Abstracts/Lung Cancer 12 (1995) 265-329

signifnncc (sex, age, histology, performance status and interval between diagnosis of the primary and brain metastws) was collected. Details of sugery, radiation and steroid usage were recorded, and any steroid side effects documeoted. Survival was calculated from the date of diagnosis of brain metestases. Stepwise regression based on Cox’s proportional hazards model was used to determine significant prognostic factors effecting survival. Patients with and without steroid side effects were compared using Yates’s corrected chi-square test. Resulti: The overall estimated median survival was only 3.3 months (95% confidence interval 2.9-3.7 months). Only two factors were found to be associated with a significantly improved survival-surgical intervention and good performance states. A&r taking these hvo factors into account, the dose of radiation used (< 30 Gy or 30 Gy) did not influence survival. There was a 3% incidence of gastric bleeding or perforation in patients taking steroids, with a 40% fatality rate. Predisposing factors to gastric side effects were II prior history of peptic ulcer and/or aspirin or nonstemidal anti-inflammatory drug consumption. Conclusion: Radiation of brain metastases from primary lung cancer results in modest survival benetit. Radiation dose (< 30 Gy or 30 Gy) is not a significant determinant of survival. Other treatment moditications, such as concurrent radiation and chemotherapy, should be explored Steroids should be used with caution as fatal side effects can occur.

Impact of radiial systematic mcdinstinal lymphadencctomy oo tumor staging in lung cancer Izbicki JR, Passlick B. Karg 0, Bloechlc C, Pantcl K, Knoefel WT et al. Deparhnent of Surgery. Universiry o/Hamburg, Marlinistrasse 52, 20246 Hamburg. Aon Thorac Surg 1995;59:209-14.

The extent of lymphadenectomy in the treatment of non-small cell lung cancer is still a matter of controversy. While some centers perform mediastinal lymph node sampling with resection of only suspicious lymph nodes, others recommend a radical, systematic mediastinsl lymphadenectomy (LA) to improve survival and achieve a better staging. Herein we report on the impact of LA on tumor staging in a controlled, prospective, randomized clinical trial comparing lymph node sampling and IA in a total of I82 patients with operable non-small cell lung cancer. Regardless of the type of lymphadcnectomy performed, the percentage of patients with pathologic Nl or N2 (sampling: n = 23,23.0%; LA: n = 22 26.8%) disease WBS very similar in both groups, indicating that systematic radical lymphadenectomy is not an essential prerequisite to determine the N stage of a patient. lo contrast, the number of patients detected to have lymph node involvemeot at multiple levels was significantly increased by LA. In the lymph node sampling gmup only 4 of 23 patients (17.4%) with N2 disease were found to have more than one lymph node level involved, whereas LA results in the detection of excessive N2 disease in I2 of 21 patients (57.2%; p = 0.007). which was associated with a shorter distant mctastases-free (p = 0.021) and overall survival. In conclusion, IA. is not essential to determine the N stage of a patient, but results in a more detailed staging of the N2 region, which is of prognostic significance. Therefore, it might be useful to Identify patients with 8 higher risk for tumor relapse.

Carcinoid tumors of the lung: Do atypical features require aggressive maoagemeot? Marty-Ane C.-H. Castes V. Pojol J.-L. Alauzen M. Baldet P. Mary H. Serv

Chirurgie ThoraciqueNasculaire, Hopi& Arnaud de Villeneuve. Centre Hospitalier Universilaire, 34295 Montpellier Cedex 5. Ann Thorac Surg 1995;59:78-83.

Atypical carcinoids are an intermediate form of tumor behveen low-grade malignant typical carcinoid and high-grade malignant smell cell carcinoma, which represent the two cods of the spcotrum of ncuroendcainc bronchopulmonary tumors. Bdween 1983 and 1993,27 patients with atypical carcinoids underwent surgical treatment. The histologic diagnosis of an atypical carcinoid was established if the criteria proposed by Arrigoni and associates were fulfilled. Seven pneumoneotomics, 16 lob&or&s, 2 segmcntcctomies, and 2 wedge resections were performed Thirteen patients (48.1%) had regional nodal met&a.ses and 6 patients (22%) had N2 disease at the time of surgical therapy. Distant metestases dcvel oped in 5 patients (18.5%) afler initial treatmmt. The IO-year survival in patients with an atypical carcinoid was 49%, versus the t34% IO-year survival rate observed in patients with a typical carcinoid. We conclude that the aggressive behavior of atypical carcinoids precludes the use of limited surgical resection and

requires a more aggressive approach, with lobeetomy and mediastinal lymph node dissection constituting a minimal procedure. The same criteria used for well-differentiated lung carcinoma should apply to this fono of ncuroendocrine lung tumor. Adjuvant chemotherapy is recammmdcd for patients with stage III or distant me&stases.

Coaehlog persons with lung caocer to report sensory pain: Literature reviewaodpilotstudyfindin~ Wilkie DJ, Williams AR, Grevstad P, Mckwa J. Deportment of Physiological Nursing, Vniversiry of Washington, Seattle, WA 98195. Cancer Nurs 1995; I&7- 15.

Because clinicians often do not recognize that patients have pain and patients do not spontaneously communicate their pain, clinicians may fail to prescribe or administer adequate pain medications. One method of improving clinicians’ assessments of pain is to coach gimts to communicate their pain in ways that clinicians recognize. The aims of our pilot study were to (a) examine the feasibility of implementing .a randomized clinical trial of a COACHING protocol in I8 outpatients with lung cancer pain and(b) estimate the effects ofCOACHING on nurses knowledge of patients’ pain location, intensity, quality, and pattern. The expectation was that COACHING would show a trend toward reducing the discrepancy between patient self-report of seosory pain and sensory pain data known to nurse clinicians. Patients were randomly assigned to be COACHED or NOT-COACHED (usual care) and pretest- posttest measures with the McGill Pain Questionnaire @&‘QJ) and Vwual Analogue Scale (VAS) were taken from nurses and patients. Patient- and nurse- completed MPQs and VASs were compared foragreement. Improvement in percmt agreement occurred consistently more often (pretest to posttest) tehveen patient self-report of seosoty pain and nurses’ pain assessments in the COACHED group than in the NOT-COACHED group. Pilot study findings demonstrated feasibility of implementing the COACHING protocol and suggest that COACHING may be effective in reducing discrepancies behveen patients’ self-reports and nurses’ assessments of sensoty pain. Design moditications are recommended for implementation of future studies.

Serum neuron-specific enolw and immunohistocbemical markers of ncumcndoerlnc differentiation in lung cancer O’Shea P, Cassidy M, Freaney R, McCarthy P, Fcnnelly J. Deportment of Oncolo~, St Kwents Hospital, ElmPark, Dublin 4. II J Med Sci 1995; l&l:3 l-6.

An enzyme immunoassay for serum neuron-specific enolasc (NSE) was evaluated with respect to analytical performance and clinical utility and compared with immunohistochcmical evaluation of neuroendocrinc differentiation. Values obtained agreed well with values obtained using a radioimmunoassay method giving a correlation coefficient of 0.934. Analytical performance of the enzyme immunoassay was good but the diagnostic sensitivity of 82% in eaemive and 67% m limited disease was insuffIcient for serum NSE to be of value in the diagnosis of small cell lung cancer (SCLC). Serum NSE decreased significantly in 11 of 15 patients with SCLC following institotion of chemotherapy. Classification of lung cancers into SCLC and non small cell lung cancer (NSCLC) types is largely based on timour morphology. Neumendocrine differentiation may not be morphologically evident. Immunohistochcmical staining of tumour tissue with markers of ncuroendocrine differentiation, i.e. NSE (both monoclonal and polyclonal antibodies) Leo 7, Chromogranin A and P G P 9.5 was performed in both patients with SCLC and NSCLC. 38 per cent of patients with NSCLC had both raised serum NSE and positive NSE (polyclonal) immunopemxidase staining of lung tissue. A further 35 per cent of patients showed a raised serum NSE or positive immunohistochcmistly but not both. The presence of two positive immunopcroxidase markers in lung tissue has been suggested as an indicator of responsiveness to chemotherapy in NSCLC patients. A number of factors may effect immunohistochcmical positivity in tissue sections and the additional use of B serum marker may better define chemotherapy responsive groups.

Percutaneous balloon pericardiotomy for management of cardiac tamponade in a patient with lungcanccr and large pcricardialeftihn

Kouvaras G, Polydorou A, Hatziantoniou G. Cardiac Catheterization Loboralo*y. General Slate Hospital, Piraeus SI Panteleimon. Acta Cardiol 199449549-53.

We describe the case of a 32-year-old man with lung cancer Involving the pericardium on which we pcrformcd pericardiotomy, using a balloon dilating catheter, to create B non-surgical pericardial window. For the percutaneous creation of pericardial window we advanced into the pericardium by subxiphoid approach