211

pharynx whcrc lightdosimetry i:, more difficult, theratcofrecurreflctcs

IS higher (3/10 lesions treated). In the broach1 (one case) and ocsopha-

gus ( one cast), the longest disease-lice surwval is now 5 years. The

madiatlon of a non-cancerous zone of normal buccal mucosa on 25

p&n& having rccc~vcd HPD showed necrosis in all cases with light

dose!, as low as 50mW/cm7 lbr 20 min (601 cm 2). even wth Photofria

II. We cncountcred six complications (three cicatricial stenosis, IWO

flswlae, one scvcrc sunburn), mos1 of them resulting from the lack of

cclcct1~11y of HPD. Accordmg to thcac experiments, PDT is efficient at

dcstroymg early squamous cell carunomas in the pharynx, “esophagus

and bronchi, b”1 the turnour selccuwty of HPD IS poor in the digestive

tract lmcd wth squamow ccl1 cplthclium. The only hope for the fulurc

hcs m the synthesis of a more selccuvely and mow stable photosensi-

twx This discusuon rcvicws pos\iblc directions of research for the

dcvclopmcnt of new dyes (catlomc dyes, dyes attached to monoclonal

antdx)dvx, ctc). for PDT and hypcrthcrmla, for photodctection of ezly

cancers uamg a lluoro-cndoscopc, and fmally, for tttmour depth profil-

mg m hollow organs usmg law ofdlffcrcnt wavclcnghts.

Endoscnpic photodynamic therapy in lung cancer

Spmellt P, Dal Fame M. lstifuro N&male per lo Studio e la Cum dei

7‘umuri. Mkzno. Lasers Mcd SCI 1990;5:381-3.

The main purpose ofcanccr therapy 1s to treat mahgnant tissue wrth

the lcast damage to normal surrounding ~tr~ct~r~s. Photodynamic

therapy (PDT) wcms to be able to fulfil this simple but fundamental

prcmw. The mcchamams of actton of the photosensiuzer-light system

can be summarizd m two main pomts. Chiefly, it seems to be a photo-

dynanuc process, with cncrgy uansler from the bght to the photosensi-

twer and from 11 to the oxygen molecules. Oxygen is excited and

becomes singlet oxygen, which IS extremely reactive and very noxious

for tissues rn which itdevclops. Secondly, a thermal mechantsm related

to light absorptmn and consequent temperature rise also seems to be

mvolvcd m mabgnant nccmsis by PDT. Thtrtcen males wcrc submitted

to endoscoplc PDT. 4 total of 15 txatmenta were given: 2 patrents were

submitted to 2 sessions of PDT. Forty-eight hours after HDT admini-

stratton (72 h in a few caseq), the lcstons were exposed lo a 630 nm light

from an argon-dye law system. The total es1imated energy dose

dchvcred to the turnour surface was YO-lSOJ/cm, in I I cases. All cases

trcalcd rcspondcd well and total dlsappearancc was obtained. Median

follow-up was 9.5 monthc (l-20 months) and the estimated energy

delwcrcd from YO-6OOJ/cm,. No maJor complications wcrc reported.

Aneesthesia for resection of tumours in the trachea and central

bronchi using the Nd-YAC-laser technique

Blomquist S, Algotsson L, Karlsson SE. Department ofAnaesthesm/-

ogy. Unn~ers~ty tlosp~tul, S-221 8.5 Lund. Acta Anaesthestol Stand

lY90;34:506-IO.

The USC of lasers in upper mrway surgery ts now common practice.

The mtroduction of the Nd-YAG laser technique makes it possible to

perform endoscopic resection of tumours located in the trachea and

central bronchi. Usually these patients requtre general anaesthcsta. Our

cxpenencc m 13 pattents using total mtravenous anacsthesta and jet

ventilation wttb ax is rcporlcd. Oxygen saturation was mamtained at a

higher level than when the patients were breathing 100% oxygen before

anaesthesia. Occastonal rcductlons m saturation were due lo auway

obstructton and were easily corrected by a short interruption of the

procedure. All patients tolerated the anaesthesia and surgery well. No

complications related to the anacsthctic method or the use of the Nd-

YAG-laser occurred. A rcvuv of the possible haurds in thcsc proce-

dures 1s gwcn togcthcr with adwcc on safety precautions needed.

Reviews

Biology of small cell lung cancer: An overview

Weynants P, Humble1 Y, Canon JL, Symann M. Catholic University of

Louvain. Department of Pneumoiogy. I/CL Mont-Godinne Ilospilal,

5180 Yvorr. Em Respir J 1990;3:699-714.

Despttc disappointing resulti m the treatment of small cell lung

cancer (SCLC), major progress in our understanding of SCLC biology

has occurred m the past decade. Advances in the technique for culturing

SCLC turnours m vitro have greatly facditatcd the study of the btologi-

cal properties of thts tumour. The major progress m our understanding

of SCLC mcludcs: I) the availabdlty ol-nonspecific biologtcal lttmour

markers such as neuron-specific cnolasc (NSE), the BB wcnzymc of

crcatinc phosphokmase (CPKBB), bombcsm/gastrm rcleasing pcptides

(CRP)andchromogranin A: 2) thcgcncrationol~monoclonalantibodics

raised against lhc neural and cptthclial fcaturcs of SCLC lumours: 3) the

idcnttfication of several autocrinc growth factors such as bombesm/

GRP, insulin-hke growth factor (IGF), transfeenm and physalaemin; 4)

the close study ol~cytogcnctlc ahnormahtics leading to the discovery of

a umquc chromosomal dcletlon of the short arm of chromosome 3 (dcl

3p 14.21). and to changes in oncogcmc cxpressron, c.g. c-myc, L-myc

and N-myc, accountmg for known biologIca and trcatmcnl rcsulls.

These data suggest that all lung cancers arIse from a common \tem ccl1

of endodcrmal origin. The information derived from thcsc biologtcal

studies reprcscnts the most promwng avenue towards new treatment

saatcgies m SCLC.

Treatment of long cancer: Therapeutic possibilities and new prog

ress in molecular biology

Ludwig Ch U. Onkologische Ahiedung, Depar~ement,fur innew Me-

dirin. Kunrons.cpml, Cll-4031 Basel. Schweo Mtxl Wochcnschr

1990:120:1143-X.

Clcarc”1 progress has been achlevcd m the trcalm~nt of lung cancer

m the last dccadc. While small ccl1 lung cancer has proven a htghly

chemosensitwc tumor, only rcmlssions of relatively short duration are

obtamcd. The htgh relapse rate IS probably due to the rcappearancc of

chemorcslstant subclones. In contra%, non small ccl1 lung cancer IS

often chcmorcsistant from 1hc o”1sc1, a fact whtch liml1s [he thcrapcutic

possrbditlcs in thcsc 1”mors. Dtffcrcnt forms of chcmorcwxtce arc

descrdxd and potenttal modahtic?, of circumvenlmg or rcversmg it are

disc”sscd.lnrecentyears,greatcrinsigh1intomolec”larmechanismsof

tumor formatton has been achwcd. The role of activatton or overex-

press)“” ofoncogcncs has been dcmonsuated. More rccenlly the role of

tumor suppressor gent inactivatton has become cwdcnt. By means of

restnction fragment length polymorphism (RFLP) a combmalton of

gent dclcuons in vartous chromosomes has been demonstrated m lung

cancer. The pattcm of chromosomes mvolvcd appears lo vary between

small cell and non small cell lung cancer. It IS 10 be hoped that these new

mslghts will bc translated mto new trcalment modahttc~ for lung

cancer.

New directions in non-small cell lung cancer

Gralla RJ. Ochsner Cancer Instmle, Ochsner Medu crl In.%tirurmns.

IS16 Jefferson Ilighway, New Orleans, LA 70121. Semm O~COI

1990;17:s”ppl7:14-9.

A number of regtmens are now available that can mducc antltumor

responses in many patienfi wtth non-small cell lung cancer. Surgery

remains the treatment of choice in slagcs I and Il. Combinatton

regimens have beendemonstrated tocliclt h~ghcrresponscrates,aswcll

as an improvement m survival, than smgle agents or ucatment other

than chemotherapy for patients wth nonrescctable tumors. The major-

ity of effective regimens wi1h reproducible acuwty have “scd clsplatin

as part of the combination. Intercsting new agents arc now being used

m clintcal studies, such as monoclonal armbodies, anthracyclmes and

anlifolatcs, eg, IO-ethyl-deaza-amlnoptcrtn.

Future directions in the treatment of non-small cell lung cancer

Ihde DC. NC/-Navy Medical Oncology Branch. Narional Naval Medi-

cal Center, Bethesda. MD 20814. Semin Oncol 1990: 17:S”ppl7: 33-6.

Five-year survival rates for pattents with non-small cell lung cancer

havechangedonly minimally overthepast20 years. Although systemic

chemotherapy has not yet proved to be of major clinical value, sugges-

110ns of Improving efficacy have bccn noted over the past decade. A

small but real fractton of complete responses has been obtamed with

combinalion chemotherapy m patients wtth favorable prognosttc char-

aclerlslics. A few studtes ofadjuvant chemotherapy, given after surgery

or in con~unclton with definitive irradiation, have demonstrated )m-

proved disease-free OI overall surwval permds. F”~“re approaches

suggesled by laboratory observations of t”mor cell biology, such as

identifxation of pauems more likely to respond to chemotherapy and

early detection of patients at high risk to develop lung cancer, may

eventually prove useful.