1 5 1

generated using probit analysis. A steep dose response effect was found. The predic- ted E.D. value for 50% incidence was approx- imately 990 with a standard error of +30.

This E.D. value is equivalent to an avera- ge lung dose of 3270 cGy in 15 fractions. This dose response curve emphasises the need for accuracy in clinical dosimetry, as a 10% increase in dose predicts for a 30% increase in the incidence of acute lung damage.

Radiosensitivity of Human Lung Cancer Cells Grown in Nude Mice a~d in Culture. Miyamot~, T., Momiki x, S., Ohara, S., Ya- maguchi-, Y., Tunemoto, H. National Insti- tute of Radiological Sciences. i. Insti- tute of Pulmonary Cancer Research, Chiba University, Chiba City, Japan.

For the quantitive determination of radiosensitivity of human lung cancer, the tumors and cells obtained from 43 patients with primary lung cancer have been hetero- transplanted into nude mice primed with x- -ray at 4 to 5 Gy. These tumor cells also have been cultivated IN VITRO. As a result, we have established 17 (40%) nude tumors (adeno.; i0, epidermoid; 4, small; 2, large; i) and 7 (18%) culture cell lines (adeno.; 2, epidermoid; i, small; 3, large; l). Three of the nude tumors and 3 of the culture lines were used to obtain a dose- survival curve (DRC) for x-ray by using a regrowth and colony assay technique, respec- tively.

Nude Tumor Culture Cell (Gy) adeno, adeno, larse adeno, adeno L~rge

Dq 4.8 2.0 1.2 3.5 2.5 0 ,2

D. 2 .8 2 ,8 2 .2 1 ,0 1 .2 0 , 8

1. Radioresistance of adenocarcinoma of the lung was more dependent on Dq of DRC for x-ray than D.

2. D of DRC of the IN VIVO (nude tumor) ce°lls for x-ray was about 2 to 3 times higher than that of the culture cells.

9, CO~INED TREATMENT MODALITIES

Survival in Lung Cancer According to Treat- ment Modality: Results of 327 Patients From 1982 in One Institution. Hawson, G.A.T., Zimmerman, P.V. The Prince Charles Hospital, Queensland, Australia, 4032.

Survival figures for 327 patients with primary lung malignancy out of a total of 366 malignancies recorded in a computerized data base (50% of the total for the State) from a single Australian referral centre are presented for the year 1982. Follow up for a two, to three year period has been obtained from the Cancer Registry. At this stage 76% of patients have died.

Survival was not related to histological

subtype (except small cell). RADICAL RADIO-

THERAPY was given to patients with surgically

inoperable, localised tumours of small bulk. SURGERY was performed in patients whose pre- operative evaluation demonstrated localised disease and who were considered medically fit. CHEMOTHERAPY was given to almost all E.C.O.G. performance status 0-3 but only two non small cell patients were treated.

SURVIVAL no. 1 yr % 2 yr % median

Surgery 53 77 60 25 Radiotherapy Radical 76 61 30 14 Palliative 52 27 13 7

Chemotherapy 31 55 16 12 Palliation 92 22 13 3

The contribution to survival of a number of other prognostic indicates including T.N.M. staging, performance status, Feinstein index and weight loss will be presented.

Radiotherapy Versus Chemotherapy as Initial Therapy in Non-Resectable Non-Small Cell Car- cinoma of the Ltmg (NSCCL). II Quality of Life

Studi~s. 2 3 Kaasa , ~., Nmss , S., Ol~nes , B.T. Thorud I, E., H~st-, H., Mastekaasa , A., Lund ~, E. i. General Department, The Norwegian Radium Hos- pital. 2. Institute of Applied Social Research. 3. Neuropsychological Sect., XIV Department, Oslo City Hospital, Oslo, Norway.

Little attention has been paid to quality of life studies in patients subjected to in- tensive treatment by radiation and/or chemo- therapy. In the present study 60 patients with non-resectable non-small cell cancer of the lung were randomized to either radiothe- rapy (2,8 Gy x 15) or combination chemotherapy (cis-platin, etoposide). Assessment of the quality of life was performed at start of tre- atment, during and at certain intervals after treatment by:

i) psycho-social life evaluation, 2) neuro- psychological fundation test, 3) performance status evaluation and 4) therapeutic side ef- fects.

All patients have been followed for at least 12 months. The response rates and the survival in the two treatment arms have been compared and related to the effect on the quality of life. The immediate toxicity was most pronoun- ced following chemotherapy.

Radiotherapy (RT) Combined With Cisdiammine- Dichloroplatinum (cDDP) as Radioenhancer in a Dose Escalating Way, in Non Small Cell Lung Cancer (NSCLC) I 1+2 Schaake-Koning , C.,2van Zandwijk 2 , N., Schu~ter-Uitterhoeve , L., Koolen , M., Barte- link , H. i. The Netherlands Cancer Institute. 2. The Academic Medical Centre, Amsterdam, The Netherlands.

There is growing evidence that cDDP can en- hance the effects of RT on tumor cells in vi-

tro. In order to establish the maximum dose of

152

cDDP that can be combined once a week with the RT schedule: i0 x 3 Gy (5 fractions a week) 2 weeks split, i0 x 2.5 Gy for in- operable NSCLC, TI-3, NO-2, MO, a dose finding study was carried out. From May 1983 - May 1984, 20 patients (pts) ente- 9 red the study. Three pts received i0 mg/m ~ cDDP each first day of a series of 52daily RT fractions,A3~ pts received 50 mg/m , 4 pts 30 mg/m~, 3 pts 35 mg/m- and another 7 pts 30 mg/m ~. Nausea and vomiting, WHO score grade 4 lasting 3 or more days jeo- pardizing adequate fluid intake, appeared to be the dose limiting factor ~or large- scale use at a level of 35 mg/m-. No im- portant haematological or renal toxicity was observed. Of the 14 pts surviving lon- ger than 6 months 13 showed changes on the chest x-rays, compatible with radia- tion pneumonitis and/or fibrosis. Of these 13 pts i0 complained about dyspnea (9 exertional, 1 at rest).

Of the 9 pts with complete remission (CR) 2 developed local recurrence, 3 distant metastases; 4 pts showed no evidence of disease 4-11 months after assessment of CR. Partial remission was observed in 7 pts, stable disease in 4 pts.

Small Cell Carcinoma of Lung Treated With Surgery, Radiation and Chemotherapy. Shetty, M.R., Brouhard, J.W., Devi, B.S., Stefani, S. Northwest Community Hospital, Arlington Heights, Illinois, U.S.A. 60005.

Purpose of the study is to combine all modalities in small cell lung cancer to prolong survival and possible cure.

26 patients with small cell lung can- cer were treated from 3/76 to 12/84 with surgery, if resectable, chemotherapy, and radiation therapy. There were 18 males and 8 females. 13 patients had limited disease and 13 patients had extensive dis- ease. Ages ranged from 33 to 73 years. Ra- diation therapy (R.T.) was delivered to primary t~nor and regional nodes (4500 r to 5000 r in 5 weeks) and prophylactical- ly to the brain (2500 r to 3000 r in l0 fractions). Concomitant chemotherapy with cytoxan, (750 mg/m-) was given every 3 weeks. UpOn completion of R.T. vinc{istine (1.4 mg/m-) and adriamycin (50 mg/m-) were added to cytoxan. Afte~ cumulative dose of adriamycin to 550 mg/m , cytoxan was con- tinued as maintenance therapy. Toxicity was nausea, vomiting and alopecia. Myelo- suppression was not a problem. 3 patients developed central nervous system relapses. 5 patients are alive and free of disease at 28, 53, 64, 81 and 105 months. 4 patients died at i0, 30, 56 and 60 months. 3 of the 5 living patients had surgery. Combi- ned modalities may have an important role in producing long term survival.

Adjuvant Postoperative Mediastinal Radiation in Non-Small Cell Carcinoma of the Lung. Fass, D., Macher, M., Cooper, J., Steinfeld, A. NYU Medical Center, New York City, U.S.A.

The use of adjuvant postoperative mediasti- nal radiation in patients undergoing curative resection of non-small cell lung carcinoma (NSCLC) has been the subject of several small retrospective studies. The value of such treatment, as well as the effect of histology and nodal status on prognosis, remain unclear. We therefore analyzed the results of therapy for all patients at NYU Medical Center refer- red for postoperative mediastinal irradiation between 1972 and 1982.

All patients had undergone curative resec- tion for NSCLC and were found to have micro- scopic involvement of peribronchial, hilar and/or mediastinal nodes. A total of 40 pa- tients were treated: 22 had adenocarcinoma, 12 had squamous cell, and 6 had large cell or mixed histologies. All but two received a mid- plane dose of 4500 cGy to the mediastinum in 5 weeks.

Overall survival was 35% with a minimum fol- low-up of 2 years. When peribronchial and/or hilar nodes only were involved with disease, survival was 40%; when mediastinal nodes were involved survival was 31%. Survival was 50% in the adenocarcinoma group and 25% in the squamous cell carcinoma group. These data sug- gest a potential survival benefit with posto- perative adjuvant mediastinal irradiation as compared to survival seen in unirradiated histo- rical controls. Our results will be compared with those available in the literature.

~itimodality Therapy in Lung Cancer. xie, D.Y., Liu, B.L., Chuk, Y.F. Cancer Hospi- tal, Shanghai First Medical College, Shanghai, China.

From 1965 to 1983, there were 3915 cases of lung cancer accepted in our hospital. Among them 1418 were treated by radiotherapy, 535 by surgery, 1962 by traditional chinese medicine or chemotherapy, or both. The 3- and 5-year survival rates for radiotherapy group were 6.6% and 4% respectively. Of 535 cases who were operated on, 450 resected (84.11%), among them, 119 had preoperative radiotherapy (resection rate 83.2%), their 3- and 5-year survival ra- tes were 33.73% and 26.81% respectively; ni- nety-five cases had postoperative radiotherapy, the 3- and 5-year survival rates were 40.12% and 28.81% respectively. The 3-year survival rate of those cases with hilar lymph nodes metastasis treated by surgery along was 22%, while the 3-year survival rate of those cases treated by surgery plus post-operative radio- therapy was 48% (p < 0.05). Among 85 unresec- ted cases, 41 were treated by cryosurgery, and Ii of them survived over three years.

Changes in the View of the Treatment of Small

Cell Lung Cancer.