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We have found that the pleural effusion obtained from a patient with lung cancer (adenocarcinoma) has cytotoxic activity against the pa- tient’s lung cancer cells. This fmding occurred in the course of estab- lishing a lung cancer cell line from the patient’s pleural effusion. The cytotoxic factor was partially purified from the pleural effusion and characterized. It had cytotoxicity against L-929 mouse fibroblasts in the standard 18-h killing assay of tumor necrosis factor (TNF). By molecu- lar sieving chromatography, the activity appeared at molecular weight of 50,000. This activity was completely blocked by a monoclonal antibody to TNF. From these results, we conclude that the cytotoxic factor in the pleural effusion is TNF. The concenuation of TNF in the pleural effusion was 34.5 pg/ml by radioimmunoassay. In addition, we detected TNF activity and protein in two other cases of carcinomatous pleural effusion. Therefore, it would appear that in viva TNF displays cytotoxic activity against cancer cells.

Analysisofthe decreasedNK (natural killer) activity in lung cancer patients, using whole blood versus separated mononuclear cells Nielsen LR, Kimose H-H, Linnet L, Moller NP, Bukh A. Instin& of Medical Microbiology, Universify of Aarhus, Aarhus. J Clin Lab Immunol 1989;29:71-7.

The aim of this study was to analyze whether a whole blood assay would give a more correct measure of NK activity than assays using separated mononuclear cells (S MNC). We found that the NK activity of whole blood was higher than the NK activity of SMNC m the 28 lung cancer patients investigated (p = O.Ol), whereas this thfference between the assays could not be demonstrated in the 29 healthy conuols. Since no differences were found between the NK activity of washed blood, SMNC, and monocy=-dcplcted lymphoid cells, there was no indication that the lower NK activity of SMNC in comparison with whole blood was due to cell loss or to a systematic disturbing effect due to mon- ocytes. The possible effect of plasma factors on the whole blood NK activity was analyzed by comparing whole blood and washed blood. The NK activity of whole blood was increased m comparison with washed blood in the lung cancer patients (p<O.OOOl) indicating a stimulatory effect of plasma. Further, the finding that the reactive capability of lymphocytes from cancer panents was tngher than in con- trols could indicate preactivation of the lymphocytes from the cancer paucnts due to the presence of stimulatory plasma factors. The NK activity of lung cancer patients was lower than the NK activity of healthy controls. The difference was found to be smaller with whole blood than with SMNC as effectorcells, although both differences were significant. The decrcascd NK activity of cancer patients could be due to blocking immune complexes (IC), but we found no evidence for circulalmg or cell-bound IC m the lung cancer patients.

Predictorsof5-yearsurvivalandcnrabilityinsmallcelllnngcancer Crown JPA, Chahinian AP, Jaffrey IS, Glidewell OJ, Kaneko M, Holland JF. Memorial Sloan-Kerrering Cancer Center, 1275 York Avenue, New York. NY 10021. Cancer 1990;66:382-6.

A retrospective analysis of various characteristics in 81 small cell lung cancer patients treated at the Mount Sinai Medical Center, New York, from 1974 to 1982 was carried out to identify factors which had prognostic significance for long-term survival, defined as actual dis- ease-free survival for at least 5 years from initiation of therapy. Six patients, five. female patients (16.7%) and one male patient (2%). includingfourlimi~disease(9.7%)andtwoextensivediseasepatients (5%) were long-term survivors (73 to 96+ months from onset of therapy), and among them three remain alive and disease-free at 84.84, and 96 months from first treatment, respecuvely. Although several factors, includmg sex, stage of disease (limited versus extensive), and occurrence of herpes u)ster predicted overall survival duration, female sex and an occurrence of herpes zoster were the only variables which were statistically significantly related to 5-year survival. Herpes roster was a relatively latcoccurrcnce whereas female sex wasan independent positive prognostic factors.

Humoral leukocyte adherence inhibition (H-LAI) test in screening of high risk group for lung cancer Kubasova T. Bank J, Kotcles CJ, Horvath M. National Research

Insrirurefor Radiobiology and Radiohygiene, H-l 775, Budapest. NKI-

plasma 1990;37:173-8. In the screening examinations of 150ore miners the positive humoral

immune response against lung tumor antigen was measured in 30 serum samples. Repeated testing ofpositrve scra (after 1-3 years) was possible only in 15 cases. Among them, the reaction of 12 serum samples was again positive, and 2 persons died of lung cancer. The results obtained in these follow-up investigations are discussed.

Bronchogenic carcinoma presenting as neuromusculoskeletal pain DownsSE.276 U.S.,RouteOne, York. MEO3909. JManipPhysiolTher 1990;13:221-4.

A case of bronchogenic carcino a manifesting Pancoast’s syndrome is presented. A 48-year-old female patient suffered from pain in the neck, axilla, anterior lower ribs and sudscapular regions, with thoracic pardspinal muscle spasm, and paresthesia in the right upper extremity. An anteropostcrior lower cervical radiomph demonstrated a homogenous mass lesion in the apex of the right lung. The patient was referred for medical diagnosis and trcatmcnt. A significant reduction in the pain experienced by the patient was achieved with spinal manipulative therapy while the patient was undergoing medical therapy for the malignancy.

Distribution of skeleIal metastases in prostatic and lung cancer. Mechanisms of skeletal metastases Morgan JWM, Adcock KA, Donahue RE. Medical Imaging Service 115. Denver Veterans Adminiswatlon Medical Center, 1055 Clermonl

Street, Denver, CO 80220. Urology 1990;36:31-4. The distribution of skeletal metastases in prostatic and lung cancer

was examined to test the hypothesis that prostatic carcinoma spreads by a unique hematogcnous route. Abnormal technetium-99m methylene diphosphonate bone scans were retrospectively reviewed in 71 patients with prostatic carcinoma and 41 paliens with lung cancer comparing patterns of osseous involvement. Differences in the distribution of lesions were not significant. It is concluded that prostatic carcinoma does not metastasize to spcclfic skeletal sites by a singular hemato- genous pathway.

Classifying clinical severity to help solve problems of stage migra- tion in nonconcurrent comparisons of lung cancer therapy Pfister DG, Wells CK, Chan CK, Feinstein AR. Yale Universiry School

of Medicine, P.O. Box 3333, New Haven, CT 06510. Cancer Res 1990;50:4664-9.

To compare the effects of stage migration in the ‘traditional’ 3-stage TNM (tumor, node, metastasis) system with those in a new ‘expanded 5-stage system, which has two additional stages for the poor prognostic groups, we used both systems to classify a cohort of 178 patients with primary lungcancer. Tocheckformigrations,thestagesin bothsystems were first assigned using only ‘old’ technological information and were thenreassignedusingall theavailable ‘new’aswellasoldtechnological data. Although the 5-stage system had more migrations than the 3-stage system, survival rates were relatively unaffected for patients in the two new stages with poor prognosis. In both TNM staging patterns, the effects ofstage migration on survival statistics were most impressive in the prognostically better (TNM I and II) stages. A solution to the migration problem is offered by the ‘clinical severity’ (CS) staging system. LikethcexpandedTNM systcm,theCS system has5 stagesand a sharp prognostic gradient among stages. The CS system, however, had fewer technology-induced stage migrations than either TNM system, and the migrations had no substantial impact on stage-specific survival results. The excellent prognostic discrimination and secular stability of the CS system make it superior to the TNM system for comparing treatment results from different eras, especially for patients with stage I and II disease.

Primary bony chest wall tumours Sabanathan ES, Pradhan GN, Meams AJ. Deparrmenl of Thoracic

Surgery, Bradford Royal :nfirmary, Bradford BD9 6RJ. 3 R Co11 Surg Edinburgh 1990:35:44-7.

A retrospective review of 81 cases of primary chest wall turnours was carried out to analyse their clinical, radiological and surgical features.