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286 Small cell lung cancer: Surgery, adjuvant and neoadjuvant chemotherapy
p = 0.02). Five-year survival rates based on T-status in adenocarcinoma were 83.7% in Tl, 35.9% in T2 (p < 0.005). Considering those data, we concluded that more detailed evaluation of mediastinal nodes and useful adjuvant therapy would be necessary for patients with T2 adenocarcinoma.
286 L-l
Small cell lung cancer: Surgery, adjuvant and neoadjuvant chemotherapy
V. Zharkov, Yu Demidchik, P. Moiseev, Thoracic Oncology Cancer Research
V. Kurchin, N. Shishko. Institute, Minsk, Belarus
Dept. for
The total number of enrolled SCLC patients was 132. Of these 95 (71.7%) were operated on. 80 of them received adjuvant chemotherapy: 49 alternating and 31 -sequential. 15 refused from chemotherapy. 37 patients with primary unresectable disease received neoadjuvant chemotherapy. Alternating schedule of therapy included combination A: Adriamycin 50 mg/m2/day 1 + lfosfamide 2 g/mz/day l-4 (+Mesna) + Vincristine 2 mg/day 1 and combination 8: Cisplatin 90 mg/mz/day 1 + VP-1 6 150 mg/m*/day l-3. Sequential schedule included combination C: Cisplatin 80 mg/m*/day 5 + VP-16 200 mg/m2/day l-3. In each case the interval between courses was from 3 to 4 weeks. In general no a single case of serious complications was observed. For the patients with adjuvant alternating chemotherapy 2-year overall survival was 54.7% + 6.2, with sequential chemotherapy - 59.5% f 21.5. The patients (37) enrolled into the neoadjuvant therapy group had advanced SCLC including cN2-3 bulky disease or/and tumor spread to extrapulmonary structures. Of the 37 patients enrolled 29 (78.3%) were complete responders and were recognized as potentially operable and requiring thoracotomy, but IO refused from further operation. The important fact was that Karnofsky index in them increased up to 90-100% while before chemotherapy no patient had more than 80%. Complete resections were performed in 13. incomplete in 1 and exploration in 1. 2-year overall survival was 30.7% & 12.8.
287
El
Interleukin-2 (IL-S)/interferon-cY (IF) after initial chemotherapy - Beneficial effects in extensive small cell luna carcinoma (SCLC)? . ,
R. Henriksson, B. Bergman, P. Bergstrom, E. Karlsson, J. Nystrom, L. Hetta, L. Bjermer. Depts of Oncology Lungmed, UmeB Univ, Univ Gofhenburg, Sweden, Trondheim, Norway Although SCLC initially is highly responsive to treatment most patients relapse in few months. New approaches are needed, e.g. biotherapy in addition to chemo(CT)and radio(RT)-therapy. Aim: To determine if a prolongation of the survival time could be obtained after initial CT/RT by a schedule including both IL-2/IF compared to continuous CT. Methods: The study was an open randomized study including 46 patients (age 35-72). Stratification was done according to the disease status and the presence of remaining tumour after initial CT, and RT (40 Gy) with regard to LD. CT included 4 courses of conventional SOVA. Within 4 weeks later patients received either subcutaneous IL-2 (Proleukin) and IF (Roceron) for 2 cycles of 6 weeks each (see Atzpodien and coworkers). The other group received 2 further courses of CT. Results: After induction CT 14 CR and 25 PR were seen. The results are summarized: Survival months (mean, range)
CT
Total 10 (5-37) 14 (7-37+) LD (limited) ED (extensive) 9 (5-11) No of patients survived >lO mo from randomization Total 9122 ED O/S
IL-2AF 13 (5-53) 15 (5-53+) 12 (6-27) 12/23 7113
There was a significant correlation between survival time and the dose delivered of IL-2/IF. A dose reduction was necessary in almost all patients due to the known toxicity of this treatment, especially evident in patients with LD. The side effects will be more property presented. Conclusion: This small controlled trial suggested that patients with at least ED seemed to benefit from the use of consolidation treatment with IL-2/IF. The toxicity is a substantial problem. Even though the study
included a limited number of patients, we would like to propose that the use of biotherapy in the management of SCLC deserves further evaluation.
0288 Marco
The endoscopic therapy with laser and stents in the tracheal neoplastic stenosis Patelli. Pneumologia,
Ospedale
Maggiore,
Bologna,
Ha/y
Endoscopic therapy is a rapid and effective method of treatment for the tracheal obstructions. Since 1990 we performed Endoscopic Therapy in general anesthesia by using the rigid bronchoscope and Nd-YAG-Laser and inserted 97 silicone Stents in 139 patients affected by tracheal obstruction for neoplastic disease. The endoscopic findings were polipoid tumors or infiltration and external compression of the Trachea. The patients were symptomatic for different level of respiratory Failure because of the airways obstruction. In 22 patients we performed more of 2 endoscopic treatments (the top was 6 treatments in 4 years in one case of metastatic thyroid tumor). 123 patients were affected by Carcinoma, 10 by metastatic tumor: 2 patients were affected by Adenoidcystic Carcinoma, 1 by carcinoid tumor, 1 by low grade Adenocarcinoma (surgically treated after Laser removal), 1 by mioepitelial tumor and 1 by Hamartoma. We inserted 1 stent in 75 cases, 2 stents in 8 and 3 stents in 2 patients. 72 stents were inserted in the Trachea, 22 in the left main bronchus and 3 in the right main bronchus. In 10 cases we had to replace the stent after Displacement. 2 patients died 5 and 24 hours after the treatment. The results were the Resolution or the Improvement of the Symptom in all the cases and the Improvement of the Quality of Life. The Survivals vary from months to years, depending on the possibility to performing the Radiotherapy after the ricanalizing therapy.
289 El
Photodynamic
therapy in early stage lung cancer
Marco Patelli, Fabio Monari. Pneumologia, Radioterapia, Ospedale Be//aria, Bologna,
Ospedale ltaly
Maggiore,
Bologna;
Photodynamic therapy (PDT) is proved to be an effective form of Laser therapy for the endoscopic treatment of precancerous lesions and early stage central type lung cancer; PDT has been employed in the therapy of advanced carcinoma associated with Nd-Yag-Laser and Radiotherapy. We oerformed PDT in 21 cases of earlv staae sauamous luna cancer of the trachea or main bronchi in 18 not surgical because of endobro&hial size or other disease patients. 48 hours after intravenously Hematoporphyrin at the dose of 5 mg/Kg we performed PDT by using the red light (630 nm) of an Aroon Dye Laser in 16 treatments and a Gold Vapour Laser in the last five. 3 patients were treated twice: the first because of 2 early Cancer, an other one with extensive superficial cancer of the intermedius and right lower bronchus and the third after an unsuccessful PDT. The results of the therapy were necrosis and microvascular damage in all the cases. In our experience of early stage cancers we obtained curative effects of PDT with complete response (CR) in 12/21 cases and partial response (PR) in the other 9 cases. We did not observe no response. In early stage cases it is possible to obtain complete tumor remission by using PDT. The method is well tolerated.
12901 Thymic carcinoma: Outcome of a retrospective series of 56 patients J.J. Bretel, R. Arriagada, T. Le Chevalier, P. Baldeyrou, L. Belk, D. Grunenwald, C. Le Pechoux, P. Ruffie, K. De Jaeger, lnstifuf Gustave-Roussy, Wejuif 94805, France From March 1982 to October 1994, 56 patients with thymic carcrnoma (or thymoma) were treated at the lnstitut Gustave-Roussy. The “GETT” classification was used for the analysis. There were 5 Stage la, 5 Stage lb, 5 Stage Ila, 8 Stage Ilb, 3 Stage Illa, 17 Stage Illb, 17 Stage IVa, and 6 Stage IVb patients. Median age was 51 years (27-75). Thirteen patients (23%) had an associated auto-immune disease and six of them had myasthenia gravis (11%). A complete surgical resection was performed in 26 patients (46%). Surgical resection was incomplete in 15 patients (27%) and the remaining 15 patients had only a biopsy. Forty-six patients had thoracic radiotherapy (TRT) (82%) at the dose of 40 Gy with a boost of 5 to 25 Gy. Treatment combined surgery and TRT in 24 pts (43%) whereas 22 patients (39%)
286 L-l
Small cell lung cancer: Surgery, adjuvant and neoadjuvant chemotherapy
V. Zharkov, Yu Demidchik, P. Moiseev, Thoracic Oncology Cancer Research
V. Kurchin, N. Shishko. Institute, Minsk, Belarus
Dept. for
The total number of enrolled SCLC patients was 132. Of these 95 (71.7%) were operated on. 80 of them received adjuvant chemotherapy: 49 alternating and 31 -sequential. 15 refused from chemotherapy. 37 patients with primary unresectable disease received neoadjuvant chemotherapy. Alternating schedule of therapy included combination A: Adriamycin 50 mg/m2/day 1 + lfosfamide 2 g/mz/day l-4 (+Mesna) + Vincristine 2 mg/day 1 and combination 8: Cisplatin 90 mg/mz/day 1 + VP-1 6 150 mg/m*/day l-3. Sequential schedule included combination C: Cisplatin 80 mg/m*/day 5 + VP-16 200 mg/m2/day l-3. In each case the interval between courses was from 3 to 4 weeks. In general no a single case of serious complications was observed. For the patients with adjuvant alternating chemotherapy 2-year overall survival was 54.7% + 6.2, with sequential chemotherapy - 59.5% f 21.5. The patients (37) enrolled into the neoadjuvant therapy group had advanced SCLC including cN2-3 bulky disease or/and tumor spread to extrapulmonary structures. Of the 37 patients enrolled 29 (78.3%) were complete responders and were recognized as potentially operable and requiring thoracotomy, but IO refused from further operation. The important fact was that Karnofsky index in them increased up to 90-100% while before chemotherapy no patient had more than 80%. Complete resections were performed in 13. incomplete in 1 and exploration in 1. 2-year overall survival was 30.7% & 12.8.
287
El
Interleukin-2 (IL-S)/interferon-cY (IF) after initial chemotherapy - Beneficial effects in extensive small cell luna carcinoma (SCLC)? . ,
R. Henriksson, B. Bergman, P. Bergstrom, E. Karlsson, J. Nystrom, L. Hetta, L. Bjermer. Depts of Oncology Lungmed, UmeB Univ, Univ Gofhenburg, Sweden, Trondheim, Norway Although SCLC initially is highly responsive to treatment most patients relapse in few months. New approaches are needed, e.g. biotherapy in addition to chemo(CT)and radio(RT)-therapy. Aim: To determine if a prolongation of the survival time could be obtained after initial CT/RT by a schedule including both IL-2/IF compared to continuous CT. Methods: The study was an open randomized study including 46 patients (age 35-72). Stratification was done according to the disease status and the presence of remaining tumour after initial CT, and RT (40 Gy) with regard to LD. CT included 4 courses of conventional SOVA. Within 4 weeks later patients received either subcutaneous IL-2 (Proleukin) and IF (Roceron) for 2 cycles of 6 weeks each (see Atzpodien and coworkers). The other group received 2 further courses of CT. Results: After induction CT 14 CR and 25 PR were seen. The results are summarized: Survival months (mean, range)
CT
Total 10 (5-37) 14 (7-37+) LD (limited) ED (extensive) 9 (5-11) No of patients survived >lO mo from randomization Total 9122 ED O/S
IL-2AF 13 (5-53) 15 (5-53+) 12 (6-27) 12/23 7113
There was a significant correlation between survival time and the dose delivered of IL-2/IF. A dose reduction was necessary in almost all patients due to the known toxicity of this treatment, especially evident in patients with LD. The side effects will be more property presented. Conclusion: This small controlled trial suggested that patients with at least ED seemed to benefit from the use of consolidation treatment with IL-2/IF. The toxicity is a substantial problem. Even though the study
included a limited number of patients, we would like to propose that the use of biotherapy in the management of SCLC deserves further evaluation.
0288 Marco
The endoscopic therapy with laser and stents in the tracheal neoplastic stenosis Patelli. Pneumologia,
Ospedale
Maggiore,
Bologna,
Ha/y
Endoscopic therapy is a rapid and effective method of treatment for the tracheal obstructions. Since 1990 we performed Endoscopic Therapy in general anesthesia by using the rigid bronchoscope and Nd-YAG-Laser and inserted 97 silicone Stents in 139 patients affected by tracheal obstruction for neoplastic disease. The endoscopic findings were polipoid tumors or infiltration and external compression of the Trachea. The patients were symptomatic for different level of respiratory Failure because of the airways obstruction. In 22 patients we performed more of 2 endoscopic treatments (the top was 6 treatments in 4 years in one case of metastatic thyroid tumor). 123 patients were affected by Carcinoma, 10 by metastatic tumor: 2 patients were affected by Adenoidcystic Carcinoma, 1 by carcinoid tumor, 1 by low grade Adenocarcinoma (surgically treated after Laser removal), 1 by mioepitelial tumor and 1 by Hamartoma. We inserted 1 stent in 75 cases, 2 stents in 8 and 3 stents in 2 patients. 72 stents were inserted in the Trachea, 22 in the left main bronchus and 3 in the right main bronchus. In 10 cases we had to replace the stent after Displacement. 2 patients died 5 and 24 hours after the treatment. The results were the Resolution or the Improvement of the Symptom in all the cases and the Improvement of the Quality of Life. The Survivals vary from months to years, depending on the possibility to performing the Radiotherapy after the ricanalizing therapy.
289 El
Photodynamic
therapy in early stage lung cancer
Marco Patelli, Fabio Monari. Pneumologia, Radioterapia, Ospedale Be//aria, Bologna,
Ospedale ltaly
Maggiore,
Bologna;
Photodynamic therapy (PDT) is proved to be an effective form of Laser therapy for the endoscopic treatment of precancerous lesions and early stage central type lung cancer; PDT has been employed in the therapy of advanced carcinoma associated with Nd-Yag-Laser and Radiotherapy. We oerformed PDT in 21 cases of earlv staae sauamous luna cancer of the trachea or main bronchi in 18 not surgical because of endobro&hial size or other disease patients. 48 hours after intravenously Hematoporphyrin at the dose of 5 mg/Kg we performed PDT by using the red light (630 nm) of an Aroon Dye Laser in 16 treatments and a Gold Vapour Laser in the last five. 3 patients were treated twice: the first because of 2 early Cancer, an other one with extensive superficial cancer of the intermedius and right lower bronchus and the third after an unsuccessful PDT. The results of the therapy were necrosis and microvascular damage in all the cases. In our experience of early stage cancers we obtained curative effects of PDT with complete response (CR) in 12/21 cases and partial response (PR) in the other 9 cases. We did not observe no response. In early stage cases it is possible to obtain complete tumor remission by using PDT. The method is well tolerated.
12901 Thymic carcinoma: Outcome of a retrospective series of 56 patients J.J. Bretel, R. Arriagada, T. Le Chevalier, P. Baldeyrou, L. Belk, D. Grunenwald, C. Le Pechoux, P. Ruffie, K. De Jaeger, lnstifuf Gustave-Roussy, Wejuif 94805, France From March 1982 to October 1994, 56 patients with thymic carcrnoma (or thymoma) were treated at the lnstitut Gustave-Roussy. The “GETT” classification was used for the analysis. There were 5 Stage la, 5 Stage lb, 5 Stage Ila, 8 Stage Ilb, 3 Stage Illa, 17 Stage Illb, 17 Stage IVa, and 6 Stage IVb patients. Median age was 51 years (27-75). Thirteen patients (23%) had an associated auto-immune disease and six of them had myasthenia gravis (11%). A complete surgical resection was performed in 26 patients (46%). Surgical resection was incomplete in 15 patients (27%) and the remaining 15 patients had only a biopsy. Forty-six patients had thoracic radiotherapy (TRT) (82%) at the dose of 40 Gy with a boost of 5 to 25 Gy. Treatment combined surgery and TRT in 24 pts (43%) whereas 22 patients (39%)