Abstracts/Lung Cancer 10 (1993) 266-286 285

adjuvaot chemotherapy (n = 54) (cyclophosphamide 400 mg/m2, doxorubicin 40 mglm2, and cisplatin 40 mglm’ [CAP] for six cycles) or

no active treatment (n = 56). Results: After 10 years from the start of

the study, 61% of patients were alive in the chemotherapy group and 48% were alive in tbe control group (P = ,050). Seventeen patients (31%) in the CAPgroupzmd27 patients(48%) in thecontrol group bad arecurrenceduriog Ihefollow-opperiod(P = .Ol). TheS-year survival

rate was 67% in tbe chemotherapy group and was 56% in tbe control group (P = ,050). The patients in the chemotherapy group who

completed the planned treatment had P slightly better 5-year survival

than those whose chemotherapy was discontinued (72.5 46 v 50.3 46; P = .15). Chemotherapy-related gastrointestinal toxicity grade 3 to 4 (WHO) occurred in 63 % and was the main reason why pabents refused

further planned therapy. Conclusron: Our results suggest that patients with NSCLC at pathologic stage 1 who have undergone radical surgery

benefit from adjuvant chemotherapy.

Adjuvant chemotherapy with cyclophosphamide, doxomhicin, and cisplatin in patients with completely resected stage I non-smallcell luog cancer Feld R, Robinstein L, Thomas PA, Holmes EC, Piantadosi S, Ruckdeschel JC. Princess Margnrer Hospital, SW Sherbourne Sfreet. Toronto, Onr. M4X IK9. I Nat1 Cancer lnst 1993;85:299-306.

Background: Most studiesof adjuvant chemotherapy, radiotherapy,

or onmunotherapy in non-small-cell lungcancerpatients with complete surgical resectionofdwasehaveshownnegativeresults. However, two

studies of stage II and 111 dwase by our Lung Cancer Study Group

suggested an advantage to adjuvant therapy with cyclophosphamide,

doxorublcm, and cisplatin (CAP). Purpose: Since neither of those studies had an untreated control, the Lung Cancer Study Group undertook a trial that mcluded a control group and also offered the potential benefit of adJuvant therapy with CAP to patients with Tl, Nl

or T2, NO (stage I) non-small-cell lung cancer. Methods: After complete resection, eligible patients with stage I disease were classified

by known prognosttc factors and randomly assngned to receive or not to

receive four courses of CAP at 3.week intervals beginning on day 30

after surgery. The CAP regtmen consisted of 400 mglm’ cyclophosphamide, 40 mglml doxorubicin. and 60 mglm’ cisplatin.

Stratification by prognostic factorswasas follows: hastology (squamous

versus nonsquamous), white blood cell count before surgery (9 1OOimm versus < 9 1 CO/mm’), and Kamofsky performance status before surgrry

(?490% versus 100%). Results: Ofthe269patientsentered in thestudy, IO1 had recurrence and 127 have dwd. Mean time since randomization

IS 6.4 years; mean follow-up IS 3.8 years. There were no differences III tune to recurrence or overall survwal (not stratified by hrstology)

ktweenthetwogroups, evenwhenanalyseswereadjustedforprognostlc vanables. There was one treatment-related death on the CAP arm due

to mf-tion dung neutropenla. Only 53% of the eligible patients

receivedall fourcoursesofCAP. andonly57W ofsuchpatientsreceived all four cycles on tnne. In 74% of the patients, the site of initial

recurrence was distant. Conclusions: The most likely explanations for

the lack of efficacy of CAP are poor compliance to the protocol and relative inactivity of the regimen, compared with the activity of drug combinations used in more recent studies. On the basis of this trial,

adJuvant therapy with CAP should not be recommended for patients wth resected stage I lung cancer. Implications: Further trials to test

adJuvant therapy are indicated, but investigators should use better antiemetics to improve patient compliance as well as more active

chemotherapy regnnens.

Other treatment modalities

Radical laser segmentectomy for Tl NO lung cancer KodamaK, Doi 0, YasodaT, HigashiyamaM. Yokoochi H. Departmew of 771oracicSurgery. CenterforAdulr Diseases, 3 Nokomichi I-chome, Hi,qarhinari-ku, Osaka 537. AM Thorac Surg 1992;54: 1193.5.

Over the last 40 months, I8 lung cancer patients wrth TI NO noo- small cell lung carcinoma have been treated with radical laser segmentectomy. This mnovative operative method consists of a

combination of anatonucal or nonanatomical segmentectomy by

nwdymium:yttrium-aluminum garnet laser parenchyma sparing with

complete hilar lymph node dissection. Although the median follow-up

period is too short, there is no local recurrence and no cancer deaths.

There have been no major complications. Even deep-seated tumors can lx resected with a clear safety margin using this method. Radical laser segmentectomy may be a useful adjunct to preserve normal lung tissue

and to perform very radwal resection.

Preoperative laser therapy in a patient with resectable bmnchogenic carcinoma and severe coronary artery disease Powney J. Scott AD, George PJM, Feneck RO, Wright I, Barnes NC.

Department of Ihoracic Medicine, London Chest Hospital, London EZ 91X. Thorax 1992;47:1075-6.

A 67 year old man with severe coronary artery disease was found to

havea resectablebronchogenic carcinoma. Myocardial revascolarisation

and lung resection were considered to be unduly hazardous as either separate or combined operations. Preoperative laser therapy, however, enabled the two procedures to be performed in greater safety in the most appropriate sequence.

Photodynamic therapy (PDT) in early stage lung cancer Hayata Y, Kate H, Konaka C, Okunaka T. Tokyo Medical Colle@’ Cancer Center, Depanment of Surgery, Tokyo Medical College, 6-7-l Nishishinjuku, Shinjuku-ku. Tokyo 160. Lung Cancer (Ireland) 1993;9:287-93.

In order to evaluate the possibility of curative treatment of

photodynamic therapy (PDT) inearly stagecentral type lung cancer, 57 lesions in 48 patients were treated with PDT at Tokyo Medical College and 70 lesions at the Hay&a Cancer Research Group of the Ministry of

Health and Welfare of Japan. Apparent complete remission (CR) was

obtained in 7 1.9 46 in the former and m 82 96 in the latter. There was a relationship between CR and the extent and growth type of the tomor.

From the therapeutic results in these cases we estimated the indications

of PDT in early stage lung canceras follows. (1) Theentire lesion should

be visible endoscopically. (2) The tomor should be located at a site to

which the laser team can be delivered easily and sufficiently. (3) The

lesion should be superficial and not more than 1.0 cm in dlameter. (4) The histologic type should be squamous cell carcinoma. (5) There should te no lymph node involvement.

Reviews

Advances in lung cancer? Teirstein AS. Div. of Pulmonary/Critical Care Med., Mounr Sinai Medical Center, Mount Sinai School of Medicine, New York. NY lW29. Environ Res 199259: 145-9.

Selikoff was among the first to emphasize the ettologic role of

cigarette smoking and asbestos exposure in lung cancer. Recent reports

suggest that aggressive chemotherapy and radiotherapy combined with

surgery have improved the prognosis in lung cancer. The outcome of 100 patients with non-small-cell long cancer (NSCLC) seen in 1979- 1980wascomparedwiththeoutcomeof IOOpatientsseenin 1989-1990. The two groups consisted of consecutive patients with proven NSCLC whowerereferredtoapulmonaryconsultant. In28oftheearberpat1ents

and 38 of the later group the cancers were completely resectable. Only 12 of the 1979-1980 group have been cured of their cancer, while 25 of

the 1989-1990 are free of cancer during the less than 2-year follow-up

period. It can be assumed that this number will diminish with time.

Current treatment of NSCLC with surgical resection, chemotherapy,

and radiotherapy has done little to improve the prognosis of lung cancer

in the past 10 years. As stressed by Selikoff. the best available current

method for control of lung cancer is prevention.

Development of new therapeutic strategies for mewthelioma RobiinBWS. Depattmen~ofhiexiicine. UniwrsiryofWesrernAlrrrralro. Queen Elizabeth II Medical Cenrre. Nedloo&, WA 6009. Lung Cancer

(Ireland) 1993;9:413-8 Malignant mesothelioma is one of the mast aggresswe solid

malignancies of mankind and most current therapeutic strategies,