Abstracts /Lung Cancer I I ( 1994) 323-344 343

The immunomodulating eJfect of indometacin in the course of chemoradiation treatment for inoperable lung cancer Kasyanenko IV, Pivnyuk VM, Lisitsa AM. Kovrdeako NA, Bagiryan MA. Kawrsky hut. for Erp. Pathology. Oncology and Radiobiology,

Academy of Sciences of the Ukraine. Kiev. Vopr Onkol 1992;38: 1183- 1.

The immunocorrecting effect of indometacin in the course of chemoradiation treatment for inopenble lung cancer was established in a group of II7 patients. It manifested itself in an increase in T- lymphocyte level, notmalizPtioa of their membrane structure and improvement in immunoregulatory function mainly due to a rise in T- helper/inductor level. Blood plasma-circulating immune complex concentration returned to normal. The concomitant administration of indometacin during chemoradirtion therapy improved subjective status of patients and tumor response, but failed to increase survival.

A randomized trial comparing preoperative chemotherapy plussurgerywithsurgeryalonein patientswith non-small~ell lung cancer Rosell R. Gomez-Codina J. Camps C, Maestre J, Padille J, Canto A et al. Medical Oncology Department, Univ. Hospital Germans Trias i

Pujol, Box 72. 08916 Badalona (Barcelona). New Engl J Med 1994;330:153-8.

Bockground: The efficacy of surgery for patients with non- small-cell lung cancer is limited, although recent studies suggest that preoperative chemotherapy may improve survival. We conducted a randomized trial to examine the. possible benefit of preoperative chemotherapy and surgery for the treatment of patients with non-small- cell lung cancer. Metho&: We studied 60 patients (59 men and I woman) with stage IIIA non-small<ell lung cancer. The patients were randomly as..igned to receive either surgery alone or three courses of chemotherapy (6 mg of mitomycin per square meter of body-surface area, 3 g of ifosfamide per square meter, and 50 mg of cisplatin per square meter) given intravenously at three-week intervals and followed by surgery. All patients received mediastinal radiation after surgery. The resected tumors were evaluated by means of K-ras oncogene analysis and How cytometry. Resulf.~: The median period ofsurvival was 26 months in the patients treated with chemotherapy plus surgery, as compared wilh 8 months in the patients treated with surgery alone (P<O.oOl); the median period of disease-free survival was 20 months ~ntheformrrgroup,ascomparulwith5monthsinthelat~er(P<O.~l). The rate of rezxrrence was 56 percent m the group treated with chemotherapy plus surgery and 74 percent in the group treated with surgery alone. The prevalence of mutated K-ras oncogenes was IS pcrccnt among the patients receiving preoperative chemotherapy and 42 percent among those rreated with surgery alone (P = 0.05). Most ofthe patients treatrd with chemotherapy plus surgery had tumors that consisted of diploid cells. whereas the patients treated with surgery alone had tumors with aneuploid cells. Comlusions: Preoperative chemotherapy incrass the median survival in patients with non-small- cell lung ca”cer.

Induction chemotherapy plus high-dose radiotherapy versus radiotherapy alone in locally advanced unresectable non- small-cell lung cancer Gino L, Latini P. Meacci M. Corgna E, Maranwo E. Danvish S et al. Division ofMedical Oncology. Policlinico Hospital, 06122 Perugio.

AM Oncol 1993;4:847-51.

Acaseofsuaxssfulcurativeoperation followed by neoadjuvant chemotherapy for stage clIlA epidermoid carcinoma of the lung Kur~sswa T. lkede N, Yamadori H, Sate A, Nakatani K. Takahashi K et al. Depomnen~ of Respiratory Medicine, National Minami Kyoro

Hospital. Naka-Ashiharo I I Joyo, Kyoro 610-01. lryo Jpn J Nat1 Med Serv 1994;48:5762.

Background: High-dose radiation therapy is generally We report r~ 42-yearaId male case with lung cancer effectively

recommended as standard treatment in regionally advanced unresectable treated by chemotbempy and the subsequmt curative operation. He was

non-smallcell lung cancer (NSCLC), but median- and long-term diagnosed as epidermoid carcinoma of right upper bronchus of clinical

survivalremainpoor. Somzrepor(shnve-tlyshown~improvemen( of results in advanced NSCLC when cisplatin was included in the chemotherapy regimens. Therefore., we designed a randomized trial to determine whether induction chemotherapy before high- dose radiotherapy improves response rate and survival in stage Ill NSCLC over that achieved with radiotherapy alone. Pafienrsondmefhc&: From March, 1984 to December, 1988,66 consecutive patients with stage III unresectable NSCLC were randomized to one of two treatment arms; 6 I were evaluable for survival and 58 for response and toxicity. Patients randomly assigned lo arm A received cisplatin (CDDP 100 mglm’ on day I) and eroposide (VP I6 120 mg/m’ on days I, 2, 3) every 3 wks for 3 courses followed by radiotherapy 56 Gy on pre-treatment tumor volume and 40 Gy on media&mm and bilateral supruclavicular nodes. Patients assigned to arm B received only the same radiotherapy. The 6 I eligible patients were comparable in terms of age, performance StBU histology end treatnet& Results: Response rate was 53 96 in arm A and 32% in arm B. The median survival was 52 wks for the combined treatment arm and 36 wks for the radiation therapy arm. At six years of follow-up all the patients were dead. Toxicity was mild and no treat- ment-relateddeathswererecorded. Conclusion: Inductionchemotherapy produced a ktter response rate and a trend of improved survival (4 months) but P signiticenl survival advantage was nol achieved (p C 0. I I), prohebly because of the smell numkr of patients enrolled in the

trial.

A patient with D2 lung cancer surviving for nine years following resection and chemotherapy YamadaM. TsukamotoT. DepartnwntofSurgery, YamogotoPrefectural

Central Hosp., Yatnogam. Lung Cancer (Japan) 1993;33:1071& A 64-yearaId female patient underwent surgery following the

discovery of a shadow, measuring I3 x 19 mm in tk let? S’. During thoracolomy, numerous disseminated lesions in both the visceral and parietal pleura were. observed. This was classified as D2 according to the Japanese Management Code of Lung Cancer. No retention of pleural fluid was noted. The surgical stage grouping was T4N2M0, Stage Ill B. Only the tumor was resec:ted. Histology showed the cancer to k moderalely differentiated adenocarcinoma and this was also true for the disseminated lesions. After the operation, chemotherapy consisting of MMC+CPM and MMC+OK432 was administered in the thoracic cavity. Further chemotherapy such as 5-FIJ + MMC+Ara-C was also introduced. CT examinations in the 6th and 7th years after operation revealed multiple nodules with a diameter of 0.3 to 0.5 cm in the periphery of the left lung. These hardly changed in size, and the patient had no evidence of distant metastases. It has been nine years since the operation was performed and she is now in Performance Status 0. Survival for a long period is usually rare with cases of D2 lung cancer. In this case, either chemotherapy has worked very well or this is a case of adenocarcinoma with a long naNnil course of development. At the moment. we an trying to decide which therapy lo choose in the future, taking quality of life into accoun1.