Surgery for brain metastases from nonsmall cell lung carcinomas and tissue cultures from the resected specimens

Abstracts/Lung

Cancer

Resection of lung cancer is justitied in higb-risk patients selected by exehr oxygen consumption Walsh GL, Morice RC, Putnam JB Jr. Nesbin JC, McMurtrey UT, Ryan MB et al. Depr Tboracic/Cwdi?nwxulor Surgny, MD Anderson Cancer Centi Box 109,l515 HolcombeBhd., Hm&on. TX 77030. Ann Thorac Surg 1994;58:70411. The medical criteria for inoperability have ban difficult to define in patients with lung cancer. Sixty-six patients with non-small cell lung cancer and radiographicaliy reseetable lesions were evaluated prospectively in a clinical trial. The patients wcrc considered by cardiac or pulmonary criteria to bc high risk for pulmonary resection. If cxcrcisc testing rcvcalcd a peak oxygen uptake of 15 mL ” kg’ ‘. mirr’ or greater, the patient was offered surgical treatment. Of the 20 procedures pe&rmed. nine wcrc lobcctamics, hvo were bilobcctomics, and nine were wedge or segmental rcscetions. All patients wcrc cxtubated within 24 hours and discharged within 22 days atIer operation (median time to discharge, 8 days). There were no deaths, and complications occurred in 8 (40%) of the 20 patients. Five patients whose peak oxygen uptake was lower than I5 mL - kg! .’ “in” also underwent surgical intervention; thcrc was one death. Thirty-four patients whose peak oxygen uptake was less than I5 mL ” kg-’ “in” and 7 who declined operation undcrwcnt radiation therapy alone (35 patients) or radiation therapy and chemotherapy (6 patients). Thcrc wcrc no treatment-related deaths, and the morbidity rate was 12% (S/41). The median duration of survival was 48 f 4.3 months for the patients trcatcd surgically and I7 -t 2.7 months for those trcatcd medically (p = 0.0014). We conclude that a subgroup of pstients who would be considered to have inoperable disease by traditional medical criteria can be selcetcd for operation on the basis of oxygen consumption cxcrcisc testing. Them is a striking survival benefit to an aggressive surgical approach in these patients.

Preoperative risk evaluation for lung cancer postoperativeproductasaprediirofur@calmortality

resection:

Predicted

Pierce RJ, Copland JM, Sharpc K, Barter CE. Deporfmenf ofRespir&wy Medicine, HeidelbrrgReporriation Ho@&/. Heidelbrrg. fir. 3081. Am JRespir Crit Care Med 1994,150:947-55. We asscsscd the capacity to predict surgical mortality, complications, end functional loss by using the results of resting and cxcmise respiratory function. Mcasurcments were made bcforc and 4 me after lung nscetian in 54 eonsccutivc patients with bronchogcnic carcinoma. Prcdictcd postoperative (ppo) FEV, and DL(C0) were derived using quantitative lung perfusion scans when baseline WV, was < 55% prcdictcd, and by proportional loss of pulmonary scgmcnts (total = 19 segments) when FEV, was > 55% prcdictcd. The patients were aged 67 -t 7 (“can f SD) yr, with an FEV, of 76 * 23% predicted, FEV,ffVC of 55 i 13%, and DL&O) of 85 * 22% predicted. Eleven of the patients had pncumonectomy, 29 had lobcctomy, I2 had wedge rcseetion, and two had no resection. Wilcoxon and stcpwisc logistic regression analyses were used to determine which indices best predicted outcome. Postoperative values were comlated (r = 0.87, p < O.OOOl) with actual 4112 postopcrativc values ofFEV,% and of DL(C0) (r = 0.56, p < O.ooOl). The best prcdicton (all p < 0.05) for each outcome, in order of usefulness, wcrc as follow. For surgical mortality: (1) the prcdictcd postopcrativc product (PPP) of ppo FEV,% x ppo DL(CO)%, (2) ppo DL(CO)“/.; (3) ppo FEV,%, and (4) RV, FRC, and Sa(O?) on the maximal step cxercisc test. For respiratory complications: body mass mdcx (BMl) (for patients undergoing lobectomy or wedge resection only). For cardiac complications: (1) age; (2) Sa(0,) at baseline and on the maximal step exercise test, (3) Pa(0,); (4) Pa&O,); and (5) minute ventilation at maximal cxcrcisc. For surgical complications: (I) DL(CO)%; (2) ppe DL(CO); (3) BMI, (4) maximal work rate on the step test; and (5) Borg score for leg discomfort on the cycle test. For respiratory failure: (I) 6- min minimal walking distance (6MWD); and (2) dccrcascd Sa(0,) on exercise. All complications: Pa(COz). The PPP was < 1,650 in six of eight deaths and in five of 44 survivors, and % 1,850 in seven of eight deaths and five of 44 survivors in the first 2 pmtoperetive months. Prediction equations were derived on the basis of the best predictors of survival and complications. The best predictor of surgical mortality was PPP.

Surgery for brain metastases from nonsmatl cell lung carcinomas sod tissue cultures fmm the resected specimens Kodama K, Doi 0, Higashiyama M, Yokouchi H, Nakagawa H, Mori Y. Deporbnmt of Thwack Surgery. Cenrer for Aduh Diseases, 3 Nakamichi Ichome, Higashinori-ku. Osaka 537. J Surg Oncol 1994;57:121-8. Behuccn 1978 and 1989, 44 patients underwent 44 thoracotomies and 55

12 (1995)

265-329

craniotomics for nonsmall cell lung carcinoma (NSCLC) and its brain mctastases. Patient ages ranged from 20 to 75 years. There wcrc no intraopcrativc mortalities. The 2-, 3-, and S-year survival rates following the initial craniotomy were 23%, 10%. and IO%, respectively. Patient survival did not differ with respect to solitary or multiple metastascs or the sequence of surgery for primary lesion and brain metsstases. Moreover, there was no significant difference in survival bchvcen patients trcatcd by surgery alone and those receiving surgery followed by whole brain radiotherapy. A&r 1985, in vitro tissue culture was ancmptcd using freshly rcscctcd specimens of brain m&stases obtained from 30 consecutive cases. Of those specimens, nine (30%) were successfully established as permanent cell lines. Eight of those cell lines revealed DNAancuploid pattern on flow cytometric analysis. The remaining cell line was not analyzed. Karyotypc analysis was also performed in eight of nine established cell lines. Two adenocarcinoma cell lines showed the prcscncc of +3pchromosome, and three showed +7q- chromosome as recurrent chromosomal abnormalities. These findings provide new evidence concerning the presence of 3p- and/or 7q- marker chromosomes in certain adenocarcinoma cell lines established from brain mctastascs. The prognosis was poorer in the group with in vitro tumor growth than that in the group showing no in vitro tumor growth. These ccl1 lines established fmm brain mctastases may bc useful materials not only for studying the biological characteristics and chemo-sensitivity testing, but also for estimating prognoses after resection of brain metastases.

Surgery

for bmochogenic

cancer

in patients

75 and over

Manac’h D, Riquct M, Dujon A, Le Pimpcc-Barthes F, Dcbmssc D, Debcssc 9. Service de Chinrrgie Thoracique, Hopi& Leennec. 42, Rue de Sewes, 75007 Paris. Rev Pncumol Clin 1994;SO: 155-9. From April 1984 to December 199O,66 patients 75 years of age or older underwent curative mcdiastinal lymph node dissection. There were 37 pneumonectomies. Post-operative moriality was 12% and was not affcctcd by the type of dissection. Five-year survival was 16.2*6.29% (median 23 months) and was more than 45% in less elderly patients. Survival rate was highly affected by pnscncc of metastasis in the mcdiastinal nodes and was zero in N2 casts. More than half of the patients died from cancer-related causes. Gcncrally, WC operate all the N2 casts which appear technically dissectable. Restrespectively, WC think that N2 stage dot&al, and confirmed histologically in patients over 75, would be the only contra-indication for this attitude.

Chemotherapy Phase II trial of a 75mg/m’ dose of docetuel with prednisone medication for patients with rdvaoced non-smaUcellhmgcancer

pre-

Miller VA, Rigas JR, Francis PA, Grant SC, Pistcrs KMW, Vcnkatraman ES et al. MonorialSlwn-Kerg Cancer C&, 1275 YorkAvenue. New York, NY 10021. Cancer 1995;75:%8-972. Background: A prior Phase II study of a LOO-“g/m’ dose of docetaxcl conducted et the Memorial Sloan-Ken&g Cancer Cmtcr (NOW York, NY) dcmonstratcd a 38% response rate with grade 3 or 4 neutropenia in 76% of the patients and a grade 2 or grcatcr rash or infusion-r&cd reaction in 41% and 34% of the patients, respectively. The current Phase II study sought to determine the activity of a 75-“g/m* dose of docctaxel to establish whether this lower dose, combined with prcdnisonc, amclioratcs toxicity. Merhods: Twenty untreated patients with advanced non-small cell lung cancer (NSCLC) received a l-hour 75“p/m’ dose of do&axe1 every 21 days. Fifty milligrams of prednisone were administered twice the day bcforc chemotherapy and once each of the next 3 days. Patients’ disease-r&ted symptoms were asscwd prospectively using the Lung Cancer Symptom Scale (LCSS). Resulti: All patients wcrc assessable for response and toxicity. Five patients had a major objective rcsponsc (25%; 95% confidence interval. 1l-SO%). The median duration of rcsponsc was 9.1 months. The pmjcctcd I-year survival was 71%. Grade 3 or 4 ncutmpcnia occurrod in 70% ofthc patients. Grade 2 or grcatcr rash and infusion-nlatcd reactions deer-cased to 25% wh. Analysis of the LCSS mcasuremenlx found that six of nine component symptoms improved on Day 22, and all improved when baseline mcasurcmcnts were compared with fhe best value for each patient during the study. ConclunonS: Dwetaxel administered at a dose of 75 mp/m* cvcry 21 days shows significant antitumor activity in untreated patients with NSCLC. Ncutmpcnia is comparable