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operative electrocardiogram, a forced vital capacity of 2.8 liters or less, a one-se- cond forced expiratory volume (FEVsub i) of less than 1.7 liters, an oxygen tensi- on of less than 60 mm Hg, or the senior- ity of the surgeon (resident versus at- tending). An increased number of compli- cations (p < 0 05) was found in male pa- tients, in patients operated on for car- cinoma, and in patients older than 60 years. Stepwise discriminant analysis in- cluded FEVsub 1 as a significant predictor of postoperative complications. We con- clude that elective lobectomy in a well- supervised residency program can be per- formed with a low mortality and that modern care techniques bring the vast majority of complications to a success- ful resolution.

Pulmonary Resection in Patients after Pneumonectomy. Kittle, C.F., Faber, L P., Jensik, R.J., Warren, W.H. Department of Cardiovascular and Thoracic Surgery, Rush-Prebyterian St. Luke's Medical Center, Chicago, IL U.S.A. Ann. Thorac. Surg. 40: 294-299, 1985.

In 15 patients with a previous pneumo- nectomy (eight on the right and seven on the left), a new 'lesion' developed in the remaining lung. Fourteen had the pneumonectomy for carcinoma (13 men and 1 woman), and 1 woman had a pneumonectomy for blastomycosis. At the second operation (4 months to 16 years after the pneumo- nectomy), limited resection of a primary or metastatic malignancy was done. The excision ranged from lobectomy to multiple wedges. One patient died on the sixth postoperative day, presumably a cardiac death. Eight patients died 2 to 33 months postoperatively. Six patients are now li- ving: 3 have no evidence of disease (18, 35 and 70 months), and 3 have recurrent disease (26, 41, and 73 months). There is evidence that pulmonary resection after pneumonectomy is feasible with a low operative mortality and that resec- tion of these secondary' tumors can result in prolonged, worthwhile survival.

Effect of Initial Resection of Small-Cell Carcinoma of the Lung: A Review of South- west Oncology Group Study 7628. Friess, G.G., McCracken, J.D., Troxell, M.L. et al. Brooke Army Medical Center, San Antonio, TX, U S.A. J Clin. Oncol. 3: 964-968, 1985.

The role of surgery in small-cell car- cinoma of the lung (SCCL) has been recent- ly re-evaluated. We reviewed the records of 262 patients with limited SCCL on Southwest Oncology Group (SWOG) protocol 7628. Fifteen patients were identified

who presented after surgical resection (12 lobec- tomy, 3 pneumonectomy). All patients were subse- quently treated with chemotherapy, radiotherapy + or - immunotherapy (BCG). Median survival time was 10.5 months. Median survival time of patients with initial surgical resection was 25 months (P = .004). Forty-five percent of the surgical patients were alive at 2 years v 13.7% of the nonsurgical patients (P < .05). A second subgroup of 33 patients v,as i- dentified with small primary tumors who did not undergo surgical resection. Median survival time in this group was i0 months (P = .03). Site of ini- tial relapse was clearly documented in 142 patients. Fifty-six percent of patients notreceiving surge- ry had initial relapse within the chest compared tb 13% of patients undergoing surgery (P = .002). ~ether the survival benefit identified was caused by or was incidental to surgical resection of the primary lesion remains to be determined in rando- mized prospective trials of operable candidates.

Bronchoplastic Procedures and Pulmonary Artery Reconstruction in the Treatment of Bronchogenic Cancer. Belli, L., Meroni, A., Rondinara, G., Beati, C.A. Department of Surgery 'Pizzamiglio II', Niguarda Hospital, 20100 Milano, Italy. J. Thorac. Cardio- vasc. Surg. 90 167-171, 1985.

Nineteen patients with primary bronchogenic carci. noma underwent bronchoplastic procedures (six wedge and 13 sleeve resections) between 1970 and 1982. In six of them lobectomy was combined with sleeve resection and reconstruction of the pulmonary ar- tery: In one a synthetic prosthesis was insertedr Twelve patients had squamous cell carcinoma, five adenocarcinoma, and two large cell carcinoma. No operative deaths were observed, and the 5 year sur- vival rate is 28.1%. One patient had an early bron- chial fistula and two patients had bronchial steno- sis (one suture granulation and one local recur- rence). No patient with resection of the pulmonary artery had vascular complications. Survival rates on the basis of nodal involvement indicate 50% survival at 5 years without nodal metastasis (ii cases) versus 9.7% with nodal involvement (eight cases) (p < 0.05). Bronchoplastic procedures, even if accompanied by segmental resection of the pul- monary artery, can be performed safely with long- term results comparable to those following major pulmonary resections.

Bronchial Adenoma: Surgical Experience with Long- Term Follow-Up (4-17 Years). Halevy, A., Schachner, A., Nili, M. et al. Depart- ment of Thoracic and Cardiovascular Surgery, Bei- linson Medicine Center, Petach Tikva, Israel. J. Surg. Oncol. 29: 66-68, 1985.

Of 16 patients with bronchial adenoma who were operated on at Beilinson Medical Center from 1967 to 1980, only three presented the 'triad' of cough, hemoptysis, and recurrent pulmonary infections. In two patients the tumor was diagnosed incidentally and in five patients histological evidence of ade- noma was made during bronchoscopy. One patient died

of myocardial infarction following reoperation for

225

bleeding, and one patient was lost to follow-up. The remaining 14 patients were followed for 4 to 17 years without evi- dence of local recurrence or distant me- tastases. We conclude that the long-term prognosis of patients with bronchial ade- noma is excellent and limited surgical procedure should be the treatment of choice whenever possible.

Diagnosis and ~nnagement of Synchronous Lung Cancers. Ferguson, M.K., DeMeester, T.R., DesLau- riers, J. et al. Department of Surgery, The University of Chicago Pritzker Schoel of Medicine, Chicago, IL 60637, U.S.A. J. Thorac. Cardiovasc. Surg. 89: 378-385, 1985.

The findings in 28 patients with syn- chronous lung cancers are reviewed. Me- diastinoscopy and systemic staging were performed to exclude the possibilities that one pulmonary lesion was metastatic from the other or that both represented systemic metastases from another tumor. Nineteen patients underwent resection of both tumors. Median survival was 25 months for four patients with definite Stage I synchronous cancers (no nodal involvement; different cell types, bron- choscopically separate endobronchial le sions or arising from separate foci of carcinoma in situ) and was 27 months for seven patients with possible svnchronous Stage I cancers (no nodal involvement;

similar cell types; located in separate lobes). Median survival was ii months for 16 patients having Stage II or III lung cancer accompanied by a second syn- chronous lung cancer. In the absence of hilar or mediastinal nodal involvement and systemic metastases, synchronous tumors should be considered separate primaries when located in different lobes, even if they have similar histologic features. Prognosis of synchronous cancers is re- lated to the presence or absence of nodal metastases. Pneumonectomy is the operation of choice for synchronous unilateral tu- mors. With bilateral tumors, sequential resection starting with the most advanced lesion is appropriate. Preservation of lung tissue without compromising the cancer operation is critical.

7, CHEMOTHERAPY

Evaluation of Drug Efficacy in Vitro Using Human Small Cell Carcinoma of the Lung Spheroids. Douple, E.B., Cate, C.C., Curphey, T.J. et al. Norris Cotton Cancer Center, Dart- mouth-Hitchcock Medical Center, Hanover, NH 03756, U.S.A. Cancer 56: 1918-1925,

1985.

Five human small cell carcinoma of the lung (SCCL) cell lines selected from 25 established cul- tures were grown as three-dimentional spheroid tumor models in either spinner culture or in static, agar- coated multiwells. Volume doubling times for the cell lines were approximately 4.5 days. Decreases in spheroid volumes after exposure to a variety of chemotherapeutic agents were used as indicators of drug activity. To further quantify cell killing in SCCL spheroids by chemotherapeutic agents 24 hours after exposure to drugs, a technique was employed that measured maximum levels of incorporation of 125-IUdD after continuous labeling for

48 hours. The results of the use of this assay re- port for SCCL spheroid responses to various concen- trations of doxorubicin hydrochloride,cytosine ara- binoside, mechlorethamine hydrochloride, cisplatin, or etoposide. Some evidence for an inter#nmor he- terogeneous response to chemotherapy is presented for some of the drugs tested. This assay was also used to characterize a potentiated cell kill when etoposide is combined with cisplatin and to iden- tify activity by a new compound, diazoacetylcholine iodide (DACI), which was synthesized as an agent targeted for SCCL cells.

Phase II Study of Vincristine Infusion in Refracto- ry Small Cell Carcinoma of the Lung. Jackson, D.V.Jr., Hire, E.A., Rardin, D A. et al. Oncology Research Center, Bowman Gray of Medicine, Winston-Salem, NC 27103, U.S.A. Am. J. Clin. Oncol. Cancer Clin. Trials. 8 154-156, 1985.

Fifteen patients with extensive refractory small cell carcinoma of the lung received prolonged intra- venous infusion of vincristine. All but one patient had previously been given vincristine by conventio- nal bolus injection. Treatment consisted of a 0.5- mg b~lus injection followed immediately bv 0.25 mg/m day infusion which was continued for 5 days. Toxicity in general was minimal, but rapidly progressive disease precluded adequate assessment in the majority of patients. No objective responses were observed. Infusion of vincristine does not appear to be an efficacious salvage treatment for this disease.

Phase II Evaluation of Aclacinomycin-A in Patients ~ith Adenocarcinoma and Large Cell Carcinoma of the Lung. Tapazoglou, E., Samson, M.K., Pazdur, R. et al. Department of Internal Medicine, Wayne State Univer- sity School of Medicine, Harper-Grace Hospitals, Detroit, MI 48201, U.S.A. Am. J. Clin. Oncol., Can- cer Clin. Trials 8 298-301, 1985.

Aclacinomycin-A (ACLA-A) the new anthracycline antibiotic that produces substantially less cardio- toxicity relative to doxorubicin, was evaluated in a phase II trial for advanced large cell and adeno- carcinoma of the lung patients. Twenty-three patients with measurable disease were entered into the trial and received ACLA-A in ~oses of a weekly infusion of 65 mg/m and 85 mg/m . Eighteen patients were evaluable for response and toxicity. '±~o pa- tients were evaluable for toxicity only, one died

before completion of a full course of therapy, and