- Email: [email protected]
Small cell lung cancer treatment
442
Abstracts/
Lung Cancer 11 (1994) 423-444
and 3-year sutvival rateswere60% and 56% for the p&operative chemotherapy patients and 25% and 15% for those who had surgery alone, respectively. Conclusion: In this trial, the treatment strategy using perioperative chemotherapy and surgery was more effective than surgery alone. Implications: This clinical trial strengthens the validity of using perioperative chemotherapy in the management of patients with resectable stage IIIA non-small-cell lung cancer. Further investigation of the perioperative chemotherapy strategy in earlier stage lung cancer is warranted.
Treatment of small cell lung cancer. Recent experience of the EORTC lung cancer cooperative group Van Zandwik N. Department of Chest Oncology, lhe Netherlands Cancer Itutitute, Ple.wnunloan 121, 1066 CX Am.vterdatn. Anticancer Res 199414: B 313-5. In this paper an overview of the activities since 1982 of the EORTC Lung Cancer Cooperative Group is given. Although the last decade has brought only small improvements, several important questions have been answered. Prognostic factors, optimal duration of chemotherapy, retreatment policies, non-cross resistant combiitions and chemotherapy of brain metastases have been the subject of cooperative effort during the last ten years, allowing batter choices to be made in the treatment of individual patients. Currently the place and timing of radiotherapy and the efficacy of several new drugs are under study. In order to assess reliably the relatively small gains of different treatment options, cooperative groups like the EORTC LCCG will continue to play an important role in the future.
Other treatment modalities Potentiation oflong-tennaltured lymphokine-activated killer cell cytotoxicity against small-cell lung carcinoma by anti-CD3 x anti(tumor-associated antigen) biipecific antibody Azuma A, Yagita H, Okumura K, Kudoh S, Niitani H. Departtnent of InternalMedicine, Nippon Medical School, l-l-5 Sendagi. Bunkyo-ku, Tokyo 113. Cancer Immuool Immunother 1994;38:294-8. Lymphokina+activatedkiller(LAK)cellsexhibitapotent cytotoxicity to malignant cells in vitro. However, a satisfactory effect has not been obtained in many clinical studies except for a few cases. One of the most important reasons why cytolytic activity could not be exhibited in vivo is that LAK cells do not accumulate in the tumor tissue because of a lack of specificity. In the present study, we.show the effect of a bispecific antibody (bsAb) on the accumulation of LAK cells around the small-cell lung carciooms (SCLC!) cell and the subsequent enhancement of LAK cell cytotoxicity against SCLC. When short-term(4days)-cultured LAK cells wereused, 0KT3 x LU246 bsAb, which direct CD3’T-LAK cells to the target cell, induced a similar level of cytotoxicity to that induced by 3G8 x LU246 bsAb, which directs CD16’LAK cells. Longterm (21 days)-cultured LAK cells exhibited a reduced spontaneous cytotoxicity but retained high cytotoxic activity, which could he. directed by 0KT3 x LU246 or 3G8 x LU246 bsAb. The inhibitory effect of LAK cells on tumor cell clonogenicity in soft agar was also enhanced by both bsAb. These. results indicate that application of the therapy with LAK cells and 0KT3 x LU246 bsAb to SCLC patients might be a promising new method of adoptive immunotherapy.
While the overall survival of patients with lung cancer has remained relatively unchanged over the past decade, there. have been major advances in our understanding of the biology of small cell and non-small cell lung cancer through the study of lung cancer cell lmes. Surface molecules associated with lung cancer have been identified and their molecular structure and function are being elucidated. Growth factors which stimulate the lung cancer cells in an autocrine fashion have been identified. Genetic changes of lung cancer cells have been defined on a chromosomal and a molecular level. This review summarizes many biologic properties of lung cancer cells that have been described in the literature.
Chemotherapy of lung cancer Egger T, Cerny T. Institutfur Medizinische Onkologie. Inselspital, Bern. Ther Umsch 1994;51:267-71. Lung cancer is still one of the main reasons for death in the western world. Its prevalence follows the pattern of smoking habits. Despite extensive research efforts them is still no breakthrough in systemic therapy of advanced lung cancer. Nevertheless, long-term survival has steadily been increasing during the last decades. This review is focussing on recent progress in treating non-small cell and small cell lung cancer patients.
Epidemiology, screening, and prevention of lung cancer Petersen GM. Depmmtenr OfEpiduniology, JHSHPHOC, Johns Hopkins Sckol of Medicine, 615 North Wolfe Street, Baltimore, MD 21205. Curt Opii Oncol 1994;6:156-61. With an estimated 170,000 new cases and 149,000 deaths in the United States during 1993, lung cancer is now the leading cause of cancer deaths in both men and women. Tobacco smokiig isan important risk factor, and a large fraction of the risk can be. attributed to it. Other risk factors have been implicated, including environmental tobacco srnoke,occupationalexposureatocarcinogens,andgene.ticsusceptibility. Prevention of lung cancer through early detection and identification of individuals at risk is the goal of many recent studies. This review summarizes the current status of epidemiologic and biomarker research inundemtandingboththeetiologyandprognosticutilityofenvirrnnnental and host factors.
Overview on small cell lung m in the world: IndMrialized countries, third world, Eastern Europe Parkin DM, Sa&ranarayanan R. Unit of Descriptiw Epidemiology, lntemat Ageny Research on Cancer, 150, cows Albert lhomos. 69372 Lyon G&x 08. Anticancer Res 1994; 14: B 277-82. Lung cancer cases were abstracted from cancer registries in 20 countries to study the distribution of small cell lung cancer around 1985. The international patterns of small cell lung cancer resemble those of squamous cell tumors, and of lung cancer as a whole. Cigarette smoking andoccupationalri~factorsaremorestronglyaasociatedwithsquamous and small cell lung cancers than with adenocaminoma. Inspection of sex differences and time trends in incidence show some differences which may relate. to a higher risk for small cell lung cancer in female smokers than in males, and a less rapid decline in risk on smoking cessation.
Miscellaneous Biology of lung cancer Stahel RA. Division of Oncology, Department of Medicine, University Hospital, CH-8091 Zurich. Lung Cancer (Ireland) 1994; 1O:Suppl l:S59-S65.
small cell lung cnncer treatment Schuller MP, Lebeau B. Service de Pneutnologie, Hopital SaintAntoine, 184 Rue du Fbg Saint-Antoine, 75571 Paris Cedex 12. Med Hyg 1994;52:797-9.
Abstracts/Lung
Cancer II (1994) 423-444
IIldcellIlmg-,themliomodalityi8chemotherapy, unnbii with early thoracic radiation therapy for patients with limited diseasee. The precocity of the rwponse after initiating multimodality beatment is the mia prognosis tbctor. Patients with very limited small cell lung cancer (TNM stage I and II) can be managed by surgery. Association with colony stimulating factors can Ithe severity of oeutmpenicandinfectiousepiscdee. Themleofmaintenancetherapyby alpha interfemo in cliically disease tiw patients is suggwted.
Recentadv-
in diagnosis and treatment of small ceil and nonsmnllcelllungcancar Sorensen JB, Hansen HH. Department of OncoIogy, lke Finsen Center/ Rigsbospitaler. 9 Blegdamsvej. DK-2100 Copenhagen. Curt Opio Oncol 1994;6: 162-70. Despite much effort and many published reports, pmgrees in diagncsingandtmstinoglungzancer hasbeenslow.Theuseofmonoclonal antibodies for detection of metastasis and oeumendocrine markers for subclassification ofoon-small cell lung cancer into different prognostic groups may be useful in future staging and tmatment. Dose-intensive chemotherapy in small cell lung cancer is still experimental, which is alsothecaseforpmphylacticcranialirradiatioo.Adjuvantchemotherapy for completely rcsccted patients with non- small cell lung cancer may be associated with a marginal survival benefit, which also seems to hold true for patients with advanced disease when compared with untreated control subjects solely receiving supportive care. The modest survival benefit is achieved at the cost of increased toxicity. Neoadjuvant treatmentmmainsacootmversialissue, oneofthemajorpmblemsbeing the lack of an effective standard systemic therapy in non- small cell lung cancer.
Reviews Functlonnl status in women with lung cnncer Sarna L. School of Nursing, Uniwrsityof California, 10833 Le Conte Avenue, Los Angeles, CA 900246918. Cancer NW 1994;17:87-93. Lung cancer remains the number one cause of cancer-related death and the third most common csncer for women in the United States. The msjor purpose of this study was to describe physical hmctional status in a sample of women with lung cancer. Functional status was objectively measured by the Karnofsky Performance Status Scale, and subjectively by the Rand Physical Function Scale, and the Physical Function Subscale of the CARES-Short Form. A convenience sample of 69 women participated in a one-time data collection. The typical subject was <65 years of age, had lived with primary or recurrent lung cancer for > 12 months, had non-small cell limited disease, and was not curmntly receiving treatment. The most prevalent disruptions in physical function were reduced energy (59%), difficulty with household chores (33 %), and interference with work (28 46). A third of the sample had serious limitations in three or more activities. Approximately 26% of the sample had severe limitations in moderate activities, 20% in walking short distances, and 16 % in walking one flight of stairs. Only a quarter weresatisfiedwiththeirlevelofactivity. Physical functioowasdifferent by income category (one-way analysis of variance), with those with the lowest income having the poorest function.
current statusof lung cancer diagno& and mtment
in Shawhai Lip0 ML, Yang ZP, Ling ZQ, Gao YT, Gao RN, ZJwo W et al. Shanghai Chest Hospital, 241 Huai-haiRoad, Shanghai 2ooO30. Lung Cancer (Ireland) 1994 10/S-6 (333-338)
443
The status of diagnosis and treatment of lung cancers discovered duringlyeuintheShn~populationue~~.AtotPlof940 lung cancers was detected from inhabitants of 35-64 years of age, with a male/female ratio of 1.8: I. Pathology showed 35.7 % ademxcinoma and 35.1% aquamow c8ll caAnonu.Tbefewaaapredominauceof admocmiiorm (47.6%) in femalce and of squammm cell capGoomn (44.6%) in males. Most (68.6%) of the lesions dete&d werealreedy advanced in contrast to 14.7 96of Stage I disease. The needfor vigilance oothepartofdoctorswasdemonst&d by the fact that 23.3% of patients were seen by the doctor within 1 month after presenting with symptoms and 44.5 96 of them had their diagnosis suspected within 1 month after their first hospital visit. The treatment consisted of surgery for 33.3 96, chemotherapy for 35 96, traditional Chinese medicine for 20% and symptomatic management for 9.6% of patients. As only 55.8% Stage I patients were treated by surgery, the tmatment pmtocol seemed to be improperly biased. The adcqua@training ofhealth workers was shown by the t&t that 79.7 46 of these patients were confirmed by pathology and/or cytology and most of the Stage I lesions were diagnosed outside the hospital.
Evaluation of clinical elficacy of Ninjin Yoh-eito extract granules with special reference to the quality of life of lung cancer patients TsuburaE, NakajimaS, FuruseK, Iikegami H, FukuokaM, Nishikawa H. Department of Internal Medicine, OsakaHospital, Antituberculosis Ass. Osaka Branch, Osaka. Tlwr Res 1994;15:487-500. We investigated whether Niojin Yoh-eito, a Chinese medicine is clinically useful in impmving the QOL of lung cancer patients after consolidation chemotherapy. The clinical efficacy of this medication was evaluated by physician assessment of the signs and symptoms of the patients, self-asse3sment of the patients with regard to their symptoms (QOL), and the results of laboratory teats. Whereas the severity of PS, pain, dyspnea, cough, and production of sputa, which were assemed by thephysician-in-charge, worsenedover thecourseoftherapy, symptoms whicbwereammsedbytbepatientsthemselves, sucbasmood,anorexia, and malaise, clearly improved as treatment progressed. Significant increases in the red blood cell count, hemoglobin, and hematocrit were observed in the PS(O-1) group at the 4th, Sth, 16th and 20th week of the administration of Niojin Yoh-eito. Serum pmteins were significantly incmasedatthe4thandl6thweek,whilesemmalbumiowassignificantly increased at the 16th week of the administration of Ninjin Yoh-eito @ < 0.05 and p C 0.01, respectively). Reference values were established with regard to the results of the laboratory teats conducted at the initiation of this investigation. On the basis of these reference values the patients were divided into 2 groups, one showing normal and the other showing abnormal laboratory values. Impmv-ts in red blood cell count, hemoglobin, and hematocrit in the gmup showing abnormal laboratory values were observed after the 4th week. Improvement of the hematological picture noted after the ingestion of Nmjin Yoh-eito invariably leads to improvement of the general condition of the patients. It is further expected that improvement in the QOL will follow these positivechangeeinpati~tsbltusoccWlingasa~ltofUleadrninistration of this Chinese medication.
pulmonary cancer from the general prtxtitioner’s point of view: Experience from the health centm area of Kungsbwlca, Sweden ~&UWSOO J, Ikngtsson C. Heabh Centre of LovgaxIet, Vaniljgotan 28. S-424 45 Angered. Stand J Prim Hcaltb Core l%%l2:39-43. Objecri~ - To study the incidence of pulmonary CpllcBTin a conununity with special reface to the diagnostic procas~ and the mle of the general practitioner. Design - Study of the records of all patimts
Abstracts/
Lung Cancer 11 (1994) 423-444
and 3-year sutvival rateswere60% and 56% for the p&operative chemotherapy patients and 25% and 15% for those who had surgery alone, respectively. Conclusion: In this trial, the treatment strategy using perioperative chemotherapy and surgery was more effective than surgery alone. Implications: This clinical trial strengthens the validity of using perioperative chemotherapy in the management of patients with resectable stage IIIA non-small-cell lung cancer. Further investigation of the perioperative chemotherapy strategy in earlier stage lung cancer is warranted.
Treatment of small cell lung cancer. Recent experience of the EORTC lung cancer cooperative group Van Zandwik N. Department of Chest Oncology, lhe Netherlands Cancer Itutitute, Ple.wnunloan 121, 1066 CX Am.vterdatn. Anticancer Res 199414: B 313-5. In this paper an overview of the activities since 1982 of the EORTC Lung Cancer Cooperative Group is given. Although the last decade has brought only small improvements, several important questions have been answered. Prognostic factors, optimal duration of chemotherapy, retreatment policies, non-cross resistant combiitions and chemotherapy of brain metastases have been the subject of cooperative effort during the last ten years, allowing batter choices to be made in the treatment of individual patients. Currently the place and timing of radiotherapy and the efficacy of several new drugs are under study. In order to assess reliably the relatively small gains of different treatment options, cooperative groups like the EORTC LCCG will continue to play an important role in the future.
Other treatment modalities Potentiation oflong-tennaltured lymphokine-activated killer cell cytotoxicity against small-cell lung carcinoma by anti-CD3 x anti(tumor-associated antigen) biipecific antibody Azuma A, Yagita H, Okumura K, Kudoh S, Niitani H. Departtnent of InternalMedicine, Nippon Medical School, l-l-5 Sendagi. Bunkyo-ku, Tokyo 113. Cancer Immuool Immunother 1994;38:294-8. Lymphokina+activatedkiller(LAK)cellsexhibitapotent cytotoxicity to malignant cells in vitro. However, a satisfactory effect has not been obtained in many clinical studies except for a few cases. One of the most important reasons why cytolytic activity could not be exhibited in vivo is that LAK cells do not accumulate in the tumor tissue because of a lack of specificity. In the present study, we.show the effect of a bispecific antibody (bsAb) on the accumulation of LAK cells around the small-cell lung carciooms (SCLC!) cell and the subsequent enhancement of LAK cell cytotoxicity against SCLC. When short-term(4days)-cultured LAK cells wereused, 0KT3 x LU246 bsAb, which direct CD3’T-LAK cells to the target cell, induced a similar level of cytotoxicity to that induced by 3G8 x LU246 bsAb, which directs CD16’LAK cells. Longterm (21 days)-cultured LAK cells exhibited a reduced spontaneous cytotoxicity but retained high cytotoxic activity, which could he. directed by 0KT3 x LU246 or 3G8 x LU246 bsAb. The inhibitory effect of LAK cells on tumor cell clonogenicity in soft agar was also enhanced by both bsAb. These. results indicate that application of the therapy with LAK cells and 0KT3 x LU246 bsAb to SCLC patients might be a promising new method of adoptive immunotherapy.
While the overall survival of patients with lung cancer has remained relatively unchanged over the past decade, there. have been major advances in our understanding of the biology of small cell and non-small cell lung cancer through the study of lung cancer cell lmes. Surface molecules associated with lung cancer have been identified and their molecular structure and function are being elucidated. Growth factors which stimulate the lung cancer cells in an autocrine fashion have been identified. Genetic changes of lung cancer cells have been defined on a chromosomal and a molecular level. This review summarizes many biologic properties of lung cancer cells that have been described in the literature.
Chemotherapy of lung cancer Egger T, Cerny T. Institutfur Medizinische Onkologie. Inselspital, Bern. Ther Umsch 1994;51:267-71. Lung cancer is still one of the main reasons for death in the western world. Its prevalence follows the pattern of smoking habits. Despite extensive research efforts them is still no breakthrough in systemic therapy of advanced lung cancer. Nevertheless, long-term survival has steadily been increasing during the last decades. This review is focussing on recent progress in treating non-small cell and small cell lung cancer patients.
Epidemiology, screening, and prevention of lung cancer Petersen GM. Depmmtenr OfEpiduniology, JHSHPHOC, Johns Hopkins Sckol of Medicine, 615 North Wolfe Street, Baltimore, MD 21205. Curt Opii Oncol 1994;6:156-61. With an estimated 170,000 new cases and 149,000 deaths in the United States during 1993, lung cancer is now the leading cause of cancer deaths in both men and women. Tobacco smokiig isan important risk factor, and a large fraction of the risk can be. attributed to it. Other risk factors have been implicated, including environmental tobacco srnoke,occupationalexposureatocarcinogens,andgene.ticsusceptibility. Prevention of lung cancer through early detection and identification of individuals at risk is the goal of many recent studies. This review summarizes the current status of epidemiologic and biomarker research inundemtandingboththeetiologyandprognosticutilityofenvirrnnnental and host factors.
Overview on small cell lung m in the world: IndMrialized countries, third world, Eastern Europe Parkin DM, Sa&ranarayanan R. Unit of Descriptiw Epidemiology, lntemat Ageny Research on Cancer, 150, cows Albert lhomos. 69372 Lyon G&x 08. Anticancer Res 1994; 14: B 277-82. Lung cancer cases were abstracted from cancer registries in 20 countries to study the distribution of small cell lung cancer around 1985. The international patterns of small cell lung cancer resemble those of squamous cell tumors, and of lung cancer as a whole. Cigarette smoking andoccupationalri~factorsaremorestronglyaasociatedwithsquamous and small cell lung cancers than with adenocaminoma. Inspection of sex differences and time trends in incidence show some differences which may relate. to a higher risk for small cell lung cancer in female smokers than in males, and a less rapid decline in risk on smoking cessation.
Miscellaneous Biology of lung cancer Stahel RA. Division of Oncology, Department of Medicine, University Hospital, CH-8091 Zurich. Lung Cancer (Ireland) 1994; 1O:Suppl l:S59-S65.
small cell lung cnncer treatment Schuller MP, Lebeau B. Service de Pneutnologie, Hopital SaintAntoine, 184 Rue du Fbg Saint-Antoine, 75571 Paris Cedex 12. Med Hyg 1994;52:797-9.
Abstracts/Lung
Cancer II (1994) 423-444
IIldcellIlmg-,themliomodalityi8chemotherapy, unnbii with early thoracic radiation therapy for patients with limited diseasee. The precocity of the rwponse after initiating multimodality beatment is the mia prognosis tbctor. Patients with very limited small cell lung cancer (TNM stage I and II) can be managed by surgery. Association with colony stimulating factors can Ithe severity of oeutmpenicandinfectiousepiscdee. Themleofmaintenancetherapyby alpha interfemo in cliically disease tiw patients is suggwted.
Recentadv-
in diagnosis and treatment of small ceil and nonsmnllcelllungcancar Sorensen JB, Hansen HH. Department of OncoIogy, lke Finsen Center/ Rigsbospitaler. 9 Blegdamsvej. DK-2100 Copenhagen. Curt Opio Oncol 1994;6: 162-70. Despite much effort and many published reports, pmgrees in diagncsingandtmstinoglungzancer hasbeenslow.Theuseofmonoclonal antibodies for detection of metastasis and oeumendocrine markers for subclassification ofoon-small cell lung cancer into different prognostic groups may be useful in future staging and tmatment. Dose-intensive chemotherapy in small cell lung cancer is still experimental, which is alsothecaseforpmphylacticcranialirradiatioo.Adjuvantchemotherapy for completely rcsccted patients with non- small cell lung cancer may be associated with a marginal survival benefit, which also seems to hold true for patients with advanced disease when compared with untreated control subjects solely receiving supportive care. The modest survival benefit is achieved at the cost of increased toxicity. Neoadjuvant treatmentmmainsacootmversialissue, oneofthemajorpmblemsbeing the lack of an effective standard systemic therapy in non- small cell lung cancer.
Reviews Functlonnl status in women with lung cnncer Sarna L. School of Nursing, Uniwrsityof California, 10833 Le Conte Avenue, Los Angeles, CA 900246918. Cancer NW 1994;17:87-93. Lung cancer remains the number one cause of cancer-related death and the third most common csncer for women in the United States. The msjor purpose of this study was to describe physical hmctional status in a sample of women with lung cancer. Functional status was objectively measured by the Karnofsky Performance Status Scale, and subjectively by the Rand Physical Function Scale, and the Physical Function Subscale of the CARES-Short Form. A convenience sample of 69 women participated in a one-time data collection. The typical subject was <65 years of age, had lived with primary or recurrent lung cancer for > 12 months, had non-small cell limited disease, and was not curmntly receiving treatment. The most prevalent disruptions in physical function were reduced energy (59%), difficulty with household chores (33 %), and interference with work (28 46). A third of the sample had serious limitations in three or more activities. Approximately 26% of the sample had severe limitations in moderate activities, 20% in walking short distances, and 16 % in walking one flight of stairs. Only a quarter weresatisfiedwiththeirlevelofactivity. Physical functioowasdifferent by income category (one-way analysis of variance), with those with the lowest income having the poorest function.
current statusof lung cancer diagno& and mtment
in Shawhai Lip0 ML, Yang ZP, Ling ZQ, Gao YT, Gao RN, ZJwo W et al. Shanghai Chest Hospital, 241 Huai-haiRoad, Shanghai 2ooO30. Lung Cancer (Ireland) 1994 10/S-6 (333-338)
443
The status of diagnosis and treatment of lung cancers discovered duringlyeuintheShn~populationue~~.AtotPlof940 lung cancers was detected from inhabitants of 35-64 years of age, with a male/female ratio of 1.8: I. Pathology showed 35.7 % ademxcinoma and 35.1% aquamow c8ll caAnonu.Tbefewaaapredominauceof admocmiiorm (47.6%) in femalce and of squammm cell capGoomn (44.6%) in males. Most (68.6%) of the lesions dete&d werealreedy advanced in contrast to 14.7 96of Stage I disease. The needfor vigilance oothepartofdoctorswasdemonst&d by the fact that 23.3% of patients were seen by the doctor within 1 month after presenting with symptoms and 44.5 96 of them had their diagnosis suspected within 1 month after their first hospital visit. The treatment consisted of surgery for 33.3 96, chemotherapy for 35 96, traditional Chinese medicine for 20% and symptomatic management for 9.6% of patients. As only 55.8% Stage I patients were treated by surgery, the tmatment pmtocol seemed to be improperly biased. The adcqua@training ofhealth workers was shown by the t&t that 79.7 46 of these patients were confirmed by pathology and/or cytology and most of the Stage I lesions were diagnosed outside the hospital.
Evaluation of clinical elficacy of Ninjin Yoh-eito extract granules with special reference to the quality of life of lung cancer patients TsuburaE, NakajimaS, FuruseK, Iikegami H, FukuokaM, Nishikawa H. Department of Internal Medicine, OsakaHospital, Antituberculosis Ass. Osaka Branch, Osaka. Tlwr Res 1994;15:487-500. We investigated whether Niojin Yoh-eito, a Chinese medicine is clinically useful in impmving the QOL of lung cancer patients after consolidation chemotherapy. The clinical efficacy of this medication was evaluated by physician assessment of the signs and symptoms of the patients, self-asse3sment of the patients with regard to their symptoms (QOL), and the results of laboratory teats. Whereas the severity of PS, pain, dyspnea, cough, and production of sputa, which were assemed by thephysician-in-charge, worsenedover thecourseoftherapy, symptoms whicbwereammsedbytbepatientsthemselves, sucbasmood,anorexia, and malaise, clearly improved as treatment progressed. Significant increases in the red blood cell count, hemoglobin, and hematocrit were observed in the PS(O-1) group at the 4th, Sth, 16th and 20th week of the administration of Niojin Yoh-eito. Serum pmteins were significantly incmasedatthe4thandl6thweek,whilesemmalbumiowassignificantly increased at the 16th week of the administration of Ninjin Yoh-eito @ < 0.05 and p C 0.01, respectively). Reference values were established with regard to the results of the laboratory teats conducted at the initiation of this investigation. On the basis of these reference values the patients were divided into 2 groups, one showing normal and the other showing abnormal laboratory values. Impmv-ts in red blood cell count, hemoglobin, and hematocrit in the gmup showing abnormal laboratory values were observed after the 4th week. Improvement of the hematological picture noted after the ingestion of Nmjin Yoh-eito invariably leads to improvement of the general condition of the patients. It is further expected that improvement in the QOL will follow these positivechangeeinpati~tsbltusoccWlingasa~ltofUleadrninistration of this Chinese medication.
pulmonary cancer from the general prtxtitioner’s point of view: Experience from the health centm area of Kungsbwlca, Sweden ~&UWSOO J, Ikngtsson C. Heabh Centre of LovgaxIet, Vaniljgotan 28. S-424 45 Angered. Stand J Prim Hcaltb Core l%%l2:39-43. Objecri~ - To study the incidence of pulmonary CpllcBTin a conununity with special reface to the diagnostic procas~ and the mle of the general practitioner. Design - Study of the records of all patimts