Abstracts/Lung Cancer 12 (1995) 265-329

who have achieved a complete rcsponsc to chemotbcmpy with or without thorn&c radiation therapy (TRT). Mefhods: Bctwccn 1975 and 1990, the Mayo Clinic and North Central Cancer Treatment Group entered 1,617 patients on 15 phase II and III SCLC protocols of chemotherapy with or without TRT and PCI. Results: Of 772 patients with limited discasc, 457 (59%) achieved a complete rcsponsc, compared with 200 of 845 patients (24%) with extensive disease. With follow-up durations of 2 to 17 years (median, 4), the median survival time and 2-, S-, and IO-year survival rates for the 457 completely responding limitcd- discasc (LD-CR) patients wcrc 19.6 months. 41%, 17%, and 5%, compared with 13.9 months, 26%, 8%. and 5%. respectively, for the 200 completely responding extensive discasc (ED-CR) patients (P = .OOOl). Multiple prognostic factors, including whether the patient did or did not rcceivc PC1 (30 to 38 Gy in 2- to 3.6- Gy fractions) were analyzed. In both univariatc and multivariatc analyses, PC1 was not associated with improved (or worsened) survival. The brain relapse rate was 37% for LD-CR patients who did not receive PC1 versus 9% for those who did (F’ = .oOOl). In ED-CR patients, the brain relapse rate was 31% without PC1 and 8% with (P = ,009). Essentially all patients who developed brain relapse died within 2 years, with a median survival time of 3.7 months following relapse. Severe, life- threatening, or fatal CNS toxicity occurred in appmximatcly 3% of patients who received PCI. Conc/wion: The use of PC1 remains contmvcnial outside the setting of a clinical trial.

l%erdeofradiotherapyio thetreatment ofstageIIInon-cannll eelllung cancer: A tasrvey ofclinkd practices in Lombardy, Italy, by the Ai* LombardiaC~Grmp Palazzi M. Valda8ni R. Poli M. Buffoli A. Leoni M. Vavassori V et aI. Divisicme di Radiotempia C., Istihtto Nariatole Tumori, l% Venezian 1. 20133 Milan. Tumori 1994,80:286-9.

Aim and background: The role of radiotherapy in the treatment of stage III non-small cell lung cancer is controversial. The aim of this survey was to investigate the use of this modality in cumnt clinical practice in Lombardy, a highly industrialized region of northern Italy. Mcrhods: A questionnaire was sent to all 13 radiothcmpy centers in Lombardy, covering statistical, clinical, technical and stmte8ical aspects, and the responses were analyzed. Results: A tide mgc of attitudes was observed among participating radiation oncologists; the percentage of casts titcd with curative intent varied largely between centers (4-IOO%), Bs did the proportion of patients given to radiation only rather than combined modality treatment (S-LOO% vs O-90%). Conclusions: An urgent riced exists for better coopcrati3n bchvcctt all cliiicims involved in lung cancer bcetment, pursuing the goals ofa more uniform clinical practice and a mote aggressive clinical mscamh attitude.

The bronchoscopic brachytberapy in early stage lung cancer of Mar trpe One R, Hirano H, Kaneko M. Jpn J Clin Radio1 1994;39: I 117-26.

The bronchoscopic brachytherapy is a new technique being presently invcstigatcd for the trcatmcnt of cancer involving the tracheobronchial tree. This paper reports the potential application of the bronchoscopic brachytherapy in the local treatment of cancer in the respiratory tract. The bmnchoscopic brachythcrapy was pcrformcd on the 17 patients with rocntgenographically occult lung cancer having biopsy proved I7 malignant lesions of the trachea and bronchus. Those patients came to tbc National Cancer Center Hospital during the period from Septcmbcr 1992 to December 1993.

Radiotherapy pbuudng for lungcaucerz Can we do better? Atkinson CH, Hamilton CS, Wynne CJ. Deparment of Radiation Oncolo~, Newcasde Mater Misericordiae Hosp., War&ah, NSW 2298. Australas Radio1 1994;38:303-4.

Modem radiotherapy planning and treatment techniques allow the delivery of treatment with considerable geographic and dosimetric precision. Uncertainties and variability in the radiotherapy process prior to this stage. that is, localization of the target volume, has received little systematic study. The results of a planning study in non-small cell carcinoma of the lung are presented to highlight the possible variability in the planning process, both at an inter-clinician and intraclinician level. The implications of this survey, both in terms of treatment outcome and training issues, are discussed.

Changes in plasma TGFE levels during pulmonary radiotherapy as a predictor of the risk of developing radiation paeumonitis Anschcr MS, Muwc T, Prescott DM, Marks LB, Rcisenbichler H, Bcntcl GC. Deporbnmt ofRadiation Onco/ogv. Duke Universi~Medical Center Box 3085. D&am. NC 27710. In1 J R&at Chxol Biol Phys 1994,30:6716.

Purpose: To determine whcthcr plasma transforming growth factor-8 (TGF- 0) lcvcls mc.wwcd bcfon and during radical radiotherapy for lung cancer could be used to predict paticnts at risk for the development of radiation pneumonitis. Mehds andMoferia/s: The tint eight patients with lung cancer (nonsmall cell: seven, small cell: one) cnmllcd in a prospective study designed to evaluate physiological and molecular biologic correlates of radiation induced normal tissue injury arc described. The study began in Juno 1991. All patients were treated with radiotherapy with curative intent. Plasma transforming growth factor-8 lcvcls were obtained before, weekly during, and at each follow-up after trcatmcnt. Prctrcatmcnt pulmonary function tests and single photon omission computed tomography scans were obtained to assess baseline lung function and wcrc rep&cd at follow-up visits. Dosbvolume histogram analyses were pcrformcd to dctcrminc the volume of lung which rcceivcd 30 Gy. Patients wcrc assessed at each follow-up visit for signs and symptoms of pncumonitis. Resulfs: Five patients dcvclopcd signs and/or symptoms of pulmonary injury consistat with pncumonitis and three patients did not. In all three patients not developing pncumonitis, plasma TGF-8 lcvcls normalized by the end of radiotherapy. In contrast, four out of five patients who suffered pneumonitis had pcmistcntly elevated plasma TGF-8 lcvcls by the end of therapy. This finding appamd to be indcpcndcnt of the volume of irmdiatcd lung. Conclusions: Those results suggest that plasma TGF-8 lcvcls during trcatmcnt may be useful to detumii whiih patients arc at high risk of developing symptomatic pncumonitis following thomcic radiotherapy. This finding may have implications when planning additiolul therapy (either chcmothcmpy or mdiotbempy) which may h.VC p&h”,’ dvn& CO”Sq”C”aS 0” th0 hg.

Combined treatment modalities

Ikahaeatofsmalleell~gcnncerwithcombmedmodnlitytrcPtmeot Hiram A. Depmbnm: ofIn&malMedicine. Jikei Unimsiry SchwlofMedicine. Minofo-ku, T+ 105. Tokyo Jikcikay Mcd J 1994,109:133146.

Behvcen November 1981 and December 1989. hvcnty-three patients with small cell lung cancer rcccived a chemotherapy with or without chest irradiation. A combination chcmothcrapy cons&d of vincristinc (VCR), etoposide (ETP), and cyclophosphamidc (CPM) (VEC rcgimcn). After hvo courses ofthc aggressive induction chemotherapy which employed doubled doses of ETP (high-dosc- VEC; HD-VEC), major responders were irradiated to their thorn& lesions at the dose of 30 gray concurrently with VEC chemotherapy (standard dose-VEC; SD VEC). Non-responders were switched to a salvage chemotherapy employing cisplatin and vinblastine (PV regimen). Complete responders then received prophylactic total brain irradiation. Of the hvcnty-three patients, the response rate was 91% with 7 complete responses (30%) and 14 partial responses (61%) end the median survival time was 15.7 months (range 1.2 - 55.5+). The survival time was signiticantly longer in the patients with limited disease (LD), 19.7 months (7.5 - 55.5+) than in those with extensive disease (ED), 9.6 months (I.2 - 21.7) and the r&c of three year disasc fret survival was also higher in LD patients (28.6%) than in ED (0%). Leukocytopenia was a dose limiting toxicity with 82.6% of grade III and IV and other toxicities were acceptable. These results meet the ‘State of the AII for Chemotherapy’ reviewed by the workshop under the auspicces of the International Association for the Study of Lung Cancer, however, further study is warranted to develop II more active strategy for small cell lung cancer.

Randomizedtrialofhyperfrxtionated radiationtberapytiti~orwithout concumnt chemotherapy for stage IIl non-small~ell lung cancer Jcremic B, Shibamoto Y, Acimovic L, Djuric L. Depormmr ofOnco/opv. Chesf Disease Research Insfilute, Kyoro lJniversi@ Kyoro 606-01. J Clin Oncol 1995;13:452-8.

Purpose: To investigate the cffwacy of combined hypafractionated radiation therapy (HFX RT) and concurrent chemotherapy (CHT) in stage IIIA or IIIB non-small-cell lung crmcer (NSCLC) compared with that of HFX RT alone.