Raymond Yesner

Influence of cell type on failure pattern after irradiation for locally advanced carcinoma of the lung

Patterns of failure after treatment for carcinoma of the lung were analyzed by the major WHO cell types. Only diagnoses of the review panel of the Veterans Administration Lung Group were used. First sites of progression were analyzed for 185 patients in a clinical trial, and cause of death was evaluated in 300 consecutive autopsies from VALG studies. Clinical progression was similar for all cell types—20% failed locally and 30% developed metastases. Carcinomatosis or brain metastasis caused death in only 27% of patients with squamous, in over half with large cell and adenocarcinoma, and in 70% of patients with small cell carcinoma. Complications of the local tumor (infection, hemorrhage, and respiratory failure) caused death in 50% of patients with squamous, in 1/3 with large cell and adenocarcinoma, and in 21% of those with small cell carcinoma. These clinical and autopsy data suggest the need for aggressive treatment of the local tumor in all cell types, and systemic therapy for small cell carcinoma. Both local and systemic approaches are needed for large cell and adenocarcinoma.

Histopathologic classification of small cell carcinoma of the lung. Comments based on an interobserver examination

In order to evaluate the consistency in diagnosing the morphologic subtypes of small cell carcinoma of the lung (SCCL), 93 microscopic slides were blindly classified by three panelists according to the World Health Organizations (WHO) Lung Tumor Classifications of 1967 and 1981. Unanimity in the diagnosis of SCCL as the main cell type was obtained in 91 and 94% respectively. With regard to the diagnosis of the various morphologic subtypes unanimity among the three panelists was achieved in 38% according to the WHO 1967 classification and in 54% using the 1981 classification.

Improved local control of thoracic disease in small cell lung cancer with higher dose thoracic irradiation and cyclic chemotherapy rose

Over the past decade, improvement in survival has developed for patients with small cell lung carcinoma (SCLC) due to treatment strategies that include: cyclic combination chemotherapy, thoracic irradiation, and prophylactic cranial irradiation. In this study, we assess the outcome of treatment with initial cyclic combination chemotherapy including: cyclophosphamide, VP 16-123 and methotrexate combined with radiotherapy (RT), 6000 cGY [corrected] to the thorax for patients with limited disease and 3000 cGy [corrected] for patients with extensive disease. Forty-six patients are evaluated: 26 patients with limited disease and 20 with extensive disease. In patients who received 6000 cGy [corrected], to thoracic lesions, in combination with chemotherapy, administered for 3 courses prior to and following RT, the rate of clinically detected failure in the thorax was 3.8%. Morbidity was considered acceptable, although the occurrence of encephalopathy in 6 of 19 cases who received cranial irradiation, 3000 cGy [corrected], and concomitant chemotherapy was a serious consequence. Control of the primary tumor achieved by the use of higher dose RT is shown to be superior to that observed at lower doses of RT. This suggests that for the small cohort of patients whose disease is truly limited at the time of diagnosis, therapeutic regimens, which include higher dose RT, could increase the number of long term survivors of SCLC.

Small‐cell carcinoma of the lung—survival according to histologic subtype: A veterans administration lung group study

Six‐hundred‐twenty cases of small‐cell carcinoma of the lung entered into the Veterans Administration Lung Group protocols 9–15 were retrospectively subdivided into histologic subtype, as proposed by the WHO (1977). Medium survival was greater for subtype No. 21 (lymphocyte‐like) than for subtype No. 22 (intermediate) (17.2 vs. 12.6 weeks; P = 0.005). Patients with extensive disease survived longer with subtype No. 21 than subtype No. 22 (14.5 vs. 10.9 weeks; P = 0.026). However, no median survival difference was seen with limited disease. Survival for subtype 21 was greater than No. 22 (P = 0.016) for patients with poor initial performance status (IPS; Karnofsky 70 or less); for ambulatory patients (IPS 80‐100) a survival advantage was seen for subtype No. 21 compared with No. 22, but did not quite reach statistical significance (P = 0.09). Survival in subtype No. 21 was better than in subtype No. 22 (24.3 vs. 14.7 weeks; P = 0.001) when no weight loss (less than 10 pounds over the six‐month period prior to therapy) was documented. However, with weight loss (greater than 10 pounds) survival in each subtype was similar.

Case report 174

A 63-year-old man presented with a three-year history o f a slowly growing, painless mass in the right thigh. In the proceeding months , more rapid growth had resulted. He gave a history of being wounded in battle in Germany in 1945 (approximately 35 years previously), incurring a right femoral fracture with retained shrapnel in the soft tissues. Several months later, in England, he underwent a definitive repair with internal fixation and bone grafting. Thereafter, he reported no problems with the leg until the present episode. On physical examination, a large (approximately 10 x 20 cm), firm, movable, non-tender, posterolateral mass in the right thigh was noted. N o sinus tract was observed and the mass was no t pulsatile. The hematological and blood chemical studies were within normal limits. Roentgenograms of the right femur (Fig. 1) and addit ional special studies were obtained (see later). Surgical explorat ion was undertaken.

Radiographic changes associated with giant cell hyalin angiopathy

A case report of a rare oral lesion termed giant cell hyaline angiopathy is presented. The clinical, radiographic, and histopathologic appearances are discussed, together with a successful mode of antibiotic treatment. The absence of vasculitis and foreign bodies and the therapeutic efficacy of antibiotics suggest that angiopathy may not be the appropriate term.

Two patients with non-regional metastases of adenocarcinoma of the lung 11 and 14 years following surgery

Abstract Two patients are described who developed non-regional metastases of adenocarcinoma of the lung at 11, and 14 years following resection of the primary tumor. In each case a careful search failed to reveal a second primary lung tumor. The metastases were discovered in brain and a supraclavicular lymph node. Such distant metastases arising more than 10 years after primary surgery is a very rare event in adenocarcinoma of the lung. These patients were part of a small group who had received adjuvant immunochemotherapy following curative surgery. They developed moderate to very strong delayed hypersensitivity reactions to soluble tumor antigens that persisted from 10 to more than 14 years. The clinical course of these patients share many features with the conditions needed for the induction, maintenance and abrogation of tumor dormancy in animal models.