Abstracts/Lung Cancer I2 (1995) 265-329

Lipid pneumonia and associated broochi~ahwlar carcinoma Breton JL, Jeffredo Y, Ranfaing E, Clement F, Faure E, Gamier G. Service de Pneumologie, CHG. 14, Rue deMulhouse. F 90000 Be-l/or:. Rev Mal Respir 1994;11:596-8.

The authors report a new case of bmnchio9lveolarcarcinoma which developed on a background of iatrogenic exogenous lipid pneumonia; this association is extremely rare (less than 20 cases in the literahue) and poses the problem of possible cancer developing in the centre of the lipid pneumonia.

MR imaging of bmnchogeaic carcinoma Zhang Z-Q. 2nd Hospiral, Tionjin Medico/ Universi& Tionjin. Chin J Clin Oncol 1994~2 1:894-7

Sixty-eight patients with bronchogenic carcinoma were studied with MR imaging. Comparison was made between h4RI. CT and chest plain radiographs. It was shown that MRI was superior to CT and plain films in demonstrating cancer invasion of chest wall and great vessels IIS well as in detecting media&al lymphnode metastasis

Measurement of cytokeratin 19 fragments as a marker of lung caocer by CYFRA 21-1 enzyme immunoassay Taksda M, Masuda N, Matsuura E, Kusunoki Y, Matui K, Nakagawa K et al. Deporbnenf of Internal Medicine. Osaka Prefeclural Habikino Hospital, 3-7-I Habikino, Habikino. Osaka 583. Br J Cancer 1995,71:160-S.

Soluble cytokeratin fragment 19 levels were measured with an enzyme mununoassay method developed by Boehringer Mannheim (Enzymun-Test CYFRA 21-l) in the serum of 185 patients with lung cancer [I49 with non- small-cell lung cancer (NSCLC) and 36 with small-cell lung cancer (SCLC)] and 97 patients with benign lung diseases in order to determine its clinical usefulness in the diagnosis of lung cancer and follow-up of treatment. We used the cut-off value of 3.5 ng ml-‘. established by the Japan CYFRA research group. This cut- off value is based on calculations using the receiver operating characteristic approach instead of using the 95% specificity approach recommended by other authors. The resulting sensitivity and specificity for the group of all lung cancer patients were 65.4% and 84.5% respectively. The sensitivity was highest (76.1%) for squamous cell carcinoma and lowest (44.4%) for SCLC. For NSCLC patients, when CYFRA 21-l levels were analysed by node (N) factor, patients who presented with media&ml lymph node metastasis (N2 or N3) demonstrated higher serum CYFRA 21-l levels (5.6; interquartile range 3.2-l 1.5 ng mt’) than patients without mediastinal node metastasis (NO or NI, 3.9: interquartile range 2.2-10.0 ng ml-‘; Mann-Whitney U-test, P = 0.0373). We compared the discriminatorypowerofCYFRA21-I with that ofother tumourmarkersincluding carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC) and neuron-specific cnolese (NSE). The area under the curve (AUC) of each ROC curve was calculated using the CLABROC program for statistical analysis. CYFR4 21-1 appeared to have the most discriminatory power of the markers tested in the diagnosis of lung cancer. In serial measurements of 14 patients receiving chemotherapy or radiotherapy, a high degree of correlation was noted behveen serum levels of CYFRA 21-l and extent of clinical response (Wilcoxon, P = 0.0093).

CYFRA214:Anewtumormarkerforlungcamxr? Lequaglic C, Marina P, Maioli C, Preda F, Ravasi G. Isfirufo Norion& Tumori, tiia Venetian 1. 20133Milan. Oncol Rep 1995;2:119-22.

Among 20 known cytokeratins, cytokcratin fragment I9 is a 40 kD acidic molecule whose distribution is restricted to simple or pseudo-stratified epithelia, such as the epithelial layer of the bronchial tree. An immunoradiometric assay. CYFRA 21-1, was used to detect a fragment of cytokeretin 19 in the serum of 90 subjects and compared with serum levels of CEA, NSE and TPA. Sixty-seven consecutive patients with lung cancer and 23 healthy subjects were tested. Cut- off velucs for tumor markers were considered as the 95% of specificity versus controls. There were 32 sdmocarcinomas, 29 squamous carcinomas and 6 other hmors. Increased serum levels ofCYFRA 2 l-l were found in lung cancer patients compared to controls [I .6 (0.2-3.2) versus 0.5 (0.2-l .8): p < O.oOl]. In OUT study TPA was more sensitive than CYFRA 21-l: 49% versus40%; when wecombined both markers the sensitivity increased to 63%. Significant difference in values were found before and after surgery in serum levels of 34 operated patients: p <

0.01. We found higher levels of soluble cytokeratin I9 in lung cancer patients and in the adamcarcinoma subgroup. This study does not support the exclusive use of soluble cytokeratin I9 as a specific marker of lung cancer and not only in squamous carcinoma subgroup. This suggested that diagnostic and prognostic sensitivity increase when CYFRA 21-1 and TPA or other markers are combined.

Analysis of the energy balance io lung cancer patients Staal-Van den Brekel AJ, Schols AMWJ, Ten Velde GPM, Buurman WA, Wouters EFM Deparbnenr of Pulmonoiogy, Universiry Hospital. I! 0. Box 5800, 6202 AZ Mousm’chr. Cancer Res 1994;54:6430-3.

Previous studies have shown that an elevated resting energy expenditure (REE) frequently occurs in lung cancer patients. The aim of the present study was to assess the balance between REE and dietary intake and to analyze the contributing factors of elevated REE in newly detected lung cancer patients. One hundred newly detected lung cancer patients were evaluated. Measured values of REE were adjusted for the v&es predicted by the Harris-Benedict formuta end for fat-free mass asscsstd by the bioele&cal impedance method. Dietary intake was measured using a dietary histoty. A substantial number of patients (30%) had a we@ loss of 10% or more from their preillncss stable weight. An elevated REE wss found in 74% of the patients. Stratification by tumor localization revealed that patients with a central tumor had a signiticantly higher REE [ 121 f 13% (SD) versus 1 IO f 10% of predicted, P < O.OOl] and significantly higher level of C-reactive protein (35 f 35 mg/liter versus 16 f 26 mg&ter, P = 0.006) compared with patients with a peripheral tumor. Dietary intake was signiticantly lower in the weight- losing group (1872 i 542 k-l/day versus 2169 f 782 kc& day, P < 0.05) compared with the weight-stable group. We conclude that both elevated REE and decreased dietsty intake contribute to weight loss in lung cancer patients. Tumor localization and inflammation were-found to be contributing factors to the elevated REE.

Ketocomuuk ia the maoagement ofparaneophstic Gushing’s syndrome secondary to ectopic adrPnocortirotropin pmduction Winquist EW, Laskey J, Camp M, Khamsi F, Shepherd FA. Toronfo Hap&/, 200 Elizabeth St, Tomnto. Onf. MSG 2C4. J Clin Oncol 1995;13: 157-64.

Purpose: To evaluate the safety and efiiutcy of ketoconazole treatment in the management of patients with paraneoplastic Gushing’s syndrome (CS) secondary to ectopic adrcnocorticotropin (ACTH) production by malignant neoplasms (ECS). Pofienls and Methods: A retrospective chart review was undertaken for 15 consecutive patients with ECS treated with ketoconazole. Strict criteria were defined for diagnosis of ECS and for clinical, biochemical, and hormonal responses. ResuL: There were four women and 1 I men with a m&an age of 59 years (range, 44 to 84). Eleven patients had primely lung cancer (nine small-cell [SCLC], one mixed SCLC/non-SCLC, and one non-SCLC); two had carcinoid tumors (one bronchial, one pancreatic); one had hepatocellular carcinoma; and one had medullary carcinoma of the thyroid. Eight patients had ECS diagnosed at hlmor presentation. Clinical findings included proximal muscle weakness (n = IO), peripheral edema (n = S), and hypertension (n = 8). Biochemical abnormalities included hypokalcmia (n = 14). metabolic alkalosis (n = 13), and new or worsened diabetes mellitus (n = IO). Patients received ketoconarole in dosages of 400 to 1,200 mg/d titrated by changes in urinary free-catisol (UFC) levels for a median duration of26 days (range, 3 to 1,059), and nine also received chemotherapy with ketoeonazole. Hypokalemia, metabolic alkalosis, diabetes mellitus, and hypertension improved in the majority of patients. Ten patients had a hormonal response, with seven complete responses (median duration, 25 days; range, 6 to 989). The occurrence of symptomatic hypoadrenalism was definite in three patients and probable in one. Most patients died of brogressive malignant disease accompanied by cscapc from hormonal control by kctoconazole The median survival duration of the group was 19 weeks (range, 1 to 154). Conclusion: Ketoconazole results in biochemical and hormonal improvement for most patients with ECS. It has few adverse effects, but may impair the cortisol response to stress. For that reason, replacement corticosteroids should be considered for patients with hormonal response, and moderate to high-dose carticosteroids should be given for any potential stress sihtations. The ultimate control of the syndrome is dependent on successful treatment of the underlying tumor.