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L., Donnelly, E., Cairns, V. Miami V.A. Hospital and Comprehensive Cancer Center,

University of Miami School of Medicine,

Miami, FL., USA. Gallium scanning is often used in stag-

ing lung Ca. A retrospective analysis of survival was done in 56 consecutive SCLC patients (i;ts) whose workup included a staging Ga scan at the time of diagnosis. All were treated according to a treatment protocol consisting of induction chemothe- rapy (CT) with vincristine, adriamycin, procarbazine and etoposide (VAPE). All com- plete responders (CR) received prophylac- tic brain radiation therapy (RT) and com- plete responders with regional disease received chest RT. Subsequent maintenance therapy was randomized to either VAPE or cytoxan, CCNU, and methotrexate (CCM). In patients not responding to or failing VAPE CT, salvage was attempted with CCM and subsequently with hexamethylmelamine, mitomycin, and vinblastine. Clinical brain metastases were treated with RT. There were 55 men and 1 woman with median age 60 years (range 36 to 79). Staging work-up included liver scan, bone scan, brain CT scan, and aspiration and biopsy of bone mar- row, in addition to Ga scan. 62.5% were Ga(-) and 37-5% were Ga(+). Among the 49 pts with complete staging of disease, 53.1% had extensive disease. 39.3% achieved complete response to treatment, and 19.6% partial response (8.9% unknown). The esti- mated median survival in all pts was 13 months (mo.). The estimated median sur- vival in Ga (-) pts compared to over 50% in Ga(+) pts. A positive Ga scan indicated a good prognosis in SCLC, independent of age, stage of disease, bone marrow invol- vement, and response.

P e r f u s i o n ~nnd V e n t i l a t i o n o f t he LLmgs in P a t i e n t s w i t h Small Ce l l Carcinoma Before and A f t e r Combina t ion Chemotherapy. S~rensen, P.G., Groth, S., Hansen, S.W., Hansen, F., Dirksen, H. The Finsen Insti- tute, Department of Clinical Physiology and Department of Chemotherapy, Copenhagen,

Denmark. In order to characterize changes of

lung function in patients with small cell carcinoma of the lung, we studied 25 pa- tients (group I) during combination che- motherapy and 25 patients who had obtained a long time survival (group II). Prior to the treatment a mixed pattern of re- strictive and obstructive lung function decrease was observed in group I. The pa- tients had a significant decrease in both ventilation and perfusion of the affected lung including a ventilation-perfusion mismatch. Three months after initiation of

treatment, 8 patients had obtained com-

plete response defined as a normalization

of the x-ray picture. Their TLC, VC and FEV in

one sec. had improved significantly (p < 0.01) rendering them statistically inseparable from

a healthy control group. The ventilation of the affected lung in the patients obtaining com- plete response equally increased (p < 0.01), but only a minor increase in the perfusion (p < 0.01) was seen. The ventilation/perfusion ratio remained distorted. The ventilation and perfusion of the 25 patients who had obtained long time survival was almost normal. Two con- clusions were drawn:

i) Complete responders also obtain a normaliza- tion of many lung function variables including the ventilation of the affected lung, but a marked functional decrease of the perfusion and of the ventilation /perfusion ratio remains. 2) The patterns of ventilation and perfusion in long time survivors are almost normal. Thus, this index may prove useful as a predictive factor for the prognosis of the disease.

U l t r a s o n o g r a p h i c E v a l u a t i o n o f Cancerous Inva- s i o n I n t o t he Ches t IVall. T a m a k i , S . , D a n b a r a , T . , K o b a y a s h i , H . , Sugama, Y., Kira, S. Jichi Medical School, Tochigi, Japan.

When pathological lesion are extended to sur- face of the pleura as in peripheral lung can- cer just beneath the thoracic wall, pleurisy and atelectasis, ultrasonographic diagnostics (US) are quite useful even in pulmonary medi- cine to delineate their in vivo anatomy and their movement by respiration.

From this evidence, we have been evaluating a significance of US to analyse chest wall invation of lung cancer in vivo.

In 55 subjects of primary lung cancer (epi- dermoid 25, adeno 23, large 3, alveolar cell 2, small 1), preoperative findings concerned with their chest wall invasions were compared with those of macroscopic findings on opera- tion.

Based on the General Rule of the Japan Lung Cancer Society (P0: no invasion, PI: visceral pleuarl invasion, P2: parietal pleural inva- sion, P3: chest walI invasion), US findings were digided into four groups (uP0: no inva- sion, UPl: vi:~ ..~, [~oo~al invaslon, uP : parietal pleural invasion, uP3: chest wa~l invasion).

The accuracy rate of the diagnosis by US was 78% in total subjects, 73% in 22 subjects of uP , 44% in 9 of uP I, 92% in 13 of uP , 100% in011 of uP 3. 2

We may conclude that US can delineate ex- actly enough the degree of the thoracic wall invasion and is very useful in an evaluation of the stage of lung cancer patients.

Size o f M e t a s t a t i z e d N e d i a s t i n a l L ~ p b Node [!- v a l u a t i o n in Vivo. Danbara, T., Kobayashi, H., Sugama, Y., Saito, T., Takahashi, H., Tamaki, S., Hata, E., Hase-

Gawa, T., Kira, S. Jichi Medical School,

82

Tochigi-ken, Japan. Although presurgical e~aluation of medi-

astinal lymph node metastasis is facilita- ted by an introduction of computed tomogra- phy, its information is rather limited on its transverse diameter. Therefore, we are appling an ultrasonic endoscope e- quipped with a linear real-time probe on the head of fiberesophagoscopy, be- cause the approach can measure both trans- verse and sagittal diameters of the nodes in subcarinal, tracheo-bronchial, subaortic and retrotracheal area. Subjects were 38 cases of pr-mary lung cancer, 37 of which were operated and one autopsied. All 116 nodes visualized by this approach were patho- logically checked for metastasis. The measured sagittal and transverse diame- ters are depicted in the figure on ab- scissa and ordinate respectively. The lymph nodes with and without metastases are shown with 0 and 0. The results suggest that the metastasized lymph nodes generally increases its transverse and

°- ~ 0.':~

° . . . . .

sagittal diameters simultaneously, but the accuracy by their sizes are 80%, when the mean + one S.D. values of transverse and sagittal diameters of the nodes without metastasis (12 and 21 mm) are assumed as their upper limits.

Incidence of Central Nervous System (CNS) Metastases in Small Cell Lung Cancer (SCLC). Drings, P., Hohenstadt, B., Abel, U., van Kaick, G. Chest Hospital Rohrbach, Heidelberg FRG, German Cancer Research Center, Heidelberg FRG.

Metastases in CNS of 368 patients (308 men, 60 women) have been subject to analyses retrospectively. 335 patients proved to be evaluable. In 67 of them were observed metastases in CNS. Patients with metastases in CNS have been classi- fied significantly more as advanced tumor stage already in the beginning of disease.

In ii out of 67 patients (16.4%) meta- stases in CNS have been diagnosed in pri- mary staging procedure. Refered to all patients this number amount to 3,3% (11/335). In the further course 41 patients (41/67=61,2%; 41/335=12.2%) developed metastases in CNS, while 15 patients (15/67=22.4%; 15/335=4.4%) only showed clinical symptoms, leading to the suspicion on involvement of CNS.

The Karnofsky-scale of all our patients ranged around 70% at the time of diagno- sis. The median age was 58 years. Distant

metastases could be proven in 32% of our

patients in liver, in 40% in sceleton, in 20% in CNS, in 12% in the retroperitoneal space. Only 14 patients (4% of all patients)developed

metastases in CNS exclusively as only hint of progressive tumor growth. On 28 out of 42 patients brain metastases have been the only localization of distant metastases. CT showed best results in detecting metastases in CNS. Nevertheless it is not necessarely required in primary staging of asymptomatic patients routinely. 8 out of ii patients with primary metastases in CNS showed already clinical symp- toms. CT detected metastases only in 3 addi- tional asymptomatic cases (3 of 335=1%).

Metastases in CNS have been detected in ave- rage 7,8 months after diagnosis. After detec- tion of metastases, patients survived 2,7 months.

Extrapleural Pneumonectomy for Diffuse Malig- nant Mesothelioma. Faber, L.P., Kittle, C.F., Jensik, R.J., Warren, W.H. Rush-Presbyterian-St. Luke's Medical Cen- ter, Chicago, Illinois.

Extrapleural pneumonectomy for malignant mesothelioma is a radical procedure that entails an en bloc removal of the parietal pleura, lung, pericardian diaphragm. Minimal tumor remains after this procedure and good palliation and occasional long term survival can be achived in properly selected patients.

We have performed extrapleural pneumonec- tomy for diffuse malignant epithelioma in.32 patients. There were 17 procedures performed on the left and 15 on the right in 25 male patients and 7 female patients. A history of exposure to asbestos was obtained in 16 patients (50%). Pathology study revealed that 21 tumors were epithelial, 9 were of the mixed type and 2 were sarcomatous. Good palliation, defined as survival over 24 months with a return to fairly normal activities, was obtained in 8 pa- tients (25%). Survival over 36 months was a- chieved in 5 patients and 3 patients expired of their disease at 59 months, 60 months and 82 months respectively. The 3 year survival is 15%. Operative deaths occurred in 3 patients (9.4%). Serious complications occurred in 8 patients (25%) and consisted of bronchopleural fistula 2, persistent contralateral effusion i, left vocal cord paralysis 2, chylothorax i, tracheostomy 1 and cardiac arrhythmia i.

Postoperative adjunctive therapy consisting of chemotherapy or radiation was given to the majority of patients.

These findings indicate that extrapleural pneumonectomy for malignant mesothelioma can be done with an acceptable morbidity and mor- tality and little residual disease remains. Palliation is achieved in 25% of patients and an occasional long term survivor is identified. Adjunctive therapy may further extend the length of survival.

Bronchogenic Carcinoma in Patients Under 40