136 Abstracts/Lung Cancer 12 (199S] I I3- I60

Objective: To determine the factors that are related to short-term survival and to develop a model that can be used to estimate prognosis in terminal lung cancer patients. Design: Longitudinal cohort study of hospice lung cancer patients followed from date of admission to hospice until death. Serting: Community-based nonprofit home hospice service. Patients: Three hundred ten consecutive lung cancer patients admitted to hospice, with a separate validation sample of78 consecutive hospice lung cancer patients. A4eamrements: The relationships between survival and admission demographic characteristics, information from the history and physical examination, assessments of performance and nutrition, particular symptoms, and the presence of a living will were evaluated. ResuIts: Mean survival was 5 1 days, with a median survival of 27 days. Shorter survival was independently associated with those who had no living will on admission to hospice @ = 0.008), those who had tissue types other than 4uamous ceU or adenocarcinoma @ = 0.008). those who had liver metastases @ = 0.04). those who were tachycardic @ < O.OOl), those who requited assistance or were dependent in their to&sting (p < 0.001) and feeding (p = O.OOl), those who had dry mouths @ = 0.01). and those who bad severe or incapacitating pain @ < 0.05). A model estimating survival time based on the number of these significant variables present is reported (r = 0.53 in the original sample; r = 0.38 in the validation samnle). Conclusions: Multiple factors, inchtdina tissue

symptoms, and the presence of a living will, were related to short-term survivaJ in terminal lung cancer patients admitted to hospice. A model utilizing those specific factors allows useftd estimates of short-term snrvival for these patients,

Role of exercise stress testing in preoperative evahmtioo of patients for lung resection Gilbreth EM, Weisman IM. DeparOnent ofPu/monaryMedicine, WJB Dorn Veterans Hospital, Garners Ferty Road Columbia, SC 29209 Clin Chest Med 1994;15:389-403. Patientswithdiagnosedor suspectedhmgcsncerfirstrequireappropriate staging and pmven anatomic resectability. Excellent preoperative spimmetric data (FEV, >2.0 L, >60% predicted) should recommend the patient for surgery immediately without further testing. Those whose preoperative FEV, is less than 60% predicted or whose D(L)CO is less than 60% predicted should be sent for quantitative lung scanning to estimate postoperative spirometty and diffusing capacity. Results showing FEV,-PPG and D(L)CO-PPO greater than 40% of normal suggest an accepmble surgical risk, and the patient should be referred accordingly. Those whose results are less than 40% of predicted should Lx exercised in some capacity to assess oxygen transport. We believe that cycle ergometry with incremental workloads and the standard monitoring is the best technique available for this (Table 1). Patients with a predicted postoperative FEV, (or D(L)CO) greater than 35% of normal values aad whose. peak exercise VG, is greater than 15 mL/kg/ min should be offered surgery with the goal of removing the smallest volume of tissue that would be compatible with a cure. Those who do not met these criteria, however, shotdd not be smmmuily retimed surgery irtheyarewillingtoaccepttbcpossibilityofanearlicrdeathorprolonged diaabiity over the certainty of a cancer-related death in the foreseeable months ahead Because the lung scan prediction ofpmtoperative regional physiolosy and the excrcisc test of global oxygen transport examine different aspacts of physiologic operability, we would not disagree with anyone who would advocate doing both tests in those at high risk by virtue of spimmuric criteria. The logic of this wmbiied approach is iJhtstrated by Figure 1.

Glucocorticoid responsive ACTH secreting bmachial careinoid tumours contain high concentrations of giucncorticoid receptors Florkowski CM, Wittert GA, Lewis JG, Donald RA, Espiner EA. Department of Endocrinology Christchurch Hospital, Christchurch. Clin Endocrinol 1994;40:269-74. Cushing’s syndrome due to a bronchial ACTH secreting carcinoid tomour may be difmlt to distinguish from a pituitary microadenoma (cortimtrophinoma) causing Cushing’s disease, since in both disorders ACTH secretion may be responsive to glucocotticoids. Why some bronchial carcinoid tmnours are responsive is tmknown but it could be because of co-secretion of corticotrophin releasing thctor (CRF) and/or expression of ghrcocotticoid receptors. We report two patients with ghrcomrticoid responsive ACTH secreting bronchial carcinoid tumours, neither of whom produced or responded to CRF. Significant glucocorticoid receptor binding capacity (92 and 102 pmobg protein), compared with control lung tissue, was found in extra& from both tumonrs. These findings suggest that corticotrophinoma-like responses to glucocorticoids observed in some ACTH secreting bronchial carcinoids result from expression of ghrcocorticoid receptors and are not necessarily reJated to the production of CRF.

Percutaneous computed tomography-guided tine needle brachy- therapy of pulmonary malignancies Brach B, Buhler C, Hayman MH, Joyner LR Jr, Liprie SF. 200 Hudson Lane, Momve, LA 71201. Chest 1994;106:268-74. Small caliber needle aspiration of lung lesions has been successfully ad safely used for diagnostic purposes. We report our initial experience using computed tomography-guided fine needle percutaneous imphuttation for direct intralesional high-dose rate brachythempy for malignant pulmonary lesions. Twenty patients with primary lung cancer or metastatic cancer which involved the lung or chest wall were treated with a bighdosc rate remote afterloader. Eighteen of the 20 patients also received external beam radiation in conjunction with intralesional f8dhtion therapy. Fourteen patients had primary lung cancer. A complete ICSPO~S~ was obtained in 5 of the 14 patients. Ten of the 14 patients with primary non-small+ell carcinoma of the lung showed a sign&ant response to treatment (greater than 50 percent reduction in tumor meanucment). Six patients with metastatic lesions also were treated. Fii ofthe Six showed a significant tumor response measured as either 50 petcent reduction in ttmtor measurement or complete pain relief. Tbc Onb’ significant complication was pnemnothorax (6 of the 20), which did not ptevent completion of any treatment plan.

Glucose-induced thermogenesis in patients with sm8ll cell lung carcinoma. The effect of acute fJ-adrenergic inhibition Simonsen L, Bulow J, Tuxen C, Christensen NJ. Department of CIinical Physiology. Bispebjetg Hospital, DK-2400 Copenhagen AW Clin Physiol 1994;14:489-9. Seven patients with histologically verified small cell lung carcinoma were given an oral glucose load of 75 g on two occasions to examine the effect of ghtcose on whole body and forearm thermogenesis with and without acute O-adrenergic inhibition with propranolol. Whole body energy expenditure was measured by the open circuit ventilated hood system. Forearm blood flow was measured by venous occlusion strain- gauge plethysmography. The uptake of oxygen in the forearm was calculated as the product of the forearm blood flow and the difference in arteriovenous oxygen concentration. The glucose-induced thermo- genesis in the 120 mm following the ghrcose load was significantJy reduced by O-adrenergic inhibition with approximately 50% from 639t5.8 kJ 120 mid (meaniSE) to 27.ti9.8 kJ 120 min-’ (Pa.01). Almost the entire reduction took place from 60 to 120 nun (P<O.OOS). The integrated glucose-induced forearm oxygen uptake in the period