Inoperable endobronchial obstructing lung carcinoma treated with combined endobronchial and external beam irradiation

397

patients with small cell lung cancer who are unsuimble for more toxic

who experienced

chemotherapy.

mainly

local disease recurrence.

consisted of bone marrow

topenia. with one toxic death occurring

Second-line chemotherapy in small cell lung cancer Anderscn M, Kristjansen PEG, Hansen HH. Deporrmenf of OncdogY. Rigshospitolet. Blegdamsvej 9, 2100 Copenhagen. Cancer Treat Rev 3990;17:427-36. The literature on second-line chemotherapy

limited

activity

in non-small-cell

The reports consisted

Giaccone G, Iberti V, Donadio

a total of 987 patients

Free

with relatively incomplete

1979-1989

few patients per study. The information

with regard to duration of response on first-line

apy, length

of any drug-free

second-line

chemotherapy.

interval

by Ihe combination

reinduction

and duration

The overall

30%, but only 5% were complete obtained

was frequently

second-line

The response rates

(P) and VP-16

therapy were 45% and 64% (medians),

rates were superior to regimens

response rate was

responses (CR).

of cisplatinum consisting

chemother-

of response on

respectively.

of supposedly

resistant agents. With P and E not given in combination,

University

Hospital,

dam. Cancer Chemother

Pharmacol

patients

with

C. Mostsubjectsexhibitedgoodprognostic O-1; minimal

weight

Twelves

CJ, Goldman

et al. Clinical London

I, Ash CM, Souhami RL, Harper PG. Spiro SG,

Oncology

Unit,

Guy’s

SE1 9RT. Cancer Chemother

A sequential combination 23 patients with small-cell disease).

All

(ECOG)

performance

patients

Hospital,

St. Thomas

and nausea and vomiting.

lungcancer(l6,

had an Eastern

leukopenia.

The response

ratewas 39.5%. with nocompleteresponsesbeingobserved:

the median

duration of pamal responses was 23 I days and median survival was 243 the response rate and durations of both response and

containing

regimens,

with those obtamed

myelotoxicity

regimen was evaluated m

Cooperative

status of 0 or 1, normal

limit Of normal. Treatment

comprised

Oncology

Group

serum sodium

and

ifosfamide

and either vindesine

given on weeks 0,2 and 4; cisplatin and etoposide given

on weeks6,9and

12:anddoxorubicinandmethotrexategivenon

weeks

I5 and 17. The overall response rate at the end of chemotherapy 91% andthecompleteresponserate

was43%.

well tolerated and the delivered

dose intensity

was

Treatmentwasgenerally

pronounced

m the

in this type of combination

are not warranted

Radiotherapy A new applicator, positionable to the center of tracheohronchial lumen for HDR-IR-1924terloading of tracheohronchial tumors Fritz P, Schraube P, Becker HD, Loffler 0. Radiologische

Universitatsklinik,

Im Neuenheimer

Feld400,

A new bronchial applicator

Heidelberg.

M, Pastyr

Strahlentherapie.

Int J Radiat Oncol Biol

for afterloading

irradiation

is introduced

to the center of the tracheobronchial

lumen.

The central position in the lumen leads to a clear improvement distribution.

of therapy.

D-6900

E, Wannenmacher

Schwerpunkt

Phys 1991:20:1061-6. which can be positioned

was 83% of that pro-

jected.Mediansurvivalwas54weeks,with4patients(17%)beingalive 2 years after the completion

using other cisplalin-

was rather

limited disease; 7,extensive

albumin levels and alkaline phosphatase values of < I .5 times the upper Or vincristine

consisted

Four patients

Street.

Pharmacol1991;28:139-41.

chemotherapy

lung carcinoma

disease). Toxicity

present study. Farther studies of teniposide

cell lung center

HV Aouter-

[email protected],

loss; locoregional

of myelosupprewon

of Oncology,

teniposide,andmitomycin

died of sepsis due to chemotherapy-induced

small-

has

1991;28:147-9.

withacombinationofcisplatin,

survival were comparable in good-prognosis

1 I1 7, NL-1081

A total of 45 patients with advanced non-small-cell weretreated

days. Although

chemotherapy

M, Testore F. Department

De Boelelaan

These

the response

haemor-

lung cancer.

mainly

rates were less than 20%.

Sequential

due to intracerebral

(E) or

non-cross-

of ACNU thrombocy-

Mitomycin C, teniposide, and cisplatin combination chemotherapy for advanced non-small-cell carcinoma of the lung

is reviewed.

for the period

toxicity

rhage. We concluded that at this dose and on this schedule, ACNU

of Phase II type studies and comprised

(SCLC) mainly

in small cell lung Cancer

The

suppression especially

The applicator

is built on the principle

of dose

of a coaxial tube.

Parts of the outer cover can be expanded to baskets and effect a distance of the radiation source from the bronchial

mwosa

or tumor surface, and

A phase II study of ifosfamide and a(2b)-interferon in advanced non-small-cell lung cancer

at the same time, expend a relief of extreme contact doses. No obstruc-

Lind MJ, Gomm S, Simmonds AP, Ashcroft L, Kamthan A, Gurney H,

caused. The positionable

et al. Department

reducingcomplicationscausedthrough

ofClinical

Westgate Road, Newcastle Pharmacol

Oncology,

Newcastle

General

Hospital,

upon Tyne, NE4 6BE. Cancer Chemother

tion of the respiratory

dose distributions

treated with a combination

of I.5 g/m* ifosfamide

every3 weeksforfourcottrses

with3

given on days l-5

millionIUa(2b)-interferon(Intron

Cotter GW, Division

two compIete

Haematological

responses (CRs) and seven partial and non-haematological

toxicities

were generally mild and did not necessitate discontinuation

of therapy.

Splinter T.A.W Hoed

Cancer

Herbert

of Medicine,

A, &tape

et al. Department

Cancer Chemother

Greene

Pharmacol

J, Giaccone

ofMedico Hilledijk

Oncology. 301.

3075

G, Scagliotti Dr. Daniel

G, den

EA Rotterdam.

1991;28:145-6. aphaseIIstudyofACNU.

drug was given i.v. at a dose of 100 mp/m’every observed haematological

Oncology,

Initially,

the

6 weeks, but due to

side effects in chemotherapy-pretreated

KE. Department

University

Blvd.

irregular

pa-

Mobile,

AL 36688.

patients

with

symptomatic

inoperable

irradiation two

endobronchial

iridium

external

to four temporary

radiotherapy.

Individual

endobronchlal External

iridium

Ir

192 implants

beam

for endobronchial

1125 to 3OtXl cGy. Total

doses ranged from 7080 cGy to lO,OCKl cGy. Seventy-seven patients had a complete local endobmnchial 13% had a partial response. Ninety improvement

in their performance

data from

this study

treatment percent of

response to treatment, and

percent of patients experienced

an

status using an Eastern Cooperative

39%atlyearand2l%at2years,withthemediansurvivalat The

ob-

implant doses ranged from 500 to 1500 cGy.

OncologyGroup(ECOG)scale.

a partial response in two patients, one showing brain metastaseS and one

Med J

beam radiotherapy

Ir 192 implants.

tients, the dose was lowered in this group to 75 mgfm’. We observed one lung metastases and

College

South

doses ranged from 57CO to 6600 cGy. Patients were given

complete response in a subject exhibiting

multiple

of Radiology,

of South Alabama

1991;84:562-5.

Total implant doses ranged from

A total of 62 patients with metastatic or locally advanced non-smallcelllungcancerwereenteredin

DE, Ellingwood

307 University

and temporary

Center,

highconractdosesand

structing lung cancer received combined

study 08872 Ardizzoni

be

and may be able to improve the results of endolumi-

ofRadiation

Thirty

study of ACNU in non-small-cell lung cancer: EORTC ASTb,

device will

seems to be suitable for

lnoperableendobronchial obstructing lung carcinoma treated with combined endobronchial and external beam irradiation

A) given S.C. three times a week for 12 weeks. Nineobjectiveresponses

Planting

applicator

lung cancer were

were seen, including

Phase II

bronchial

nal radiotherapy.

1991;28:142-4.

A total of 45 patients with advanced non-small-cell

responses (PRs).

system through the positioning

Survival from theendoftreatmentwas indicate

that this form

IOmonlhs. of treatment

of

398

inoperable endobmnchial obstructing lung cancer is feasible and leads to a high percentage of local tumor response, improvement in patient performance status, and possibly improved survival.

Combined

treatment

modalities

Palliative interdiiiplinary therapy of malignant melanoma Richtig E, Smolle J, Sayer HP, Kerl H. Universifatstiinikf Dermamlogie und Venerologie. Auenbruggerplatz 8, A-8036 Grar. Z Hautkr 1991;66:1c6-10. Malignant melanoma is one of the most aggressive. tumors. Because of its unpredictable course and metastatic spreading, it requires thorough and comprehensive follow-up examinations. In case of metastatic manifestation, each patient should receive his own special mode of palliative treatment worked out by interdisciplinary cooperation. On the basis of some case reports, we discuss the possibilities of interdisciplinary treatment of advanced malignant melanoma. Late toxicities and complications in three-year survivors of small cell lung cancer Oshila F, Tamura T. Kojima A, Yamada K, Fukuda M, Nakagawa K, et al. Deparment oflnrernal Medicine. National Cancer Center Hospiml, Tokyo. Eur J Cancer 1991;27:427-30. 123 patients with small cell lung cancer (SCLC) presented to the National Cancer Center HospitaJ (Tokyo) between 1978 and 1986.22 of 71 patients with limited stage disease (LD) and none of 52 patients with extensive disease (ED) survived for 3 years. 15 of the 22 three year survivors had significant late complications. All patienu; received chemotherapy and either thoracic irradiation, resection or both. No prophylactic cranial irradiation was given. 4 patients developed cardiac failure, 2 with adilatedcardiomyopathy, despite the fact that no patient received over 420 mg/m’ of doxorubicin. 12 patients of the 17 who received thoracic irradiation developed radiation pneumonitis and 3

required hospitalisation for severe haemoptysis (2) or cavity formation (1). 1 patient whorcceivednimustinedevelopeda fatal myelodysplastic syndrome and 2 additional patients developed second primary turnours in the oesophagus (1) and stomach (1). Mild peripheral neuropathy (WHOgrade l)waspersistentin3 patientsandasymptomaticazotemia (WHO grade 1) in 7. Despite advances in the treatment of SCLC there are very few asymptomatic long-term survivors.

Reviews Recent outcomes for patients with carcinoma of the lung Dillman RO, Berry C, Ryan KF’,Green MR, Seagren SL. Department ofMedicine. University of California San Diego School ofMedicine, La Jolla, CA. Cancer Invest 1991;9:9-17. We undertook a retrospective study of all lung cancer patients diagnosed between 1978 to 1982 and seen at the University of California San Diego affiliated hospitals. There were. 390 evaluable patients: the vast majority were men. Overall median survival was 8 months and was similar for all histologic types. Completely asymptomatic patients had a median survival of 20.1 months while symptomatic patients had a median survival of 5-8 months. Retrospective application of the new clinical staging system forlungcancerincrcasedthe survivaldistinction between clinical Stage I and Stage II disease. Median survival for small cell carcinoma of the lung was 10 months: 16.6 months for disease limited to the chest, and 5.8 months for metastatic disease. Median survival for Stage III nonsmall cell lung cancer patients was only S months. Only those asymptomatic patients with small lesions which were detected incidentally or by screening chest x-ray had any likelihood of long-term, disease-free survival with more than 60% alive two years after diagnosis. This study suggests that screening and early detection programs in existence during the period of observation were not effective in detecting early disease, and that no therapy of advanced diseases [Stages II through IV] was sufficiently efficacious to be considered standard.