I01

symptoms. In 33 evaluable patients, two partial remissions were documented, with seven additional patients showing evidence of minor responses. Although modest, these responses warrant further study of acivicin in non-small cell lung cancer in combination with other agents.

8. RADIOTHERAPY

Palliation of Bronohogenic Carcinoma With 198Au Implantation Using the Fiberoptic Bronchoscope. Rabie, T., Wilson, R.K., Easley, J.D. et al. Pulmonary Section, Baylor College of Medicine, Houston, TX 77030, U.S.A. Chest 90: 641-645, 1986.

The majority of cases of bronchogenic carcinoma remain incurable, and many of these patients require palliation of the effects of the tumor on the airway. We have developed a~echnique for implanting radioactive (l~Au) seeds via the fiberoptic bronchoscope. We now retrospectively review the results ob- tained in iii procedures in 54 patients. Response was assessed by improvement in symptoms, chest roentgenogram, or bron- choscopic appearance. Nineteen of 29 (66%) patients with occluding endobron- chial lesions benefitted. Twenty of 22 (91%) with hemoptysis improved. All six patients with tracheal lesions benefitted. Two of six (33%) patients with nonoccluding endobronchial lesions responded. Complications directly related to the procedure were rarely of major consequence, although a single patient had an exsanguinating hemoptysis four days following the last of multiple implantations. The simplicity, relative safety, and potential wide availability coupled with low equipment costs would suggest an increasing role for this tech- nique in the palliation of endobronchial neoplasms.

9. COMBINED TREATMENT MODALITIES

Tntratumoral Bacillus Calmette-Guerin Im- munotherapy Prior to Surgery for Car- cinoma of the Lung: Results of a Prospec- tive Randomized Trial. Matthay, R.A., Mahler, D.A., Beck, G.J. et al. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, U.S.A. Cancer Res. 46: 5963-5968, 1986.

A prospective randomized trial of preoperative intratumoral therapy with Bacillus Calmette-Guerin (BCG) was con- ducted in non-small cell lung cancer patients. Eighty-eight patients (48 BCG- treated and 40 control subjects) were en- tered into the study; three control sub- jects were removed from data analysis be- cause histology revealed pathology other than non-small cell lung cancer. There were no differences between BCG-treated and control patients in sex, age,

cigarettes smoked per day, pack-years of cigarette smoking, white blood cell count, or number of peripheral blood lymphocytes. Toxicity of BCG was limited to transient malaise and fever (average peak temperature, 38.7 degr. C). There was no significant difference in outcome (recurrence or survival) between BCG- treated and control groups with Stage I or Stage III tumors; there were too few Stage II tumors for separate statistical analysis. Outcome was not affected within or between the two treatment groups, Stage III patients had a worse outcome than did Stage I-II patients, non- squamous cell tumor patients (large cell and adenocarcinoma) had worse outcomes than did squamous cell tumor patients, and men had a worse outcome than women. We conclude that, although preoperative intratumoral BCG therapy is safe, it does not lengthen disease-free interval or prolong survival in patients with non- small cell lung cancer.

Modified Stage I (TINOM0, T2NOM0), Non- small Cell Lung Cancer: Treatment Results, Recurrence Patterns, and Ad- juvant Immunotherapy. Little, A.G., DeMeester, T.R., Ferguson, M.K. et al. Department of Surgery, University of Chicago Medical Center, Chicago, IL, U.S.A. Surgery 100: 621-627, 1986.

We analysed 96 patients who had sur- gery with TINOM0 or T2NOM0 nonsmall cell lung cancer (NSCLC) to identify survival rates and recurrence patterns in well- staged patients and to evaluate adjuvant recurrence patterns in well-staged patients and to evaluate adjuvant therapy. Preoperative staging included chest x-ray, gallium 67 scanning, and bronchoscopy in all patients. At thoracotomy, multiple mediastinal lymph node sites were routinely sampled. The results included an operative mortality rate of 5.2%, and the actuarial 5-year survival rate of all patients was 70.0%. Survival of TIN0 (n = 44) and T2N0 (n = 47) patients was 72.1% and 68.3%, respec- tively (p = NS). Survival was not af- fected by type of surgery, cell type, sex, age, or race. Late death was due to recurrence in 12 patients, a new airway malignancy in three, and a noncancer problem in six. Disease recurred in 15 patients: four (9.1%) TIN0 patients ver- sus ii (23.4%) T2N0 patients, p < 0.05. Recurrence was local in four patients and distant in ii. Second lung cancers developed in six patients at a mean in- terval of 65.7 months after resection. A prospective, randomized trial of systemic immunotherapy with bacillus Calmette- Guerin (BCG) skin scarification was carried out in 29 patients. Survival in those patients receiving BCG was 85,9% compared with 63.9% for control subjects (p = 0.075) and 69.6% for patients not in the study (p = 0.077). The following con-