428 Abstracts/Lung Cancer IO (1994) 395-430

who achieved a complere response (CR) received one course of late- mtensification (LI) treatment consisting of cyclophosphamide (4 g/m’) and etoposide (900 mgim:). Prophylactic cranial irradiation (PCI) was optional. Results: Nineteen of 32 assessable patients achieved a CR (59%) and 12 had a partial response(38’%), for an overall response rate of 97 46 (95 46 confidence interval [Cl], 84% to 99 46). Median survival was 18 months, while 2-year progression-free survival was 47%. Leukopenia ‘A l,OCO/L occurred in 12% of induction treatment cycles. Severe esophagitis was uncommon. Pulmonary fibrosis that was asymptomarrc or minimally symptomatic was observed in eight patients (25%). There was one episode of adult respiratory distress syndrome (ARJX) during LI cbemorherapy. Life-threatening neutropenia (% 500/L) developed in all patients who undenvent LI chemotherapy, with amediandurationof lOdays(range. 8 to 19). Twopatientsdiedofsepsis durmg LI chemotherapy. Conclusion: Altemaung PE and TRT as performed in this tnal is an effective brief induction regimen for limited- stage SCLC. However, this particular regimen did not appear to be substantrally different LO terms of efficacy or toxicity compared with rqmens using concurrent chemotherapy and standard- fracllon TRT. LI chemotherapy was associated with unacceptable toxicity and did not appear to have a favorable impact on survival.

A prospective analysis of chemotherdpy following surgical resection of clinicul stage I-II small-cell lung cancer Davis S. Crino L, Tonato M, Darwish S, Pelicci PG. Grignani F. lwiruro di Clinica Medica. Clniv di Peru& Div di Oncologia, Policlinico Mon~eluce. Perugia. Am J Clin Oncol Cancer Clin Trials 1993;16:93-5.

Thirty-seven (37) consecutive patients with climcal Stage I (Tl- 2N0. MO). and Stage II (Tl-2NI MO) central small-cell lung cancer (SCLC) undenvent complete surgical resection of the primary tumor. Ten pattents were subsequently pat_holoy~caIIy Stage I, 14 patients were Stage II. and 8 were Stage III (T3;N2). The pathologically Stage I, II. and III patients were. then treated with chemotherapy consisting of cyclophosphamidti (1 gim’), doxorubicin (50 mgim:), and vincristine 2 mg (CAV) every 3 weeks for six courses followed by prophylactic cramal irradiation (2Ooo cGy in 10 fractions). Median survival in Stage I patients is 162 weeks and calculated j-year survival is 50%; for Stage II panems, median survival 1s 86 weeks and calculared S-year survival 1s 35 %. T3 ,N2 patients have a median survival of 63 weeks; calculated 5-year survival is 21%. Our data suggest surgery plus adjuvant chemotherapy and cramal n-radiation results m long-term survival in early central SCLC. These data support the need for randomized surgical trials m Stage I. II. and III central SCLC.

Chemotherapy and ndirtion for the tre&nent of non-smaJlseIl lung cancer: A critiwl review MurrenJR, Buzaid AC. DepamnenrofI~~rerMlMedici~~e, Yale Uniwrsiry School of Medicine. 333 Cedar Street. New Haven, CT 06510. Clin Chest Med 1993;14:161-71.

:Most patients with non-small-cell lung cancer require treatment with radianon or chemotherapy at some point during the course of their rllncss. Radiotherapy may be curative for some small primary lesions, but in general it IS used to palliate unresectable lung tumors or symptomatic metaslascs. Chemotherapy may be useful m selected patients wnh disseminated disease. Current research defies ihe role of chemotherapy in combination with radiation and surgery in patients with locally advanced tumors. In addition, new classes of drugs with novel mecbamsmsofactionare becommgavadable. Preliminary reports of these drugs, which mclude lax01 and the topoisomerase I inhibitors, demonstrate pronusmg activity m this disease.

Other treatment modalities

Ancillary therapicsin themanqemmtof hmgcancer: Wotodynamic therdpy, laser therapy, and endobroncbid prosthetic devices Edell ES, Cortese DA, McDougall JC. noracic Diseases/lnrernal Med. Div., Mayo Clinic Rochester. Rochester, MN. Mayo CIin Proc 1993;68:685-90.

Endoscopic therapy for cancer that involves the tracbeobroachial treeiscurremIyavailablefortwodistincttypesoflesions: radiographically occult superficial squamous cell carcinoma and advanced malignant tumors that cause severe airway obstruction. Photodynamic therapy. which uses a photosensitizing agent, ts effective for managing early superficial squamous cell carcinoma. Neodymium:yttrium-aluminum- garnet ker therapy has been etktive in the palliative management of patients with advanced or recurrent malignant obstructive airway lesions. dither alone or in combination with intraluminal radiation therapy. Most receody, endobroachial prostheuc dev1ce.s (stents) have been used in pallears wirh advanceddalrway obstruction. The useofeach of these modalities in the management of lung cancer is reviewed.

Photodynamic thempy as an alternative treatment for surgery in P patient with hmg cancer undergoing bone morrow transplantition Sutedja T. Kwa B. Van Kamp H. Van Zandwijk N. Pulmonary Department. Free Universiry Hospital, loDo MB Amsrerdam. Chest 1993;103: 1908-9.

We describe a patient who suffered from a bacterial pneumonia and had a left-sided infiltrate on his chest radiograph. He was found to be cytopenic and acute myeloid leukemia was diagnosed. A complete remission was achieved after chemotherapy, and the patient was scheduledtohaveautologousbonemarrowtransplantatioa. Bmncboscopy was performed because of persistent hemoptysis and a squamous cell carcinoma in the right upper lobe bronchus was found. This small tumor was successti~lly treated with photodynamic therapy preventing any delay in the treatment of his leukemia, which would have occurred if surgery had been the treatment of chotce. The patreat 1s still in complete renussion after a follow-up penod of 12 months.

An emerging role for photodynamic therapy in hmg cancer Van Zandwljk N, Sutedja T, Baas P. Stewart FA. Division tfMedicu1 Oncology, Nerheriands Cuncer Insriture, Plesmanlaan 121, 1066 CX Amsterdam. Forum Trends Exp CIin Med 1993:3:33-9.

Photodynamic therapy (PDT) is a new cancer treatment modality that selecclively destroys cancerous tissue by an interaction between absorbed light and a photosensitising agent. This review discusses rbe principlesofphotodynamicactivityandexaminestheclinicalapplication of PDT in the treatment of non-small cell lung cancer (NSCLC). The treatment results for early-stage NSCLC are highly encouraging. In advanced NSCLC. random&d studies are needed to asses the value of this treaatment in addition to standard treatment. Apart from a further elucidation of the fundamental basis of the photochemical mechanism of PDT, technological advances will optimise this treatment for a wldar range of lung cancer patlams.

Experimental studies to assgs the potential of photodynamic thempy for the treatment of bronchiill carcinomas Smith SGT. Bedwell J, MacRobert AJ, Gnffitbs MH. Bown SG, Hetze.1 MR. Department of lhoracic Medicine, Vniversiry College Hospital. London WClE 6AU. Thorax 1993:48:474-80.

Background - Phomdynamic therapy (PDT) is a rechnique for producing locakd tissue necrosis with light after prior administration