Abstracts/Lung Cancer 12 (1995) 265-329

Risk of second aemdigestive cancers increases in patients who cllrvive free of small-eel1 luagcancerfor more thaa 2 years Johnson BE, Linnoila RI, Williams JP, Venmn DJ, Okunieff P, Anderson GB et al. Naty Medical Oncoiogv Branch. Narionnt Cancer Ins;ihue, Nationof Nova1 MedicalCenreq Bethesda. MD 20889-5105. J Clin Oncol 1995;13:101-1 I.

Purpose: Patients who survived small-cell lung cancer (SCLC) for more than 2 years were evaluated to determine the frequency and anatomic pattern of redevelopment of smallcell cancer and development of non-small+eil lung cancer (NSCLC) and aemdigestive cancers with the passage of time. ParientsondMethods: From April 1973 through Deeember 199 I, 578 patients with previously untreated SCLC were entered onto prospective therapeutic trials at the National Cancer Institute @ICI), Bethesda, MD. Sixty-two (11%) were cancer-free 2 years after initiation of therapy and were assessable for redevelopment of SCLC and development of NSCLC, and aerodigcstive cancers. Resulrs: Twenty patients redeveloped SCLC 2.0 to 12.2 years after initiation of chemotherapy, of whom two patients were deemed to have a second primary smallsell cancer that involved the aerodigestivc tract. Fifteen patients developed 16 cancers in the lung other than SCLC 3.4 to 14.9 years aRer initiation of therapy. Two developed other nerodigestive cancers that involved the larynx and lip. The risk of a NSCLC and eemdigestive cancer in these patients increased more than sixfold from 2% per patient per year during years 2 IO 4 to 12.6% and 14.4%. respectively, a&r more than 10 years. The cumulative actuarial risk of a second primary NSCLC or nerodigestive cancer at 16 years is 69% and 72%, respativcly. Conclusion: The increasing risk of second aerodrgestive cancers with the passage of lime is a mounting problem for patients cured of SCLC. Chemoprevention trials for these patients should be considered.

The value of baae marrow examination in small cell carciwma of the lung Horlyck A, Henriques U, Jakobscn A. Rugmorken 108, DK-8520 Lysbwp. Acta onwl 1994;33:909-11.

Of 668 consecutive patients with SCLC, 472 underwent bone marrow examination for staging. In 330 patients a triple examination (stemal aspiration, iliac crest aspiration and biopsy) was performed. othtise a single pmoedure. Bone marrow infiltration (MI) wea found in 37% of the patients with extensive disease, and the frequencies of a positive finding in single and triple examineton were not statistically different. In the group having triple examination performed iliac crest aspiration alone disclosrd MI in 32%. When all three prccedores were included still more patients with MI were found (42%) but the two ~fdues were not significantly differeot. In 6.6% of patients who would have been classified as ‘limited’ did bone marrow examination change the stage to extensive disease. Based on these results we recommend iliac crest aspiration, but not triple examination with iliac crest biopsy, in the staging of SCLC.

A case report of pulmonary squamous cell carcinoma accompanying myastknia gravis Tomoyasu H, Tanimura S, Bamba J. Departmenf of Pulmonary Surgeq Toranomon HospiIoI, TokyaJpn J Chest Dis 1994;53:993-7.

The patient was a 69-year-old man who had been under medical care for about 20 years became of hiyasthcnia Gravis (Osscrman type Iv\). A chest X- my demonstrated a mass shadow in the letl S 1 + 2 which was diagnosed as a squamous cell carcinoma with mediastinel lymphnodes enlargement (Stage lIL4). Attcr the combination chemotherapy (CDDP + VDS) the size of the carcinoma decreased and MO symptoms also improved than bcforc. By means of the L- shaped excision the extended total thymmtomy and radical Icfl upper lobectomy with mediastinal lymphnodes dissection were performed simultaneously. Histological examination revealed an intermediate differatiated squamous cell carcinoma and en involuted thymus. Clinical characteristics were discussed in addition to the review of the literature.

TNF-a determioatioa in serum and pleural effusion in patients with lungcancer Scagliotti GV, Gatti E, Ferrari G, Mutti L, Pozzi E. Universiry o~Torino. Depl. of Clinic&Bio/ogical &is., S. Luigi Gonzaga Hospital, Regione Conrole IO. IO034 Grbassano. Int J Oncol 1995;6:147-51.

The relationship between Tumor Necrosis Factor-a (TNFa) in the serum and pleural fluid of lung cancer patients and the extent and the histological cell

type wes studied. TNFa level wlls determined in the serum of 68 patients with lung cancer [5 1 non-smell cell lung cancer VSCLC) and 17 small cell lung cancer (SCLC)] and in pleural fluid of 30 patients with lung cancer (22 NSCLC, 11 of them positive for neoplastic eells and 8 SCLC, 7 of them positive). Scra of 31 healthy subjmts and the pleural fluid of 15 non-malignant pleural effusions were teeled es controls. TNFu serum level was increaed in patients with lung cancer (healthy subjects 7.8 f 3.3 pg/ml; lung cancer 16.2 i 9.1 pgiml), in NSCLC as well as SCLC and a relationship with the extent of the disease was found in both the histological types. In pleural fluid, no differences of TNF-a level were observed between neoplastic and benign inflammatory effusion, between SCLC and NSCLC or between cases positive and negative for the presence of neoplastic cells. Serum TNFa may be an indicator of tomour burden; conversely, TNFa in pleural fluid, was unable to discriminate between neoplastic and benign effusion.

Broncbogcnic carcinoma in HIV-positive patients: Findings on chest radiihsandCTscans Fishman JE. Schwartz DS, Sais GJ, Flares MR, Sridhar KS. Deparbnenf of Rodiologv Jackson Memorial Hospital. Miami Universi~ School of Medicine. 1611 N.U! IZlhAw.. Miami, n 33136-1094.Am JRoentgenolI995;164:57-61.

Objectiw: The radiographic manifestations of bronchogcnic carcinoma in HIV-positive individuals may resemble or accompany changes of inflammatory disease. To provide information that is useful in the differential diagnosis, we studied the findings on plain radiographs and chest CT sxans in 30 HIV- positive patients with proven bmnchogcnic carcinoma and correlated the radiographic features with the presence or absence of thoracic opportunistic infeotion. Sr&ectr and Methods: Thirty HIV-positive individuals had bronchogenic carcinoma diagnoscd at our instihdion between 1986 and 1993. Fourteen (47%) of the 30 had AIDS at the time of cancer diagnosis. All but one of the patients were men, and the median age at diagnosis was 48 years (range, 32-66 years). Most (90%) had a history of smoking. Eightzen (60%) of the 30 had a history of pulmonary tuberculosis, Pncumocystis carinii pneumonia, or both. We retrospectively reviewed all available chest radiographs (n = 27) and chest CT scans (n = 25) lot tumor size and location, adcnopathy, pleural disease, and pulmonary infdtrates. Resulrr: Eighteen tumors (60%) were peripheral, I1 (37%) were central (hilar or mediastinal), and one manifested as a metestatic pleural mass. Of the peripheral tumors, 17 (94%) were in the upper lobes. All the central tumors showed obstructive consolidation of lung in the distribution of the affected airway. Adenopsthy was present in 63% of the patients, and pleural effusions or masses were seen in 33%. A history of tuberculosis or Pneumocystis carinii pneumonia wes present in 83% of the patients with peripheral tumors but only 27% of the patients with central lesions (p = 005). Superimposed iniiltrates were present in six patients (20%). Three (17%) of 18 peripheral tumors were obscured by or mistaken for intlammatoly disease, delaying the diagnosis of cancer. Conclusion: Bmnchogenic carcinoma usually manifests as a peripheral upper lobe mass in HIV-positive patients with a history of tuberculosis or Pneumoeystis carinii pneumonia, whereas ccntrsl masses are more common in patients without a history of thoracic opportunistic infection. Carcinoma should be suspected in patients with pxiphcral lesions that persist despite approprirde antibiotic therapy.

Measurements of resting energy expenditure and body composition before and atkr treatment af small cell hmg cancer Jebb SA, Osborne RJ, Dixon AK, Bleeheo NM, Elia M. MRC Dunn Clinical NuWion Cmbv, Hills Road, Cambridge CB2 2DH. Ann Onwl 1994;5:91 S-9.

BocCground Meny petimls with small cell lung cancer are reported to lose weight, but the mechanism of this effect is unclear. Pafienfs and meBods: Measurements of resting energy expenditore (REE), using indirect calorimetry and body composition (fat, fat-free maea and organ mass), using dual energy X- my absorptiometry (DXA) and abdominal CT scans were measured in 38 patients with newly-diagnosed small cell lung cancer. Twenty-eight patients were restudied at the end of treatment. Results In those who responded to treatment there was nochange in bodyweight, but adecreaseinRFZ of 15.7*11.7 kJ/kgfat freemass/ day, whilst in the non-responders body weight decreased by 4.33i5.4 kg, but REE was unchanged. Conclusion: This study pmvides evidence for tumour- induced hypcrmctabolism which is independent of changes in gross body composition, although the absolute increase is small, appmximately 0.8 Ml/day. However since body wei& was maintained in those patients who responded to treatment either total energy expenditure was decreased, implying decreases in physical activity. or energy intake was increased.