- Email: [email protected]
Lung cancer
326
Abstracts/Lung
fnbalation therapy of interferon-gamma carcinomaofthe lung; a cast report
against
Cancer
brouchoalveolar
Yano T, Yokoyama H, Ueda T, Inouc T, Asoh H, Ichinose Y J Jpn Sot Cancer Thcr 1994;29:1778-81. A 46-y-r-old man, who had undergone a right middle-lower lobectomy due to bronchoalveolar carcinoma of the lung, suffered from multiple air-borne metastasis in the residual lungs. The patient was treated with local administration of interferon-gamma @‘N-gamma). The treatment consisted of transbronchoscopic instillation of IFN-gamma (1 x IO6 JRU/20 ml saline) on days 1,4,7 and 10, and inhalation ofaerosolized IFN-gamma (3 x IO6 JRUiday) on days 2.3, 5, 6. 8 and 9. Afler treatment, alveolar macrophsgcs exhibited a high level of cytotoxicity in vitro. The IFN-gamma therapy was repeated every three months. AtIer four cycles of the therapy over a year, tllmors remain stable and good quality of life has been maintained.
Sekctii emboliition ment of lungcaocer
af bmncbial
rrtery
with drug gelfoam in treat-
He De-Xin. Tangdu Hospital, Far& Milifory Medical University, Xi-an. Chin J Clin Or& 1994;21:746-8. Fifteen cases of lung cancer were treated with selective drug gelfoam cmbolization of bronchial artery. It was found that the mass disappeared cxxnpletcly in one patient and diminished in excess of 50% of buck in 5 patients and below 50% in 6 patients. It is concluded that this treatment is one of the effeetivc and safe measure in a multimodal approach treatment of lung cancer. The indication of this treatment was discussed.
Gene therapy for carciooembryooic cancer cells by cell type-specific tbymidioe kinase gene
265-329
in the OK-432 positive group. Over half of the patients had transient I- or 2day febrile reactions at?er intmpleural OK-432 injection. It was concluded that neither clinical observation nor immunological monitoring of peripheral blood could demonstrate a beneficial effect from intraplcural OK432 immunotherapy after complete reseelion of the tumor.
Stent-implantation
for stenotic malignant
immunotherapy with intrapleural Streptococcus io lung cancer patients after resection
pyogeocs
Lee Y-C, Luh S-P, Wu R-M, Lee C-J. Departmen of Surgery. Notional Taiwan Vniwrsi@ Hospiml, No 7 Chung-Shan, So& Road, Taipei 10016. Cancer Immunol Immunother 1994;39:269-74. A prospective randomized study to evaluate the effect of adjuvant intraplcural OK432 immunotherapy at?er resection of lung tumor was conducted in 93 patients with primary lung cancer. Among them, 46 patients had had intraplcural OK-432 injection, 47 had not. In the meantime, mial measurements of serum immunosuppressive acidic protein, of serum interleukin-2 receptor and of the subpopulation of the peripheral blood cells and lymphocytes were perfomwd in all these patients. Patient chameteristics in these two groups (sex, age, histological type, pathological stage. type of operation, and perfommnce status) were compatible. The results showed that adjuvant intrapleural OK432 injection a&x resection had no beneficial effect on a patient’s survival time. Patients who received intrapleural OK-432, had an increase in blood leukocytes, granulocytcs and monocytes and serum immunosuppressive acidic protein level. But the cell numbers of total T cells, suppressor/cytoxic cells, helper/inducer cells and natural killer cells of peripheral blood were decreased
trachcobmncbial
tumors
Keller H, Kreuzcr A, Heller K, Torzsok L. Neumann M. I. Interne Lungenableilung. Pulmologixhes Zenbum. Sonatoriumstrosse 2. A-11 40 Wien. AtC”tWe&-hnge#lkr 1994;20:53942. The implantation of stcnts in the central tracheobronchial tree for relief of obstruction due to malignant tumors is a palliative method for the recanalisation of narrowed airways. From Januaty 1990 till March 1993 we used this method in I4 patients (I 1 men, 3 women) and inserted 16 stents. The intubation was indicated beeauw of life-threatening narrowing of the trachea or main bronchi causing dyspnea, strider and/or poststenotic symptoms. 2 metallic stents and 14 silicone stats were inserted under general anesthesia using combined rigid and flexible bronchoscopy. There were no complications during intubation. Mean survival was 83,6 days (7 h-209 d). Follow-up showed mucus plugging (3 cases), migration (1 case). dislocation (1 case), reactive fibrous granulation tissue (2 cases), massive tracheal hemorrhage (I case - probably due to tumor progression) and in metallic stents grown of tumor through the wall-stents (2 cases). The implantation of stents is a palliative method to improve quality of life in these patients. The use of metallic stents is recommended in extratracheal/ bronchial compmsion, silicone stcnts were inserted successfully in obstructions involving the distal trachea, carina and main bronchi.
antigen-producing buman lung expression of herpes simplex virus
O&i T, Tani0 Y, Tachibana I, Hosoe S, Kumagai T, Kawesc I et al. Depor0nenr of Medicine III, Osaka University Medical School, 2-2, Yomadooka. Suita. Osaka 565. Cancer Rcs 1994;54:5258-61. A carcinoembryonic antigen (CEA)-producing human lung cancer cell line (A549), a nonproducing human lung cancer cell line (CADG-LC9), and a human uterine cervical cancer (HeLa) were transfected with the herpes simplex virus thymidinc kinase (HSV-TK) gene regulated by 445 nucleotides upstream from the translational start of CEA gene. Fifty % growth inhibitory concentration of ganciclovir (GCV) was 0.57 iM for HSV-TK-transfected A549; relative sensitivity to GCV was more than 1000 times higher compared to the 50% growth inhibitory wneentration of the parental cell line. Both CADO-LC9 and HeLa transfectcd with HSV-TK were still resistant to GCV. There was no difference in either morphology or doubling time behveen HSV-TK-transfccted and parental clones. Injections (i.p.) of GCV resulted in significant regression of HSV- TK-transfected A549 tumors in nude mice. These data show the possibility of gene therapy using the cell type-specific promoter of CEA gene against CEA- producing adenwarcinoma of the lung.
Adjuvaot (OK-432)
12 (1995)
Reviews Thestrategyfortberapyoflungcancer Konska C, Nakajima S, Kate H. Deparbnent of Surgery. Tokyo Medico1 College Hospital, Nishi-shinjuku 6-7-1, Shinjuku-ku, To& 160. J Jastro 1994;6:207-I 5. In therapy of lung cancer it is important to be decided what type of therapeutic strategy is most appropriate and what kind of results can be anticipated. Selection of type of therapy in primary lung cancer depends on the following factors: Histological type, Location and Stage. The differences of methodology, which is necessary in deciding therapeutic strategy, employed to diagnose and evaluate cases which are X-ray-negative and sputum cytology-positive (rea~tgcnologically occult lung cancer) and cases which reveal abnormal findings on chest X-ray are described. Especially in occult lung cancer cases, with the remarkable improvements that have ban made in the fiberoptic bronchoscope, bronchowopy has become relatively simple to perform and is extremely effective for detailed examination as far as 4th order bronchi for hmwr localization. Surgery treatment is the treatment of choice for lung cancer. Until 196Os, pncumonectomy was a common surgical method for lung cancer, but at&r that period lobe&my and systemic media&al lymph node dissection became standard. As for the survival rate according to pathological stage, out of a total of I ,2 I I resected casts, among stage I and II cases in which the surgical procedure was thought to be curative, the 5-year survival rate were 67.4% and 41.1%, respectively. The 5-year survival rates of stage IIIA and IIIB, on the other hand, were only 14.7% and 0% respectively. In order to improve the survival rate of lung cancer, more ctTorts must be made for early detection of early stage lung cancer cases, and the development of more effective adjuvant therapy is anticipated.
Lung cancer Travis WD, Travis LB, Devesa SS. Pulmono~~ediastinaIPa~o~ Dept., Armed Forces Institufe of Pathologv. Washington. DC 20306-6000. Cancer 1995;75:Suppl:I91-202. Background. Lung caneer is the most eomman cause of cancer death in the United States, and its incidence has been rising for at least 50 years. Shifts in histologic type and differences in sex and race distribution have accompanied the increased incidence of lung malignancies. Methods Population-based data regarding lung eaneer reported to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program for the 15-year period 19731987 were analyzed. Resulrs. Results indicate that from 1973-1977 to 19831987, the age-adjusted rates of lung cancer increased by 30%, with the gain markedly greater in women (70%) than in men (17%). The largest percentage
Abstracts/Lung increases in age-adjusted rates were observed for small cell carcinoma end adcnocsrcinoma (epproximetcly 60% each), with a more modest change for squamous cell carcinoma (+14%). For squamous cell carcinoma, the age-adjusted rates increased substantially for black (65%) and white (70%) woman and only slightly for black men (10%). whereas it decreased slightly in rcccnt years for white men. Conclusions. In recent years, .sdcnocarcinoma has replaced squamous cell carcinoma as the most frequent histologic subtype for all scxcs and races combined. Thcsc shills in histologic types by sex and race may be rclatcd to differences in exposure to tobacco products, dietary factors, environmental or occupational carcinogens, and host characteristics. Increased USCof transbronchial and needle biopsy may have also influenced thcsc trends to scmc cxtcnt. Over the study period, 5-year relative survival rate did not change appreciably for lung canccr. suggesting that therapeutic advances have had little cffcct.
Cancer 12 (1995) 265-329
327
‘Ikatmeat of small cell bmgcaacer Ucoka H, Ohnoshi T. Second Deporbnenf of Medicine, Okayama University Medical School, 2-S-I Shikafa-cho, Okayama 700. Jpn J Cancer Chcmother 1994;21:2571-7. This paper overviews the recent treatment results for small cell lung cancer. The last decade has brought only a small improvement, supposedly, mainly due to the development of drug resistance. However, current trials of non-crossr&tat chemotherapy, dowintensive wakly chemotherapy, l&e intensification with autologous bone marrow transplantation, and combined modality treabnent with thomcic irradiation have shown a substantial advance in the tmabncnt of smell cell lung cancer. Becent cbaageof
management
in advanced
Kodsma N, Kawahsre M, Furuse K. Department
Extrapulmoaary small cell carcinoma: A rioglekwtitotioo experience aodreviewdtheliterature Lo Re G, Canzonieri V, Vcronesi A. Dal Bo V, Barzan L, Zancanaro C et al. Division o/Mcdcol Oncology Cfz Regionale Rijoimenfo Oncolog., INRCCS, Ko Pedemonfana Occle, I-33081 Aviano. Ann Oncol 1994;5:909-13. Bw&grmmd. Small cell carcinoma (XC) is a distinct pathologic entity that may also occur in extrapulmonary sitea. In this report ~JICrctrospeetive results of multimodal therapy of primitive extrapulmonary (I.$ SCC, in a single institution series, are presented. Me&o& Twenty-four patients (pts) with ESCC were referred to the Centro di Riftimento Oncologico, Aviano, Italy, from 1986 to 1992. Clinics-therapeutic findings were cvalusted in 20 pts. Their ages ranged from 20 to 87, with 8 median of 60.5 years. Primaly tumor sites were urinary bladder (5 pts), prostate (4 pts), larynx (3 pts), kidney (2 pts), ovary, skin, ampharynx, trachea, uterine cervix, cthmoid, and stomach (1 pt each); lymph node mctastascs of unknown origin were observed in 3 pts. More than 50% of pts presented extensive disease. Resulfs. Histologically, I6 cases were pure ESCCs and 8 cases were combined. 4 of them with adamcarcinoma, 2 with transitional cell carcinoma, and 2 with squamous cell carcinoma. Immunohistochemical stud& pcrformcd in 7 cases, demonstmtcd the cpithclial nature of these tumors. The cisplatin-VP16 (PE) rcgimcn was used in 13 pts, and 9 of them (69%) obtained objective responses after chemotherapy (CT) alone, with 3 complete remissions (CR) and 6 partial rcmiwions (PR). Median CR and PR duration was 13+ and 24 months, rcspcctivcly. Radiotherapy was performed in 7113 pts after induction CT and before consolidation CT. The objective response rate was loO%, with 6 CR and 1 PR. No severe toxic side effects and no toxic deaths were reported. A patient trcatcd with surgery alone for a urinary bladder tumor showed continuous long-m survival, while 1 of 2 pts treated with radiotherapy alone obtained PR. Conclusions. The PE regimen has an activity similar to the one observed in pulmonary SCC.
Branchial sod thymic carchmid tumon: A rekw Dusmct M, McKncally MF. Division of Thonzcic Surges The Toronfo Hospifal, 200 Elizabefh Sfrvef, Tomnfo, Onf. h45G 2C4. Digestion 1994;55:Suppl3:706. Bronchial carcinoid tumors arc usually indolent, slow-growing hrmors with an excellent prognosis. However, even typical carcinoids can mctastazisc to regional lymph nodea or to distant sites. Atypical carcinoids tend to behave more invasivcly with ma-c frcqucnt nodal and distant metastwx. Despite this, longtcmr survival can be expected as many tumors grow end spread slowly. At the end of the spectrum are the highly aggressive small cell carcinomas which have a very poor prognosis despite aggressive chemotherapy. Clinically, car&mid tumors arc frcqucntly asymptomatic. Symptoms arc most frcqucntly due to obstruction (pneumonia, ‘asthma’, coughing) or bleeding. Carcinoid syndrome is seen infrcqucntly and usually signifies mctastatic discax Gushing’s syndrome is occasionally seen in association with these tumors. The treatment of carcinoid hlmors is surgical. Rex&ion should be complete and cncompsss the regional lymph node?..
ooo-small
cell hmgcaocer Nu&ional Sabi 591. Jpn J
of InfernalMedicine,
Kinhi Cenbal Hospifal, Chest Disease, 1180 Nagwow-cho. Cancer Chemother 1994;21:2564-2570. The value of chemotherapy in advanced non-small cell lung cancer (NSCLC) has ban shown in combination chemotherapy with cisplatin, which yields only marginal survival benefits. Chcmoradiothcrapy with cisplatin improves the survival of patients who have unrcscctablc, locally advanced NSCLC when compared with the treatment by radiation therapy alone. The 2- and 3-year survival rates arc nearly doubled on evcragc. Ncoadjuvant chemotherapy is more effective than surgery alone for the treatment of stage EtA NSCLC in the randomized phase lJJl trials. It is suggested that ncoadjuvant chcmothcrapy will be a standard therapy for stage fUA NSCLC which is marginally resectable. There are many studies about radiation methods such as hyperfractionatcd radiation therapy and CHART, irradiated dose, and timing of radiation. There is e need to develop new, more active anticancer agents, and to find more effective regimens.
Future directions in clinical research for hmgcaacer Bunn PA Jr. Box B18.8. 4200 E 9th. Denver, CO 80262. Chest 1994:106, Suppl:399S-407S. Even since the Surgeon General’s 1964 report, the mortality rate fmm lung cancer has continued to rise. Although there is evidence that this continued increase in mortality will slow or level in the next decade, lung cancer motility is a major health problem destined to remain with us for at least the next generation. There have been no established advances in the early d&&ion or prevention of lung cancer in the last 30 years and our therapies have increased the cure rate only from 5 to 13% in this 30-year interval. Biologic advances have outpaced clinical advances in recent times and many of the adv~ccs arc now ripe for clinical exploitation. There are currently more exciting clinical trials for all phases of lung cancer than at any time and it till be stimulating to wihxss the results of the clinical trials discussed herein. Hopefully, the results of these studies will lead to a decreusc in lung cancer mortality in the next cenhuy, much as it increased in the past century. Ev~atioadtbetberapeutkp~osisandlong-tena sarviwrsdsmaU cell lung cancer Nskayama H, Yokoyama A, Kinamcri K, Kurita Y. Deparbnenf o/Infernal Medicine, Niigafo Cancer Cenfer Hospiral, Niigafa. Lung Cancer (Japan) 1994;34:867-74. The thcrapcutic prognosis and long-term survival wcrc evaluated in 207 patients with small cell lung cancer who were treated after October, 1982. There were 121 patients with limited disease (LD) and 86 with extensive disease (ED). Rcscction was perfomxd in 19% of the casts and 44% were treated with LLcombination of chemotherapy and radiotherapy. Comparmg induction chemotherapy @CT, 2S cases) and adjuvant chemotherapy (I2 cases), ICT was superior in median survival time (MST, 36,29 months, respectively) and J-year survival (3YS, 57,45%, respectively). There was no difference in MST and 3YS (14, 18%, rcspcctively) bchvecn the concurrent (7 cases) and sequential method (22 cases) of radiotherapy. The combination chemotherapy of CDDP, ADM and VP-16 with G-CSF for patients with ED had B longer MST (22 months) and bcttcr 3YS (21%) than those without C-CSF. Of 24 long-term survivors (greater than 3 years), 21 patients had LD and 3 had ED. Thirteen patients underwent surgical rcscction. There were 6 CR and 4 PR among 10 SCLC patients who received chemotherapy and radiotherapy. Now 5 are alive and disease free for more than 5 years. One patient had a second cancer. ICT for surgical patients and dose intensive chemotherapy for patients with ED seemed to improve survival rate, but there was no statistically significant difference.
Abstracts/Lung
fnbalation therapy of interferon-gamma carcinomaofthe lung; a cast report
against
Cancer
brouchoalveolar
Yano T, Yokoyama H, Ueda T, Inouc T, Asoh H, Ichinose Y J Jpn Sot Cancer Thcr 1994;29:1778-81. A 46-y-r-old man, who had undergone a right middle-lower lobectomy due to bronchoalveolar carcinoma of the lung, suffered from multiple air-borne metastasis in the residual lungs. The patient was treated with local administration of interferon-gamma @‘N-gamma). The treatment consisted of transbronchoscopic instillation of IFN-gamma (1 x IO6 JRU/20 ml saline) on days 1,4,7 and 10, and inhalation ofaerosolized IFN-gamma (3 x IO6 JRUiday) on days 2.3, 5, 6. 8 and 9. Afler treatment, alveolar macrophsgcs exhibited a high level of cytotoxicity in vitro. The IFN-gamma therapy was repeated every three months. AtIer four cycles of the therapy over a year, tllmors remain stable and good quality of life has been maintained.
Sekctii emboliition ment of lungcaocer
af bmncbial
rrtery
with drug gelfoam in treat-
He De-Xin. Tangdu Hospital, Far& Milifory Medical University, Xi-an. Chin J Clin Or& 1994;21:746-8. Fifteen cases of lung cancer were treated with selective drug gelfoam cmbolization of bronchial artery. It was found that the mass disappeared cxxnpletcly in one patient and diminished in excess of 50% of buck in 5 patients and below 50% in 6 patients. It is concluded that this treatment is one of the effeetivc and safe measure in a multimodal approach treatment of lung cancer. The indication of this treatment was discussed.
Gene therapy for carciooembryooic cancer cells by cell type-specific tbymidioe kinase gene
265-329
in the OK-432 positive group. Over half of the patients had transient I- or 2day febrile reactions at?er intmpleural OK-432 injection. It was concluded that neither clinical observation nor immunological monitoring of peripheral blood could demonstrate a beneficial effect from intraplcural OK432 immunotherapy after complete reseelion of the tumor.
Stent-implantation
for stenotic malignant
immunotherapy with intrapleural Streptococcus io lung cancer patients after resection
pyogeocs
Lee Y-C, Luh S-P, Wu R-M, Lee C-J. Departmen of Surgery. Notional Taiwan Vniwrsi@ Hospiml, No 7 Chung-Shan, So& Road, Taipei 10016. Cancer Immunol Immunother 1994;39:269-74. A prospective randomized study to evaluate the effect of adjuvant intraplcural OK432 immunotherapy at?er resection of lung tumor was conducted in 93 patients with primary lung cancer. Among them, 46 patients had had intraplcural OK-432 injection, 47 had not. In the meantime, mial measurements of serum immunosuppressive acidic protein, of serum interleukin-2 receptor and of the subpopulation of the peripheral blood cells and lymphocytes were perfomwd in all these patients. Patient chameteristics in these two groups (sex, age, histological type, pathological stage. type of operation, and perfommnce status) were compatible. The results showed that adjuvant intrapleural OK432 injection a&x resection had no beneficial effect on a patient’s survival time. Patients who received intrapleural OK-432, had an increase in blood leukocytes, granulocytcs and monocytes and serum immunosuppressive acidic protein level. But the cell numbers of total T cells, suppressor/cytoxic cells, helper/inducer cells and natural killer cells of peripheral blood were decreased
trachcobmncbial
tumors
Keller H, Kreuzcr A, Heller K, Torzsok L. Neumann M. I. Interne Lungenableilung. Pulmologixhes Zenbum. Sonatoriumstrosse 2. A-11 40 Wien. AtC”tWe&-hnge#lkr 1994;20:53942. The implantation of stcnts in the central tracheobronchial tree for relief of obstruction due to malignant tumors is a palliative method for the recanalisation of narrowed airways. From Januaty 1990 till March 1993 we used this method in I4 patients (I 1 men, 3 women) and inserted 16 stents. The intubation was indicated beeauw of life-threatening narrowing of the trachea or main bronchi causing dyspnea, strider and/or poststenotic symptoms. 2 metallic stents and 14 silicone stats were inserted under general anesthesia using combined rigid and flexible bronchoscopy. There were no complications during intubation. Mean survival was 83,6 days (7 h-209 d). Follow-up showed mucus plugging (3 cases), migration (1 case). dislocation (1 case), reactive fibrous granulation tissue (2 cases), massive tracheal hemorrhage (I case - probably due to tumor progression) and in metallic stents grown of tumor through the wall-stents (2 cases). The implantation of stents is a palliative method to improve quality of life in these patients. The use of metallic stents is recommended in extratracheal/ bronchial compmsion, silicone stcnts were inserted successfully in obstructions involving the distal trachea, carina and main bronchi.
antigen-producing buman lung expression of herpes simplex virus
O&i T, Tani0 Y, Tachibana I, Hosoe S, Kumagai T, Kawesc I et al. Depor0nenr of Medicine III, Osaka University Medical School, 2-2, Yomadooka. Suita. Osaka 565. Cancer Rcs 1994;54:5258-61. A carcinoembryonic antigen (CEA)-producing human lung cancer cell line (A549), a nonproducing human lung cancer cell line (CADG-LC9), and a human uterine cervical cancer (HeLa) were transfected with the herpes simplex virus thymidinc kinase (HSV-TK) gene regulated by 445 nucleotides upstream from the translational start of CEA gene. Fifty % growth inhibitory concentration of ganciclovir (GCV) was 0.57 iM for HSV-TK-transfected A549; relative sensitivity to GCV was more than 1000 times higher compared to the 50% growth inhibitory wneentration of the parental cell line. Both CADO-LC9 and HeLa transfectcd with HSV-TK were still resistant to GCV. There was no difference in either morphology or doubling time behveen HSV-TK-transfccted and parental clones. Injections (i.p.) of GCV resulted in significant regression of HSV- TK-transfected A549 tumors in nude mice. These data show the possibility of gene therapy using the cell type-specific promoter of CEA gene against CEA- producing adenwarcinoma of the lung.
Adjuvaot (OK-432)
12 (1995)
Reviews Thestrategyfortberapyoflungcancer Konska C, Nakajima S, Kate H. Deparbnent of Surgery. Tokyo Medico1 College Hospital, Nishi-shinjuku 6-7-1, Shinjuku-ku, To& 160. J Jastro 1994;6:207-I 5. In therapy of lung cancer it is important to be decided what type of therapeutic strategy is most appropriate and what kind of results can be anticipated. Selection of type of therapy in primary lung cancer depends on the following factors: Histological type, Location and Stage. The differences of methodology, which is necessary in deciding therapeutic strategy, employed to diagnose and evaluate cases which are X-ray-negative and sputum cytology-positive (rea~tgcnologically occult lung cancer) and cases which reveal abnormal findings on chest X-ray are described. Especially in occult lung cancer cases, with the remarkable improvements that have ban made in the fiberoptic bronchoscope, bronchowopy has become relatively simple to perform and is extremely effective for detailed examination as far as 4th order bronchi for hmwr localization. Surgery treatment is the treatment of choice for lung cancer. Until 196Os, pncumonectomy was a common surgical method for lung cancer, but at&r that period lobe&my and systemic media&al lymph node dissection became standard. As for the survival rate according to pathological stage, out of a total of I ,2 I I resected casts, among stage I and II cases in which the surgical procedure was thought to be curative, the 5-year survival rate were 67.4% and 41.1%, respectively. The 5-year survival rates of stage IIIA and IIIB, on the other hand, were only 14.7% and 0% respectively. In order to improve the survival rate of lung cancer, more ctTorts must be made for early detection of early stage lung cancer cases, and the development of more effective adjuvant therapy is anticipated.
Lung cancer Travis WD, Travis LB, Devesa SS. Pulmono~~ediastinaIPa~o~ Dept., Armed Forces Institufe of Pathologv. Washington. DC 20306-6000. Cancer 1995;75:Suppl:I91-202. Background. Lung caneer is the most eomman cause of cancer death in the United States, and its incidence has been rising for at least 50 years. Shifts in histologic type and differences in sex and race distribution have accompanied the increased incidence of lung malignancies. Methods Population-based data regarding lung eaneer reported to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program for the 15-year period 19731987 were analyzed. Resulrs. Results indicate that from 1973-1977 to 19831987, the age-adjusted rates of lung cancer increased by 30%, with the gain markedly greater in women (70%) than in men (17%). The largest percentage
Abstracts/Lung increases in age-adjusted rates were observed for small cell carcinoma end adcnocsrcinoma (epproximetcly 60% each), with a more modest change for squamous cell carcinoma (+14%). For squamous cell carcinoma, the age-adjusted rates increased substantially for black (65%) and white (70%) woman and only slightly for black men (10%). whereas it decreased slightly in rcccnt years for white men. Conclusions. In recent years, .sdcnocarcinoma has replaced squamous cell carcinoma as the most frequent histologic subtype for all scxcs and races combined. Thcsc shills in histologic types by sex and race may be rclatcd to differences in exposure to tobacco products, dietary factors, environmental or occupational carcinogens, and host characteristics. Increased USCof transbronchial and needle biopsy may have also influenced thcsc trends to scmc cxtcnt. Over the study period, 5-year relative survival rate did not change appreciably for lung canccr. suggesting that therapeutic advances have had little cffcct.
Cancer 12 (1995) 265-329
327
‘Ikatmeat of small cell bmgcaacer Ucoka H, Ohnoshi T. Second Deporbnenf of Medicine, Okayama University Medical School, 2-S-I Shikafa-cho, Okayama 700. Jpn J Cancer Chcmother 1994;21:2571-7. This paper overviews the recent treatment results for small cell lung cancer. The last decade has brought only a small improvement, supposedly, mainly due to the development of drug resistance. However, current trials of non-crossr&tat chemotherapy, dowintensive wakly chemotherapy, l&e intensification with autologous bone marrow transplantation, and combined modality treabnent with thomcic irradiation have shown a substantial advance in the tmabncnt of smell cell lung cancer. Becent cbaageof
management
in advanced
Kodsma N, Kawahsre M, Furuse K. Department
Extrapulmoaary small cell carcinoma: A rioglekwtitotioo experience aodreviewdtheliterature Lo Re G, Canzonieri V, Vcronesi A. Dal Bo V, Barzan L, Zancanaro C et al. Division o/Mcdcol Oncology Cfz Regionale Rijoimenfo Oncolog., INRCCS, Ko Pedemonfana Occle, I-33081 Aviano. Ann Oncol 1994;5:909-13. Bw&grmmd. Small cell carcinoma (XC) is a distinct pathologic entity that may also occur in extrapulmonary sitea. In this report ~JICrctrospeetive results of multimodal therapy of primitive extrapulmonary (I.$ SCC, in a single institution series, are presented. Me&o& Twenty-four patients (pts) with ESCC were referred to the Centro di Riftimento Oncologico, Aviano, Italy, from 1986 to 1992. Clinics-therapeutic findings were cvalusted in 20 pts. Their ages ranged from 20 to 87, with 8 median of 60.5 years. Primaly tumor sites were urinary bladder (5 pts), prostate (4 pts), larynx (3 pts), kidney (2 pts), ovary, skin, ampharynx, trachea, uterine cervix, cthmoid, and stomach (1 pt each); lymph node mctastascs of unknown origin were observed in 3 pts. More than 50% of pts presented extensive disease. Resulfs. Histologically, I6 cases were pure ESCCs and 8 cases were combined. 4 of them with adamcarcinoma, 2 with transitional cell carcinoma, and 2 with squamous cell carcinoma. Immunohistochemical stud& pcrformcd in 7 cases, demonstmtcd the cpithclial nature of these tumors. The cisplatin-VP16 (PE) rcgimcn was used in 13 pts, and 9 of them (69%) obtained objective responses after chemotherapy (CT) alone, with 3 complete remissions (CR) and 6 partial rcmiwions (PR). Median CR and PR duration was 13+ and 24 months, rcspcctivcly. Radiotherapy was performed in 7113 pts after induction CT and before consolidation CT. The objective response rate was loO%, with 6 CR and 1 PR. No severe toxic side effects and no toxic deaths were reported. A patient trcatcd with surgery alone for a urinary bladder tumor showed continuous long-m survival, while 1 of 2 pts treated with radiotherapy alone obtained PR. Conclusions. The PE regimen has an activity similar to the one observed in pulmonary SCC.
Branchial sod thymic carchmid tumon: A rekw Dusmct M, McKncally MF. Division of Thonzcic Surges The Toronfo Hospifal, 200 Elizabefh Sfrvef, Tomnfo, Onf. h45G 2C4. Digestion 1994;55:Suppl3:706. Bronchial carcinoid tumors arc usually indolent, slow-growing hrmors with an excellent prognosis. However, even typical carcinoids can mctastazisc to regional lymph nodea or to distant sites. Atypical carcinoids tend to behave more invasivcly with ma-c frcqucnt nodal and distant metastwx. Despite this, longtcmr survival can be expected as many tumors grow end spread slowly. At the end of the spectrum are the highly aggressive small cell carcinomas which have a very poor prognosis despite aggressive chemotherapy. Clinically, car&mid tumors arc frcqucntly asymptomatic. Symptoms arc most frcqucntly due to obstruction (pneumonia, ‘asthma’, coughing) or bleeding. Carcinoid syndrome is seen infrcqucntly and usually signifies mctastatic discax Gushing’s syndrome is occasionally seen in association with these tumors. The treatment of carcinoid hlmors is surgical. Rex&ion should be complete and cncompsss the regional lymph node?..
ooo-small
cell hmgcaocer Nu&ional Sabi 591. Jpn J
of InfernalMedicine,
Kinhi Cenbal Hospifal, Chest Disease, 1180 Nagwow-cho. Cancer Chemother 1994;21:2564-2570. The value of chemotherapy in advanced non-small cell lung cancer (NSCLC) has ban shown in combination chemotherapy with cisplatin, which yields only marginal survival benefits. Chcmoradiothcrapy with cisplatin improves the survival of patients who have unrcscctablc, locally advanced NSCLC when compared with the treatment by radiation therapy alone. The 2- and 3-year survival rates arc nearly doubled on evcragc. Ncoadjuvant chemotherapy is more effective than surgery alone for the treatment of stage EtA NSCLC in the randomized phase lJJl trials. It is suggested that ncoadjuvant chcmothcrapy will be a standard therapy for stage fUA NSCLC which is marginally resectable. There are many studies about radiation methods such as hyperfractionatcd radiation therapy and CHART, irradiated dose, and timing of radiation. There is e need to develop new, more active anticancer agents, and to find more effective regimens.
Future directions in clinical research for hmgcaacer Bunn PA Jr. Box B18.8. 4200 E 9th. Denver, CO 80262. Chest 1994:106, Suppl:399S-407S. Even since the Surgeon General’s 1964 report, the mortality rate fmm lung cancer has continued to rise. Although there is evidence that this continued increase in mortality will slow or level in the next decade, lung cancer motility is a major health problem destined to remain with us for at least the next generation. There have been no established advances in the early d&&ion or prevention of lung cancer in the last 30 years and our therapies have increased the cure rate only from 5 to 13% in this 30-year interval. Biologic advances have outpaced clinical advances in recent times and many of the adv~ccs arc now ripe for clinical exploitation. There are currently more exciting clinical trials for all phases of lung cancer than at any time and it till be stimulating to wihxss the results of the clinical trials discussed herein. Hopefully, the results of these studies will lead to a decreusc in lung cancer mortality in the next cenhuy, much as it increased in the past century. Ev~atioadtbetberapeutkp~osisandlong-tena sarviwrsdsmaU cell lung cancer Nskayama H, Yokoyama A, Kinamcri K, Kurita Y. Deparbnenf o/Infernal Medicine, Niigafo Cancer Cenfer Hospiral, Niigafa. Lung Cancer (Japan) 1994;34:867-74. The thcrapcutic prognosis and long-term survival wcrc evaluated in 207 patients with small cell lung cancer who were treated after October, 1982. There were 121 patients with limited disease (LD) and 86 with extensive disease (ED). Rcscction was perfomxd in 19% of the casts and 44% were treated with LLcombination of chemotherapy and radiotherapy. Comparmg induction chemotherapy @CT, 2S cases) and adjuvant chemotherapy (I2 cases), ICT was superior in median survival time (MST, 36,29 months, respectively) and J-year survival (3YS, 57,45%, respectively). There was no difference in MST and 3YS (14, 18%, rcspcctively) bchvecn the concurrent (7 cases) and sequential method (22 cases) of radiotherapy. The combination chemotherapy of CDDP, ADM and VP-16 with G-CSF for patients with ED had B longer MST (22 months) and bcttcr 3YS (21%) than those without C-CSF. Of 24 long-term survivors (greater than 3 years), 21 patients had LD and 3 had ED. Thirteen patients underwent surgical rcscction. There were 6 CR and 4 PR among 10 SCLC patients who received chemotherapy and radiotherapy. Now 5 are alive and disease free for more than 5 years. One patient had a second cancer. ICT for surgical patients and dose intensive chemotherapy for patients with ED seemed to improve survival rate, but there was no statistically significant difference.