Abstracts /Lung Cancer 13 (1995) 323-356 353

0.04). No patients in the nonchemotherapy group had survived 5 years. Moreover, multivariate analysis showed that failure to employ preoperative chemotherapy was the strongest prognostic factor causing a poor prognosis (p = 0.01). On the other band, eight (30.8%) out of 26 patients with c-Stage I or II disease. postoperatively proved to have mediastinaJ lymph node involvement (pN2-3). and Iwo (7.7%) proved to have intrapulmonary metastasis (FM). Considering the advantage of preoperative chemotherapy and the discrepancy between c- and p-stage, sufficient chemotherapy prior to surgery should be employed, and may realize a good prognosis in patients with c-Stage I or II disease. In contrast, patients with c-Stage III disease are not appropriate as candidates for surgery even if preoperative chemotherapy is performed.

Radiosurgical treatment of lung cancer Uematsu M, Fukui T, Shioda A, Tokumitsu H, Takai K, Kojima T et al. Jpn J Clin Radio1 1995;40:847-9.

We made a single couch treatment unit combining a linear accelerator with x-my simulator and CT scan, and treated three patients with 5 lesions of primary or metastatic lung cancer. Multiple non-coplanar ares treatment was used with 4+5OGy/lO fractions at 80% dose area. So far, all treatments were safely performed and all lesions showed clinical responses, although follow- up was very short. Further studies are needed to assess whether this approach is truly safe and effective.

Concurrent paclitaxel and thoracic radiition for advanced non- small cell lung cancer Akerley W, Choy H. Department Medtcal Oncology Rhode Island Hospital, 593 Eddy Stnzet. Pnwidence, RI 02903. Lung Cancer (Ireland) 1995;12:Sup~l 2:S107-15.

A phase I trial of paclitaxel therapy, administered as a weekly 3-h infusion for 6 weeks with concurrent daily thoracic radiation to patients with advanced or medically inoperable non-small cell lung cancer, was performed. Paclitaxel was escalated in increments of 10 mp/mVweek in successive cohorts of three new patients as toleraoxl, starting at 10 mg/ m’lweek. Radiation was administered to the primary tumor and regional lymph nodes (40 Gy over 4 weeks), followed by a boost to the primary tumor (20 Gy in 2 weeks). Twenty-seven patients entered this study through seven dose levels of paclitaxel ranging from IO-70 mg/m*/week for the primary purpose of evaluating the toxicity of concurrent chemoradiation treatment. Esophagitis was the principal and dose- limiting toxicity. Radiation pneumonitis occurred in hvo patients. Other toxicities were mild. Although not designed as an efficacy study, 23 patients were available for response, and an overall response rate of 74% (confidence interval, 65-83%) was observed.

Scheduling of chemotherapy and radiotherapy in locally advanced non-small cell lung cancer Bishop JF. Division Hematology/uedical Oncology. Peter MacCallum Cancer Instihrte. St. Andrew Place. East Melbourne, MC. 3002. Lung Cancer (Ireland) 1995;12:Suppl2:S53-61.

In scheduling chemotherapy and radiotherapy for locally advanced non-small cell lung cancer (NSCLC), chemotherapy can be given pre- tadiothcmpy or concurrently as a single agent or in combiion Optimal scheduling has yet to be established. Optimal preradi&ierapy for NSCLC requires further development but cisplatin with vinblastine, vi&sine, etoposide or navelbine appear the best currently available. A number of new drugs show potential for enhancing radiation effects. Concurrent chemotherapy and radiotherapy has been tested in a number of experimental tumours in cell culture. In these systems cisplatin, carboplatin, 5-fluorouracil, mitomycinC and other agents appear to improve cell kill compared to chemotherapy alone. Mouse xenograft

models allow the study of various concurrent drug and radiation schedules including the effect of radiation with cisplatiu, carboplatin, paclitaxel and gemcitabine. In these systems, cisplatin in divided doses shows optimal enhancement with fractionated radiotherapy. There are a number of drug candidates for concurrent chemotherapy and radiotherapy programs. Clinical studies in head and neck cancer. esophageal cancer, small cell lung cancer and NSCLC show promising results with concurrent chemotherapy and radiotherapy. Cisplatin given daily with radiotherapy improved survival in NSCLC compared to cisplatin given weekly with radiotherapy or to radiotherapy alone. To study the toxicity of radiation and concurrent carboplatin. we have studied 170 patients with mues&able locally advanced NSCLC in a 4- arm randomized trial. An analysis of the first 100 patienls entered revealed significantly more neutropenia (P < 0.0001) and thrombocytopenia (P < 0.004) with the combined modality arms. Esophagitis was worse on all three experimental arms but was significantly more prolonged with accelerated radiotherapy arms. In general, the program was well tolerated. It is anticipated that these laboratory and clinical studies will better define optimal schedules for concurrent chemotherapy and radiotherapy. However, combined modality treatment already has an important place in the treatment Of locally advanced NSCLC.

Combined modality treatment for stage III non-small cell lung cancer Bonomi P. Section of Medical Oncology, Rush University Medical Cente,: Chicago, IL 60612. Lung Cancer (Ireland). 1995;12:Suppl 2:S41-52.

There are increasing reports of studies in which combined modality treatment is being tested in stage III non-small cell lung cancer. Ran- domized trials in which sequential chemoradiotherapy has been compared to radiation alone and in which single agent cisplatin and simultaueuts thoraeic radiation were. compared to radiation are reviewed and discussed. The largest and the most mature phase II trials of preoperative chemotherapy are also included in this review. Similarly the results from recently reported small random&d trials evaluating preoperative treatment are described. Potential future directions for clinical trials are sugges&d, including the incorporation of new agents in combined modality regimens.

Neoadjuvant (mduction) tlutment for non-small cell lung cancer Gin&erg RJ. Department of Sutge~, Memorial Sloan Kettering Cancer Ch: 1275 York Avenue, New York. NY 10021. Lung Cancer (Ireland) 1995;12:Suppl2:S33-40.

Preoperative treatment for non-small tell lung cancer is not new, but recently it has gained increasing acceptance in the management of locally advanced disease. Preoperative radiotherapy has been studied extensively but bas never been demonstrated to improve survival in locally advanced (NZ,T3) disease. However, it is still considered part of the accepted management for superior sulcus tumors. In the past 15 years, many Phase II trials have investigated the use of induction chemotherapy or chemoradiotherapy as part of the treatment plan for Stage IIIA patients, especially those with preoperatively identified N2 disease who have a poor prognosis following primary surgical resection, with or without postoperative adjuvant therapy. Preoperative chemo- therapy trials, as exemplified by the Memorial Sloan-Kettering Cancer Center and Toronto MVF (mitomycin, vinblastine, and cisplatin) trials, have demonstrated what appear to be improved median survival time and prolonged S-year survival when compared to historical controls. More recently, three relatively small randomized trials have demon- strated statistically significant improvement in patients treated preopemtively with induction chemotherapy. More widely investigated