment technique, results, and complications of endobronchial brachytherapy are reviewed here.

Antitumor activity of treosulfan in human lung carcinomas Kopf-Maier P, Sass G. Institut Anatomic, Freie Universitat Berlin. Konigin-Luise-Srrasse 15,D-14195Berlin. CancerChemotherPharmacol 1996;37:211-21.

Treosulfan (L-threitol 1,4-bismethanesulfonate, Ovastat) is an alkylating agent and a structural analogue of busulfan. It has been established in the clinical chemotherapy of human ovarian carcinomas for several years and has additionally been shown to be effective against xenografted human breast carcinomas. No other human carcinoma is yet known to be sensitive to treosulfan. The present study confirms the pronounced and significant antitumor activity of treosulfan against heterotransplanted human lung carcinomas ofboth the small-cell and the non-small-cell type. Treosulfan reduced thegrowthofall four small-cell lung carcinomas that were investigated in a significant manner. It was even more active than equitoxic doses of the clinically approved cytostatics ifosfamide. cisplatin. and etoposide toward threeof themand induced long-lastmg growth reductions (60-98 96 of control tumor size) corresponding to partial and nearly complete remissions. In the case of the nine non-small-cell lung carcinomas investigated, treosulfan effected significant growth inhibition ofmore than 50%) again inallofthem, and was moreactive than thecomparativecompounds ifosfamide, mitomycin C, and cisplatin at least in one of fourepidermoid lung carcmomas, one large-cell carcinoma, and one of three lung adenocarcinomas. These results are remarkable and unexpected, and the present study should be followed rapidly by phase II clinical trials of treosulfan against human lung carcinomas of both the small-cell and the non-small-cell type.

Technique and early results of percutaneous tineneedle brachytherapy for lung carcinoma HaymanMH, MerlinCS, MonsourPD, BrachBB, BuhIerC, LiprieSF. 4300 Houma Boulevard, Metairie, LA 70006. Endocuriether Hyperthermia Oncol 1995; 11!241-5.

The purpose of this study is to evaluate the feasibility and local control rates as well as long-term complications seen with tine-needle brachytherapy of primary lung carcinoma. Nine patients (one needle in six patients, two needles in two patients, and three needles in one patient) with primary lung carcinoma were treated with 6600 to 7000 cGy of external beam radiation therapy (EBRT). Fine-needle brachytherapy between 1000 and 2000 cGy was delivered under computed tomographic guidance as part of the planned boost. The patients were followed up for six to 33 months. Local control has been excellent (approximately 67%). The number of patients and case selection do not allow us to draw general conclusions about the utility of treatment in a patient population with residual disease after a full course of EBRT. Fine- needle brachytherapy may he an acceptable mode of additional boost therapy that may give a higher rate of local control.

Necrosis of the bronchus: Role of radiation Mehta AC, Dweik RA. PulmonaryKritical Care Med. Dept, Cleveland Clinic Foundation. 96lX Euclid Avenue, Cleveland, OH 44195. Chest 1995; 108: 1462-6.

The effwts of radiation on the lung parenchyma and pleura are web described in theliterature. Necrosisofthelarynx isaknowncomplication of radiation therapy. Necrosis of a part of the tracheobronchial tree following radiation therapy for bronchogenic carcinoma is likely to occur; however, there is little mention in theEnglish-language literature about such an effect. This report describes four ca.ses with total necrosis of a specific bronchus following radiation therapy for squamous cell carcinoma of the lung. All patients received 5,000 to 6,400 rad (50 to 64 Gy) of external- beam radiation. Two patients presented with massive hemoptysis and two with pneumonia. In all four cases, the patients were found to have, by bronchoscopy, necrosis of the bronchus with the involved lobe of the lung replaced by a large cavity lined by tumor tissue. Diagnosis was made 5 to 7 months after radiation therapy was completed. Three of the patients died of exsanguination within weeks following diagnosis of the complication. We suspect that such necrosis occurs as a consequence of radiation therapy in combination with infection in the set up of squamous cell carcinoma, and is a marker of poor prognosis.

The curative treatment by radiotherapy alone of stage I non- small cell carcinoma of the lung Gauden S, Ramsay J, Tripcony L. Queemhd Radium Institute. Royal Brisbane Hospital, Herston, QLD. Chest 1995;lOS: 1278-82.

This review was initiated to assess the outcome of treatment with radical radiotherapy with curative intent for patients diagnosed as having stage I non-small cell lung cancer. The study involved a retro- spective review of 347 patients with Tl and TZNOMO tomors treated at the Queensland Radium Institute during the period 1985 to 1992. The main reasons for not proceeding to surgery included poor performance status, old age, or refusal to submit to surgery. The median age for the group was 70 years, with the range being 34 to 90 years. Patients in this group were all treated by a standard technique involving external-beam radiotherapy to 50 Gy, minimum tumor dose, in 20 fractions over 4 weeks. The overall survival rate was 27% at 5 years with a median survival of 27.9 months. The 5-year recurrence-free survival was 23 I with the median being 19.5 months. There was a strong correlation of survival to tumor size with 5-year survival rates being 32% and 21% for Tl and T2 tumors,respectively. Multivariate analysis found only T stage to be associated with overall survival (p<O.Ol). In addition, the analysis showed that age younger than 70 years was a prognostic factor that approached statistical significanceat thep < 0.05 level of significance. We conclude from this large series of patients with stage I non-small cell lung cancer that radical radiotherapy with curative intent may be a viable alternative to surgery in those patients who either refuse surgery or are judged to be unfit for operation.