354 Abstracts/Lmtg Cancer 13 (1995) 323-356

in Phase II trials has been the use of chemoradiotherapy as an induction protocol. The chemotherapy has usually been platinum based and has been given prior to, or concurrent with, radiotherapy. The two largest series to date (Rush-Presbyterian and Southwest Oncology Group) have both suggested improved median survival times and prolonged survival using this approach. Three recently completed nonsurgical trials have demonstrated the superiority in median and long-term survival of primary chemoradiotherapy compared to primary radiotherapy alone in treating locally &aixed, inoperable Stage IIIA and IIIB lung cancer. Both induction therapy approaches followed by surgical resection are now being tested against nonsurgical approaches in large-scale Phase III trials of clinically Stage IIIA lung cancer patients. A Canadian trial tests induction chemotherapy plus surgery versus radiotherapy alone, and an American intergroup trial tests induction chemoradiotherapy plus surgery versus chemoradiotherapy alone. Recently, because of apparent improved survival with induction therapy, interest has been sparked in this approach for more advanced IIIB disease (T4 and N3) and poor-prognosis lesser disease (TZNO and Nl). These encouraging data suggest that induction therapy will play an increasing role in the management of locally advanced lung cancer, whether the local control treatment is surgery or radiotherapy. Ultimately, Phase III trials, now under way, will allow us to determine the best method of primary control.

A historical perspective of multi-modality treatment for resectable non-small cell lung cancer Jaklitsch MT, Strauss GM, Healey EA. DeCamp MM Jr, Liptay MJ, Sugarbaker DJ. Division of Thoracic Sutgmy, Br$ham and Women’s Hospital, 75 Francis Street, Boston, MA 02115. Limg Cancer (Ireland) 1995;12:Suppl2:SI7-32.

We examine the origins of surgical therapy, radiotherapy, and chemotherapy as they were applied to lung cancer in the mid-portion of this century. Surgical therapy for lung cancer started in the 1930s with pneumonectomies. The prognostic signiScance of nodal metastaxs was soon recognized, and surgical staging procedures became an important part of patient workup. Radical radiotherapy for potential cure of lung cancer began in the 1950s with megavoltage linear accelerators. The first application of chemotherapy for lung cancer was the use of nitrogen mustards in the 1940s. Single modality surgical therapy has become the treatment of choice for Stages I and II non-small cell lung cancer, but 50% of clinical Stage I patients die of recurrent disease, and 70% of those recur outside the chest. Biologic markers may identify high risk subgroups of Stage I and II patients who may benefit from adjuvant chemo- or radictherapy. Within the last decade, several single and multi- institutional Phase II trials and two single institution Phase III trials have reported improved survival in Stage IIIA patients treated with cisplatin-based neoadjuvant chemotherapy prior to surgical resection. These trials have reported high response and resectability rates, but at a substantial toxicity. A new standard of care for Stage IIIA disease has not been conclusively established.

Neoadjuvant chemotherapy of stage III-A and B lung carcinoma using the PACCO regimen Takita II, Blumenso LE. Raghavan D. Dept. of Thoracic Swgery/ Oncology, Rowe/l Park Cancer Institute, Elm and Carlton Sheets. Buffalo, N1: 14263. J Surg Gncol 1995;59:147-50.

Previously, we reported an effective chemotherapeutic combination regimen for non-small cell lung carcinoma (NSCLC): cisplatinum, doxorubicin, cyclophosphamide, CCND, and vincristine (PACCO). Forty-one patients with a diagnosis of NSCLC Stages III-A and III-B were entered into the protocol of neoadjuvant PACCO chemotherapy. Following two courses of chemotherapy, the patients were evaluated

for surgical therapy. The overall response rate to the chemotherapy was 60%. Subsequently, 65% of the patients underwent surgical resection. The overall estimated median survival was 18 months. The smvival of patients in III-A was 36 months and that of III-B was 18 months (95% confidence lower bounds for III-A: 8 months and for III-B: I3 months). There was one chemotherapy-related mortality but no surgical mortality. Neoadjuvant chemotherapy with PACCO regiment offers an alternative to chemoradiation therapy, without increasing the surgical mortality, and should be validated in a randomized clinical trial. For succes&l neoadjuvant chemotherapy of Stage III NSCLC, chemotherapy combination which would give a high response rate without sign&ant side effects must be chosen.

Adoptive immunotherapy in tbe postoperative treatment of non- small cell lung cancer Ratto GB, Melioli C, Fantino G, Tassara E, Ponte M, Angelini Met al. Ist. Patologia Speciale Chirurgica, Universita degli Studi, I/isle BenedettoXV IO, 16132 Geneva. Chirurgia 1995;8:82-7.

This study has been carried out to evaluate the efficacy of Adoptive Immunotherapy (AI) with TIL (Tumor Intiltrating Lymphocytes) cells and recombinant Interleukin-2 @IL-2) in patients who underwent surgery for non small cell lung cancer fNSCLC) at Stage II, IIIa or IIIb. Seventy- one patients were stratiBed according to the disease Stage, randomized and treated with AI or standard therapies (Chemo-radiotherapy in Stage III; no therapy in Stage II). TIL cells, obtained from the removed specimens, were in vitro expanded and infused iv. Subcutaneous administration of rIL-2, starting at the TIL infusion day, lasted for 3 months. For Stage II patients, the survival curve in the AI Gmup was similar to that in the Control Gmup. For Stage IIIa patients, survival tended to bc higher in the AI Group with respect to the Control Group. For Stage IIIb patients, survival was signitIcantly (p < 0.05) better in the AI Group. The Performance Status, as far as Stage III patients are concerned was improved in the AI Group, with respect to the Control Group. The number of intrathoracic recurrences was lower (50%) in patients undergoing AI, while no diIference between Gmups was found for distant relapse.

Pre-treatment prognostic factors in patients with Stage III non- small cell lung cancer treated witb hyperfractionated radiation therapy with or without concurrent chemotherapy Jeremic B, Shibamoto Y. Department of Oncology Chest Disease Reseatch Institute, Kyoto University. Kpto 606-01. Lung Cancer (Ireland) 1995;13:21-30.

We analyzed prognostic factors for non-small cell lung cancer (NSCLC) treated with hyperfractionated radiotherapy (HFX RT) with or without concurrent chemotherapy. One hundred sixty-nine patients with histologically or cytologically proven, Stage III NSCLC, Kamofkky performance status W’S) 50, and no previous therapy were treated in a randomized trial as follows: Group 1 - HFX RT to a total dose of 64.8 Gy (61 patients); Group 2 - the same HFX RT with chemotherapy consisting of 100 mg of carboplatin on days 1 and 2 and 100 mg of etoposide on days l-3 of each week during the RT course (52 patients); and Group 3 - the same HFX RT with chemotherapy consisting of 200 mg of carboplatin on days 1 and 2 and 100 mg of etoposide on days I- 5 of the first, third, and tiflh weeks of the RT course (56 patients). The median survival time for all 169 patients was 13 months and the 5-year survival rate was 13.4%. The median time to relapse (local or distant) was 11 months and the 5-year relapse-free tival was 12.8%. Group 2 patients had a better prognosis than Group 1 patients (P = 0.0028) but there were no differences in prognosis between Groups 2 and 3 and between Groups 1 and 3. Gf potential prognostic factors examined, female gender (P = 0.00012), age 60 (P = O.OOOOO). KPS 80 (P =