- Email: [email protected]
897 Five-year survival in patients with stage I non-small-cell lung cancer
Biology eosinophils from BAL fluid relate to tumor size. It indicates that the cytological analysis of BAL specimens might be of importance in prognosis of spread of lung malignancy.
I
897
localization. A single radiologist evaluated all PET scans and assigned a mediastinal reading and a standardized uptake value (SUV). Mediastinoscopy identified mediastinal lymph node metastases in 8 of 22 patients (36%). PET scan was 75% sensitive and 78% specific in evaluating mediastinal lymph nodes for metastases, using an SUV cut off of 2.5. There were 3 false positives and 2 false negatives. No distant metastatic sites were detected. In this pilot study PET did not demonstrate a significant improvement over CT scan in evaluating the mediastinum for lymph node metastases in NSCLC. If therapeutic decisions would have been made on PET readings alone, the 5 patients with false negative or false positive readings would have been assigned an incorrect stage. The role of PET scanning in staging NSCLC remains unclear and will require further studies.
Five-year survival in patients with stage I non-small-cell lung cancer
J. Stanic, 2. Eri, M. Antonic, Dj. Povazan, B. Perin, N. Secen, M. Ilic, A. Gavric. University of Novi Sad, School of Medicine, lnsfitute of Lung Diseases, Sremska Kamenica, Yugoslavia In the period January 1992-October 1996 there were 63 patients who were diagnosed and treated for stage I non-small-cell lung cancer (NSCLC) at the Institute of Lung Diseases in Sremska Kamenica (Yugoslavia). In the majority of patients, the lung cancer was discovered due to symptoms (58/63). The smoking habit was registered in 95% of the affected patients. Regarding the histologic type of NSCLC, adenocarcinoma and epidermoid lung cancer were almost evenly distributed. Operative treatment was performed in 84% of the patients (53/63). Lobectomy was the most frequent surgery applied (71%). Ten patients received irradiation, chemotherapy or symptomatic therapy. Nine patients of the examined series had the tumor progression into stage IV in spite of the applied treatment. After a radical surgery 7 patients developed metastases in 4-25 months following the surgery. In the period of 4-31 months after the diagnosis had been established, 18/63 patients died. Cumulative survival was 0.71 in the examined series.
I
898
Endobronchial neoplasms
900
El
899
The role of positron emission tomography (PET) scan in staging non-small cell lung cancer
J.D. Luketich, CC. Meltzer, K. Ursa. L.O. Kapucu, P.F. Ferson, R.J. Keenan. Univ. of Pitt., Pittsburgh,
J. Jett, D. Townsend, PA, USA
Mediastinoscopy currently plays a pivotal role in staging of lung cancer but requires a general anesthetic and surgical procedure. PET is a new non-invasive imaging technology that has been reported to be accurate in staging the mediastinum in lung cancer patients. The objective of this study was to compare PET to mediastinoscopy in staging patients with potentially resectable lung cancer. Twenty two patients with non-small cell lung cancer were entered into the study. All underwent total body PET using [18F]-fluorodeoxyglucose followed by mediastinoscopy. CT alignment with PET allowed anatomic
lnstifufe
at the of Lung
The study includes the analyses of 160 patients with pathohistologically verified primary lung Adenocarcinoma registered in the Cancer Registry of the Institute of Lung Diseases and TB, Belgrade. In the studied group age, sex, smoking habbits, clinical-roentgenological characteristics were analysed at the moment of diagnosis establishment. Out of the total of 160 pts the average age was 50, 85 yrs, with 2.3 times higher incidence of males. The age range was 30-80 yrs. As to the smoking habbit smokers with longer duration of smoking significaly dominated. In roentgenological aspect, infiltrative shadows were predominant. Tumor localized peripheraly was found in 85 pts (52.9%) while centraly was verified in 75 pts (46.6%). The diagnosis was established by bronchoscopy in 63 pts (39.3%). percutaneus needle lung biopsy in 53 (33.1%), percutaneus needle lgl biopsy in 19 pts (11.8%), percutaneus biopsy of subcutaneus meta in 2 pts (1.25%) and by thoracotomy in 23 pts (14.3%). In the analysed group, there was noticed a significant percent of extrathoracic metastases (31.57%), above all in the bones. According to our data the matter of concern is that at the moment of diagnosis lung Adenocarcinoma was significaly advanced.
E. Bukurov-Sudjie, D. Mandaric, J. Zivkovic, T. Jasnovski-Lutovac. Department of Bronchology and invasive Diagnostics, lnsfitute for Lung Diseases and Tuberculosis, University Clinical Cenfre, Be/grade, Yugoslavia
I
Extent of primary lung adenocarcinoma moment of diagnosis
A. Zdravkovid, D. Jovanovic, G. MrEiC-Martinovid. Diseases and TB, CCS, Belgrade, Yugoslavia
metastasis of extrathoracic
Lungs are the commonest sites of secondary deposits of various of primary tumors (breasts, stomach, uterus, colon, larynx, testis, kidney, bones etc.). The accepted opinion is that the lung metastases do not have prominent endobronchial findings. We examined endoscopic appearance of lung metastases in the series of patients in the period 1993-1996 during which 11,373 bronchoscopies were completed, nearly 4 thousand per year. Indications which referred to malignant diseases accounted for nearly 50% of bronchoscopies. Endoscopic examination in patients with lung metastases of established primary tumor were completed in 84 patients (0.76%). Most of the cases, namely 66 of 84 (78.8%) were pathohystologically verified and 64 had direct or indirect endobronchial signs of malignancy. Cancer of larynx, was the most common malignancy that gave pulmonary metastasis, and was hystologically proven in 23 patients next was carcinoma of mammary glands (15 patients). Metastatic deposits in lungs were found in cancer of uterus (ll), stomach (5) testis (2), skin (4) urinary bladder (5) colon (3), kidney (3), and nose (2). Adenocarcinoma was present in 15, and squamous cell in 28 patients. Bronchoscope is inevitable diagnostic tool for verification of lung metastasis, as more than two thirds have endoscopic signs for malignancy and possibility of histological verification is high (78.8%) approaching that in lung cancer.
229
I
901
Single disseminated tumor cells in bone marrow and PBSC in patients with small cell lung cancer
U. Seifart. S. Henrich, G. Jaques, K. Havemann. Philipps-Universiftit
C. Loechelt, A. Wachtel, Marburg, Germany
M. Wolf,
Objective: It is well known that SCLC has a high potential to metastasize to the bone marrow and that such involvement has a prognostic significance. With the introduction of monoclonal antibodies (MoAb) in immunohistochemistry, the detection of single, disseminated tumor cells in bone marrow (BM) became possible. Furthermore, it has been demonstrated by several investigators that the presence of those micrometastases” in BM correlates with the rate of tumor relapse and survival in different tumors. However, the clinical relevance of disseminated tumor cells in BM in SCLC is still unclear and needs further investigations. Material and Methods: 39 bone marrow aspirates from 31 patients (pts) were obtained during initial tumor staging. The presence of disseminated tumor cells was assayed using three monoclonal antibodies (epithelial specific antigen (VU-l D9), human epithelial antigen (HEA 125) and a pancytokeratin (KL-I)), in combination with the alkaline-anti-alkaline-phosphatase (APAAP) immunostaining technique. In addition, we performed this technique on four PBSC harvest products of two pts with limited disease (LD) or extensive disease I (ED I) (Marburg Classification) harvested after two courses chemotherapy. BM or PBSC were positive, if one of the three antibodies show a positive reaction. Results: According to the initial tumor staging, 87% of the pts had LD or ED I, 6.5% ED II and 6.5 had VLD (very limited disease). VLD pts showed in 50% (2/4) and LD or ED I pts in 29% (8/29) disseminated tumor cells in BM. No tumor cells were detectable in any of the according leukapheresis products from pts with LD or ED I. Conclusion: Immunological staining methods are capable of revealing tumor cells in the BM of SCLC pts. It seems remarkable that patients with VLD and LD or ED I already show tumor cells in the bone marrow in such high frequencies. Our results confirm the utility of immunodetection in the diagnosis of SCLC, even in localised stage by using a panel of MoAbs with
I
897
localization. A single radiologist evaluated all PET scans and assigned a mediastinal reading and a standardized uptake value (SUV). Mediastinoscopy identified mediastinal lymph node metastases in 8 of 22 patients (36%). PET scan was 75% sensitive and 78% specific in evaluating mediastinal lymph nodes for metastases, using an SUV cut off of 2.5. There were 3 false positives and 2 false negatives. No distant metastatic sites were detected. In this pilot study PET did not demonstrate a significant improvement over CT scan in evaluating the mediastinum for lymph node metastases in NSCLC. If therapeutic decisions would have been made on PET readings alone, the 5 patients with false negative or false positive readings would have been assigned an incorrect stage. The role of PET scanning in staging NSCLC remains unclear and will require further studies.
Five-year survival in patients with stage I non-small-cell lung cancer
J. Stanic, 2. Eri, M. Antonic, Dj. Povazan, B. Perin, N. Secen, M. Ilic, A. Gavric. University of Novi Sad, School of Medicine, lnsfitute of Lung Diseases, Sremska Kamenica, Yugoslavia In the period January 1992-October 1996 there were 63 patients who were diagnosed and treated for stage I non-small-cell lung cancer (NSCLC) at the Institute of Lung Diseases in Sremska Kamenica (Yugoslavia). In the majority of patients, the lung cancer was discovered due to symptoms (58/63). The smoking habit was registered in 95% of the affected patients. Regarding the histologic type of NSCLC, adenocarcinoma and epidermoid lung cancer were almost evenly distributed. Operative treatment was performed in 84% of the patients (53/63). Lobectomy was the most frequent surgery applied (71%). Ten patients received irradiation, chemotherapy or symptomatic therapy. Nine patients of the examined series had the tumor progression into stage IV in spite of the applied treatment. After a radical surgery 7 patients developed metastases in 4-25 months following the surgery. In the period of 4-31 months after the diagnosis had been established, 18/63 patients died. Cumulative survival was 0.71 in the examined series.
I
898
Endobronchial neoplasms
900
El
899
The role of positron emission tomography (PET) scan in staging non-small cell lung cancer
J.D. Luketich, CC. Meltzer, K. Ursa. L.O. Kapucu, P.F. Ferson, R.J. Keenan. Univ. of Pitt., Pittsburgh,
J. Jett, D. Townsend, PA, USA
Mediastinoscopy currently plays a pivotal role in staging of lung cancer but requires a general anesthetic and surgical procedure. PET is a new non-invasive imaging technology that has been reported to be accurate in staging the mediastinum in lung cancer patients. The objective of this study was to compare PET to mediastinoscopy in staging patients with potentially resectable lung cancer. Twenty two patients with non-small cell lung cancer were entered into the study. All underwent total body PET using [18F]-fluorodeoxyglucose followed by mediastinoscopy. CT alignment with PET allowed anatomic
lnstifufe
at the of Lung
The study includes the analyses of 160 patients with pathohistologically verified primary lung Adenocarcinoma registered in the Cancer Registry of the Institute of Lung Diseases and TB, Belgrade. In the studied group age, sex, smoking habbits, clinical-roentgenological characteristics were analysed at the moment of diagnosis establishment. Out of the total of 160 pts the average age was 50, 85 yrs, with 2.3 times higher incidence of males. The age range was 30-80 yrs. As to the smoking habbit smokers with longer duration of smoking significaly dominated. In roentgenological aspect, infiltrative shadows were predominant. Tumor localized peripheraly was found in 85 pts (52.9%) while centraly was verified in 75 pts (46.6%). The diagnosis was established by bronchoscopy in 63 pts (39.3%). percutaneus needle lung biopsy in 53 (33.1%), percutaneus needle lgl biopsy in 19 pts (11.8%), percutaneus biopsy of subcutaneus meta in 2 pts (1.25%) and by thoracotomy in 23 pts (14.3%). In the analysed group, there was noticed a significant percent of extrathoracic metastases (31.57%), above all in the bones. According to our data the matter of concern is that at the moment of diagnosis lung Adenocarcinoma was significaly advanced.
E. Bukurov-Sudjie, D. Mandaric, J. Zivkovic, T. Jasnovski-Lutovac. Department of Bronchology and invasive Diagnostics, lnsfitute for Lung Diseases and Tuberculosis, University Clinical Cenfre, Be/grade, Yugoslavia
I
Extent of primary lung adenocarcinoma moment of diagnosis
A. Zdravkovid, D. Jovanovic, G. MrEiC-Martinovid. Diseases and TB, CCS, Belgrade, Yugoslavia
metastasis of extrathoracic
Lungs are the commonest sites of secondary deposits of various of primary tumors (breasts, stomach, uterus, colon, larynx, testis, kidney, bones etc.). The accepted opinion is that the lung metastases do not have prominent endobronchial findings. We examined endoscopic appearance of lung metastases in the series of patients in the period 1993-1996 during which 11,373 bronchoscopies were completed, nearly 4 thousand per year. Indications which referred to malignant diseases accounted for nearly 50% of bronchoscopies. Endoscopic examination in patients with lung metastases of established primary tumor were completed in 84 patients (0.76%). Most of the cases, namely 66 of 84 (78.8%) were pathohystologically verified and 64 had direct or indirect endobronchial signs of malignancy. Cancer of larynx, was the most common malignancy that gave pulmonary metastasis, and was hystologically proven in 23 patients next was carcinoma of mammary glands (15 patients). Metastatic deposits in lungs were found in cancer of uterus (ll), stomach (5) testis (2), skin (4) urinary bladder (5) colon (3), kidney (3), and nose (2). Adenocarcinoma was present in 15, and squamous cell in 28 patients. Bronchoscope is inevitable diagnostic tool for verification of lung metastasis, as more than two thirds have endoscopic signs for malignancy and possibility of histological verification is high (78.8%) approaching that in lung cancer.
229
I
901
Single disseminated tumor cells in bone marrow and PBSC in patients with small cell lung cancer
U. Seifart. S. Henrich, G. Jaques, K. Havemann. Philipps-Universiftit
C. Loechelt, A. Wachtel, Marburg, Germany
M. Wolf,
Objective: It is well known that SCLC has a high potential to metastasize to the bone marrow and that such involvement has a prognostic significance. With the introduction of monoclonal antibodies (MoAb) in immunohistochemistry, the detection of single, disseminated tumor cells in bone marrow (BM) became possible. Furthermore, it has been demonstrated by several investigators that the presence of those micrometastases” in BM correlates with the rate of tumor relapse and survival in different tumors. However, the clinical relevance of disseminated tumor cells in BM in SCLC is still unclear and needs further investigations. Material and Methods: 39 bone marrow aspirates from 31 patients (pts) were obtained during initial tumor staging. The presence of disseminated tumor cells was assayed using three monoclonal antibodies (epithelial specific antigen (VU-l D9), human epithelial antigen (HEA 125) and a pancytokeratin (KL-I)), in combination with the alkaline-anti-alkaline-phosphatase (APAAP) immunostaining technique. In addition, we performed this technique on four PBSC harvest products of two pts with limited disease (LD) or extensive disease I (ED I) (Marburg Classification) harvested after two courses chemotherapy. BM or PBSC were positive, if one of the three antibodies show a positive reaction. Results: According to the initial tumor staging, 87% of the pts had LD or ED I, 6.5% ED II and 6.5 had VLD (very limited disease). VLD pts showed in 50% (2/4) and LD or ED I pts in 29% (8/29) disseminated tumor cells in BM. No tumor cells were detectable in any of the according leukapheresis products from pts with LD or ED I. Conclusion: Immunological staining methods are capable of revealing tumor cells in the BM of SCLC pts. It seems remarkable that patients with VLD and LD or ED I already show tumor cells in the bone marrow in such high frequencies. Our results confirm the utility of immunodetection in the diagnosis of SCLC, even in localised stage by using a panel of MoAbs with