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invasion from primary foci, three cases of intrabronchial polypoid tumor or in-

vasion of the carina by primary lesions, eight cases of polypoid tumor or invasion of the main bronchus, and two cases of double primary foci. Argon dye lasers were used in this study. Preoperative laser photodynamic therapy was performed 48 to 72 hours after intravenous administra- tion of hematoporphyrin derivative. The- rapeutic conditions were 60 to 600 joules for the superficial invasive areas and ad- ditional 200 to 800 mW for 8 to 15 minutes for polypoid tumors. Operaion was performed 1 to 9 weeks after photodynamic therapy. The initial purpose of photodynamic the- rapy was achieved in ii of 15 patients treated. In four of five originally inope- rable cases, conversion to an operable condition was achieved. Ten patients were originally candidates for pneumonectomy, and it became possible to reduce the ex- tent of resection to lobectomy or bilo- bectomy in seven of them. This study sug- gests that photodynamic therapy may have an important role in combination with operation and other modalities in advan- ced lung cancers.

i0. OTHER TREATMENT MODALITIES

Limited Impact of Total Parenteral Nutri- tion on Nutritional Status During Treat- ment for Small Cell Lung Cancer. Evans, W.K., Makuch, R., Clamon, G.H. et al. University of Toronto, Toronto, Ont. M5G IL7, Canada. Cancer Res. 45: 3347- 3353, 1985.

During a randomized trial of total parenteral nutrition (TPN) in patients with small cell lung cancer, we evaluated the short- and long-term effects of 4

weeks of TPN on nutritional assessment parameters. All 119 patients who were accrued to the study received the same chemotherapy and radiotherapy protocol which extended over a 1-year period; 57 patients received TPN; and 62 served as controls. At base line, patients with >5% pretreatment weight loss had signifi- cantly lower levels of serum albumin, to- tal iron-binding capacity, and creatinine/ height index. TPM administration led to a significant increase in mean caloric intake and weight compared with controls (P < 0.001). In the short-term study, body fat, as measured by triceps skinfold thickness, was maintained, and there was a small increase in arm muscle circumfe- rence. Serum albumin and hematocrit de- creased but promptly returned to pretreat- ment levels when TPN was stopped. There were no long-term differences in any of

the nutritional assessment parameters be tween the two groups.

Effects of Intravenous Hyperalimentation During Treatment in Patients with Small-Cell Lung Cancer. Weiner, R.S., Kramer, B.S., Clamon, G.H. et al. Department of Medicine, University of Florida, Gainesville, FL 32610, U.S.A.J. Clin. Oncol. 3: 949-957, 1985.

One hundred nineteen patients were entered onto a randomized trial of the role of intravenous hyperalimentation (IVH) in patients with small-cell lung cancer. IVH was given during the first 30 days of induction chemotherapy to 54 patients. IVH did not effect any improvement in response or sur- vival from therapy. In view of the lack of benefits from IVH, an analysis was made of the toxicities suffered by the 54 patients receiving IVH as well as any effects IVH might have made on chemotherapy- induced toxicity. Toxicities observed included me- chanical difficulties with the catheter leading to temporary or permanent discontinuation of the IVH (ii patients), subclavian vein thrombosis (i patient), sepsis in 9 patients v none of the 62 control patients, fluid overload (27 patients), hyponatremia (25 patients), and hyperglycemia re- quiring insulin (13 patients). Patients receiving IVH had higher granulocyte counts on days 14 and 21 of the first cycle of chemotherapy. Analysis shows that this difference is likely caused by fever and infection associated with IVH rather than any nutritional effect on granulopoiesis.

In this population of patients, IVH had significant complications but did not ameliorate chemotherapy- induced toxicity and it did not effect any clini- cal benefit. Future studies of adjunctive nutritional therapy must consider the significant risk in this older population and must limit IVH volume or exclude patients with even mild compromise in cardiovascular functions. Further, any new trial must have a significant rationale for adjunctive use to justify the potential risks.

Ketoconazole. Use in the Treatment of Ectopic Adrenocorticotropic Hormone Productionand Cushing's Syndrome in Small-Cell Lung Cancer. Shepherd, F.A., Hoffert, B., Evans, W.K. et al. Department of Medicine, Toronto General Hospital, Toronto, Ont. M5G 9Z9, Canada. Arch. Intern. Med. 145: 863-864, 1985.

Recently, ketoconazole, and imidazole derivative with antifungal properties, has been shown to inhibit adrenal corticosteroid and androgen pro- duction. We treated a patient with small-cell lung cancer and Cushing's syndrome secondary to ectopic secretion of adrenocorticotropic hormone in whom it was necessary to discontinue chemotherapy. The patient was treated with ketoconazole, with a re- sultant reduction in urinary free cortisol and ke- tosteroid excretion and improvement in electrolyte balance. Ketoconazole may be a useful adjunct in

the treatment of small-cell lung cancer or other malignancies associated with excessive cortico- steroid production or as a hormonal therapy in breast or prostatic cancer.

Elimination of Small Cell Lung Cancer Cells in Vitro from Human Bone Marrow by a Nbnoclonal Anti-

body.