78

Chest Wall Resection for Bronchogenic Car-- cinoma. Van de Wal, H.J.C.M., Lacquer, L.K., Jongerius, C.M. Department of Thdracic, Cardiac, and Vascular Surgery, St. Radboud University Hospital, Nijmegen, The Nether- lands. Thorac. Cardiovasc. Surg. 32: 170- 173, 1984.

The incidence rate of chest wall in- vasion in bronchogenic carcinoma is diffi- cult to estimate, but is possibly as high as 5%. These cancers can be locally ex- tensive without systemic dissemination. From 1973 to 1982, 9 patients in our hos- pital underwent en bloc pulmonary and partial chest wall resection for broncho- genic carcinoma with local invasion of the thoracic wall. All the patients were male, their ages ranging from 49 to 67 years. Pain was the most prominent symptom. Bronchoscopy examination revealed no tumors in 7 of the 9 patients, in one a tumor was seen in the apex of the right lower lobe and in another in the apex of the right upper lobe. Seven lobectomies and 2 pneumonectomies were performed. The macroscopic size of the tumor ranged from 3 to 17 cm, the number of partially resec- ted ribs ranged from 1 to 4. In 8 cases squamous cell carcinoma was found, in one adenocarcinoma. After operation 7 pa- tients were classified as Tsub 3Nsub OMsub 0 and 2 as Tsub 3Nsub iI1sub 0. One Tsub 3Nsub 0?4sub 0 patient died shortly after operation due to a lung embolism. ~o out of the 6 patients with Tsub 3Nsub 0Msub 0 neoplasm survived more than 5 years, none of the patients with Tsub 3i~sub iMsub 0 neoplasm survived more than 3 month. Late deaths were due to recurrent carcinoma in the chest wall (2 cases), cerebral meta- stasis (i case), cardiac failure (i case) and unknown causes (2 cases). In cases where the lymph nodes are not involved, the survival rate is not unfavorably in- fluenced by chest wall invasion. In the literature the mean operative mortality rate is 12%, the median survival time approximately 1 year and the mean 5-year survival rate, 18%; resection is also of great importance in relieving pain.

Segment Resection for Lung Cancer. Kutschera, W. I. Department of Surgery, Vienna-Lainz Hospital, Vienna, Austria. Thorac. Cardiovasc. Surg. 32: 102-104, 1984.

From 1958 to 1979 1,951 pulmonary re- sections for lung cancer were performed in our hospital. Segment or wedge resec- tions were carried out in 91 patients, in 34 as palliative operations while in 57, with stage I peripheral carcinoma, the resection was curative. The operative mor-

tality rate for this procedure showed no

difference to that for lobectomy at the same

stage. The 5-year survival rate for these seg- ment resection patients was 23%, while it was 45% for lobectomy patients. Consequently, seg- ment resection cannot be regarded as a routine method, but rather as an emergency procedure in functionally otherwise inoperable cases.

7. CHF_~THERAPY

Cis-platin, Vinblastine, and Bleomycin in in- operable Non-Small Cell Lung Cancer. Stuart-Harris, R., Fox, R.M., Raghavan, D., et al. Ludwig Institute for Cancer Research, Uni- versity of Sydney, Sydney, Australia. Thorax 40: 346-350, 1985.

Forty two patients with inoperable non-small cell lung cancer were entered into a phase II study of the combination chemotherapy regimen PVB (cisplatin 60 mg/msup 2 by intravenous bo- lus on days 1 and 2, and bleomycin 15 mg intra- muscularly on days i, 8, and 15), repeated at three weekly intervals. Twelve of 40 evaluable patients (30%) achieved partial responses; there were no complete responses. The median duration of response was 16 weeks (range > 8-73 weeks). The median survival of responding patients cal- culated from entry to the study until death (40 weeks) was superior to that of patients failing to respond (15 weeks). Treatment was accompanied by signs of moderate toxicity, par- ticularly myelosuppression, nausea and vomiting, alopecia, and neuropathy. One patient died from a neutropenic infection. PVB is a moderate- ly toxic regimen for non-small cell lung cancer and appears similar in efficacy and toxicity to high dose cisplatin and vindesine.

A Controlled Evaluation of Combined 5-Fluorou- racil, Doxorubicin, and Mitomycin C (FA~D for the Treatment of Advanced Non-Small-Cell Lung Cancer. Krook, J.E., Jett, J.R., Fleming, T.R., et al. Duluth Clinic CCOP, Duluth, MN 55805, U.S.A. J. Clin. Oncol. 3: 842-848, 1985.

One hundred eighty-six patients with advan- ced non-small-cell lung cancer were randomly assigned to treatment with combined 5-fluorou- racil, doxorubicin, and mitomycin C (FAM) or combined methotrexate, doxorubicin, cyclophos- phamide, and lomustine (MACC). Respective ob- jective regression rates were comparable at 20% and 16%. Distribution of intervals to pro- gression (overall median, 2.8 months) and sur- vival times (overall median, 5.0 months) were essentially identical between the t~o regimens. The comparability of therapeutic effect was also evident within the subset of 81 patients who had adenocarcinoma cell type, although MACC showed a small advantage in survival after co- variate analysis. In large-cell carcinoma, MACC showed a higher regression rate than that of FAM as well as a small advantage in survival. In squamous-cell carcinoma, however, FAM was

superior to MACC in regression rates (32% v 4%)