LUNG CANcEa

Lung Cancer I1 (1994) 315-317 -a!&

IASLC Conference

A Summary of the 2nd Central European Conference on Lung Cancer

Ljlrbljana, Slovenia 13-16 April 1994

The 2nd Central European Conference on Lung Cancer was held in Ljubljana, the capital of Slovenia, on 13-16 April 1994, under the auspices of the International Association for the Study of Lung Cancer (IASLC), organized by the Slovenian Sur- gical Association, the Slovenian Respiratory Society, the Slovenian Cancerologic Association, and sponsored by the European Respiratory Society. One-hundred sixty-two delegates from 22, mainly European, countries attended the conference for 2 and l/2 days. The program contained 29 invited lectures, presented by 23 speakers from 11 European countries, 61 free papers and 22 posters prepared by 265 authors from 23 countries, even from as far away as Japan.

The first invited lecture was about the epidermiological features of lung cancer in Slovenia and in Europe. V. Pompe-Kim (SLO), director of the Cancer Registry of Slovenia (established in 1950), stressed that the incidence of lung cancer in Slovenia is still increasing in both sexes. The risk of lung cancer in men is almost 81100, in comparison with the Netherlands and Lower Silesia, Poland where the risk is about 1 MOO, and with Norway and Sweden where the rates are lowest at 3-41100.

B. Corrin (UK) showed some very interesting slides of pre-malignant lung lesions. These changes are widespread and there is a high incidence of double or second lung cancers; synchronous, 4% and metachronous, 6%. The patients most at risk of developing lung cancer are those who have had one in the past.

One of the plenary sessions was devoted to cyto-pathological themes with as many as 26 presentations in this field. G. Viale (I) stressed that the high incidence of lung tumors and their overall ominous prognosis have prompted several studies which have shown the deregulated expression of BLC-2 in NSCLC and of p53 and retino- blastoma susceptibility (Rb) tumor suppressor genes in pulmonary neuroendocrine tumors. These findings are promising for exploring carcinogenesis, and an important supplement to conventional microscopy for making the most accurate classification of tumors, for deciding on appropriate therapy and for prognosis. The first clinical aspect of the conference was presented by J. Schirren (D), a member of the Heidelberg team. He pointed out that surgery is the treatment of choice in non-small

0169-XXW94N7.00 0 1994 Elsevicr Science Ireland Ltd. All rights reserved SSDI 0169-5002(94)00363-R

316 2nd CECLCILung Cancer 11 (1994) 315-317

cell lung cancer (NSCLC) up to Stage III/a. Complete mediastinal lymph node dis- section is mandatory for radicality, exact staging and correct indication for adjuvant therapy. There is no place for video assisted thoracoscopic lung resections (VATS) for lung cancer. For surgical treatment of pulmonary metastases they advocate medi- an stemotomy, because this permits examinations of both lungs. Mediastinal lym- phadenectomy is also indicated for most histological types of pulmonary metastases.

L.K. Lacquet (NL) reviewed the results and prognostic factors of patients with un- suspected N2 NSCLC. He concluded that these patients benefit from complete tumor resection and mediastinal lymphadenectomy, especially if the resection can be limited to lobectomy for a central tumor, and he advocated an accurate pre- operative staging with CT-scan and mediastinoscopy for all potentially operable lung cancers.

P. Goldstraw (UK) discussed the problem of post-pneumonectomy empyema, a devastating complication that still occurs in 2-16% and raises mortality from 7 to 25%. He proposed individual treatment for each case ranging from drainage, irriga- tion of the pleural space, closure of the tistula, to myoplasty and omentoplasty. He did not recommend extensive thoracoplasty and an esophageal by-pass operation for esophago-pleural fistula.

While surgery is the treatment of choice for NSCLC patients with Stages I and II, controversy exists with regard to the optimal treatment of the more advanced disease (Stages IIIa, IIIb, and IV). J.B. Sorensen (DK) described his experience with the combination of the most promising chemotherapeutic drugs in such patients. The average response rate was about 20% and the overall median survival was increased by 50%, to 80%. Nevertheless, these results allow a cautious optimism; this kind of therapy is not advocated for routine clinical use, but justifies continued investiga- tions of multimodality programs as a means of finally improving the outlook of NSCLC.

P.A. Rocmans (B) advocated immediate adjuvant chemotherapy after complete resection of NSCLC if the rise of tumor markers, K-ru.r oncogene mutation and pep- tide growth factors are detected.

H. Osada (J) showed the results of pulmonary resections in 10 patients with im- paired pulmonary function (FEV 1,390-970 ml). He proposed limited lung resection for such patients with Stage I NSCLC disease, if they passed the one-flight step test pre-operatively.

One session was devoted to the treatment of small cell lung cancer (SCLC). Four invited lecturers informed delegates that the last decade has brought only modest im- provement in the treatment of SCLC, but several important questions have been answered, such as prognostic factors, place of surgery, optimal duration of chemo- therapy, combination of drugs and re-treatment policies. Everyone agreed with N. van Zandwijk (NL) who concluded that in order to assess reliably the relatively small gains of different treatment options, co-operative groups will continue to play an im- portant role in the f\lture.

The general opinion of the delegates was that this conference was a great success. Lung cancer is a multidisciplinary problem and the conference fulfilled its expecta- tions as a gathering for international collaboration in research and treatment and

2nd CECLC/Lmg Gnxer II (1994) 315-317 317

also for promoting education. The local organizing committee, under the leadership of J. Orel, tried to reach the ultimate goal of our efforts, which was to show the par- ticipants our country and its capital Ljubljana, to get to know each other better, to exchange views, to identify common problems, wishes and aims, to make new friends and to draw up many plans for future international professional and scientific collaboration.

Dr Stank0 Viahar