IMMUNE STATUS, CHEMOTHERAPY, AND LUNG CANCER

751 IMMUNE STATUS, CHEMOTHERAPY, AND LUNG CANCER

SIR,-In non-resectable squamous-cell carcinoma of the lung combination chemotherapy seems very disappointing. trials indicate that the association of chemoincrease the We have studied of and survival-time.’ percentage responses the variations in the immune status of 64 patients given combination chemotherapy with ’Adriamycin’, vincristine, chloroethyl cyclohexyl nitrosourea (C.C.N.U.) and 5-fluoroura-

However,

some

explain the therapy.

poor results of

Institut de Cancerologie (INSERM), Hôpital Paul-Brousse,

et

chemotherapy applied after

d’Immunogénétique

94800-Villejuif, France

therapy with systemic adjuvants of immunity can

cil (5-F.u.). We found a good correlation between the skin reactions of delayed hypersensitivity and the inhibitory migration activity of the serum of these series of patients. During the evolution

of the disease,

we

observed that the 2, 4-dinitrochlorobenzene

keyhole limpet haemocyanin reactivity disappeared first, then the inhibitory migration activity of the serum, and then the delayed cutaneous hypersensitivity to secondary antigens. At this time, the mean level of lymphocytes and monocytes was or

significantly lower than before the treatment. Such results have been found in patients with other types of tumour. 2-5 The sensitivity of the tumour to combination chemotherapy depended on the immune status of the patient at the time treatment began. The overall percentage of objective responses was 43% but 28% of patients with negative responses to skin tests responded only poorly to the treatment, whereas 63% of patients with positive skin tests responded. There was a significant increase in the mean survival-time of the group of responders. But there is a strong correlation between the mean survival-time and the skin reactivity to primary and secondary antigens and the presence in the serum of the factor inhibiting leucocyte migration (see figure). We conclude that chemotherapy is not indicated for the group of patients with deficient immune status, and this may

1. Hersh, E. M., Gutterman, J. V., Mavligit. G. M. Cancer Treatment, 1974, 1, 65. 2. Eilber, F. R., Nizze, J. A., Morton, D. L. Cancer, 1975, 35, 660. 3. Eilber, F. R., Morton, D. L. ibid, 1970, 25, 362. 4. Israel, L., Mugica, J., Chamiman, P. Biomedicine, 1973, 19, 68. 5. Krant, M. J., Manskoff, G., Brandrup, C. F., Madoff, M. A. Cancer, 1968, 21, 623.

Centre

radio-

Médico-Chirurgical de Bligny, 91640-Briissous-Forges, France

P. POUILLART L. SCHWARZENBERG P. HUGUENIN G. BOTTO

H. GAUTHIER

LOWER ŒSOPHAGEAL SPHINCTER RELAXATION IS NOT A MYTH

SIR,-It has been argued convincingly that the apparent relaxation of the lower oesophageal sphincter (L.o.s.) during swallowing may be merely a recording artefact caused by movements of the recording catheter and the oesophagus relative to one another.’ A drop in pressure caused by a transient movement of the catheter out of the high-pressure zone could be interpreted as relaxation of the sphincter. These problems are due to the use of a stationary catheter method for measuring sphincter pressure. A rapid pull-through technique2avoids such difficulties by ensuring that the recording orifice travels the whole length of the sphincter and therefore must pass through the zone of highest pressure. Using this technique I recorded L.o.s. pressures in 10 subjects before and after swallowing. In most instances following a swallow the pressure profile recorded as the tube was withdrawn showed a change from intragastric to intraoesophageal pressure with little or no intervening high-pressure zone. Occasionally apparently normal sphincter pressures were detected after a swallow. The frequent persistence of a high-pressure zone, albeit considerably reduced, seemed to be inversely related to the size of the peristaltic wave. When peristalsis was

vigorous the sphincter profile was missing or greatly attenuated. Weak peristaltic waves were associated with the persistence of a well-developed high-pressure zone and when peristalsis failed to develop the L.O.S. profile remained unaltered. This variable response of the sphincter to swallowing is consistent with the variable myographic response reported by other workers3 and supports the hypothesis that previous consistent manometric recordings of "sphincter relaxation" were indeed due to recording artefact.’ Nevertheless they are also consistent with the view of receptive relaxation of the sphincter during swallowing although the extent and constancy of the relaxation may not be quite as described classi-

cally.4 Department of Physiology,

University of Dundee, Dundee DD1 4HN.

J. S. DAVISON

VAGINAL DISCHARGE AND THE I.U.D.

SiR,—The complaint of a little vaginal discharge is common amongst women fitted with an intrauterine contraceptive device (I.U.D.) and in most cases this appears to be due to cervicitis. I have lately seen cases where the cause has been different. These women were all established l.U.D. users. All complained of a foul-smelling vaginal discharge and all had received only temporary relief from a variety of local and systemic treatments. On clinical examination all had evidence of a slight vaginitis with a foul-smelling discharge. In each the "tail" of the I.U.D. Sullivan, S. N. Lancet, 1974, ii, 809. Dodds, W. J., Hogan, W. J., Stef, J. J., Stewart, E. T., Ramin, S. Clin. Res. 1973, 21, 825. 3. Hellmans, J., Van Trappen, G., Valembois, P., Janssens, J. Vandenbroucke, J. Am. J. dig. Dis. 1968, 13, 320. 4. Code, C. F., Creamer, B. Schlegel, J. F., Olsen, A. M., Donoghue, F. E., Andersen, H. A. An Atlas of Esophageal Motility in Health and Disease. Springfield, Illinois, 1958. 1. 2.

Correlation of survival with skin reactivity (DHS) to recall antigens in patients with inoperable squamous-cell carcinoma of the lung.