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Female patients with small cell lung cancer live longer than male patients. Johnson BE, Steinberg SM. Phelps R, Edison M, Veach SR, Ihde DC. National Cancer Inslilufe-Navy Medical Oncology Branch, Naval Hospital, Berhesda. MD 20814. Am J Med 1988;85:194-6.

The incidence of lung cancer is rising in women in the United States, and recent reports have suggested that female patients treated for small cell lung cancer have an improved survival compared with their male counterparts. In view of these findings, we decided to determine if, in our patient population, women live longer than men and if a higher proportion of female patients are entering our trials. Patients and methods: The survival of women entering therapeutic clinical trials for small cell lung cancer from 1973 through 1986 at the National Cancer Institute-Navy Medical Oncology Branch was evaluated and compared with the survival of similarly treated men during the same period. Results: The survival of female patients was longer than that of male patients (median of 13 months versus 10 months). Cox proportional hazards modeling incorporating multiple prognostic factors indicated that women survived significantly longer than men (p = 0.002) when adjustment for other significant factors was made. This survival advan- tage for women was consistent in both early and late time periods analyzed. In addition, women constituted a largerproportion ofpatients entering clinical trials in the later time period, as is consistent with the rising incidence of lung cancer in women nationwide. Conclusion: We believe it will be important that comparisons of current clinical trials with older trials that enrolled fewer women control for the favorable prognostic factor of the female sex.

Usefulness of the tumor markers NSE, CEA and SCC as a diagnostic tool in suspected bronchial carcinoma? Jany B, Fischbach W, Chowanetz W. Medizinische Poiiklinik der Universitat, D-8700 Wurrburg. Med Klin 1988;83:1214.

69 consecutive patients with suspected bronchial carcinoma were investigated. Before undergoing fiberoptic bronchoscopy serum samples were taken and tested for the tumor markers NSE, CEA and SCC. In 27 patients bronchial carcinoma was diagnosed, while eight patients suffered from primary non-pulmonary malignancies. In the other 34 patients a malignant tumor could be excluded. 14/16 patients with elevated serum NSE, 13/18 patients with pathological CEA levels, and 8/15 patients showing raised SCC concentrations had a bronchial carcinoma. In three patients with normal tumor markers a localized central carcinoma could be diagnosed by fiberoptic bronchoscopy. No patient with normal serum markers and negative bronchoscopy showed evidence of lung cancer during the follow-up period. Six patients with negative bronchoscopy but at least one of the analysed markers elevated revealed bronchial carcinoma as finally diagnosed. We conclude that combinationofNSE,CEAandSCC canbeusedasanadjunctdiagnostic aid in patients with suspected bronchial carcinoma.

Localization of human malignant tumors with radioiodinated re- combinant tissue plasminogen activator. Karonen S-L, Aronen H, Liewendahl K, Nikkinen P, Mantyla M, Lindgren J. Division of Nuclear Medicine, Departmenr of Clinical Chemistry, Helsinki University Hospital, 00290 Helsinki. J Nucl Med 1988;29:1194-9.

Human recombinant tissue plasminogen activator (tPA), labeled with “‘I(1 .l to 6.2 mCi) by the iodogen method, was administered intrave- nously to 15 patients with various soft-tissue malignant tumors after blocking of thyroidal radioiodine uptake. Gamma camera imaging was performed 4 and 24 hr after injection; three patients were also imaged 5 days following injection. We observed accumulation of radioactivity in primary and secondary lesions in 11 patients. In this preliminary study we did not detect any definite association between the magnitude of

uptake and type of tumor. Tumors were usually visualized already after 4 hr but the uptake was more intense at 24 hr. The target-to-nontarget ratiosat24hr.determined bycomputeranalysisofstoredimages,varied from cl.2 to 2.1. This is the first demonstration of accumulation of radiolabeled tPA in malignant tissue. We do not know the mechanism of the uptake but because tPA is known to be avidly bound to fibrin, a component of the stroma of many malignant tumors, it is possible that [“‘lItPA is bound to fibrin rather than taken up by the malignant cell; various possible cell uptake mechanisms are discussed. Due to the relatively early maximal uptake of this radiopharmaceutical it will be possible to substitute ‘23I for 13iI, a possibility suggesting a potential clinical use of radioiodinated tPA for the detection of malignant tumors of various origin.

Cutireaction with ubiquitous antigens as a survival test in patients suffering from inoperable bronchogenic carcinoma. Giorgis GE, Oliaro A, GaIietti F, Barberis S, Ardizzi A, Gallo E, Onoscuri E. Universita di Torino. Torino. Minerva Med 1988;79:447- 9.

Fifty-three patients suffering from inoperable, non-micmcytoma, bronchogenic carcinoma in which a cutireaction with ubiquitous anti- gens (tetanus, diphtheria, streptococcus, tuberculin, proteus, trichophyton, candida) had been carried out were followed up to check on the possible relationship between cutireactivity and survival period. Asignificantcorrelation wasfoundbetween thedegreeofpositivityand duration of survival, with mean survival values greater than 69.1 weeks being observed in patients positive to live or more antigens. Among preliminary tests, it would therefore appear that cutireaction with ubiquitous antigens may provide indications for predicting survival.

“Co-bleomycin scintigraphy for the preoperative detection and staging of lung tumors. Frederiksen PB, Christensen JB, Vejlsted H, Rasmussen JW, Pedersen B, Edeling C-J. DepartmenrofCardiothoracicSurgery, Odense Univer- sity Hospital, Odense. Nucl Med 1988;27:79-82.

Twenty-five consecutive patients with lung tumors were classified according to the presence of metastases by the use of 57Co-bleomycin scintigraphy. Twenty-two of the tumors were visualized but metastatic spread to hilar lymph nodes was not detected. Reliable separation of central tumors with and without growth into neighbouting organs was not possible. MediastinaI uptake was found in eightcases but only apart of these could be verified by operation. The method can contribute to the evaluation of lung tumors and can be helpful to avoid some unnecessary thoracotomies.

Diagnostic validity of the SCC antigen assays in squamous cell carcinoma of the lung. Ebert W, Kayser K, Buelzebrnck H, Vogt-Moykopf I.Thoraxklinik Heidelberg-Rohrbach. 6900 Heidelberg. J Tumor Marker Oncol 1988;3:35-44.

Squamous cell carcinoma (SCC) antigen levels were measured in 145 patients with lung cancer prior to treatment and in 92 patients suffering from benign lung diseases using SCC-RIA. The percentage of positive cases (>2.5 &ml) was found to be 76.6% in SCC, 24.2% in adenocar- cinema, and 3.7% in small cell anaplastic carcinoma. The rate of true negatives(specificity)wascalculated96.7%.PretreaunentSCCantigen levels correlated with the stage of disease in SCC. Elevated values were found in 44.4% of stage Tl patients, in 73.7% of stage T2 patients, and in 93.1% of stage T3 patients. All patients with distant metastases (Ml) showed SCC antigen values above the cut-off level. SCC antigen assay is a useful tool for the monitoring of the effects of therapy for SCC. Elevated SCC antigen levels rapidly fell to normal within 48 hours after