172

cells and BCG had no significant effect on overall survival after resection of lung

cancer. It did appear to increase survival in DNCB positive patients.

Adjuvant I.ununotherapy for Non-Small Cell Lung Carcinoma by Levamisole or IK-432. Takeoka, T., Uzawa, S., Takeda, H., Okaya- su, T., Hashimoto, M., Tanabe, T. Hokkaido University, Sapporo, Japan.

A controlled, randomized study has been conducted to assess if levamisole or OK- 432 can increase the postoperative survi- val of non-small cell lung cancer patients. This study was begun in Aug. 1980 and was concluded in July, 1983, with a total of 193 patients. The stage of disease was established after a histological review of resected specimens and of hilar and mediastinal nodes; thereafter, 136 patients

were eligible for the evaluation. Prior to lung resection, patients were

randomized into 3 groups: I), no immunothe- rapy (49 pts), II) 0K-432 (45 pts), and III), levamisole (42 pts).

All patients were given postoperative combination chemotherapy of FAMT (5-FU, en- doxan, MMC and toyomycin) i.v. every 12 weeks, and 200 mg of 5-FU p.o. between the cycles of FAMT as a common protocol

for 2 years. Survival was measured by the Cutler-

Ederer method and the statistical signifi- cance was calculated by a generalized Wil- coxon test and a Cox-Mantel test.

Three year survival was 56% for g~oup I, 66% for group II, and 51% for group III. Neither immunotherapeutic agent resulted in any significant improvement in survival at present. However, data suggest that OK- 432 has beneficial effects in stage I+II patients while levamisole has such effects

in stage III+IV patients.

Combined Photodynamic Therapy and Radio- therapy in the Treatment of Endobronchial

Tumors. Lam, S., Olivotto, I.A., Kostashuk, E.C., LeRiche, J.C., Miller, R.R. Cancer Control Agency of British Columbia and the Vancou- ver General Hospital, Vancouver, B.C.,

Canada. Residual tumor is commonly found follow-

ing radiotherapy (RT) of obstructive endo- bronchial cancer. Thirty-one patients with inoperable endobronchial tumor involving a main stem bronchus, truncus intermedius or lower lobe bronchus received radiothe- rapy by the parallel pair technique (2000- 4800 cGy). Radiologic assessment one month following completion of radiotherapy show- ed that the area involved or obstructed by tumor decreased by a mean of 18 percent for tumors in a main bronchus and i0 per-

cent for tumors in the truncus interme- dius or lower lobe bronchus. Twelve of the

thirty-one patients were rebronchoscoped fol- lowing radiotherapy. All had significant re-

sidual tumor. Twenty-two patients with obstruc-

tive endobronchial tumors were treated with pho- todynamic therapy (PDT) using hematoporphyrin derivative and argon-dye laser. Although re- opening of the obstructed lumen to the bron- chial wall could be achieved, microscopic evi- dence of residual tumor was found in all pa- tients, usually at the site of origin of the tumor. We, therefore, evaluated the use of PDT followed by RT in eight patients. Bronchoscopi- cally, although re-opening of the obstructed lumen to the bronchial wall was achieved after PDT, extrinsic compression of the bronchial wall was a~h~.~ed a~er PDT, extrinsic com- pression of the bronchial lumen from enlarged lymph nodes or peribronchial tumor was present in five patients. RT following PDT resulted in further increase in the luminal diameter.

Our study suggests that residual tumor is common following PDT or RT alone. Combined PDT and RT gives the best result in the local control of obstructive endobronchial tumor.

Photodynamic Therapy with Hematopophyrin De- rivative for Endobronchial Tumors. Regal, A.-M., Takita, H., Antkowiak, J.G., Dougherty, T., Nseyo, U., Boyle, D., Sullivan,

L. Roswell Park Memorial Institute, Buffalo, N.Y.,U.S.A.

The technique used at Roswell Park for endo- bronchial administration of photodynamic the- rapy prior to March 1984 was not consistently effective in reopening the bronchus. Since that time, we have treated 9 patients for a total of 13 treatments. The patient population included 6 males and 3 females, ranging in age from 47 to 78 years (mean - 61.5). In 1 patient, both left upper and left lower lobes were in- volved; whereas, in the other 8 patients, one bronchus was treated. The endobronchial loca- tion of the lesions was right main bronchus (3), right upper lobe bronchus (i), left main bronchus (2), left upper lobe bronchus (3), and left lower lobe bronchus (i). The histology of the diseases treated was both bronchogenic in origin and metastatic. Four were squamous cell carcinoma, 2 undifferentiated carcinoma, 1 small cell carcinoma, 1 renal cell carcinoma, and 1 thyroid follicular carcinoma. One debri- dement bronchoscopy re-established the bronchi- al lumen in i0 out of 13 cases; and, in the remaining 3 instances, two such clean-up pro- cesses were required. Among the 6 patients with the gross appearance of totally occluded bronchi, the roentgenographic findings corre-

sponded in only 4 post-treatments; however, 2 showed objective evidence of increased aeration on chest film. Seven complete (re-establish- ment of 100% of the original diameter of the bronchus) and 4 partial (80-90% of the origi- nal bronchial diameter re-established) response were effected. No deaths were attributable

to photodynamic therapy with hematoporphyrin

173

derivative. We strongly advocate the use of photo-

dynamic therapy by the Balchum method for occlusive endobronchial disease, because it is a safe and more effective means of reopening the bronchus when compared with the earlier techniques.

Comparative Laser Bronchoscopy With Nd:YAC and Carbon Dioxide in ~nagement of Trache- obronchial Lesions. Miller, J.I., Landolt, C., Hatcher, C.R. Jr. Emory University Clinic, Atlanta, Geor- gia 30322, U.S.A.

Thirty one patients (pts) underwent 43 laser bronchoscopies, 17 carbon dioxide (CO 2) and 26 neodymium: Yttrium Aluminum Garnet (Nd:YAG), from 10/1/83 to 8/1/84 on the Thoracic Surgical Service of Emory University Affliated Hospitals. Indica- tions were benign adenoma - 1 pt; signifi- cant hemoptysis (> 300 cc) - 4 pts; high grade tracheobronchial malignant obstruc~ tion (> 70%) - 26 pts. All had failed con- ventional modalities of treatment. Results were excellent - 25 pts; good - 4 pts; no help - 1 pt. There was one late death secon- dary to esophageal perforation. All other pts left the hospital within 7 days. Ten pts required ventilatory management for up to 48 hours after endoscopy. All pts under- went a standard protocol work-up. Anesthe- tic and surgical technique will be discussed. General anesthesia with the open rigid bronchoscope is our technique of choice. Com- parative analysis of the two laser systems demonstrates the superiority of the Nd:YAG laser over the CO 2 laser because of safety, anesthetic management, decreased operative time (avg. 35 min.), and fiberoptic deli- very system. Predominant disadvantages of the YAG is the scatter effect. Recommen- dations for laser endoscopy, anesthesia, surgical technique, cost analysis, and cost/benefit ratio will be discussed.

Lung Cancer Therapy With Low Energy Nd- YAG Laser as an Alternative Method of Achie- ving Local Hyperthermia Using the Inter- stitial Technique: Experimental Studies and Clinical Trials. Chung, F.M., Takizawa, N., Matsushima, Y., Taira, O., Amemiya, R., Oho, K., Hayata, Y. Department of Surgery, Tokyo Medical Colle-

ge, Tokyo, Japan. Treatment of the lung and bronchial tu-

mors with the endoscopic Nd-YAG laser has been used mainly to vaporize the obstruc- ting lesions of large airways using high energy. Using low energy to treat deep- seated or peripheral lung lesions with a bare quartz fiber and sheath-coated fiber equipped with a ceramic rod were studied. (Materials and Method) An Olympus MYL-I

laser apparatus was used. 600 ~ bare

quartz fiber with a tapered and hemispherical tip and a sheath-coated quartz fiber equipped with a ceramic rod (SLT Japan) were utilized to deliver energy. The studied specimens in- cluded pig liver, nude mice implanted tumor and resected lungs. A power of 3 to i0 W for interval of 1 to 60 sec was applied by intersti- tial method.

(Results) Using a power of 3-5 W for 20 sec or more, a round shaped thermal coagulation of about 8 mm in size with a tiny carbonized cavity was obtained. The bare quartz fiber broke easily during manipulation in comparison with the fiber equipped with a ceramic tip. The tapered fiber or ceramic micro-rod could be used to pierce through the bronchial wall to treat extrabronchial lesions. Some clinical cases treated by this method will be presen- ted.

Randomized Control Study of Nocardia Rubra Cell Wall Skeleton (N-O~S) in Lung Cancer With Surgery. Hayata, Y., Taira, O., Oho, K., Ogawa, I., Matsushima, Y., Amemita, R., Takizawa, N. Tokyo Medical College, Tokyo, Japan.

A randomized control study of nonspecific immunotherapy was performed in non-small cell lung cancer cases following surgery using No- cardia rubra cell wall skeleton (N-CWS), an agent established by professor Yamamura of Osaka University between December 1978 and October 1982. Among 153 cases registered eva- luable cases for randomization consisted 53 in the N-CWS group and 57 in controls. Thera- peutic strategy was divided into 38 groups ac- cording to histologic type, clinical stage, T and N factor, adjuvant therapy and presence and absence of immunotherapy.

However, some cases of T 1 2 N M were treat- - 00

ed with N-CWS alone. N-CWS was in3ected sub- sutaneously with 400 ~g on the first occasion, followed with 200 ~g every two weeks for 5 years.

Better resultLwas obtained in the N-CWS groups in curatively and/or relatively curati- vely resected cases. However, there was no significant difference statistically. Also bet- ter results were obtained in N cases with N-

O CWS compared to cases received chemotherapy without N-CWS. However, there was no signifi- cant difference between both groups in terms of clinical stage, T and NI and N2 statisti- cally.

Nd-YAG Laser Bronchoscopy in Tracheobronchial Malignancies: Palliation, Adjuvant Therapy and Diagnostic Aid: First Canadian Experience. Jeanneret-Grosjean, A., Nadeau, P., Bolduc, Ph., Couture, J. H6tel-Dieu Hospital, University of Montreal, Montreal, Canada.

Since Feb. 84 we used the Medilas Nd-YAG laser to treat malignant tracheobraonchial le- sions. 23 patients (mean age 59.5, range 26- 78 years) underwent photo-evaporation in 33 sessions. 9 patients had a tracheobronchial