AbstracidLung Cancer 10 (1993) 266-286 275

m patients wth small-cell lung cancer. Design: An algorithm was constructed by analyzing all pemwtat~ons of a sequence of procedures requwed to stage disease m patients with small-cell lung cancer. Procedural costs were. detennmed, and the model was applied to the small-cell lung cancer patient population treated at the National Cancer Institute. Bethesda, Md. from 1973 to 1989. The final algorithm was derived from the permutation with the lowest cost per accurately staged

patent. Srttmg: A single government institute, the National Cancer

Institute. Patvats: Four hundred fifiydne patients wth pmwously

untreated, con~ut~vehistolog~c~llydocumentedsmall-celllungcancer

entered into therapeutic protocols at the National Cancer Institute from

Apnl 1973 through July 1989. Datawereohtained fromsmall-cell lung

cancer protocol databases and patients’ medical records. Main Outcome Measure: The cost per patent of each sequence of stagmg procedures when applied to the patvmt population. Results: The least expenswe sequence of procedures saved $1418 per patient when compared with application of a standard set of stagmg procedures to all patients. The

maJor factor in reducing costs was the concept of stoppmg the staging

procedures after a ate ofdistant m&static disease had been idenhtied. Conclusions: An algorithm consisting of a set of sequential staging

procedures can accurately stage disease il patients with small-cell lung

cancer and save more than one tlurd of the costs of an incluwe standard

\et ot staging procedures.

Superior vena cave syndrome in small-cell lung cancer Urban T, L&au B. Chastang C, Leclerc P, Botto MI, Sauvaget I.

Service de Pneumologie, Hopiral Saint-Antoine, 184 rue du Faubourg

Sainr-Anroine, 75571 Paris Ceder 12. Arch Intern Med 1993;153:384-

I.

Background: The aim of tlus study was to analyze the features of the superior vena cwa syndrome (SVCS) as initial characteristics tn small- cell lung cancer: mcidence, d~ssemmation of &sease. dlagnosttc

procedures, efficacy and toxic effects of chemotherapy, and m&an survival III patients with SVCS. Methods: In a prospective sene.s of 724

patwits wth biopsy- proved small-cell lung cancer seen during a 6.year period. we reviewed data from patients who also had SVCS. Results:

The incidence of SVCS was 87 of 724 at the time of diagnosis. Initial

emergency radiation therapy was not used in these patients. Diagnostic

procedures tn these patwnts were not associated with mortality. Rapid

initiation of intenswe chemotherapy, often wth heparin therapy,

resulted in complete or patiml responses in 81% and no response in I2 ?? ; data were not w&able m 7 % Two of these 87 patients died of apalsla wthm 4 weeks of chemotherapy. Median surwval was not significantly different in the patients with SVCS (median, 42 weeks) and wlthoutSVCS(med1an,40weeks). Asignificant increaseminitial bran metastases a.t the time of diagnosis was observed in patients with SVCS

(22% vs I I %). Conclusions: Intensive chemotherapy is the first line of

therapy m small-cell lung cancer. Histologw diagnostic procedures

must be performed in patients with SVCS to adapt the treatment to the

underlymg cause. Initial enwrgawy radiotherapy, before diagnosis or

chemotherapy. does not seem to he useful in these patients. Computed

tomography of the brain should be performed routtnely in patients wth

SVCS, and prophylactic brain irradiation could be helpful in such pahents. Apparently SVCS is not a pwr prognostic factor in treated smallsell lung cancer.

M&static spinal cord compression secondary to lung cancer Bach F, Agerlin N, Sorensen JB, Rasmussen TB, Dombemowsky P, Sorensen PS et al. Depanmenrof Oncology, University Hospital He&w, DK-2730 Copenhagen. J Clin Gncol 1992;10:1781-7.

Purpose: M&static spinal cord compression (MSCC) is a disabling complication to cancer, the optimal treatment for which is not settled.

Ananalysiswasperfonned forall patie&withMSCCsecondary tolung cancer in East Denmark fmm 1979 to 1988. Patients and Methods: The

total series included ICI2 cae.s with small-cell carcinoma (SCLC; 40%),

adenocarcmoma (ACL; 26 %), squamous cell carcinoma (SQLC; IS %) and large-cell carcinoma(LCC; 9%). Symptoms, clinical presentations, aodthempettticmsultsnredesctibed. Results: Theoutcomeoftreatment

depended fundamentally on the patieat’s neurologic condition at the time of the diagnosis. All patients with SCLC who were able to walk at the tnne of MSCC remained ambulatory, whereas 15% of the nonambulatory SCLC patients regamed walking ability. In non-SCLC,

95 46 of patients continued to be able to walk, whereas 22 46 regamed the

abdity to walk. No maJo’ differences in the immediate outcome of

treatment between the various histologic types of lung cancer and the different treatment modalities were obsaved; however, 82% of the patients with non-SCLC benefited from treatment with laminectomy

followed by radiotherapy (RT) compared with either latninectomy

(47%)orRT(39W)alone(P = .03, clu’test). Thegroupofpatieots who were treated with laminectomy followed by RT had a better survival

(median value, 3.5; range, 0 to 132 months) than patients who were treated wtth either laminstomy (median value, 1.5; range, 0 to 32 months)or RT(median value. I; range, Oto59 months) alone(P = .03, log-rank test). No significant difference was observed in survival

between the various hwtologic types of lung cancer (P = IS. log- rank test). Conclusion: Despiteashortsurvival,early diagnosisandimmediate

treatment is crucial because It may preserve the gait function m 97 W of

lung cancer patients who develop malignant spinal cord compression.

Granulocyte colony-stimulating factor in lung cancer Johnson DH. Division ofMedical Oncology. Depanment ofMedicine. Vanderbilr Univ. School ofMedicine, Nashvilk. 7’N37232-5536. Lung Cancer (Ireland) 1993;9:3543.

Hematopoietic growth factors, specifically G-CSF and GM-CSF, have proved to be effective in abrogating myelosuppression associated

withcytotoxicchemotherapy. BothG-CSFandGM-CSF havebeenwell

tolerated although GM-CSF has been associated with more

thrombocytopenia and a first dose reaction consistmg of dyspnea, hypotension and tachycardia. G-CSF has clearly reduced the incidence

of infection as manifested by fever during neutropaia in two placebo controlled prospective trials. Similar data are lacking for GM-CSF.

Neither growth factor seems to have a clinically significant direct effect

on lung cancer growth. However, further studies are necessary to clarify

thisissuegirenthewnflictmginvitrodatacnnceminggrowthstimtdation. Further study also is needed to ascertain what impact, if any, the hematopaetlc protective effect has on response and survival.

Lamb&-Eaton syndrome and small cell lung cancer ZenoneT, Souquet PI, Mlchaud E, El Khoury MT, Demolombe-Rague S, Bady Bet al. Servicede Pneumologie, Cenrre HospiralierLyon-Sud, 69310 Pierre-&wire. Rev Med lnteme 1993;14:54-7.

TheauthorsreporttwocasesofLambert-Eatonmyasthenicsyndrom~

associated with small cell lung carcinoma. Following the observations, the chnical diagnosis of this syndrome is considered. We discuss the

autoimmune pathogen&s and the relation between paraneaplasttc

syndromeandsmallcellcancer. Thissyndromeiscausedhyaut~tibodiff

that block the voltage-dependent calcium channels at motor newe

tetinals. Smallcellcarcinomacellsappeartoexpresscalciumchannsls, suggesting that autoantibody production may be triggered by tumor

calciumchanneldetenninants.Theautoimmuneparaneoplasticsyndrome

theory refers to cross-antigenicity,

Women with lung cancer: Impact on quality of life Sama L. School of Nursing, University of California, 10833 Le Conre,

Los Angeles, CA 90024-6918. QuaI. Life Res 1993;Z: 13-22.

The purpose of this shtdy was to describe disruptions in quality of

life (QGL) in women suffering fmm lung cancer, the leading cause of cancer-related death in the United States. QGL was measured with the

CARES-SF.SymptomdistresswsmeawedwiththemodifiedSymptom Distress Scale., and fitnctional stahrs was measwed with the Knmofsky

PerfomumceStatwScale. Sixty-nioewo_withlungcancerpPlticipPted in a one-time data collection. The typul subject was under 65 years of

age, married, has had primary or recurrent non-small cell lung cancer forover 12months, hadlitniteddisease, andwsnotcurrentlyrecewing treatment. Subjects had greater disruptions in global QOL and its dimensions compared to a normative heterogeneous female cancer sample. The most prevalent serious disruptions were fatigue, difficulty with household chores, worry about ability to care for self, and worry

about cancer progrcwion. The global CARES-SF score. was moderately corre.latedtotimctionalstahas(r = 0.69, p = <0.OOl),andtosymptom distress (I = 0.72, p = <O.OOl). Symptom distress was associated

strongly with the physical subscale of QGL (r = 0.80, p = 0.001) and sigmficantly but less strongly with all other dimensions of QGL.

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

Significantlygreaterdifferencesindisruptionsofqurdityoflifeoccurred in women younger than 65 years (p = 0.04). women with recurrent disease @ = 0.003). and women with low income @ = 0.008). In stepwise regression. symptom distress predicted 53% of the variance followed by fonctional status (59 96) and recorrence (63 96) when QGL was the outcome variable.

Clinical manifestation3 of lung cancer Pate1 AM, Peters SG. Mayo Clin Prw 1993;68:273-7.

Theiniti~cl~crlmpnif~tioasoflungcollcerarediverse~dmav

lesions areproduced bb l&xl nrowth or invasion. &astaticdisea& or . . . syndrome or the superior vena cava syndrome are. relatively uncommoo but well recognized. M-tic bmg cancer can involve almost any anatomicareabybem&genowemstogeaous, lymphatic,or,occasionally, interalveolar dissemination. Complications related to malnutrition, infection, electrolyte distorbances, nod coexisting diseasea influence the initial manifestations. AlthoughiadividuPltumorcelltypesnresssocintedwith characteristic features, no constellation of tindiigs is pathognomonic for P specific histologic vtisnt. Becaose stwessfld treatroeat of pulmonary carcinoma depends on early detection, awareness of the typical clinical manifestations is importaot.

Partmeoplnstic syndromes pssoeiated with lung cancer Pate1 AM, DavilnDG, Peters SG. VniversiiyofAlabamn, Birmingham, AL Mayo Clii. Pmt. 1993:68:278-87.

P~raneopl&ic pheaomerta associ&d with primary long caocer have diverse initial manifestntions and epitomize the systemic nature of human malignant disease. The spectrum of clinical features in patients witb paraneoplastic syndromes ranges from mild systemic or cutaneous disease to bypercoagulability nod severe neoromyopatbic disorders. Although the diagnosis is often one of exclusion, a0 improved understandiig of the pstbogenesis involved io some of these syndromes has provided another means of recognizing the disorders and perhaps treating the affected patients. Proposed mechanisms of paraneoplastic processes include the aberraot release of bumoral mediators such as bonnones sod hormone-likepeptides, cytokinw, and antibodies. In this update, we review the potential mechanisms, diagnosis, and treatment of paraneoplastic syndromes associated with long cancer.

Diagnostic tests for lung cancer Karsell PR, McDougall JC. Mayo Clin Proc 1993;68:288-96.

Tbegoalsofdiagnostic testing in patients withsuspected long cancer are to establish the diagnosis and to determine the stage of the disease so that appropriate therapy can be initiated. Unless a patient has bemoptysls, fever, or a change in cough as an initial rnaoifestation, resectable lung cancer will seldom be diagnosed on the basis of the history. Screeoingtests-particularlycbestroatgwography-bavewully identified the abnormality. The managing pbysiciao should then select diagnostic procedures that are associated with low risk and that will provide further diagnostic and staging information. A biopsy will almost always be necessary before definitive therapy can be planned. In many cases, a single procedure-for example, a needle biopsy of a bepatic lesion or biopsy of P supraclavicolar lymph node- will provide a definitive diagnosis and establish the stage. of the disease.. The roles of cytology, histopatbologic examination, radiologic studies, and various types of biopsy in the diagnosis of lung cancer are reviewed in this report.

Serum tumor markers CEA, CA 50, TATI, and NSE in lung cancer screening Jsrvisalo J, Hakama M, Knekt P, Stenmao U-H, Leino A, Teppo Let al. Research and Dewlopmenr Vnir, Social Insurance Insrirurion, Pelmlantie 3, SF-2OMo Turku. Cancer 1993:71: 1982-8.

Background. There are. no effective means for screening for long cancer, so the authors assessed the utility of four lung cancer honor markers for screening. Methods. A case-control study, nested in B cohort study based on the linkage of records of health survey exam&es

with Finnish Cancer Registry records, was used to test the validrty of honor markers carcinoembryonic antigen (CEA), tumor-associated trypsin inhibitor (TATI), neuron-specific eoolase (NSE), and CA 50 in lung cancer screening. Ten years after health examinations, record linkage indicated that 187 men bad lung caocer; 344 control subjects. matched for age, sex, and municipality were draw from the same records. Results. The data allowed assessment of the sensitivity of the marker assays at a 95 96 specificity level, which was highest for CEA (17% at a concentration level of 5.3 g/l). Logistic discrimination analysis indicated that of the other markers, only TATI, when used in combination. improved the discriminatory power of CEA. CEA and TAT1 levels correlated significantly with smoking. They also showed a significant gradient toward increasing risk of lung cancer from the lowest to the highest quintiles of marker levels (for CEA, crude relative risk between the highest and lowest quintiles, 8.6). The gradient also was evident in the subgroup whose cancer had been diagnosed more than 5 years after serum specimen collection. The trend persisted, although relative risk was balvedsfteradjustment for smoking. Conclusions. The markers do not seem to be useful tools for lung caocer screening. However, CEAaodTATl levelsseemtogiveinformationoncancerrisk long before the clinical cancer stage, as the quintile-based analyses of marker levels indicate.

Lung cancer in patients with immunod&ciency syndrome Karp J, Profeta G. Marantz PR, Karpel JP. Monrefiore MedicoI Center, 111 Em 210th Srreet, Brom, NY 10467. Chest 1993;103:410-3.

We report adenocarcinoma of the lung in seven patients with buman immunodeficiency virus (HIV) infection. We compared age, clinical findings sod survival data with B sex-matched control group of HIV- negative patients with adenocarcinoma of the lung. Median age of HIV- infected patients with hmgcancerwas lower than in control patients with lung cancer. The HIV- infected patients had more systemic symptoms and abnormal physical findings than control subjects. Both groups had smoking histories. Laboratory d&were similar but control subjects bad lower blood oxygen tensions than did HIV patients; HIV patients bad moreabnormalitiesoncbestroe.ntgenogramsaodcomputedtornograpby scans tbandidcontrol subjects. All HIV-infected patientswerestageIV. Median survival was 4 weeks. For control patients, 50percent bad stage IV disease; median survival was 25.5 weeks. Thus, patients with HIV infection develop lung cancer ntayoongerage than sex-matched control subjects and undergoa tnorefulminant course withshortened survivals.

Protein turnover in advanced lung cancer patients Richards EW, Long CL, Nelson KM, Tobver OK, Pinkston JA, Navari RM et al. Depanment of Research. Baprisr Medical Cenrers, 701 Princeron Ave. Birmingham, AL 35211. Metab Clin Exp 1993;42:291- 6

Understanding the extent to which changes in whole-body protein kinetics contribute to the commonly observed weight loss aod decrease in lean body mass (LBM) in patients with cancer is currently obscured by conflicting reports in the literature. While several studies have reported significant increases in whole-body protein tornover (WBPT), synthesis (WBPS), and catabolism (WL3PC) in patients with caocar, others have failed to confirm these observations. We have measured whole-body protein kinetics using II primed constant infusion of “N- glycine in a homogeneous group of 32 newly diagnosed advanced long cancer patients with cornparable staging nod before soy antineoplastic treatment, and in 19 normal healthy volunteer controls. Urinary urea and ammonia “N emicbment was determined io individully colle&d urine samples obtained during the 24-boor study period end averaged for the determination of protein kinetics. During the last 6 boors of urine collection, samples were obtained hourly for determination of “N plateau enrichment. Twenty-four-hour urinary nitrogen nod creatinine excretion was determined from 24-boor pooled urine samples. Resting metpbolic expenditore (RME) was determined by indirect calorimetry and LBM was estimated from deoterium oxide dilution. Age. body weight, LBM, RME, and 24-hour urinary nitrogen excretion did not differ between canceraod control subjects. WBPT, WBPC. and WBPS (g/kg/d) were significantly increased in long ceocer patients. However, when the same results were expressed either per kilogram LBM or per gram 24-hour urinary cnxtioine excretion, WBPT. WBPC, and WBPS rates were not statistically different from those of the controls. Net