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Diagnostic procedures in the detection of CNS metastases from small cell lung cancer (SCLC)
90
prognostic factor is a recent history of smoking, while age and histologic subtype show no influence on the patients' survival. Further prognostic information, beyond the data already mentioned, is available after the first cycle of chemotherapy. Patients with no decrease of tumor size in the chest x-ray have a significantly worse prognosis than responding patients, with median survival of 7 months vs. 11.5 months (p < 0.91), if sequential therapy is used. The same holds true for a decrease versus no change in the tumor markers CEA and calcinonin. Supported by the BMFT. Pulmonary Adenocarcinomas in Patients Under 40 Years of Age. Hoshino, K. Department of Anatomy, Faculty of Medicine, Kyoto University, Kyoto 606 Japan. Takeshi Yoneyama, Department of Surgery, National Cancer Center Hospital, Tokyo 104, Japan. Lung cancer is relatively rare in the patients under 40 years of age and increases in its incidence as ages advanced. Eighteen of 26 cases of pulmonary adenocarcinoma in the patients under 40 years of age who have been operated in National Cancer Center Hospital in Tokyo were analyzed in comparison with those in older age groups. In addition to clinical analysis, the nuclear DNA ploidy level in tumor stem-cell line(s) was analyzed from the distribution of logarithmically transformed DNA values determined by computerized fluorocytometry from each tumor. The DNA modal pattern so determined has been found to be useful for predicting prognosis of the patient with lung cancer in older patients. In the present study, DNA modal patterns of adenocarcinoma were compared among three age groups: Group i: younger than 40 years of age; Group 2: older than 70 years of age; and Group 3 between these two groups. The types of DNA modal patterns and their relations to prognoses of patients were comparable to each other and include mild to severe types in Groups 2 and 3, whereas in Group 1 their DNA modal patterns and prognoses were of worst types except for one case of carcinoid and a few cases of small adenocarcinomas with TINOM0. In group i, DNA modal patterns often showed a combination of several peaks of higher ploidy stem cell lines, and tumors often consisted of several different types of histopathological features. The present study indicates that adenocarcinomas in patients younger than 40 years of age seem to be different cellbiologically as well as clinically from those in other age groups and deserve special attention in further studies.
Diagnostic Procedures in the Detection of CNS Metastas~s From SmalllCell Lung Cancer (SCLC). Ped~rsen , A.G4, Bach , F.,.Becker , K., Maran4 5 gos , P.~ Bach , F., K ~ l e r , O., Gyldensted , C., Bunn-, P.A., Hansen , H.H. i. Finsen Institute. 5. Rigshospitalet, 4. Gentofte Hospital, Copenhagen, Denmark. 2. V.A. Medical Center. 6. NCI. ~. Natl~nal Zns~itute of Mental H~alth, Bethesda, MD 20205, U.S.A. The diagnostic accuracies of CT-scan (CT), Radionuclide scan (RN), Neurologic examination (NEU), CSF Cytology (CY), protein (PRO), glucose (GLU), LDH, Bombesin (BLI), Creatin kinase BB (CKBB), and Neuronspecific Enolase (NSE) were evaluated in 93 neurologically suspect cases from a population of 216 SCLC patients starting treatment between Oct 81 and Dec 83. A blinded evaluation of the respective investigations was made in the following number of patients: CT:66, RN:66, NEU:72, CYT:78, PRO:78, GLU:77, LDH:59, BLI:55, CKBB:56, NSE:50. Based on the first four investigations, the clinical course and autopsy findings 48 patients were concluded to have brain metastases (brain met.), 18 of these also had meningeal carcinomatosis (MC) 3 only had MC, 28 had no CNS metastases (no mets), and 14 were equivocal. Percent of patients with abnormal findings in each investigation: mu CT m CY Pm "~U Lm BLt ~ e Bratn mats. 65 79 39 - 33 8 18 40 t6 50 M: 25 39 0 65 75 35 87 88 87 100 no ,'atS. 45 0 0 0 0 S 11 7 0 t4 Feroent pr~lict.t~ value to have: NEU CT I~l ~ PRO GLU ~ BLI O ~ ~E Any mete. 75 I00 1C0 100 90 89 % 100 91 57 60 0 I00" 66 70 73 68 81 66 No mets. 66 78 55 52 39 50 54 44 63 NO E 95 83 87 70 77 94 ~ 94 IO0 * by cL~fimtim.
In conclusion: Neu is insufficient as a screening method, and in particular in patients with MC. CT is most accurate at diagnosing brain mets.. Cytologic evaluation of CSF miss 35% of patients with MC. In these pts. Bombesin and Creatin kinase BB seem more accurate. In patients with only slight neurologic symptoms a neurologic evaluation, CT-scan and a lumbar puncture are of supplementary value. No complications to the latter procedure were observed. Clinical and Laboratory Rationale for Hydrazine Sulfate Evaluation in Patients with N0n-Small Cell Lung Cancer. Chlebowski, R.T., Heber, D., Block, J.B., Grosvenor, M., Bulcavage, L. UCLA School of Medicine Department of Medicine, Harbor-UCLA Medical Center, Torrance, California 90509. Hydrazine sulfate (HS) has been shown to improve the abnormal glucose metabolism frequently found in the lung cancer patient population (Cancer Research 44: 857). To assess the influence of HS on dietary parameters in nonsmall cell lung cancer, 24 hour dietary recalls and body weights were determined before and
prognostic factor is a recent history of smoking, while age and histologic subtype show no influence on the patients' survival. Further prognostic information, beyond the data already mentioned, is available after the first cycle of chemotherapy. Patients with no decrease of tumor size in the chest x-ray have a significantly worse prognosis than responding patients, with median survival of 7 months vs. 11.5 months (p < 0.91), if sequential therapy is used. The same holds true for a decrease versus no change in the tumor markers CEA and calcinonin. Supported by the BMFT. Pulmonary Adenocarcinomas in Patients Under 40 Years of Age. Hoshino, K. Department of Anatomy, Faculty of Medicine, Kyoto University, Kyoto 606 Japan. Takeshi Yoneyama, Department of Surgery, National Cancer Center Hospital, Tokyo 104, Japan. Lung cancer is relatively rare in the patients under 40 years of age and increases in its incidence as ages advanced. Eighteen of 26 cases of pulmonary adenocarcinoma in the patients under 40 years of age who have been operated in National Cancer Center Hospital in Tokyo were analyzed in comparison with those in older age groups. In addition to clinical analysis, the nuclear DNA ploidy level in tumor stem-cell line(s) was analyzed from the distribution of logarithmically transformed DNA values determined by computerized fluorocytometry from each tumor. The DNA modal pattern so determined has been found to be useful for predicting prognosis of the patient with lung cancer in older patients. In the present study, DNA modal patterns of adenocarcinoma were compared among three age groups: Group i: younger than 40 years of age; Group 2: older than 70 years of age; and Group 3 between these two groups. The types of DNA modal patterns and their relations to prognoses of patients were comparable to each other and include mild to severe types in Groups 2 and 3, whereas in Group 1 their DNA modal patterns and prognoses were of worst types except for one case of carcinoid and a few cases of small adenocarcinomas with TINOM0. In group i, DNA modal patterns often showed a combination of several peaks of higher ploidy stem cell lines, and tumors often consisted of several different types of histopathological features. The present study indicates that adenocarcinomas in patients younger than 40 years of age seem to be different cellbiologically as well as clinically from those in other age groups and deserve special attention in further studies.
Diagnostic Procedures in the Detection of CNS Metastas~s From SmalllCell Lung Cancer (SCLC). Ped~rsen , A.G4, Bach , F.,.Becker , K., Maran4 5 gos , P.~ Bach , F., K ~ l e r , O., Gyldensted , C., Bunn-, P.A., Hansen , H.H. i. Finsen Institute. 5. Rigshospitalet, 4. Gentofte Hospital, Copenhagen, Denmark. 2. V.A. Medical Center. 6. NCI. ~. Natl~nal Zns~itute of Mental H~alth, Bethesda, MD 20205, U.S.A. The diagnostic accuracies of CT-scan (CT), Radionuclide scan (RN), Neurologic examination (NEU), CSF Cytology (CY), protein (PRO), glucose (GLU), LDH, Bombesin (BLI), Creatin kinase BB (CKBB), and Neuronspecific Enolase (NSE) were evaluated in 93 neurologically suspect cases from a population of 216 SCLC patients starting treatment between Oct 81 and Dec 83. A blinded evaluation of the respective investigations was made in the following number of patients: CT:66, RN:66, NEU:72, CYT:78, PRO:78, GLU:77, LDH:59, BLI:55, CKBB:56, NSE:50. Based on the first four investigations, the clinical course and autopsy findings 48 patients were concluded to have brain metastases (brain met.), 18 of these also had meningeal carcinomatosis (MC) 3 only had MC, 28 had no CNS metastases (no mets), and 14 were equivocal. Percent of patients with abnormal findings in each investigation: mu CT m CY Pm "~U Lm BLt ~ e Bratn mats. 65 79 39 - 33 8 18 40 t6 50 M: 25 39 0 65 75 35 87 88 87 100 no ,'atS. 45 0 0 0 0 S 11 7 0 t4 Feroent pr~lict.t~ value to have: NEU CT I~l ~ PRO GLU ~ BLI O ~ ~E Any mete. 75 I00 1C0 100 90 89 % 100 91 57 60 0 I00" 66 70 73 68 81 66 No mets. 66 78 55 52 39 50 54 44 63 NO E 95 83 87 70 77 94 ~ 94 IO0 * by cL~fimtim.
In conclusion: Neu is insufficient as a screening method, and in particular in patients with MC. CT is most accurate at diagnosing brain mets.. Cytologic evaluation of CSF miss 35% of patients with MC. In these pts. Bombesin and Creatin kinase BB seem more accurate. In patients with only slight neurologic symptoms a neurologic evaluation, CT-scan and a lumbar puncture are of supplementary value. No complications to the latter procedure were observed. Clinical and Laboratory Rationale for Hydrazine Sulfate Evaluation in Patients with N0n-Small Cell Lung Cancer. Chlebowski, R.T., Heber, D., Block, J.B., Grosvenor, M., Bulcavage, L. UCLA School of Medicine Department of Medicine, Harbor-UCLA Medical Center, Torrance, California 90509. Hydrazine sulfate (HS) has been shown to improve the abnormal glucose metabolism frequently found in the lung cancer patient population (Cancer Research 44: 857). To assess the influence of HS on dietary parameters in nonsmall cell lung cancer, 24 hour dietary recalls and body weights were determined before and