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Background and methods. Thirty-nine roentgenologically occult lung cancers in 29 patients were treated using photodynamic therapy (PDT) and/or thoracic radiotherapy (TRT) from january 1986 to March 1992. With the exception of one mixed-tumor case, all were squamous cell carcinomas. Results. Initial PDT achieved complete responses in 25 of 39 (64%) of the cancers. Of the remaining 14 cancers that showed less than complete response (CR), 10 of the 14 (71.4%) showed a CR when subsequently treated with TRT, yielding an overall CR rate of 89.7% for cancers treated. Although nine patients experienced recurrences, six of these had CR when treated with PDT and/or TRT. To date, 22 patients are alive. Causes of death in the patients enrolled in this study are as follows: pyothorax (2); heart failure due to pulmonary hypertension (1); chronic respiratory insufficiency (1); subsequent primary brain cancer (1); and subsequent primary lung cancer (1). Only one died of primary lung cancer. Conclusions. These findings suggest that PDT and/or TRT may be used as an alternative to surgery in the treatment of selected patients with roentgenologically occult lung cancer. Cancer 1994; 73:1608-14. Key words: photodynamic therapy, hematoporphyrin derivative, external beam radiation therapy, roentgenologically occult lung cancer.

Etoposide is effective against a variety of human cancers. Unlike like some chemotherapeutic agents which directly act on the genetic material inside the cell, etoposide seems to damage DNA indirectly by affecting an enzyme within the nucleus, DNA topoisomerase II. The interaction between the drug and the enzyme is reversible, and when the drug administration is stopped the topoisomerase II activity begins to return to normal. The mechanism of action of etoposide makes the effectiveness of the drug strongly dependent upon the schedule of administration. Usually, without prolonged exposure the cancer cells treated with etoposide will recover from the toxic effects rather than die. Since etoposide appears to act synergistically with the anticancer drug cisplatin, a study was undertaken to evaluate a schedule of treatment with these two drugs for 22 patients with advanced lung cancer. Eighteen patients had primary lung cancer and four had metastatic cancer in the lungs which had spread from cancer originating elsewhere in the body. The treatment consisted of intravenous cisplatin and oral etoposide on the first day of a course of treatment; the course then continued with oral etoposide every day for 21 days. After 21 days, the etoposide was discontinued for one week prior before the start of the next course. Five different dose levels were evaluated, ranging from 80 to 100 milligrams of cisplatin per square meter of body area and from 20 to 50 milligrams per day etoposide per square meter of body area. Hair loss was a common side effect, and most patients experienced nausea and vomiting that was not so severe that it could not be controlled with antiemetic drugs. Four patients achieved partial responses, which ranged from 1.3 months to over 5.8 months. The study found that an 80 milligram dose of cisplatin on day one and a 40 milligram dose of etoposide daily for 21 days, per square meter of body area, would be a reasonable starting point for further evaluation of the treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Small cell lung cancer is more responsive to chemotherapy and radiotherapy than are other forms of lung cancer. Nevertheless, most patients still relapse, and cures are rare. After failure of initial therapy, death comes rapidly, occurring within seven to eight weeks following relapse. An attempt was made to evaluate the use of high-dose etoposide with cisplatin for the treatment of small cell lung cancer in 20 patients who had relapsed after initial treatment. Two patients died from infections following treatment. Of the remaining 18 patients, half achieved responses. The average survival time was 20.3 weeks, indicating a synergistic effect between the high-dose etoposide and cisplatin. The study also experimentally treated five patients with recombinant granulocyte colony-stimulating factor in an effort to reduce the period of white blood cell suppression which follows the chemotherapy. (It is during this period that potentially fatal infections are most likely to occur.) There was no evidence that the exogenous colony-stimulating factor reduced the white blood cell recovery time in these patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Small cell lung cancer (SCLC) grows rapidly and has a high propensity for spreading quickly and widely. Although SCLC is sensitive to both radiation and chemotherapy, most patients suffer relapses within a year or two, probably due to the emergence of subpopulations of cancer cells resistant to chemotherapy. Since some anecdotal evidence suggested that doxorubicin played a role in the health of the few patients who survived SCLC more than five years, a retrospective study was completed of 159 patients with SCLC. Ten patients survived for five years or more; this indicates a five-year survival rate of 6.3 percent, and a cure rate comparable to other published reports. The nine patients who could be evaluated had a complete response to initial chemotherapy. Statistical analysis of the data did not reveal a significant role for radiotherapy. In the patients studied, age and sex did not appreciably affect survival. These results are not in agreement with some other published data. Chemotherapeutic regimens containing doxorubicin were, however, significantly correlated with improved chances of survival. These results indicate that doxorubicin is an indispensable part of combination anticancer therapy for small cell lung cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)