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a relatively simple and comparatively inexpensive technique that often producesaclinical responseandcan beausefuloption inthe management of patients with recurrent bronchogenic carcinoma.

High dose endohronchlal irradiation in recurrent hronchogenk carcinoma GauwitzM, EIlerbroekN, Komaki R, PutnamJB Jr, RyanMB, DeCaro L et al. Department of Radiation Medicine, Loma Linda University Medical Center, 11234 Anderson Sr., Loma Linda, CA 923S4. Int J Radiat Oncol Biol Phys 1992;23:397-400.

Behveen November 1988 and March 1990, 24 patients with endobronchial mmors that had recurred after external beam radiation therapy were treated with high dose rate intraluminal irradiation. A remote afterloading high dose rate unit was used, and most patients received hvo endobronchial treatments, separated by a hvo week interval. All patients were given the same dose and dose spwification to assess the feasibility and complications of the therapy. At each treatment, 15 Gy were. delivered with dose specified at a radius of 6 mm from the center of the source, which corresponds to a dose of 9 Gy at a radius of 1 cm. Overall, 21 of 24 patients (88%) showed good symptomatic improvement. Of 18 patients whose. chest x-ray showed evidence of collapse or atelectasis caused by tumor obstruction, 15 (83 96) had evidence of maeration. The median duration of palliation, marked by symptoms or a chest x-ray that worsened, was 26 weeks, the range varying from seven to 40 weeks. No patient died as a result of therapyandonlyonehadacomplication, bronchospasm,whichresponded well to bronchodilators. One patient died of hemoptysis approximately three months after treatment. Five additional patients, who were treated off protocol because they had an Eastern Cooperative Oncology Group performance status of greater than two, also received endobronchial Irradiation. All five died within one month from worsening pulmonary disease, and we do not recommend endobronchial irradiation for patients with an Eastern Cooperative Oncology Group performance states ofgreater than two. Weconclude that high dose rateendobronchial brachytherapy effectively relieves ihe symptoms of endobroochial obstruction due tp recurrent lung cancer and can be given safely aa an outpatient procedure. As the complications were minimal in this series treated withauniformdoseof 15 Gypertreatment, futunstudiesshould aim at determining the maximum tolerated dose. This technique may also be helpful as a boost after maximal external beam irradiation or to open up areas of atelectasis prior to external beam irradiation.

Does thoracic wramation improve survival and local control in limited- stage small-cell carcinoma of the long? A m&a-analysis Warde P, Payne D. SlZISherbourne St, Toronto. Ont. M4X IK9. J Clin Oncol 1992;10:890-5.

Purpose: Our main purpose was to determine whether the addition of thoracic radiation therapy to systemic chemotherapy improves Z-year survival, improves local (intrathoracic) tumor control, and affects treatment-related mortality in patients with limited-stage small-cell carcinoma of the lung. Design: Eleven randomized trials addressing this issue were identified using a computerized literature search (Medline and Cancerline) and by polling senior investigators in the field. A meta- analysis was then performed and the results of the trials were analyzed in hvo ways, the odds ratio (OR) (Peto) method and the risk difference method (Dersimoniao and Laird). Results: The overall OR for benefit of thoracic radiation on 2-year survival (ie, the odds of surviving 2 years among patients allocated to radiation compared with the odds of surviving 2 years among patients allocated to control) is 1.53 (95% confidence interval [CI], 1.30 to 1.76; chi2 = 12.76; P < ,001). The risk difference method showed that radiation therapy improved 2-year survival by 5.4% (95% CI, 1.1% to 9.7%). Local control results were availableforonlyninestudies, theOR fortreatmentbenetitis3.02(95 % Cl, 2.80 to 3.24; ch? = 101.48; P < .OOOl), and intrathoracic tumor

control was improved by 25.3 W (95% CI, 16.5 96 to 34.1%). The OR for excess treatment-related deaths in the thoracic radiation-treated patients was 2.54 (95% Cl, 1.90 to 3.18; ch? = 8.24; P < .Ol). The risk difference for treatment-related deaths was 1.2 96 (95 96 CI, - 0.6 % to 3.0%). Conclusions: Thismeta-analysisshowsasmall but signrficant improvement in survival and a major improvement in tumor control in the thorax in patients receiving thoracic radiation therapy. However, this is achieved at the cost of a small increase in treatment-related mortality.

Combined treatment modalities

Survival in patients with superior pulmonary solcw tumors Taylor LQ, Williams AJ, Santiago SM. Pulmonary Disease Section, Veterans Administration, Medical Center W. Los Angeles, Los Angeles CA 90073. Respiration 1992;59:27-9.

We report our experience with 21 patients with superior sulcus tumors. Demographic features and survtval were analyzed according to the stage of disease. Eleven patients had stage IIIA disease, 2 had stage IIIB disease and 8 had stage IV disease. Only 4 (19 X) were amenable to surgery at the time of diagnosis and only 1 underwent combined preoperative radiotherapy and surgery. The majority of our patients were nonresectable at the time of diagnosis because of extensive disease or coexisting medical conditions. Overall, the probability of survival approached zero at I year. This poor survival is a reflection of nonresectability in the majority of our patients, which may be umque to our patient population.

Phase II trial of combination chemotherapy and irradiation in non- small- cell lung cancer, Radiation Therapy Oncology Group 88-04 Sause WT, Scott C, Taylor S, Byhardt RW, Banker FL, Thomson JW et al. Am J Clin Oncol Cancer Clin Trials 1992;15: 163-7.

Encouraging results of several clinical trials utilizing combmation chemotherapy and irradiation in unresectable non-small-cell lung cancer have been reported. A recent report from a cooperative group study suggested that preirradiation vinblastine and cisplatin improved survival over irradiation alone. In an attempt to enhance the possible effectiveness of combination chemotherapy and irradiation, the Radiation Therapy Oncology Group embarked on a Phase. II trial utilizing preirradiation vinblastine (5 mglm2 weekly x 5) and cisplatin (100 mgim”) on days I and 29 prior to irradiation and on days 50,7 1, and 92 during irradiahon. The irradiation began on day 50 and consisted of 6300 cGy m 7 weeks. Between May 20, 1988 and May I, 1989, 30 patients were entered on study. Seventy-two percent of patients had Kamofsky status > 90, and 76 % had weight loss < 5 46. Forty-eight percent of the patients were younger than 60 years of age. Forty-five percent of the patients had Stage IIIA disease. Eighty-three percent of the patients received at least four courses of vinblastine, and 59% received at least four courses of cisplatin. Seventy-eight percent of the patlents received at least 95% of the prescribed irradiation. The major toxicity was hematologic, and there were. two fatal complications m the study group. The preliminary survival figures are encouraging. This combination of chemotherapy andirradiationappears tobetolerableandmaymeritfurtherinvestigat~on.