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347

TRE COYPETlNG RISK APPROACH IN DETERMINING RELAPSE-FREE SURVWAL IN LlMlTED SMALL CELL LUNG CARCINOMA

R. AFtRlAGADAt, A KRAMARt, T. LE CHEVALlERt , H. DE CREMOUX2, & the French Cancer Centers Lung Group. 1 lnstitut Gustave-Roussy (IGR), Villejutf. 2 Centre Hospttalier Intercommunal, Cretsil, France.

Two-hundred and two patients wfth limited smafi cell lung carcinoma were induded in four consecutive protocols alternating radiotherapy and chemotherapy at different dosages. The alternating schedule consisted of six cycles of chemotherapy (doxorubicin 40 mglm2, VP16213 225 to 375 mglm2, cyclophosphamide w)O to 1200 mgIm2, and methotrexate 400 mglm2in the first protocoi; cisplatinum 100 to 150 mgIm2 replaced methotrexate in the other three protocols) and three courses of thoracic radiotherapy at a total dose of 45,55,65 and 61 Gy respectively in the four consecutive protocols (accelerated hyperkactionatlon was used in the first course of the fourth protocol). A i-week gap was respected between each chemotherapy cycle and each course of radiotherapy. Seventy-six percent of patients were in complete remission at the end of the induction treatment. Relapse-free survtval was decomposed according to a model assuming competing risks in order to delne tfm first cause of failure (focal disease, distant metastasts or intercurrent death). No signtlfcant diMewes were observed between the 4 treatment groups. Overall results showed a 2- year cumulative incfdence rate of failure of 75%. When decomposed, the first cause of failure was: local oniy 33%, distant onty 25%, distant and iocal sfmultaneously g%, and 5% of intercurrent death. The methodology of competing rtsks ailowed an unequivocal description of first events in limited small cell lung cancer. The extent of the tocal pmbtem has been relatively overshadowed by the use of conventional descrtptive methods.

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346

Intraluminal Irradiation of Obstructing Bronchial Tumours. Clinical results, survival and outcome. by H.-N. Macha and B. Wahlers, HEMER FRG

273 uatients with endobronchial obstructing malignancies were treated by endoluminal _ high-dose Iridium 192 afterloading technique. Patients received a mean of 2.6 treatments with a single dose of 15 Gy at a 3 mm distance from the catheter surface. This treatment was planned as an integrated part of tumour therapie in advanced bron- chial carcinoma. The clinical data, results, survival and pattern of failure in these patients are reported.

348

Endobronchial radiotheraov for malignant bronchial obstruction or recurrence. R. Hatlevoll, K.O. Karlsen, S. Aamdal, T. Bohmann The Norwegian Radium Hospital, 0310 Oslo, Norway.

We have treated 14 patients, 2 females and 12 males, aged 37-72 years, with endoluminal brachytherapy (BT). Ten pts. had epidermoid carcinoma. The primary treat- ment was surgery and post.op. radiotherapy (RT) in one pt., chemotherapy and/or RT in 13 pts. The indications for BT was obstruction or local recurrence (11 pts), and a planned booster dose in 3 pts. Methods: 13 pts. had laser coagulation before BT with a HDR Microselectron. Correct location of the catheter was verified by X-ray, and by cutaneous marking of the endoscopic findings. The ET-dose was 18 - 24 Cy in 3 fractions, once a week.The dose specification was 1 cm from the center of the source. 4 pts. did not complete treatment due to early death or intercurrent disease. Results: Four pts. are alive, 22 - 97 days after start of BT, 10 pts died 3 - 120 days after BT. The cause of death was fatal haemoptysis in 5 pts., progressive cancer and intercurrent disease in 5 pts. The median survival for all pts. calculated from start of primary treatment was 21 - 22 months. Six pts. had subjective improvement of dyspnea, 6 pts. are not evaluable. Two pts. had progression of dyspnea. Conclus~ Survival after BT was very short. Relief of obstruction was obtained in the majority of patients, lasting for the reaaining lifetime. The high proportion of fatal bleeding is a problem, and further observation is needed to answer if it is an effect of treatment, or of the advanced stage of the disease.