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INFLUENCE OF RADIOTHERAPY (Rt) ON BLOOD HISTAMINE OF PATIENTS WITH NON-SMALL CELL LUNG CANCER(=)

E. TEIXEIRA, I. Julio, R. Sotto-Mayor, M.S. Azevedo, J. Macanita, A. Bugalho de Almeida, C. Manso and M.Freitas e Costa. Clinica de DoenCas Pulmonares and Instituto de Quimica Fis+ologica da Faculdade de Medicina de Lisboa - CnL3 and MEL2 do INIC - Lisboa, PORTUGAL.

Few previous works suggest a relationship between- growth and histamine (Hi) synthesis, and a decline inHi levels induced by tumour extirpation. No infonmtion was found in what the other anti-tumour therapeuticmzasures are concerned. The aim of the present work was to study the influence of Rt in blood Hi levels of patients with lung tumours. Nine male patients, aged from 52 to 75 years, with NSCLC were submitted to Rt (60 Gy). Hi and amine oxidases (diamine and benzylamine) were detennired in peripherial blood before and 1 month after the thera py. In 4 patients these determinations were also perfor med 2 and 3 months after the treatment. Basal Hi values (46.2222.3 ng/ml) showed a significant (p< 0.05)~rease (26.5213.2 "g/ml) 1 month after the treatment and the follow-up of the 4 patients revealed a continueddecrease Significant (p< 0.05) reduced values induced by Rt were also seen in amine oxidases (histaminase from 0.57+25 to 0.3+0.2p mol H 0

h.? /h/1/25!?

from 0,41+0.27 to C and benzylamine oxidase

l+O.ll). These results, in relation to the reduction of tGour mass, could present Hi as a monitorizing index. However this group of patients is very small to allow such a conclusion and further in- vestigation it is necessary.

EFFICACY OF RADIOI’WRAPY IN 79 PATIENTS WITH BRAIN METASTASES FR(m PRIMARY LUNG CANCER MORNEXF, NAYBL H, VIDBIRA A. Ceulre L.B&IKI, LYON, FRANCE.

The benefits of therapy for patients @I@ with brain metastases have often been questioned, since they often have disseminated disease and a limited survival. Radiotherapy remains the reference treatment To assess the symptoms relief duration, the survival and prognostic factors, we retrospectively analyzed a series of 79 pts (72 M, 8F, median age 56 yrs) irradiated for brain metaStases from lung cancer. Primary tumor was treated by surgery, radiotherapy, chemotherapy or combinations, and was uncontrolled in 70% of pnts at the time of brain irradiation. Cerebral metastases preceeded the diagnosis of the primary tumor in 39%. was concomitant in 13 8 and followed in 48 % of pts; they were solitary in 43%( surgical resection performed in 11%). and associated with other sites of metastases in 50%. Radiotherapy consisted of a whole brain kmdiation ( median dose 36 Gy, usually 3 Gy fraction, 3-5 fractions/week), with a 15 Gy median dose boost in 13 solitary deposits. Concomitant chemotherapy was used in 43% of pts. On 68 evaluable pts, improvement was obsaved in 76% (marked in 48%. mild in 28%). 20% showed no response. The median survival achieved by brain inadiation was 8.2 months (6-156 weeks), with a median response duration of 16 weeks for responders. Moreover, pts submitted to surgery exhibited a 17 months median survival. Post-irradiation CT scan, performed in 18 responding pts, showed an improvement in 3 only, nochangein 11,pmgressionin 4.Fiitypts(63%)diedofpmgressive systemic disease, 16 of brain metastases, 9 of systemic and intracranial progression, 4 of treatment complications. Porn general conditions and preirradiation neurological status, no response to irradiation, multiple brain metastases and uncontrolled primary tumcc affected ule median response and survival durations. Total dose, fractionation did not influence the response rate. In summary. irradiation of brain metastases from lung cancer allows a 8.2 months survival, with an encouraging 17 months survival if surgery- irradiation are combined in solitary lesions. Only 20% of patients died of intracranial progression with stable systemic disease. These results should encourage the use of prospective combined modalities bials.

359

META-ANALYSIS OF RANDOMIZED TRIALS EVALUATING THE ROLE OF THORACIC RADIOTHERAPY IN LIMITED SMALL CELL LUNG CARCINOMA (SCLC)

R. ARRIAGADA’, D.C. IHDE, D.H. JOHNSON, MC. PERRY, J.P. PIGNON*, R.L. SOUHAMI & the SCLC Mela-analysis Study Group. lnstitut Gustave-Roussy (IGR)*, 94605 Villejuif, France.

Most investigators agree that thoracic radiotherapy (RT) significantly decreases the incidence of thoracic recurrences in limited SCLC. However, no agreement has been reached concerning its possible impact on survival. Publiihed randomized trials have not given consistent answers, and have been too small to measure the size of any effect with precision. The hypothesis tested by the present meta- analysis was that thoracic RT gives a moderate benefit on overall survival. This study included 13 randomized trials comparing thoracic RT plus chemotherapy (CT) to CT alone performed in 8 countries (Australia, Denmark, France, Japan, Sweden, Switzerland, U.K. 8 U.S.A) recruiting 2,576 patients (pts). Data concerning performance status, age, and gender was collected and checked for all randomized pts at the IGR Statistics Department. The use of individual dais allowed the follow-up period to be extended and the inclusion of pts who had previously been excluded from the published analyses for’ reasons such as ineligibility. Basic information was obtained in 96.4% of pts. Statistical analysis included log rank test stratified by trial, Pike hazard ratio estimator, heterogeneity and interaction tests for some indirect comparison, especially concemlng RT timing.

Detailed results of the meta-analysis will be presented for the first time in this meeting.

Long Term Palliation of Advanced Tracheobronchial Tumors by HDR Brachytherapy in the interdisciplinary concept.

P.C.von Bodegom’, H.D.Becker’, P.Fritz*, P.Schraube’, P.Drings’, M.Wannenmacher’, I.Vogt-Moykopf’. ‘Univ.Depr.of Radiotherapy and ‘Chest Clinic Heidelberg, FRG. High dose rate (HDR) brachytherapy is an established tool in the interdisciplinary concept of palliative tracheobronchial cancer treatment. However, indications are limited to life threatening main airway tumors after failure of all other treatment modalities. To our experience we found a subgroup of patients whose prognosis after HDR brachytherapy seems to be extremely favorable. They had all locally advanced non-bulky inoperable tracheobronchial cancer, but without evidence for distant metastasis. HDR afterloading brachytherapy was given in 3 fractions of 5 Gy calculated at lcm of the lr-192 radiation source immediately after the percutaneous radiotherapy (46 Gy) was completed. In this concept, percutaneous RT should cause a partial shrinkage of the tumor volume, the following HDR afterloading RT was performed in order to achieve endo- and immediately peribronchial a curative dose. Between 1988 and 1991, 16 of 900 new lung cancer patients in our hospital fulfilled these criteria. In this combined therapeutic approach a total tumor dose of at least 60 Gy could be achieved. The calculated total tumor dose regarding the endobronchial tumor surface was much higher thaa could be achieved with percutaneous RT alone. A complete histologically proven remission could be reached in all patients. With life table aaalysis, median survival has not yet been reached, mean survival time is 29.4 months (SE=1.7). Although the group of patients with possible indications for this kind of combined treatment seems to be very limited (16 out of 900 lung cancer patients in our hospital in 3 y’s), these survival data are encouraging for achieving long term palliation. This is the more so if quality of life is taken into account which is generally better in lower radiotoxicity to surrounding tissue (lung, esophagus, heart).