‘Tumour volume’ as a predictor of survival after resection of non-small-cell lung cancer (NSCLC)

275

Abstracts The diagnostic role of *“Tl SPET imaging in patients with lung turnours: Comparison with computed tomography Flares LG 11, Ochiai E. Nagamachi S et al. Department Radiology, Miwxki Medical CoNegr, 5200 Ohuzu Kihuru, Kiyotake. Miyaxki 889-16. Nuci Med Commun 1996:17:493-9. The aim of the study was to evaluate the use of ‘“‘Ti Single photon emission tomography (SPET) in differentiating histological types and lymph node sizes of lung tumours based on the early uptake ratio (EUR). delayed uptake ratio (DUR) and retention index (RI). We also wished to compare the effectiveness of “‘Ti SPET and computed tomography (CT) in detecting lymphadenopathy. We examined 41 subjects using both ‘“‘Ti SPET and CT. Fifty-seven lymph nodes were detected and were grouped according to size. The EUR. DUR and RI were determined and analyzed using Student’s t-test and a P-value < 0.05 was considered significant. Lymphadenopathy detected by both ‘“‘Ti SPET and CT correlated with the operative findings. There were no statistically significant differences in the EUR. DUR and RI between the various histological types. Statistically significant differences in EUR were noted between lymph nodes > 5 cm in size and those 3-5 cm in size, as well as between those < 3 cm and > 5 cm in size. A significant difference in DUR was seen between lymph nodes < 3 cm and > 5 cm in size. No significant differences were seen for the RI. The specificity, sensitivity and accuracy of ““Ti SPET were 81.3, 90.2 and 87.7% respectively, whereas for CT they were 82.3, 100 and 94.74% respectively. In conclusion, quantitative analysis with ‘“‘Ti SPET was unable to differentiate with accuracy between histological types but it could differentiate between nodes of varying sizes. However, CT had a better specificity and accuracy.

Surgery Surgical treatment of 125 chest wall involvement Pitz CCM. De la Riviere Bosch JMM. Depurtmrnt EM Nicuwgeir!. Thorax

patients

with

non-small

cell

AB. Elbers HRJ, Westermann of’ Pulmonology, Sint Antonius 1996:5 I :846&50.

lung

cancer

and

CJJ, Van den Hospitrrl, 3430

Background-The optimum operative procedure for lung cancer with chest wall invasion (T3) remains controversial. In this study results of en bloc resection and extrapleural dissection are reviewed to determine survival characteristics. Methods-Between 1977 and 1993 125 patients underwent surgery for primary non-small cell lung cancer with chest wall invasion. Patients with superior sulcus turnours, metastatic carcinomas. synchronous turnours, or recurrences were excluded. Extrapleural dissection was performed in 73 patients and en bloc resection (range l-4 ribs) in 52. Resection was regarded as complete in 86 and incomplete in 39 patients. Actuarial survival time was estimated and risk factors for late death were identified. Results-Hospital mortality was 3.2% (?I= 4). Estimated mean five year survival was 24% for all hospital survivors (n = 121). 11% for patients with incomplete resection, and 29% for patients having a complete resection. In patients who underwent complete resection mediastinal lymph node involvement and intrapleural turnout spill worsened the prognosis. Patients with adenocarcinoma had a better chance of long term survival. No relationship was found between survival and age, type of operative procedure. depth of chest wall invasion. and postoperative radiotherapy. ConclusionsBoth operative procedures show reasonable survival results. Incomplete resection, mediastinal lymph node involvement, and intrapleural turnout spill adversely influence survival. Relationship of early postoperative dysrhythmias after resection of non-small cell lung cancer

and long-term

outcome

Amar, Cancer 9.

Burt M, Reinsel RA. Lang DHY. Memorial Sloun-Kettering Ctr, 1275 York ALE, Nw York, NY 10021. Chest 1996;110:437-

Study objectives: To determine whether supraventricular tachydysrhythmias (SVTs) occurring early after thoracic surgery for non-small cell lung cancer (NSCLC) are associated with poor long-term survival. Design: Prospective. cohort. Selling: Referral cancer center. Patients: Seventy-eight patients undergoing resection of NSCLC. Interventions: Examination of univariate and multivariate effects of factors that might influence long-term survival: advanced age. sex. perioperative chemotherapy, extent of pulmonary resection, tumor stage, and SVT occurrence. Results: In this group of patients, IO of 78 (13%) developed early postoperative SVT. Log-rank analysis showed SVT occurrence (P = 0.01). age of 70 years or older (P= 0.041, and perioperative chemotherapy (P = 0.005) to predict poor long-term survwal. Multivariate Cox regression analysis identified SVT occurrence (P = 0.007; relative risk [RR], 2.8; 95Xconfidence interval [CI], 1.3 to 6.1) and perioperative chemotherapy (P = 0.004; RR, 2.6; 95% CI. 1.4 to 5.1) to be independently associated with decreased survival. No other clinical or laboratory characteristic tested differentiated those patients who did or did not develop postoperative SVT. Conclusions: Early SVT occurrence after resection of NSCLC is associated with poor long-term survival. Although the etiology for this is unclear. this intriguing observation. not previously reported (to our knowledge), may be used in larger trials examining the effects of these and other factors on survival from lung cancer surgery. Resection of single brain metastasis in non-small-cell lung cancer: prognostic factors Mussi A. Pistolesi M, Lucchi M. Seroizio di Chirurgia Torocico, Dipurtimmto di Chirurgia. via Roma 67, 86100 Pisu. J Thorac Cardiovasc Surg 1996:112:146-53. Combined resection of primary non-small-cell lung cancer and single brain metastasis is reportedly superior to other treatments in prolonging survival and disease-free interval. To identify prognostic factors that influenced survival we reviewed clinical records and follow-up data of 52 consecutive patients with non-small-cell lung cancer and single brain metastasis who had been evaluated for combined lung and brain operation: 19 had synchronous and 33 metachronous non-small-cell lung cancer and single brain metastasis. Seven patients were excluded from combined operation because of either early brain relapse after craniotomy or single brain metastasis localization in deep brain structures. Forty-one of the 45 patients who underwent combined operation had complete remission of neurologic symptoms. Actuarial 5-year survival from the second surgical intervention was 16% (median 19 months, range 1 to 104 months). NO status and lobectomy were the only variables associated with longer survival. Actuarial 5-year survivals in patients with synchronous and metachronous presentation were 6.6% and 19%. respectively. In patients with metachronous presentation the length of survival was significantly associated with NO status. lobectomy, and interval between lung and brain operation equal to or longer than 14.5 months. The subset of patients with NO status and interval between operations longer than 14.5 months had a 61% 5-year survival. None of the patients with Ni-2 disease and shorter interval between operations was alive at 20 months. These data indicate that prognostic factors may help to identity subsets of patients with markedly different outcomes after combined lung and brain operation. ‘Tumour volume’ as a predictor of survival after resection of non-smallcelI lung cancer (NSCLC) Jefferson MF, Pendleton N. Faragher EB, Dixon OR, Myskow MW. Horan MA. Uniu Department Geriufric Medicine, Unirersity Hospital

216 South Manchester, 1996:14:456-9.

Abstracts Nell

Lane.

Manchester

MZO 2LR.

Br J Cancer

Many factors have been individually related to outcome in populations of non-small-cell lung cancer (NSCLC) patients. Factors responsible for the outcome of an individual after surgical resection are poorly understood. We have examined the importance of ‘tumour volume’ in determining prognosis of patients following resection of NSCLC in a univariate model. Cox’s proportional hazard analysis was used to determine the relative prognostic significance of stage, patient age, gender, tumour cell-type, nodal score and estimated ‘tumour volume’ in 669 cases with NSCLC treated with surgical resection, of which 280 had died. All factors (except turnour cell-type, P = 0.33) were individually related to survival (PcO.05). When examined together, survival time was significantly and independently related to ‘tumour volume’ and stage (P < O.OOl), and other factors ceased to be significant. In cases with stage I or II rumours, risk of death was found to increase significantly with increasing estimated ‘tumour volume’ (23.8% relative increase in hazard of death per doubling of ‘tumour volume’, 95% confidence interval 13.2-35.2%, P < 0.001 stage I; P < 0.006 stage II). In cases with stage IIIa tumours this factor alone was the significant prognostic variable. In conclusion, an estimate of ‘tumour volume’ significantly improves prediction of prognosis for individual NSCLC patients with UICC stage I or II tumours. Ten-year survival Rainio P, Bloign Oulrc University Thordc Cardiovasc

after resection for lung carcinoma R. Satta J, Pokela P, Pdalcko P. Dept. of Surgery, Hospital, Kajuunintie SO, FIN-90220 Oulu. Stand J Surg 1996:30:87-91.

The ObJeCtiVes were to evaluate the prognosis in resected lung cancer and to observe if perioperative blood transfusion adversely affects the prognosis. Of 208 patients with resection for lung cancer in 1978& 1980. all but five were smokers: 127 had squamous cell and 81 non-squamous cell carcinoma. Stage I disease was found in 143 patients (69%/o), stage II in 18 (9%) and stage IIIa in 47 (23%). Five-year survival was 52”/;, in stage I, 29% in stage II and 7% in stage IIIa tumour; the respective IO-year rates were 37, 19 and 3%. Patients given periop-erative blood transfusion (n = 95) had poorer prognosis than the non-transfused patients. According to Cox multivariate analysis. however, the relative risk of death was only slightly increased by perioperative transfusion (P = 0.07). In patients with stage II or IIId carcinoma at diagnosis, this relative risk was 2.17 and 4.99 times higher than in stage I (P = 0.004 and P = 0.0001). Long-term survival thus was related to extent of the disease at diagnosis rather than to numbers of blood transfusions.

Chemotherapy Ifosfamide-based chemotherapy studies at the University of Vokes EE. Hoffman PC, Krauss SA. Depurtment of MC-21 /5, 5841 S Muryiand 1996:23 Suppl. 7:lS-8.

for non-small cell lung cancer: Phase I/II Chicago Masters GA, Golomb HM, Drinkdrd LC, Medicine. Univ. of Chicago Medical Center; Am, Chicago, IL 60637-1470. Semi” Oncol

Current chnicdl investigations in the palliative care setting for pdtients with non-small cell lung cancer are focused on new drugs and combinations. The goal of these studies is to identify more effective and/or less toxic therapy. At the University of Chicago, we have conducted phase I and II studies to integrate new single agents into novel combination chemotherapy regimens. Two such studies have combined the use of ifosfamide with either vinorelbine or paclitaxel. All these drugs have established single-agent activity in non-small cell lung cancer and a favorable toxicity spectrum. We describe the study rationale and design, and the preliminary data of these trials.

Non-small cell lung cancer: Meta-analysis McVie JO. Cancer Reseurch Campaign, NWJ 4JJ. Semi” Oncol 1996;23 Suppl.

of efficacy 10 Cambridge 7:12-4.

of chemotherapy Terrace, London

The recent me&analysis of 52 trials evaluating outcomes of nonsmall cell lung cancer patients treated with various modalities is discussed. From these data, three priorities can be proposed: (I) lung cancer physicians should alter their practices to include cisplatin-containing combination chemotherapy in their management protocols, (2) many more patients with lung cancer should be entered into clinical trials, and (3) the reporting of trial data, both response and toxicity data and quality of life assessments, needs to be improved. In addition, the poor outcome of non-small cell lung cancer patients, even those with the smallest volume of disease at the time of diagnosis, emphasizes the need for application of more aggressive treatments at the earliest possible stage of disease and the need for continued new drug development. Cisplatin-etoposide combination chemotherapy for small cell long cancer in elderly patients Yokozaki M. Nishiwaki Y. Nagai K. Diuision of Thoracic Oncology, National Center Hospital Eust, Kashhru. Jpn J Chest Dis 1996;55:54853. We examined retrospectively efficacy and tolerability of cisplatin etoposide combination chemotherapy (PE) for elderly patients with small cell lung cancer (SCLC) who were 75 years or older. These 8 elderly SCLC patients with performance status (PS) O-2 were compared with 18 SCLC patients who were younger than 75 years old, PS O-2 and also treated with PE. The characteristics of elderly patients; mean age: 76 years (75-80). male/female: 7/l. PS O/ll2:1/6!1. LDIED: 7/l. Those of younger patients: mean age: 65 years (36-73), male/female: 16/2, PS O/ l/2: 2/16/O. There were no significant differences in toxicity. compliance of the therapy, response rate (88; 78%) and survival. There was some delay in starting the third course in the elderly patients due to leukopenia. This study suggests that PE is effective and tolerable for selected population, even if patients are 75 years or older. Effect of timing of granulocyte-colony stimulating factor administration on Ieukopenia induced by systemic chemotherapy in patients with nonsmall-cell lung cancer--Multi-center randomized crossover study Katakami N, Hasegawa T, Umeda B et al. Department of’ Pulmonary Disease. Kobe Citv General Hospital, Kobe City. JPN J Thorac Dis 1996:34:520-g. Sixty-six chemotherapy-naive patients with non-small-cell carcinoma of the lung were given two courses of systemic chemotherapy consisting of mitomycin C. vindesine, and cisplatin. The effect of the timing of administration of granulocyte colony-stimulating factors (G-CSF) on the incidence of neutropenic fever. the nadir leukocyte count, the duration of neutropenia ( < lOOO/mm’), and the time needed for recovery from neutropenia was studied. Patients were assigned at random to begin receiving G-CSF (50 pm/m’, subcutaneously) either when the leukocyte count was less than or equal to 1000/n& (group 1) or when it was between lOOO/mm’ and 2000/mm’ (group II). in a crossover fashion. The nadir leukocyte count was lower in group I than in group II (359/mm3 and 121 S/mm’, respectively). The duration of leukopenia (defined as a leukocyte count less than or equal to 1000/mm3) was greater in group I than in group II (1.5 days and 0.8 day. respectively), as was the time needed for recovery to a leukocyte count of 2000/n& (1.9 days, respectively) (P < 0.05). No differences were found in the incidence of neutropenic fever (group I: 44”/0. group II: 45%). in the duration of fever (group I: 2.3 days, group II: 2.8 days), or in the duration of G-CSF use (group I: 6.3 days group II: 6.8 days). There