Abstracts/Lung Cancer I1 (1994) 423-444 441

and improvement of clinical symptoms. A moderate bone marrow suppression and appetite loss were observed as the side effects, but they returned to normal soon after the drug was discontinued. The patient is now being followed at the outpntient clinic. Such P very uncommon case has been scarcely reported in Japan.

Clinical study of intrapleural administration of pirarubicin (THP- ADM) for treatment of malignant pleural efksionsecondary to lung cancer Makimoto T, Hosbino H, Tsucbiya S, Nakaoo H, Watanabe S, Naruse I et al. Depattment of Internal Medicine, National Nishi Gunma Hospital, Gunmo. Jpn J Thorac Dis 1993;31:1542-7

The efficacy of intrathoracic administration of pirarubicin (THP- ADM), a derivative of adrinmycin. was evaluated in 20 patients with malignant effusion due to lung cancer. All 20 patieuts had no previous intrapleural therapy. Accordiig to the criteria of ECGG, eight ptients were at performance status 1 (P.S.l), nine were P.S.2, and three were P.S.3. Fourteen patients were clinical stage IIIB, and six stage IV. The e&ions were first completely drained by thoracocen tesis or tube thoracostomy drainage, and 30 mg/m’THP-ADM was instilled. Gvemll response rate was 50.0%. The reqonse rate for treatment with tube thoracostomy drainagewas 69.2 96, which was significantly higher than that for treatment with tho-entesis (14.3%). Significant difference in survival was not seen between the tube thoracostomy drainage group and the tho racocentesis group. There were no severe side effects. In conclusion, intrapleural administration of THP-ADM with tube thoracostomy drainage was considered to be useful for the control of malignant pleural effusion due to lung cancer.

Radiotherapy

Prolonged survival after high-dose rate emlobronchial radiation for malignant airway obstrwtion Tredaniel J, Henaequin C, Z&man G, Walter S, Homasson J-P, Maylin C et al. Service de Pneumologie. Hopital Saint-Louis. Paris. Chest 1994;105:767-72.

Study ohjectiw: To show that prolonged survival can be observed after high-dose rate (HDR) endobmnchial brachytherapy as the sole treatment for some selected patients presenting with an endobmnchial malignant obstruction. Patients: Twenty-nine patiats (group 1) who presented with an eadoluminal localized tumor without m&static extension were treated by HDR endobmncbial brachytherapy and are comparedwith22subjectswhopresented~~~~~dissemiartion and were palliatively treated (group 2). Treatment protocol: Treatment consisted of sessions of two exposures, delivering 7 Grays at a IO-mm radius from thecenteroftheapplicatoreach, andtepmted every 15days. to a maximum of six exvres. Endoscopic response and survival are the main criteria of assessment. Results: Follow- up bnmchoscopies, performed 2 months after the end of the procedure, showed tumor regressions: macmscopic complete responses (CR) were observed in 2 1 of 25 patients evaluable in group 1, and 6 of 22 in group 2, with histologicCR in 18and2patientq respectively. Medianoverall survival was not reached in group 1 after 23 months of follow-up; it was 5 months forgmup2. Conclu.rions:Tlwserksconfitm thatHDRbrachythempy can be used as a monotherapy for carefully selected patients who have small tumors to all appearances limited to tbe bronchial lumen and bronchial wall without adjacent parenchymal extension or metastatic disease.

Combined treatment modalities

Treati& of small cell lung cancer: The Copenhagen experience Hirsch FR, Dombernowsky P, Hansen HH. Department of Medical Oncology, P Bispebjerg Hospital, 24ao Copenhagen. Anticancer Res 1994;14: B 317-9.

The present article is a review of recent treatment protocols for patients with small cell lung cancer (SCCL) treated in Copenhagen from 1985 to 1990. Furthermore, preliminary data on long-term survivors ( > 5 years) from 9 treatment protocok since 1973 are reviewed. For 484 pacents I70 years old, no survival difference was observed between 2 platinum @is-platinum or carboplatin) containing regimens, while the survival was better in these two induction regimens compared to an alternating controlarm. For patients > 70yearsold, Etoposide (VP-16) and Teniposide (VM-26) were compared in a randomized fashion. Both drugs were highly active, and no significant difference in activity was observed. All together 1527 patients have been included in clinical trials in the Copenhagen Lung Cancer Study Group since 1973. The rates of 5-and IO-yearssurvivorswere 3.5 96 and 1.8 % respectively. Lung-term survival can be achieved in all stages of SCCL.

A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer Roth JA, Fossella F, Komaki R, Ryan MB, Putnam JB Jr, Jin Soo Lee Dhingra H et al. Waun Ki Hong ~oracic/CardiovarculnrSurg. Dept., Texas Univ. M. D. Anderson Can. Ctr., Box 109,lSlS Holcombe Blvd., Houston. Ix 77030. J Nat1 Cancer Inst 1994;86:673-80.

Background: Patients with resectable stage IIIA non-smakell lung cancer have P low survival rate following standard surgical treatment. Nom-andomixedtrialsinwhichinductionchemotherapyoracombination of chemotherapy and radiation prior to surgery were used to treat patients with regionally advanced primary cancers have suggested that survival is improved when compared with treatment by surgery alone. Purpose: We performed a prospective, randomized study of patients with previously untreated, potentially resectable clinical stage IIIA non- small-cell lung cancer to compare the results of perioperative chemotherapy and surgery with those of surgery alone. Methods This trial was designed to test the null hypothesis that the proportion of patients surviving 3 years is 12 % for either treatment gmup against the alternate hypothesis that the 3-year survival rate would be 12% in the surgery alone gmup and 32 96 in the perioperative chemotherapy group. The estimated required sample size was 65 patients in each group. The trial wss terminated at an early time according to the method of O’Brien and Fleming following a single unplanned interim analysis. The decision to terminate the trial was based on ethical cokiderations, the magnitude of the treatment effect, and the high degree of statistical significance attained. In total, 60 patients were randomly assigned between 1987 and 1993 to receive either six cycles of perioperative chemotherapy (cyclophcsphamide, etoposide, andcisplatin) and surgery (28 patients) or surgery alone (32 patients). For patients in the former gmup, tumor measurements were made before each course of chemotherapy and the clinical tumor response was evaluated after three cyclesof chemotherapy; they then underwent surgical resection. Patients who had documented tumor regression after preoperative chemotherapy received three additional cycles of chemotherapy after surgery. Results: After three cycles of preoperative chemotherapy, the rate of clinical major response was 35%. Patients treated with perioperative chemotherapy and surgery had an estimated median survival of 64 months compared with 11 months for patients who had surgery alone (P < Xl08 by logrank test; P< .018 by Wilcoxon teat). The estimated 2-