89

the levamisole group as compared with the placebo group (47%). No significant diffe-

rence in survival was observed between the

placebo and levamisole-treated groups (me- dian survival, 48.2 and 45 weeks, respecti- vely). Responders to radiotherapy survived significantly longer than nonresponders (median survival, 73 vs. 33.3 weeks, p = 0.001). Among responders, the median sur- vival of patients treated with levamisole

was shorter (63.9 weeks) than that of pa~ tients receiving placebo (92.7 weeks). Tox-

icity attributable to levamisole included severe granulocytopenia in five patients

and severe nausea and vomiting in nine. It is concluded that levamisole is without significant benefit in this setting.

Small Cell Carcinoma of the Lung: Results of Combination Chemotherapy and Radiation Therapy (COF vs. COFP Randomized Analyzed). Zhang, Z., Wang-Shenzhong, Zhang-Xiafang. Department of Radiation Oncology, Cancer

Hospital of Shanghai First Medical College, Shanghai; China (People's Rep.). Int. J. Radiat. Oncol. Biol. Phys. i0: 2139-2143,

1984. Forty-three patients with small cell

carcinoma were admitted to our hospital in 1977. These patients were treated with combined chemotherapy and radiotherapy, the

latter being COsup 6sup 0 or 8 MEV Linac. The protocol for treatment is the following: i) Chemotherapy, randomized into two groups

COF (Cytoxan, Vincristin, and 5-fluorouracil) and COFP (Cytoxan, Vincristin, 5-Fu and Procarbazine). 2) Radiotherapy with 2 split courses. In the rest period chemotherapy was given as randomized above for COF and COFP groups, but drugs given only once in this rest period, followed by the whole

course of radiotherapy using same drugs as above, but only once a month for at least 2 years. The 1-year survival rates were 63.1% and 57.8% respectively, 2-year survival

rates were 21% for both programs, and 3-year survival rates were 10.5% for both programs also. Therefore, we believe that

procarbazine does not play a very important role in the program, and can be dispensed with. Compared with international reports, the efficacy of COF and COFP programs is as good as any other of the combined chemo- therapy programs in the world. These programs may be of more benefit to the patients be- cause of the very mild toxicity and very

low cost. In this study the extent of the lesion was found to play important role in prognosis, in other words, the earlier the stage the better the results, just as for other solid tumors. Median survival time

in Stage II groups is 20 months, the 1-year survival rate is 81,8% (8/11), 2-year sur-

vival rate is 45.4% (5/11), while in Stage

III groups median survival time is 11.5

months, the 1-year survival rate is 57.1% (13/

21), and 2-year survival rate is 14.2% (2/21).

Because the survival time exceeded 18 months, there are i0 of 15 patients alive and without evidence of disease (66.6%), and 6 of 8 patients

alive over 24 months without evidence of disease (75%). We offer a program that for maintenance combined chemotherapy periods should be prolon- qed to 2-3 or more years.

Radiation-Induced Lung Fibrosis After Treatment of Small Cell Carcinoma of the Lung with High- Dose Cyclophosphamide. Trask, C.W.L., Joannides, T., Harper, P.G., et

al. Department of Radiotherapy and Oncology, University College Hospital, London WCI 6AU, UK. Cancer 55: 57-60, 1985.

Twenty-five previously untreated patients

with small cell carcinoma of the lung were treat- ed with cyclophosphamide 160 to 200 mg/kg (with autologous bone marrow support) followed by radiotherapy (4000 cGy) to the primary site and mediastinum. No other treatment was given until relapse occurred. Nineteen patients were assess- able at least 4 months after radiotherapy; of these, 15 (79%) developed radiologic evidence of fibrosis, which was symptomatic in 14 (74%).

rChe time of onset of fibrosis was related to the volume of lung irradiated. A retrospective ana- lysis was made of 20 consecutive patients treat- ed with multiple-drug chemotherapy and an iden- tical radiotherapy regimen as part of a rando-

mized trial. Radiologic and symptomatic fibrosis was one half as frequent (35%) as in the high-

dose cyclophosphamide group. Very high-dose cy- clophosphamide appears to sensitize the lung to radiotherapy and promotes the production of

fibrosis.

!0, OTHER TREATMENT MODALITIES,

YAG Laser Photoresection of Lesions Obstructing the Central Airways. Kvale, P.A., Eichenhorn, M.S., Radke, J.R., Miks, V. Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI 48202, U.S.A. Chest 87: 283-288, 1985.

Some patients with cancer and others with be- nign lesions which obstruct the central airways (larynx, trachea, major brochi) can be treated with a laser. Ninety-nine patients were consi- dered for treatment during the first 18 moths of experience with YAG (yttrium aluminum garnet) laser at Henry Ford Hospital; 55 patients were treated 82 times. Results were satisfactory (surgery was avoided) in eight of ten patients with benign lesions. Satisfactory results (doub-

ling of airway size with relief of dyspnea/drai- nage of obstructive pneumonia) were obtained in

12 of 13 patients with bronchogenic carcinoma managed initially with the laser, and in 22 of

32 (69 percent) patients with recurrent malig- nancies. There were five minor and seven major complications, including two deaths. We conclude

that laser treatment can relieve central airways

40

obstruction with its associated symptoms of dyspnea and infection. Av.oidance of com-

plications requires a skillful approach, careful anesthetic management, and avail-

ability of back-up posttreatment intensive

care.

11, REVIEWS,

Smoking and Lung Cancer: An Overview. Loeb, L.A., Ernster, V.L., Warner, K.E., et al. Department of Biochemistry, Depart-

ment of Pathology, SM-30, University of Washington, Seattle, WA 98195, U.S.A. Cancer Res. 44: 5940-5958, 1984.

This position paper summarizes the over-

whelming evidence that tobacco smoking is the cause of 30 to 40% of deaths from can- cer. The focus is on lung cancer because of the sheer magnitude of this disease in males and the likelihood of a similar epi- demic in females. There are two categories of evidence that indicate smoking to be the major cause of human lung cancer. With-

out exception, epidemiological studies have demonstrated a consistent association be- tween smoking and lung cancer in men and now suggest a similar association in women. Chemical analyses of cigarette smoke reveal a multitude of known mutagens and carcino- gens. Moreover, these chemicals are absorbed,

are metabolized, and cause demonstrable genetic changes in smokers. Two consequen- ces of smoking are evaluated. The results of treatment of lung cancer are not encouraging; despite vigorous therapy, the 5-year survival

rate remains less than 10%. The social and economic costs of lung cancer and the smok- ing hibit impinge on the productiveness of our society.

Current Status of Therapy for Small Cell Carcinoma of the Lung. Ihde, D.C. National Cancer Institute-Navy

Medical Oncology Branch, Division of Cancer Treatment, National Cancer Institute, Be- thesda, MD 20814, U.S.A. Cancer 54: 2722- 2728, 1984.

Small cell carcinoma of the lung (SCCL) is distinguished from other types of lung cancer by its propensity for early deve- lopment of distant metastases and its rapid- ly fatal clinical course in the absense of treatment. The introduction of chemotherapy into the management of SCCL has led to a four- to five-fold improvement in median survival and to the cure of a small propor- tion of patients with this disease. Employ- ment of three- or four-drug regimens with or without chest irradiation in moderately intensive doses for periods of 12 months

or less has proven to be the optimal thera- peutic strategy with currently available agents. Despite these substantial gains,

it is obvious that the vast majority of

SCCL patients are continuing to die from their cancer, and a slowing in the pace of treatment advances has become apparent over the past 5

years. This article reviews current areas of active clinical investigation in SCCL and some information developed in the cell biology labo-

ratory that may have eventual application in the clinic.

Current Management of Carcinoma of the Lung. Lawrence, G.H. Department of Surgery, King Saud

University College of Medicine. Abha; Saudi Arabia. J. Thorac. Cardiovasc. Surg. 88: 858- '862, 1984.

Fifty years of surgical management of carci- noma of the lung has been associated with much enthusiasm in a search for improvement in sur- vival rate. Preoperative evaluation (including

node sampling), subsequent staging, responsible resection, and avoidance of serious postopera- tive complications have all led to an increa- singly objective system of management. Unfor- tunately, this has not been associated with a

marked improvement in overall rate of survival following pulmonary resection.

12, MISCELLANEOUS,

The Effect of Intravenous Hyperalimentation on the Dietary Intake of Patients with Small Cell Lung Cancer. A Randomized Trial. Clamon, G., Gardner, L., Pea, D., et al. Depart- ment of Internal Medicine, University of Iowa Hospitals, Iowa City, IA 52242, U.S.A. Cancer 55: 1572-1578, 1985.

In a randomized trial of i19 patients with small cell cancer of the lung, the effects of a 30-day course of central intravenous hyperali- mentation (IVH) on dietary intake were evalua ~

ted. All patients underwent the same aggressive chemotherapy and radiation therapy; 57 patients received IVH and 62 served as controls. Median caloric intake prior to antineoplastic therapy was less than 1.2 times basal energy expenditure, below the maximum necessary to maintain weight. While receiving IVH, patients had increased ca- loric and protein intake. Once the IVH was stop- ped, oral intake was transiently depressed and

thereafter similar to control patients. Baseline nutritional parameters, age, sex, and immediate toxicity from chemotherapy did not predict sub-

sequent caloric insufficiency. Direct estimation of dietary intake is likely the most valuable measure in selecting patients who will need ad-

junctive nutritional support.

Survival of Cancer Patients by Economic Status in a Free Care Setting. Keirn, W., Matter, G. City of Hope National Me- dical Center, St. Francis Medical Center, Lyn- wood, CA 90262, U.S.A. Cancer 55: 1552-1555, 1985.

Patients with lung, breast, and colorectal cancer were classified as to their economic sta-

tus for comparison of survival. Patients at the