126 Abstracts / Lung Cum

onstrating a lower uptake both before and after therapy did not relapse. although no tumor regression due to the therapy was observed. These results indicate that FDGPET plays a complementary role in both pre- dicting and assessing the therapeutic response and prognosis in pa- tients with bronchogenic carcinoma.

Prophylactic craniaJ irradiation in limited stage small cell lung cancer: Survival benefit in patients with favourable character- istics Work E, Bentzen SM, Nielsen OS, Fode K, Michalski W, Palshof T. Depmtment of Oncology, Aarhus University Hospitaal, Norrebmgade 44, DK-8000Aarhus C. Eur J Cancer Part A 19%;32:772-8.

The value of prophylactic cranial irradiation (PCI) in the treatment of small cell lung cancer (SCLC) remains controversial. As part of a random&d study investigating the timing of chest itradiation (CI) with respect to combination chemotherapy, the effect of PC1 was evaluated. Between 1981 and 1989, patients were random&d to initial chest irra- diation ICI (99 patients) or 18 weeks delayed late chest irradiation LCI (100 patients). PC1 was given to 157 patients. In the be.ginning, only ICI patients received PCI, but in October 1984 the strategy was changed so that all patients received PCI. Thus, the patients who did not receive PC1 were randomly allocated. The PC1 dose was 33 Gy/ll fractions (45 patients) and 25 Gy/ll fractions (112 patients). The 2-year CNS-recur- rence rate (t standard error) was signilicanUy lower in patients who received PCI. 16.3 + 4.1%. than in those who did not, 55.15 12.4% @ = 0.01). In contrast, the Z-year cause-specific survival was not signifl- cantlyditTerent,24.9~3.6%and 16.9+6.2%(p=0.31).TheZ-year progression-free rates with or without PC1 were 1815 + 3.3% and 11.4 + 5.4%, respectively @ = 0.58). To test the hypothesis that a benefit from PC1 would mainly be expected among the patients with the best prognosis, a multivariate regression analysis of prognostic factors was undertaken. Based on weight loss, performance status, serum sodium and age, the third of the patients with the best prognosis were identi- fied. In that group of patients, the survival advantage from PC1 was statistically signiftcant, 35.5 + 7.2% versus 14.1 + 8.0%. P = 0.029. These results are currently being tested in a Danish multicentre trial where patients with a good prognosis are randomised either to receive PC1 or not to receive PCI.

Clinical implications of prophylactic irradiation of the ipsilat- eral hilum and mediastinum for clinical stage NO non-small cell lung cancer Furuta M, Hayakawa K, Saito Y et al. Radiology/Radiation Oncology

Dept., Gunma University School ofMedicine, Gunma. Jpn J Lung Can- cer 1996;36:125-30.

From 1981 to June 1990, 17 patients with clinical stage NO non- small cell lung cancer were treated with definitive radiation therapy including prophylactic irradiation to the ipsilateral hilum and medi- astimtm. All patients had no obvious enlarged lymph nodes in the hihmt and maliastinum on plain chest radiograph and conventional tomogra- phy. Three patients had Tl disease 7 T2,6 T3, and 1 T4. In patients with squamous cell carcinoma (11 patients), prophylactic irradiation of more than 40 Gy was delivered to the hihmt/mediastinum as well as 60 Gy or more to the primary tumor. Prophylactic irradiation was given to patients with sdenocarci noma only when the primary tumor could be cowed with smaIIaiz.ed radiation portals (8 patients). All patients with squamous cell carcinoma bad no recurrence in the hilum and mediasti- mtm and the single patient with adenocarcinoma developed rccurrencc in the hilmn. Considering that some patients with clinical NO disease actually have pathological Nl-2 diseases, prophylactic irradiation of over 40 Gy might be etfeetive to control subclinical nodal metastases, at least in patients with squamous cell carcinoma.

‘er 16 (1996) 1055127

Endoscopic brachytherapy Spratling L, Speiser BL. Pulmonary Services, Lutheran Healthcare Network, 500 West 10th Place, Mesa, AZ 85201. Chest Surg Clin North Am 1996;6:293-304.

lntraluminal radiation for the local control of bronchogenic carci- noma has recently undergone rapid technological progress. Remote afterloading of high intensity radiation sources into endoscopically placed multiple small catheters with computerized optimization of dosimetry is the state-of-the-art. Fractionated high dose rate (HDR) outpatient treatment has been shown to reduce airway obstruction and improve performance status and quality of life.

Massive haemoptysis death and other morbidity associated with high dose rate intraluminal radiotherapy for carcinoma of the bronchus Gollins SW, Ryder WDJ, Burt PA, Barber PV, Stout R Vefindre NHS Trust, whitchurch, CatdiflCF4 7XL. Radio1 Oncol 1996;39: 105-16.

Four hundred and six patients with primary non-small cell carci- noma of the bronchus causing symptoms due to endobronchial disease. were treated with intraluminal radiotherapy (ILT) using the micro- Selectron-HDR machine at the Christie Hospital, Manchester, between April 1988 and the end of 1992. An assessment of morbidity for this treatment is presented, particularly with regard to the risk factors and causes of massive haemoptysis death. The most common early side- effect was a mild transient exacerbation of cough which usually ne- solved within 2-3 weeks. At various times following ILT treatment 83 bronchoscopies were carried out randomly in 55 patients. In broncho- scopies carried out within the first 3 months following ILT, no tumour was visible in 80% of cases. A mucosal radiation reaction score (RRS) was used to grade bronchoscopic appearance after ILT treatment. Over- all, 55% of bronchoscopic examinations showed some degree of mu- cosal radiation reaction. The majority of radiation reactions from 6 months onwards after ILT demonstrated a degree of fibrosis. A radia- tion reaction was seen more frequently after treatment with 2000 cGy as opposed to 1500 cGy at 1 cm from the central axis of the radiation source. Thirty-two patients were identitied who had died from massive haemoptysis (MI-I) as a terminal event. A Cox multivariate regression analysis showed that the treatment-related factors of increased dose at first ILT (P = 0.004). prior laser treatment at the site ofILT (p = 0.020) and second ILT treatment in the same location as the first ILT treat- ment (P = 0.047), all signiilcantly increased the relative risk of MH death compared with their effect on the relative risk of death from other causea (OC). (In addition a fourth treatment-related factor, namely the concurte.nt use. of ILT and external beam radiotherapy (El3) had a P value of 0.08.) ‘Bventy out of 25 assessable MHdeath patients (80%) had evidence of recurrent or residual tumour before death but 5 patients (20%) did not. For smviving patients the instantaneous risk of death at any one time (the cause-specific death rate expressed as deaths per 100 cases per month), showed a sharp peak for MH deaths between 9 and 12 months post ILT in contradistinction to OC death where the peak was between 3 and 6 months post lJ.T. These findings may imply a role for late radiation reaction in the treatment-related risk factors ident& fled as increasing the relative risk of MH death and possible mecha- nisms are discussed. The results have implications for treatment re- gimes that use a dose of 2000 cGy at I cm in a single fraction tech- nique, that have a high frequency of previous laser t&nent, that use multiple. repeated JLT treatments in the same location and that use ILT concnrrenUy with EB.