A prospective study of pulmonary function in patients receiving mitomycin

Ab,~trt~c~t.~ i LUCIA CUIIW~

women, with a mean age of 62.5 years. In 484 cases a squamous cell carcinoma was diagnosed and in 416 patients an adenccarcinoma. An alveolar cell carcinoma was found in 54 and a polymorphocellular carcinoma in 68 patients respectively. 334 patients were found to be in stage 1. 233 in stage II and 438 patients were in stage llla. The 5-year survival rate was 57.2% in stage I and 32.5% in stage Il. The group of patients with N2 lymph node metastasis according stage llla showed a very poor 5-year-survival rate of 12.3%. A standard therapeutical procedure according to a multimodal concept is necessary to improve these patients’ long-term survival. Systemic lymphadenectomy is essential for adequate therapy. Tracheal sleeve pneumonectomy for bronchogenic carcinoma: Report of 55 cases: Updated in 1995 Dartevelle PG, Khahfe I, Chapelier A Marzelle J, Navajas M, Levasseur P el al. Dept. of7?loracicNoscuiarS~~e~, Heart-Lung Hopitol Marie Lannelongue, 133 Ave de la Resistance, Robinson. Ann Thorac Surg 1995;60: 1854-5.

Transphzniation, F-92350 Plessrs-

From I966 to 1986, a total of 55 patients underwent a tracheal sleeve pneumonectomy (53 right and 2 left) for bmnchogenic carcinoma. Preoperative radiotherapy was given in only 5 patients. The overall operative death rate was 10.9%. but no patient has died since 1975 (32 survivors). Seven patients had a postoperative empyema (12.7%): 4 of these patients had a bronchopleural tistula. Twenty-five patiens had postoperative radiotherapy. 5 of whom also had chemotherapy. The actuarial survival rate, after exclusion of the 6 operative deaths, was 38% at 3 years and 23% at 5 years. Survival was correlated to regional lymph node involvement. The actuarial survival rate among patients with tumoral spread to bronchial lymph nodes was 43% at 3 years. Among the 13 patients with only subcarinal involvement, the actuarial survivaI rate was 34% at 3 years. None of the 8 patients with paratrachcal lymph node involvement survived more than 30 months. These results indicate that tracheal sleeve pneumonectomy for bronchogenic carcinoma with extension to the carina is now fully justified considering the low operative mortality and the good results observed when lateral tracheal lymph nodes were not involved.

Chemotherapy A prospective study of pulmonary function in patients receiving mitomycin Castro M, Veeder MH, Mailliard JA, Tazelaar HD, Jett IR. Washington Universily, Box 8052, 660 S. EuclidAve, St. Louis, MO 63110. Chest 1996;109:939-44. Mitomycin is a chemotherapeutic agent that is used to treat a variety of solid tumors. Pulmonary toxic reactions from this agent can be life threatening. We prospectively investigated the utility of pulmonary function tests (PFTs) in monitoring for the occurrence of pulmonary toxicity due to mitomycin. PFTs were obtained at baseline and after three cycles of mitomycin therapy. We analyzed the clinical course, radiologic studies, and PFT results in 133 patients with metastatic squamous cell carcinoma of the lung r?ndomized to treatment with either mitomycin, vinblastine, and cisplatin or mitomycin alone as part of a prospective treatment protocol, of the North Central Cancer Treatment Group (NCCTG). The difhising capacity (DCO) was available in only 40 patients after the third cycle due to a high rate of progression and death from their underlying disease. After three cycles of chemotherapy, there was an average decline in the Den of 14% (p20%change after correcting for hemoglobin) was noted in 1 I of 40 patients (28%). This decline in the Den was not

15 (1996)

381-399

393

associated with a worse prognosis (p=O.77). Seven patients (5%) developed severe pulmonary toxic reactions attributed to chemotherapy, including noncardiogenic pulmonary edema, interstitial pneumonitis, and pleural effusions. Corticosteroid therapy resulted in temporary subjective improvement in three patients. The Den did not correlate with the development of pulmonary toxic reactions in these seven patients. In conclusion, (I) the incidence of clinically significant pulmonary toxic reactions from mitomycin is relatively low (5%), (2) mitomycin therapy resulted in a greater than 20% decline in the Den in approximately one- fourth of patients receiving three cycles of chemotherapy, and (3) the use of serial PFTs in patients receiving mitomycin was not shown to be predictive of pulmonary toxicity. Cisplatin and UPT modulated with leucovorin for the treatment of advanced non-small-cell lung cancer Feliu J, Gonzalez-Baron M. Espinosa E, De Castro J, Ordonez A, Zamora P. et al.Servicio de Oncologia Medico. Hospital La Paz. Paseo de lo Castellana, 261. Madrid 28046. Am J Clin Oncol Cancer Clin Trials 1996;19:121-4 We performed a phase II study to assess the efftcacy and toxicity of the cisplatin-UFT-leucovorin (LV) combination in patients with advanced non-small~ell lung cancer (NSCLC). Rventy-five patients with measurable disease who had not received prior chemotherapy were entered into the trial. The therapeutic regimen consisted of cisplatin 90 mg/mZ and iv. LV 500 mg/m20n day I, followed by oral IJFI’ 390 mg/ mYday (in two doses) on days 1 through 14. Patients also received oral LV I5 mg/12 h on days 2 through 14. Seventeen patients required reduced doses ofUFI’ (200 mg/m’) due to toxicity. Courses were repeated every 28 days for a minimum of three per patient Three of 25 patients (12%) achieved a partial response (95% Cl: 2.6 to 32.2%) two with 390 mglm’lday and one with 200 mg/m*/day of LIFT. The main side effects were hematological and gastrointestina1. In the courses including 390 mg/mZ/day of UFf, grade 3-4 toxicity was leucopenia in 18% of the courses, nausea/vomiting in 27%, and diarrhea and epigastralgia in 13% each. Grade 3-4 toxicities for 200 mg/m’/day of UFT were leucopenia 2%. nausea/vomiting 9% and diarrhea 7%. In conclusion, this regimen cannot be recommended for the treatment of advanced NSCLC due to its low response rate and high toxicity. Phase II trial of mitoxantrone small-cell lung cancer Feun LG. Savaraj N, Solomon

and cisplatin J, Liebmann

Comprehensive Cancer Ctr, University ofMiami, Avenue, Miami, FL 33136. Am J Clin Oncol

in advanced

non-

A, Hurley

J. Sylvester 147s Northwest 12th

Cancer Clin Trials 1996;19:190-2. Because in vitro data suggest that mitoxantrone may be synergistic with cisplatin, a Phase II trial of mitoxantrone and cisplatin was conducted in patients with advanced or metastatic non-small-cell lung cancer (NSLC). Twenty-four patients were evahtable for response. Toxicity was tolerable. Partial responses occurred in three patients (13%). This response rate is similar to that reported for cisplatin alone in NSLC. Mitoxantrone did not improve the response rate when combined with cisplatin for patients with advanced NSLC. Optimal schedule for administering lating factor in chemotherapy-induced cell lung cancer Soda H, Oka M, Fukuda M, Kinoshita

granulocyte neutropenia A, Sakamoto

colony-stimuin non-smallA, An&i

J et al.

Second Department Internal Medicine, Nagasaki University School Medicine, 7-1 Sakamoto I-Chome, Nagaski 852. Cancer Chemother

Pharmacol

1996;38:9-12.