- Email: [email protected]
Primary surgery with adjuvant chemoradiationtherapy in patients (pts) with small cell lung cancer (SCLC) (T1–2, N0, M0)
126
Combined Modality Therapy
median age of 35.5 years (range 23 to 67 years). Three patients had the biphasic form of pulmonary blastoma and three the monophasic (well differentiated foetal adenocarcinoma - WDFA) form. One patient had stage Ib disease, four had stage III disease and one stage IV disease. The patient with a stage Ib WDFA underwent Iobectomy and is well at 23 months. One patient with a IIIb WDFA tumour underwent a pneumonectomy and is well at 34 months despite removal of a solitary cerebral metastasis at 9 months. Two patients with stage IIIb tumours (one WDFA, one biphasic) underwent pre-operative radical chemotherapy with good radiological response followed by resection and are well at 7 and 14 months respectively. Two patients with biphasic tumours stage IIIb and IV did not undergo resection and died at 3 and 8 months respectively despite receiving radiotherapy and radical chemotherapy. Conclusion: Early results suggest that surgical resection is the treatment of choice for pulmonary blasfoma, with pre-operative chemotherapy for advanced tumours. The WDFA form of the disease has the better prognosis. Multicentre studies are necessary to evaluate treatment strategies for this rare tumour.
surgically in the period between January 1988 and December 1993 underwent retrospective analysis. The 5-year survival was analysed. The group of 36 patients treated with adjuvant radiotherapy was compared with the group of patients without adjuvant treatment. The log-rank test revelated the statistically significant (p < 0.05) risk factors: metastasis to the single lymph node station (p = 0.0048), especially metastasis to the lymph node of aortic arch (group 5), left-sided tumours (p = 0.0419), and endobronchial lesion (p = 0.05). According to the logrank test 5-year survival in djuvant radiotherapy group was significantly longer (p = 0.007). According to the Cox regression model the hazard of recurrence was significantly greater in group of adenocarcinoma (p = 0.03), metastasis to the lymph nodes of group 4 and 7 (p = 0.02), patients with endobronchial lesion (p = 0.01), and group which has post-operative blood transfusion (p = 0.05). According to the statistical analysis it seems that the post-operative adjuvant radiotherapy was beneficial for the patients. The risk factors are: adenocarcinoma, metastasis to the lymph nodes of group 4 and 7, endobronchial lesion, post-operative blood transfusion. The patients with isolated metastasis to the lymph node of group 5 are expected to have longer survival.
•1•
•
Primary surgery with adjuvant chemoradiationtherapy in patients (pts) with small cell lung cancer (SCLC) (T1-2, NO, M0)
U. Seifart, M. Schroder, K. Hans, D. Ukena, K.P, Thiele, A. Neubauer, M.P. Wolf. Universit~t Marburg, Klinik Inhere Medizin SP H~mtologielOnkologiellmmunologie, 35033 Marburg, Germany
Objective: SCLC is known as one of the most aggressive solid tumours. The median survival in pts with limited disease (LD) under therapy is 14-18 month and with extensive disease (ED) 6-10 month. This unsatisfactory situation should be improved by applying new therapy regimes especially in Iocalised stage of disease. Therefore a phase II study was initiated to look for the effect of an operation with adjuvant chemoradiationtherapy on SCLC-pts without distant metastasis. (T1-2, NO, M0) Material and Methods: All pts received surgery (pneumonectomy or Iobectomy, bilobectomy). After the operation the patients underwent a chemotherapy that depends on the form of surgery. Pts with a pneumonectomy received three cycles of IE (Ifosfamid 1500 mg/m2 d 1-4, Etoposid 120 mg/m2 d 1-3). Pts with a Iobectomy or bilobectomy received three cycles PE (DDP 90 mg/m 2 dl, Etoposid 150 mg/m2 dl-3). Radiationtherapy with 45 Gy was conducted over the area of the primary tumour. A PCI was done in case of a complete remission. Results: 30 pts (21 men, 9 woman) were treated as described above. The data of 27 pts are available at this time period. The Karnofsky score was 80% in 12 pts, 90% in 11 pts and 100% in 7 pts. The median age was 62 years (Range 39-68). A pneumonectomy was done in 11%. A Iobectomy or bUobectomy was done in 89%. After a follow-up of 52 months the median survival is not reached. The 3-year survival is 74% in the moment. Conclusion: The operation with an adjuvant chemoradiotherapy in SCLC-pts without distant metastasis (T1-2, NO, M0) is feasible. After a follow-up of 52 months a 3-year-survival rate of 74% indicates that this schedule could be an attractive therapy for pts suffering from SCLC on a Iocalised stage of disease. influence of the post-operative radiotherpy and analysis of the risk factors on the survival in patients in stage IliA (N2 disease) NSCLC M. Chabowski, T.M. Orlowski, D. Dziedzic, W. Kupis, K. Roszkowski, National Research Institute of Tuberculosis and Chest Diseases, Warsaw, Poland
There are many controversies regarding the treatment of patients in stage IliA (N2 disease) NSCLC, especially as regards the postoperative radiotherapy. Therefore, this study was undertaken to establish the impact of the post-operative radiotherapy and the risk factors on survival. A group of 161 patients with stage IliA NSCLC resected
]
From 1970 through 1989, 228 lung carcinoma patients were administered surgical and combination treatment at Research Institute of Oncology and Medical Radiology. Fifty-six patients received surgical treatment, 172 patients were administered various options of combination treatment, including multimodal one. Forty-one patients received preoperative telegammatherapy or high energy bremsstrahlung radiation therapy with enlarged or large dose fractionation (single target dose (STD) of 4 or 6 Gy, total target dose (TTG) of 20 or 30 Gy) for the tumor and regional metastasizing areas with subsequent surgical intervention during the 72 hours after radiation treatment. Combination treatment of other 41 patients included radical surgery and postoperative conventional radiotherapy (STD 2 Gy, TTD 40 Gy). Pre- and postoperative external radiotherapy in combination with surgery was applied in 12 patients. One of the components of treatment of 75 lung adenocarcinoma patients was intravenous injection of 198Auduring the 5 days after surgery at a dose of 1.5-1.9 GBq (0.03 GBq per 1 kg of body weight); 37 of them were administered multimodality treatment including preoperative large-fraction irradiation, surgical intervention and 198Au intravenous injection in the postoperative period. In 38 patients the treatment consisted of surgery and postoperative intravenous 198Au injection. The multimodal treatment of lung adenocarcinoma produced the highest 5-year survival rates: 5-year survival rate of stage III lung carcinoma patients was 47% versus 0% with surgery alone. The advantage of this method was obvious in the cases of metastases in regional lymph nodes (N1-2): 5-year survival of these patients increased from 8 to 48%.
~-~ ~The
1
Multimodality treatment of lung adenocarcinoma
L.S. YaskevichI , N.I. Krutilina 1, L.I. Ositrova2, I.V. Davidovsky2, L.I. Shakuro 2, T.V. Kostetskaya 1. lB~/elorussian State Institute for Advanced Medical Training, Minsk; ~N.N. Alexandrov Research Institute of Oncology and Medical Radiology, Minsk, Belarus
Concurrent radiochemotherapy followed by surgery for stage IIIB non small cell lung cancer patients: Long-term follow-up of the CEBI 142 study
D. Grunenwald, F. Andre, C. Lepechoux, P. Girard, M Tarayre, A. Laplanche, R. Arriagada, 11 Le Chevalier. Institut Mutualiste Montsouris, Paris; Institut Gustave Roussy, Villejuif, France Locoregional control is a major problem for stage IIIB NSCLC. The purpose of this study was to investigate the efficacy of postradiochemotherapy surgery in stage IIIB NSCLC patients. From january 1993 to june 1996, 40 stage IIIB NSCLC patients were included in the present study. Diagnosis of preoperative stage IIIB was based on mediastinoscopy or thoracotomy in all patients. Induction treatment was two cycles of cisplatinum (100 rag/m2), 5 fiuoro uracile (1
Combined Modality Therapy
median age of 35.5 years (range 23 to 67 years). Three patients had the biphasic form of pulmonary blastoma and three the monophasic (well differentiated foetal adenocarcinoma - WDFA) form. One patient had stage Ib disease, four had stage III disease and one stage IV disease. The patient with a stage Ib WDFA underwent Iobectomy and is well at 23 months. One patient with a IIIb WDFA tumour underwent a pneumonectomy and is well at 34 months despite removal of a solitary cerebral metastasis at 9 months. Two patients with stage IIIb tumours (one WDFA, one biphasic) underwent pre-operative radical chemotherapy with good radiological response followed by resection and are well at 7 and 14 months respectively. Two patients with biphasic tumours stage IIIb and IV did not undergo resection and died at 3 and 8 months respectively despite receiving radiotherapy and radical chemotherapy. Conclusion: Early results suggest that surgical resection is the treatment of choice for pulmonary blasfoma, with pre-operative chemotherapy for advanced tumours. The WDFA form of the disease has the better prognosis. Multicentre studies are necessary to evaluate treatment strategies for this rare tumour.
surgically in the period between January 1988 and December 1993 underwent retrospective analysis. The 5-year survival was analysed. The group of 36 patients treated with adjuvant radiotherapy was compared with the group of patients without adjuvant treatment. The log-rank test revelated the statistically significant (p < 0.05) risk factors: metastasis to the single lymph node station (p = 0.0048), especially metastasis to the lymph node of aortic arch (group 5), left-sided tumours (p = 0.0419), and endobronchial lesion (p = 0.05). According to the logrank test 5-year survival in djuvant radiotherapy group was significantly longer (p = 0.007). According to the Cox regression model the hazard of recurrence was significantly greater in group of adenocarcinoma (p = 0.03), metastasis to the lymph nodes of group 4 and 7 (p = 0.02), patients with endobronchial lesion (p = 0.01), and group which has post-operative blood transfusion (p = 0.05). According to the statistical analysis it seems that the post-operative adjuvant radiotherapy was beneficial for the patients. The risk factors are: adenocarcinoma, metastasis to the lymph nodes of group 4 and 7, endobronchial lesion, post-operative blood transfusion. The patients with isolated metastasis to the lymph node of group 5 are expected to have longer survival.
•1•
•
Primary surgery with adjuvant chemoradiationtherapy in patients (pts) with small cell lung cancer (SCLC) (T1-2, NO, M0)
U. Seifart, M. Schroder, K. Hans, D. Ukena, K.P, Thiele, A. Neubauer, M.P. Wolf. Universit~t Marburg, Klinik Inhere Medizin SP H~mtologielOnkologiellmmunologie, 35033 Marburg, Germany
Objective: SCLC is known as one of the most aggressive solid tumours. The median survival in pts with limited disease (LD) under therapy is 14-18 month and with extensive disease (ED) 6-10 month. This unsatisfactory situation should be improved by applying new therapy regimes especially in Iocalised stage of disease. Therefore a phase II study was initiated to look for the effect of an operation with adjuvant chemoradiationtherapy on SCLC-pts without distant metastasis. (T1-2, NO, M0) Material and Methods: All pts received surgery (pneumonectomy or Iobectomy, bilobectomy). After the operation the patients underwent a chemotherapy that depends on the form of surgery. Pts with a pneumonectomy received three cycles of IE (Ifosfamid 1500 mg/m2 d 1-4, Etoposid 120 mg/m2 d 1-3). Pts with a Iobectomy or bilobectomy received three cycles PE (DDP 90 mg/m 2 dl, Etoposid 150 mg/m2 dl-3). Radiationtherapy with 45 Gy was conducted over the area of the primary tumour. A PCI was done in case of a complete remission. Results: 30 pts (21 men, 9 woman) were treated as described above. The data of 27 pts are available at this time period. The Karnofsky score was 80% in 12 pts, 90% in 11 pts and 100% in 7 pts. The median age was 62 years (Range 39-68). A pneumonectomy was done in 11%. A Iobectomy or bUobectomy was done in 89%. After a follow-up of 52 months the median survival is not reached. The 3-year survival is 74% in the moment. Conclusion: The operation with an adjuvant chemoradiotherapy in SCLC-pts without distant metastasis (T1-2, NO, M0) is feasible. After a follow-up of 52 months a 3-year-survival rate of 74% indicates that this schedule could be an attractive therapy for pts suffering from SCLC on a Iocalised stage of disease. influence of the post-operative radiotherpy and analysis of the risk factors on the survival in patients in stage IliA (N2 disease) NSCLC M. Chabowski, T.M. Orlowski, D. Dziedzic, W. Kupis, K. Roszkowski, National Research Institute of Tuberculosis and Chest Diseases, Warsaw, Poland
There are many controversies regarding the treatment of patients in stage IliA (N2 disease) NSCLC, especially as regards the postoperative radiotherapy. Therefore, this study was undertaken to establish the impact of the post-operative radiotherapy and the risk factors on survival. A group of 161 patients with stage IliA NSCLC resected
]
From 1970 through 1989, 228 lung carcinoma patients were administered surgical and combination treatment at Research Institute of Oncology and Medical Radiology. Fifty-six patients received surgical treatment, 172 patients were administered various options of combination treatment, including multimodal one. Forty-one patients received preoperative telegammatherapy or high energy bremsstrahlung radiation therapy with enlarged or large dose fractionation (single target dose (STD) of 4 or 6 Gy, total target dose (TTG) of 20 or 30 Gy) for the tumor and regional metastasizing areas with subsequent surgical intervention during the 72 hours after radiation treatment. Combination treatment of other 41 patients included radical surgery and postoperative conventional radiotherapy (STD 2 Gy, TTD 40 Gy). Pre- and postoperative external radiotherapy in combination with surgery was applied in 12 patients. One of the components of treatment of 75 lung adenocarcinoma patients was intravenous injection of 198Auduring the 5 days after surgery at a dose of 1.5-1.9 GBq (0.03 GBq per 1 kg of body weight); 37 of them were administered multimodality treatment including preoperative large-fraction irradiation, surgical intervention and 198Au intravenous injection in the postoperative period. In 38 patients the treatment consisted of surgery and postoperative intravenous 198Au injection. The multimodal treatment of lung adenocarcinoma produced the highest 5-year survival rates: 5-year survival rate of stage III lung carcinoma patients was 47% versus 0% with surgery alone. The advantage of this method was obvious in the cases of metastases in regional lymph nodes (N1-2): 5-year survival of these patients increased from 8 to 48%.
~-~ ~The
1
Multimodality treatment of lung adenocarcinoma
L.S. YaskevichI , N.I. Krutilina 1, L.I. Ositrova2, I.V. Davidovsky2, L.I. Shakuro 2, T.V. Kostetskaya 1. lB~/elorussian State Institute for Advanced Medical Training, Minsk; ~N.N. Alexandrov Research Institute of Oncology and Medical Radiology, Minsk, Belarus
Concurrent radiochemotherapy followed by surgery for stage IIIB non small cell lung cancer patients: Long-term follow-up of the CEBI 142 study
D. Grunenwald, F. Andre, C. Lepechoux, P. Girard, M Tarayre, A. Laplanche, R. Arriagada, 11 Le Chevalier. Institut Mutualiste Montsouris, Paris; Institut Gustave Roussy, Villejuif, France Locoregional control is a major problem for stage IIIB NSCLC. The purpose of this study was to investigate the efficacy of postradiochemotherapy surgery in stage IIIB NSCLC patients. From january 1993 to june 1996, 40 stage IIIB NSCLC patients were included in the present study. Diagnosis of preoperative stage IIIB was based on mediastinoscopy or thoracotomy in all patients. Induction treatment was two cycles of cisplatinum (100 rag/m2), 5 fiuoro uracile (1