Primary lung carcinoma disemination into abdominal organs

Pulmonary Imaging

260

Treatment: Taxol® 200 mg/m2 (3 h IV) and carboplatin AUC 6, dl q 3 wks (max. 6 cycles). If no brain response after 2 or 4 courses, brain RT 30 Gy was administered in 10 fractions before next CT. Patients characteristics: From 11/98 to 12/99, 60 patients were included, 43 pts are evaluable. M/F 35•8; median age 59 (38-75); PS 2 5%; BM at first diagnosis 95%, BM at relapse 5%; squamous cell 28%; adenocarcinoma 47%; other 26%. Results: 129 cycles were given, median number 2 (1-6). Toxicity: Hematological toxicity: grade 3/4 neutropenia 5% cycles (no febrile neutropenia) and grade 3/4 thrombopenia 3% cycles. Nonhematological toxicity: peripheral neuropathy (grade 2/3: 2/5% in pts respectively); CNS toxicity was observed in one patient after brain RT. Efficacy after 2 courses:

PR SD PD UTD

BM

Extra-BM

7 (16%) 14 (33%) 19 (45%) 3 (6%)

9 (21%) 20 (46%) 8 (19%) 6 (14%)

Conclusion: 2 courses of Taxol® and carboplatine achieved an acceptable level of efficacy on BM with a low toxicity profile. These data suggest that this combination of CT followed by RT may increase the overall treatment efficacy on BM. Classification of small cell lung cancer (SCLC): IASLC or F8--• VALG - beyond the limits of limited disease P. Micke, T. Metz, K.M. Beeh, J. HengsUerI , R. Buhl. Pulmonary Division, ///. Medical Department, University Hospital; 1Dept. of Toxicology, Mainz University, D-55101 Mainz, Germany SCLC is clinically classified into two major subgroups, limited and extensive disease (LD/ED). There are, however, distinct approaches towards the definition of LD and ED in SCLC. While the VALG (Veterans Administration Lung Study Group, 1973) defined LD by whether the primary tumor and/or nodal involvement was limited to one hemithorax, the International Association for the Study of Lung Cancer (IASLC) consensus report of 1989 suggested an adjusted classification in accordance with the revised TNM criteria of 1987. Because treatment modalities for LD and ED differ, individual clinical outcome may be influenced by the classification system chosen. Hence, data of 105 patients with SCLC treated in our clinic between 1989-1998 (20% female, age 61 ± 9.5 yr.) were analyzed. Among these, 20 patients (19%) could be either classified as LD or ED depending on the classification system used. The median survival of this group (LD/ED: 13.1 mo.) did not differ from those with "pure" limited disease (VALGLD: 13.0 mo.), although only in 50% of patients the recommended chest irradiation was performed. Patients with extensive disease had the expected poor prognosis (5.5 mo.; p < 0.03). One year survival rates showed the same prognostic correlation (VALG-LD: 56%, LD/ED: 60%, ED: 14%). In conclusion, distinct staging modalities may affect a significant number of patients with SCLC. Until now it is unclear whether the better outcome of this subgroup depends mainly on the stage of the disease or the different combined treatment modality or both. However, the IASLC classification reflects better the course of the disease and is therefore preferable in clinical practice.

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Response rate accuracy in the French neo-adjuvant chemotherapy trial

B. Milleron1, V. Westeel, E. Quoix, D. Moro, D. Braun, B. Lebeau, J.L. Breton, E. Lemari~, J.M. Br~chot, M. Monch~tre, F.X. Lebas, E Blanchon, A. Depierre. French Thoracic Cooperative Group; Paris,

France Response rate (RR) is an usual endpoint in oncology trials. This parameter is highly dependent on clinical and radiological tumor measurements. Patients and Methods: In the French prospective neo-adjuvant trial** comparing surgery with chemotherapy + surgery (CT) in nonsmall cell lung cancer, response was prospectively evaluated in all patients of the CT arm by investigator and by an evaluation committee constituted by all investigators using thoracic CT scan and fiberoptic bronchoscopy. International guidelines were used. Results were then compared with pathological findings after surgery. Pathological response was classified as complete response (CR), sub-complete response (subCR) and others. Results: Of the 187 patients enrolled in the CT arm, 179 were eligible. Response evaluation by investigator was available in 177 patients and by the evaluation committee (EC) in 170. For investigators and EC, 7 and 5 complete responses were observed, 106 and 93 partial responses, 47 and 53 stabilisations, 10 and 11 progressions and 7 and 8 patients were considered as non evaluable, respectively. The kappa (K) coefficient was 0.66 + 0.10. Disagreements were more frequent in stage IliA (K = 0.60 ± 0.12) than in stage I (K = 0.79 ± 0.14) and II (K = 0.64 ± 0.24). After surgery, pathological responses were: CR: 19, subCR: 28 and others: 123. For evaluation of CR and subCR, the specificity of both investigators and EC was 100% but the sensibility was very low (15 and 11%, respectively). In conclusion: • Concordance between investigator and EC was satisfying. • The ability of investigators and EC to identify CR is low and new technics (MRI, PEt scan) may improve this CR evaluation. • Tenon Hospital, Paris, France. ~*Proc Am Soc clin Oncol 1999; 18:1792 ~896~ Primary lung carcinoma disemination into abdominal organs R. Stevic, E. Nikolic, D. Jovanovic, I. Jovanovic, M. Markovic, L. Apostolska. Institute of Radiology, Institute for Lung Diseases and

TB, CCS, Belgrade, Yugoslavia The purpose of this study was to investigate frequencies of involvement of abdominal organs by metastases from different hystologic types of lung cancer. This study included 2496 patients treated due to lung carcinoma during three years period. There were 1339 (53.64%) pts with squamous cell carcinoma, 680 (27.2%) with adenocarcinoma, 431 (17.26%) with small cell carcinoma and 46 (0.04%) with other subtypes. The frequencies of involvement organs are showed in table.

metastatic site

liver adrenal glands paraaortal lymph nodes multiple organs total

number of cases squamous cell

adenocarcinoma

small cell

total

58 (4.3%) 25 (1.86%)

16 (2.3%) 15 (2.2%)

53 (12.3%) 10 (2.3%)

127 50

3 (0.2%)

4 (0.5%)

8 (1.8%)

15

18 (1.34%)

17 (2.5%)

41 (9.5%)

76

112 (25.%)

268

104 (7.76%) 52 (7.64%)

Conclusion: These results show that small cell carcinoma metastasised most frequently into abdominal organs with significant difference

Pulmonary Imaging compared to other two types (p < 0.001). The most frequent organ involved by metastases was the liver (p < 0.05).

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Metastases of primary lung carcinoma in relation to gender R. Stevic, N. Vasic, D. Jovanovic, E. Nikolic, Z. Colic. Institute of Radiology, Institute for Lung Diseases and TB, CCS, Belgrade, Yugoslavia

A comparative analysis of two groups of patients with verified primary lung carcinoma during one year period was made. There were 794 patients, 654 (82.3%) males, average of 55. 3 years and 140 (17. 6%) females, average of 56. 07 years. There were 415 (365 M and 50 FM) patienta with squamous cell carcinoma, 202 (147 M and 55 FM) pts with adenocarcinoma, 156 (126 M and 30 FM) with smal cell carcinoma and 21 (16 M and 5 FM) with other subtypes. The frequencies of metastatic sites are presented in table.

metastatic site liver brain bones multiple supraclavicular adrenal glands total %

squamous cell

adenocarcinoma

small cell

total

M

FM

M

FM

M

FM

M

FM

14 15 15 14 15

5 1 5 1 1

4 9 9 10 9

1 5 5 3 2

12 7 3 21 16

3 2 1 3 4

30 31 27 45 40

9 8 11 7 7

5

0

3

1

2

0

10

1

78 21.2

13 26.0

44 29.8

17 30.6

59 48

13 43.2

183 21.7

43 30.6

Conclusion: The se results show that there is no significant difference in frequencies of metastases in relation to gender compared to hystologic subtypes (p > 0.001) and metastatic site (p > 0.05). [-8--98-] Clinical significance of satellite nodules within the primary

tumor lobe in resected non-small cell lung cancer: Revisiting the new staging system K. Kim, K. Park, J. Kim, O. Kwon, E. Nam, W.S. Kim, J. Han, S.S. Yoon, W.K. Kang, H.G. Lee, KM. Kim, Y.M. Shim, H.J. Kim, C.K. Park. Department of Medicine, Diagnostic Pathology and

Thoracic Surgery, Sungkyungkwan University, School of Medicine, Samsung Medical Center, SeouI, Korea The significance of satellite nodules is one of the most controversial issues in staging non-small cell lung cancer (NSCLC). The new staging system revised in 1997 classified satellite nodules in the primary tumor lobe as T4 instead of upstaging previously. We evaluated clinical features and prognosis of the patients with satellite nodules in the primary tumor lobe. From November 1994 to November 1999, of 583 patients with NSCLC who underwent surgical resection, 25 patients (22 males and 3 females, age 32-77, median 64) had satellite nodules in the primary tumor lobe. The histologic type consisted of 7 adenocarcinoma, 14 squamous carcinoma and 4 large cell carcinoma. Lobectomy was done in 10 patients, bilobectomy in 5 and pneumonectomy in 10 patients. Ten patients had single nodule and 15 had multiple nodules. The size of nodule was <1 cm in 19 patients and >1 cm in 6 patients. Nineteen patients had satellite nodules within 1 cm from the primary tumors. Nodules in 4 patients were detected on preoperative CT scan. N stage were NO in 14, N1 in 8, and N2 in 3 patients. According to old staging system 20 patients were staged as IliA and 5 as IIIB. Fourteen patients had recurrence with 6 local and 10 systemic recurrence. The median overall survival of all 25 patients was 20 months (range 049+) and median relapse-free survival was 7 months (range 0-49+).

261

There was no significant difference in overall survival according to histology, size, number and distance from primary tumors, pathologic N stage, and stage by old staging system. We compared the survival of these patients with that of 19 pathologic IIIB patients without satellite nodule, who had surgery in the same period. Twelve of 19 patients had curative surgery. The median overall survival of 19 patients was 20 months (range 0-44+). There was no significant difference in overall survival between the two groups (p = 0.79). In conclusion, it seems to be appropiate to stage satellite nodules in the primary tumor lobe as T4 in the new staging system of non-small cell lung cancer.

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Seamless lung cancer service provision: 1) a dedicated results clinic SM. Davidson, J. McPhelim, R. Milroy. On behaff of the West of Scotland Lung Cancer Research Group; Sfobhill Hospital, Glasgow, Scotland

It is well recognised that imparting a diagnosis of lung cancer represents a crucial stage in the patientis cancer trajectory. The circumstances in which such information is conveyed is crucial to the patientis continuing care. Previously we informed the patient of the diagnosis at the start of an out-patient clinic but this led to a number of problems including unsuitable environment, missing results/case-notes and lack of dedicated nursing support. We, therefore, established a dedicated results clinic. From the 1st January 1999-31st December 1999 a total of 196 patient attendances were recorded at this clinic. The results clinic has been further refined by having a pre-clinic meeting when all the results are collated (bronchoscopy, CT scan, lung function tests, lung biopsies etc.). This clinic has the following advantages: 1. Patients are seen in a dedicated area out-with the general out-patient clinic and each appointment interval is 20 minutes. 2. There is dedicated specialist nursing input available during and following the consultation for further information giving (including written information) and support. 3. Anticipation of any potential problems, such as missing results, prior to the consultation through the pre-clinic meeting. 4. Opportunity for junior staff training and communication skills. This development has not only improved patient satisfaction subjectively but also reduced stress amongst the medical and nursing staff at a very difficult time.

~ - - ~ The impact of changing lung cancer mulUdisciplinary practice in a large teaching hospital in the United Kingdom B.J. Hutchcroff. On Behaff of the Sheffield Lung Cancer Group, UK This paper describes the impact on Lung Cancer care when the significant changes to a Multidisciplinary Team (MDT) at the Northern General Hospital described in an associated abstract were put in place. The outcome of patients discussed at the MDT in two 7 month periods, January to July 1998, and June to December 1999 were compared. Between those dates the service had been reengineered, a new Lung Cancer Physician had been appointed and the thoracic surgeon was replaced, resulting in many more patients being discussed. In the initial period there were 89 patients cancer in the chest compared with 209 in the second period. 2 of the 89 had other cancers as did 20 of the 209. in 1998 there were 3 mesotheliomas and 1 carciniod, in 1999 there were 9 mesotheliomas and 2 carciniods. Of the Lung cancers, 21 in the first 7 months and 22 in the second 7 months were Small Cell; in the first 7 months 42 (67%) were Non Small Cell compared with 103 (82%) in the second 7 month period. There were a significant number 20 (22%) and 53 (25%) respectively where a tissue diagnosis was not achieved. 8 (9%) patients were referred for surgery in 1998 compared with 25 (11%) in 1999; 22 (25%) for radiotherapy compared with 48 (23%) and 19 of each of the 21 and 22 Small Cells were referred for chemotherapy. A significant number of patients, 42 (47%) and 61 (29%) had further staging procedures recommended. The outcome of this staging was not always recorded. Over double the number of patients were assessed by the MDT but as yet relatively little impact has been made on the treatment option