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Soluble interleukin-2 receptor and soluble CDS antigen levels in serum from patients with non-resectable lung cancer V&-Petersen J, Tvede N, Diamant M, Amt Kjerulff A, Rahbck Sorensen H, Andersen V. Sfeno Memorial Hospira/, 2 Nit/s Steensens Vej. DK-2820Genfofe. Cancer Immunol Immunother 1991;33:121-7.

In a preliminary longitudinal study two women with histologically verilied adenocarcinoma of the lung, without simultaneous infectious or inflammatory conditions, were seen every 2 weeks until death. In one of the patients serum soluble interleukin-2 receptor (sIL-2R) levels rose progressively while the levels for the other patient increased during the second half of the observation period. Serum soluble CD8 antigen (sCD8 Ag) showed a pattern dissimilar to the one for sIL-2R. In a retrospective cross-sectional study circulating levels of sIL-2R and sCD8 Ag were measured before explorative thoracotomy in a total of 65 patients with histologically proven non-resectable carcinoma of the lung. The sIL-2R levels were significantly increased independently of histological subclassification while sCD8 Ag was increased only in patients with small-cell lung cancer. There was no correlation between pre-operative values and length of survival.

Allatoxins in sera from patients with lung cancer Cusumano V. Microbiology Institute, Faculty of Medicine, Piazza XX Setfembre, I-98100 Messina. Oncology (Switzerland) 1991:48:194-5.

Sera from patients with lung cancer and from healthy donors were screened for the presence of aflatoxins. Significant differences in levels of aflatoxins between the two groups were found. Only 1 of the neoplastic patients with aflatoxins in the serum was a smoker. However the percentage of sera from lung cancer containmg aflatoxins 1s not significant enough to provide evidence for a casual relationship he- tween aflatoxins exposure and development of lung cancer in humans.

Computed tomography distinction of central thoracic masses Woodring JH, Johnson PI. Deparrmenr of Diagnostic Radiology, Uni- versity of Kentucky Medical Center, 800 Rose Street, Lexington. KY 40536-0084. J Tborac Imaging 1991:6:32-9.

In an analysis of 36 central lung, 54 mediastinal, and 10 central pleural masses, features were sought that would allow accurate local- ization of the mass by CT. The mass-lung interface was the most useful feature: with few exceptions a mass with a spiculated, nodular, or irregular edge was in (he lung, and a mass with a smooth edge was in the mediastinum. In the superior mediastinal, supraazygos, and supraaortic regions lung masses were lateral to the great vessels, and mediastinal masses were medial to the great vessels. Anterior mediastinal masses were typically positioned between the sternum and great vessels: some were more laterally positioned, however, and could only bc distin- guished from lung masses by the mass-lung interface. In the infraazy- gas, infraaortic,andparaspinal areas, lung and mediastinal masses were best differentiated by the mass-lung interface. The angles formed between the mass and lung were occasionally helpful in localizing the mass. Central pleural masses were characterized by a lack of intimate mediastinal effect, obtuse angles between the mass and lung, a smooth mass-lung interface, and characteristic association with other similar areas of involvement in the pleural space. These criteria were used for thecorrectlocalizationof99of lOOmasses: therefore,theycansimplify and focus the work-up of most central thoracic masses.

Clinical evaluation oftive tumor marker assay in patients with lung cancer Mizushima Y, Tsuji H, Izumi S, Hirata H, Kin Y, Kawasaki A, et al. lstDepanmentoflnterna1 Medicine. ToyamaMedicalandPharmaceu- rical (iniversity. Toyama 930-01, Anticancer Res 1991: 11:91-5.

Five tumor markers (CAI9-9, CEA. NSE, SCC, TPA) were meas- ured concomitantly in the serum of 128 patients with primary lung cancer (LC), 148 patients with benign disease (B) and 43 normal volunteers. The positive rates for all the twnor markers were signifi- cantly higher in tie LC group than in the B group. When multiple tumor markers were quantitated, the specificity for the detection of lung cancer became lower although the sensitivity increased. However, this

negativepointwasmade upfortosomeextentbyevaluating thenumber of positive markers. In monitoring the clinical course, independent changes were observed in markers in some cancer paoents. These results implied that measuring multiple tumor markers was of climcal value in monitoring the clinical course of cancer patients as well as in assisting the diagnosis of lung cancer.

The diagnostic yield of bronchoscopy DierkesmannR.ZenrrumfurPneumologie undThoraxchirurgie, Klinik Schillerhohe. 7016 Gerlingen 2. Cardiovasc Inter-vent Radio1 1991;14:24- 8.

The endoscopic examination of the tracheobronchial tree 1s most helpful in the diagnosis and staging of bronchial carcinoma. Tumors that are endoscopically visible may he confumed in more than 95% of the cases. In localized peripheral tumors, the diagnostic yield of bmnchoscopy is significantly lower; for peripheral metastases, only about 10%. In diffuse interstitial pulmonary diseases other than malig- nancies, some infections,and histiocytosis X, bronchoscopy including trambronchial biopsy is less successful.

Theprognmticsignificanceofpretreatmentserumlactatedehydro- genase in patients with small-cell lung cancer Sagman U, Feld R, Evans WK, Warr D, Shepherd FA, Payne D, et al. Ontario Cancer Institute. 500 Sherbourne Sr, Toronto. Onr. M4X IK9. J Clin Oncol 1991;9:954-61.

Pretreatment serum lactate dehydrogenase (LDH) levels were as- sayed in 288 patients presenting with small-cell lung cancer (SCLC) between 1976 and 1985. Patients were routinely staged by physical examination,chestx-ray,bone,brain,andliverscans,andbonemarrow evaluation. Clinical response and survival were assessed following treatment with combination chemotherapy as part of four clinical trials. Patients with extensive disease (ED) presented with a higher incidence (108of 147.73%)ofabno~allyelevatedLDH(~ 193 IU/L.)thanthose (65 of 141.46%) with limiteddisease (P=2 x 104. Forty percent of patients had an initial normal LDH level and a higher response rate (89 of 108, 82%; complete response [CR], 47%) than those wth elevated values of LDH (1 I9 of 156, 76%: CR, 29%). ‘IIre CR rate varied inversely with the level of LDH in patients with LD (P= ,026) but not in those with ED (P = ,300). The median survival time and I-year and 2-year survival rates for patients with elevated LDH were 39 weeks and 33% and 6%. respectively, whereas for those with a normal LDH level these were 53 weeks and 54% and 16%. respectively. Patients with LD and elevated levels of LDH manifested a higher relative death rate (I .63: 1) when compared with patients with LD and LDH in the normal range (P = .0083). The survival of patients with ED did not differ between those with normal and elevated levels of LDH (P = ,273). A significant survival advantage persisted for patients with LDH in the normal range following adjustments for extent of disease, performance status (PS), and treatment protocol (P = ,044, log-rank analysis). In conclusion, serum LDH appears to be a significant independent pre- treatment prognostic factor in patients with SCLC that correlates with stage of disease, response to treatment. and survival.

Collateral pathways observed by radionuclide superiorcavography in 70 patients with superior vena caval obstruction Muramatsu T, Miyamae T, Dohi Y. Second Departmenr of Internal Medicine, Saitanu Medical School, 38 Moroyama. IrWna-gUn, Saitoma, 350-04. Clin Nucl Med 1991;16:332-6.

Schematic representations of collateral pathways that have devel- oped in association with superior vena caval obstruction have been established in studies using radionuclide superior cavography (RNSC). However, these were hampered by the poor resolution of earlier scintillation cameras. Using a modern scintillation camera, we per- fomxd RNSC in 7Opatients with obstruction of the superior venacaval system, and examined the differences in collateral pathways in the Presence or absence of obstruction of the azygos vein. RNSC visualized the site of obstruction and collateral pathways far more readily than in prior studies. When the orifice of the azygos vein was not obstructed,

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collateral flow drained into the azygos system. When it was obstructed, however. the collaterals drained into the inferior vena caval system. An importantcollateralpathway comprising the contraIatera1 brachioceph- alit vein and the jugular venous arch was also found, which has not previously been reported. Our diagrams of collateral circulation may provide a means of determining the site of obstruction in the superior vena caval system by RNSC.

Cardiac tampoaadeasanunasualpreseotationoflungraneer: Case report and review of the literature Huntsman WT. Brown ML, Albala DM. Depormenr of Surgery. Dartmouth-Hilchcock Medical Center, Hanover. NH 03756. Clin Cardiol 1991;14:529-32.

A case of cardiac tamponade as an unusual presentation of lung cancer and a review of the current literature are presented.

Surgery

Is there ever a role for salvage operations in limited small-cell lung cancer? Shepherd FA, Ginsberg R, Patterson GA, Feld R, Goss PE, Pearson FG, et al. Toronro General Hospiral, 200 Elizabeth SI., Toronfo, 0~. M5G 2C4. J Thorac Cardiovasc Sttrg 1991;101:196-200.

Combined modality treatment with chemotherapy and radiation produces tumor regression in most patients with small-cell lung cancer, but the impact on survival has been small, and less than 20% of patienrs with limited disease survive 2 years. Survival time is extremely short after failure to respond or relapse after treatment. Local control remains a problem, with one third of patients having recurrence only at the primary site. lnanattempt toprolong survivalandperhapsachievecure, we undertook surgical resection in 28 patients with limited small-cell lung cancer who did not have complete remission with standard treatment or who had only local recurrence after treatment. There were 28 patients, 22 male and six female, median age 61 years (range 41 to 76). All patients had been treated with chemotherapy and 13 had received preoperative radiotherapy to the primary site and medi- astinum. Eight patients underwent an operation for relapse after com- plete remission. Five patients had had no response to treatment, three had had a slight response followed by progression during chemother- apy, and 12 had achieved partial response but had greater than 3 cm residual masses. Twelve patients required pneumonectomy, IS lobec- tomy, one patient had unresectable disease, and two had bulky residual masses after the operation. Three others had microscopic residual disease. Pathologic examination showed only small-cell lung cancer in 18 patients, mixed small-cell and non-small-cell in four, and only non- small-cell lung cancer in six. There were only four patients with stage I disease, 10 with stage II, and 14 with stage III. The median survival from thedateofdiagnosis fortheentiregroup is 105 weeksandfrom the date of operation, 74 weeks. The projected 5.year survival rate is 23%. The two patients with residual masses died with local progression, and distant metastatic disease developed in 17 others. One patient died at 6 years without recurrent disease. Eight patients are alive 2 to 5 years after diagnosis. Seven of these patients required only a lobectomy, four had stage I disease, two had stage II, and two had stage III disease. Five had pure small-cell lung cancer and three had mixed small-cell and non- small-cell tumors. All of the patients with pathologic stage I disease remain alive compared with one of 10 with stage II disease and two of 14 with stage III. In summary, relapse or failure to respond to chemo- therapy may be due to non-small-cell lung cancer or a mixed tumor. A small number of patients with limited small-cell lung cancer without mediastinal node involvement may be cured by surgery after relapse or failure to respond to chemotherapy and radiotherapy.

Chemotherapy

a pharmacological strategy for circumvention of multidrag resis- tance in small cell lung cancer cell lines selected for resistance to doxorubicio Larsson R, Bergh J, Nygren P. Departmm ofClinicalPhnrmocology, Universiry Hospital, Uppsala University, S-751 85 Uppsala. Anti- cancer Res 1991;11:455-9.

The small cell lung cancer (SCLC) cell lines U-1285 and U-1690 were adapted to growth in continuous presence of doxombicin (Dox). The resulting cell lines U-1285R and U-1690R were investigated with respect to sensitivity to the glutathione (GSH) depleting agent buthion- ine sulfoximine (BSO) and the immunosuppressant cyclosporin A (CsA) as well as the Dox resistance modifying ability of these agents. The parental U-1285 cells were more sensitive to BSO compared to parental U-1690 and the multidrug resistant (MDR) sublines, whereas no difference in sensitivity to CsA was observed between parental and MDR lines. BSO (10 pM)orCsA (1 &ml) alone wereable to partially reverse Dox resistance in the MDR cell lines, CsA being only margin- ally active in U-1285R cells. However, the combination of these two drugs at the same concentrations completely reversed Dox resistance in the MDR U- 169OR cells whereas the combination was less effective in the U-1285R cells. The results demonstrate that a combination of low concentrations of BSO and CsA, only partially active by themselves in modifying Dox resistance, may be used as a pharmacological strategy to increase Dox sensitivity in wme MDR SCLC cells.

Neoadjuvaat chemotherapy of non-small cell carcinomas Pujol JL, Michel FB. Clinique des Maladies Respirafoires. Hopital 1’Aiguelongue. Rue du Major Flandre, F 34059 Monfpellier Cede*. F’resse Med 1991;20:418-22.

Lung cancer is frequent and serious. Squamous cell carcinomas, adenocarcinomas and undifferentiated non-small cell carcinomas ac- count for 80 percent of all lung cancers. Patients with one or the other of these carcinomas at the localized stage may benefit from complete and potentially curative surgical resection, but they represent only one quarter of all carcinomas. In patients with regionally more advanced carcinomas, notably when the mediastinal lymph nodes are invaded, sttrgicalresectiononly resultsina5 to 15 percentsuwival rateat S years. At this stage of lung cancer, an effective cytostatic treatment may impmve the survival rate, inasmuch as most therapeutic failures are due to metastatic progression. Neoadjuvant (preoperative) chemotherapy is now undergoing evaluation by controlled trials. This therapeutic suat- egy rests on two arguments: 1) patients treated with chemotherapy for locally advanced lung carcinomas may subsequently benefit from complete resection in over 50 percent of the cases: 2) neoadjuvant chemotherapy might sterilize the subclinical metastatic disease at the time of diagnosis. Studies are in progress to evaluate the effectiveness ofneoadjuvantchemotherapyin termsofsurvival.LJntilthefinalresults are available, this treatment cannot be proposed as a consensual therapeutic solution, but feasibility studies are encouraging.

Combination chemotherapy and interferon aZb in the treatment of advanced non-small-cell lung cancer Ardizzoni A,RossoR, SalvatiF,ScagliottiG, SoresiE,FemuaG.etal. Medical Oncology Deporfment, Isrituto narionale per la ricerca Su[ cancro, Viale Benedeffo XV, 10, 16132 Geneva. Am J Clin Oncol Cancer Clin Trials 1991;14:120-3.

Thirty-four patienrs with previously untreated advanced non-small- cell lung cancer were treated with a combination of polychemotherapy and recombinant interferon. Chemotherapy consisted of CYC~O-