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bleeding, and one patient was lost to follow-up. The remaining 14 patients were followed for 4 to 17 years without evi- dence of local recurrence or distant me- tastases. We conclude that the long-term prognosis of patients with bronchial ade- noma is excellent and limited surgical procedure should be the treatment of choice whenever possible.

Diagnosis and ~nnagement of Synchronous Lung Cancers. Ferguson, M.K., DeMeester, T.R., DesLau- riers, J. et al. Department of Surgery, The University of Chicago Pritzker Schoel of Medicine, Chicago, IL 60637, U.S.A. J. Thorac. Cardiovasc. Surg. 89: 378-385, 1985.

The findings in 28 patients with syn- chronous lung cancers are reviewed. Me- diastinoscopy and systemic staging were performed to exclude the possibilities that one pulmonary lesion was metastatic from the other or that both represented systemic metastases from another tumor. Nineteen patients underwent resection of both tumors. Median survival was 25 months for four patients with definite Stage I synchronous cancers (no nodal involvement; different cell types, bron- choscopically separate endobronchial le sions or arising from separate foci of carcinoma in situ) and was 27 months for seven patients with possible svnchronous Stage I cancers (no nodal involvement;

similar cell types; located in separate lobes). Median survival was ii months for 16 patients having Stage II or III lung cancer accompanied by a second syn- chronous lung cancer. In the absence of hilar or mediastinal nodal involvement and systemic metastases, synchronous tumors should be considered separate primaries when located in different lobes, even if they have similar histologic features. Prognosis of synchronous cancers is re- lated to the presence or absence of nodal metastases. Pneumonectomy is the operation of choice for synchronous unilateral tu- mors. With bilateral tumors, sequential resection starting with the most advanced lesion is appropriate. Preservation of lung tissue without compromising the cancer operation is critical.

7, CHEMOTHERAPY

Evaluation of Drug Efficacy in Vitro Using Human Small Cell Carcinoma of the Lung Spheroids. Douple, E.B., Cate, C.C., Curphey, T.J. et al. Norris Cotton Cancer Center, Dart- mouth-Hitchcock Medical Center, Hanover, NH 03756, U.S.A. Cancer 56: 1918-1925,

1985.

Five human small cell carcinoma of the lung (SCCL) cell lines selected from 25 established cul- tures were grown as three-dimentional spheroid tumor models in either spinner culture or in static, agar- coated multiwells. Volume doubling times for the cell lines were approximately 4.5 days. Decreases in spheroid volumes after exposure to a variety of chemotherapeutic agents were used as indicators of drug activity. To further quantify cell killing in SCCL spheroids by chemotherapeutic agents 24 hours after exposure to drugs, a technique was employed that measured maximum levels of incorporation of 125-IUdD after continuous labeling for

48 hours. The results of the use of this assay re- port for SCCL spheroid responses to various concen- trations of doxorubicin hydrochloride,cytosine ara- binoside, mechlorethamine hydrochloride, cisplatin, or etoposide. Some evidence for an inter#nmor he- terogeneous response to chemotherapy is presented for some of the drugs tested. This assay was also used to characterize a potentiated cell kill when etoposide is combined with cisplatin and to iden- tify activity by a new compound, diazoacetylcholine iodide (DACI), which was synthesized as an agent targeted for SCCL cells.

Phase II Study of Vincristine Infusion in Refracto- ry Small Cell Carcinoma of the Lung. Jackson, D.V.Jr., Hire, E.A., Rardin, D A. et al. Oncology Research Center, Bowman Gray of Medicine, Winston-Salem, NC 27103, U.S.A. Am. J. Clin. Oncol. Cancer Clin. Trials. 8 154-156, 1985.

Fifteen patients with extensive refractory small cell carcinoma of the lung received prolonged intra- venous infusion of vincristine. All but one patient had previously been given vincristine by conventio- nal bolus injection. Treatment consisted of a 0.5- mg b~lus injection followed immediately bv 0.25 mg/m day infusion which was continued for 5 days. Toxicity in general was minimal, but rapidly progressive disease precluded adequate assessment in the majority of patients. No objective responses were observed. Infusion of vincristine does not appear to be an efficacious salvage treatment for this disease.

Phase II Evaluation of Aclacinomycin-A in Patients ~ith Adenocarcinoma and Large Cell Carcinoma of the Lung. Tapazoglou, E., Samson, M.K., Pazdur, R. et al. Department of Internal Medicine, Wayne State Univer- sity School of Medicine, Harper-Grace Hospitals, Detroit, MI 48201, U.S.A. Am. J. Clin. Oncol., Can- cer Clin. Trials 8 298-301, 1985.

Aclacinomycin-A (ACLA-A) the new anthracycline antibiotic that produces substantially less cardio- toxicity relative to doxorubicin, was evaluated in a phase II trial for advanced large cell and adeno- carcinoma of the lung patients. Twenty-three patients with measurable disease were entered into the trial and received ACLA-A in ~oses of a weekly infusion of 65 mg/m and 85 mg/m . Eighteen patients were evaluable for response and toxicity. '±~o pa- tients were evaluable for toxicity only, one died

before completion of a full course of therapy, and