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In the article authors summarize the experience of new anticancer drug polyplatillen usud in the chemoradiotherapy of small cell lung cancer. Polyplatillen improves the tumor response, general and relapse-free survival of advanced small cell lung cancer treatment in comparance with traditional VEC scheme.

Based on the assumption that tumor tissue consists of normal and radiation-resistant, that the survival of both types of tumor cells may be described by LQ functions and that the count of radiation-resistant cells is in proportion to that of tumor cells, the author has developed a method for calculating the equivalent tumor dose as a function as to irradiated tumor tissue volume for the fixed value of a single dose in the session of radiation. The developed formalism may be used to test the hypothesis that the count of clonogenic and radiation-resistant cells is in proportion to the baseline number of the cells in the tumor tissue.

The immunocorrective effect of indomethacin in the course of chemoradiation treatment for inoperable lung cancer was established in a group of 117 patients. It manifested itself in an increase in T-lymphocyte level, normalization of their membrane structure and improvement in immunoregulatory function mainly due to a rise in T-helper/inductor level. Blood plasma-circulating immune complex concentration returned to normal. The concomitant administration of indomethacin during chemoradiation therapy improved subjective status of patients and tumor response but failed to increase survival.

A tumor response to chemoradiotherapy was studied in 260 patients with small-cell lung carcinoma in situ on the basis of clinical parameters using different regimens of dose fractionation and various levels of total focal doses. Nonclassical irradiation regimens were found superior to routine dose fractionation. At present it seems improbable routine dose fractionation. At present it seems improbable to predict a response of small-cell lung carcinoma to irradiation and polychemotherapy on the basis of clinical parameters in each individual case. A varied response of small-cell cancer to conservative antitumor therapy is likely to be determined by its morphological, biological and genetic heterogeneity.

Roentgenologic and bronchoscopic examination was performed in 75 patients with central carcinoma of the lung 3-5 months following radiation treatment and every 3-4 months thereafter up to 36 months and longer to establish optimal schedule of those procedures to evaluate response and timely diagnosis recurrence or progression of disease. Complex application of X-ray and endoscopy in lung cancer patients every 3-4 months following radiotherapy assures timely diagnosis of relapse or progression.

Data on 152 cases of lung cancer were studied in an attempt to identify relationship between immunogenetic markers of the HLA system, on the one hand, and histologic pattern of the disease and effectiveness of radiation treatment, on the other. Control group included 200 healthy blood donors. Eight A locus antigens and 16 B locus antigens were studied. In the entire group of patients, HLA-Aw19 antigen was observed less frequently as compared to controls. Similarly infrequent were haplotypes containing the antigen. The occurrence of HLA-B16 antigen was higher in the adenocarcinoma group. Resistance to treatment, particularly, in patients with small-cell histology was associated with the presence of HLA-B8 antigen. Possibility of tissue typing of antigens for diagnosis and prediction of response in lung cancer patients is discussed.

The superior vena cava compression syndrome (SVCCS) was detected in 340 patients with small cell lung carcinoma (SCLC): in 44--during establishing primary diagnosis (the primary syndrome), in 10--after courses of chemo- or radiotherapy (the secondary syndrome). In 32 patients with the primary SVCCS therapy was started with chemotherapy courses, a complete clinical effect was noted in 20 (62.5%) of them, on an average, in 11.7 days. Radiotherapy or chemo- and radiotherapy were given to 32 patients: to 12 patients as kind of primary therapy, to 12 patients after a partial effect of chemotherapy, and to 8 patients with the secondary SVCCS. A complete clinical effect was noted in 28 (87.5%) patients, on an average, in 23 days. Complete and partial tumor regressions (an objective effect) were noted in 30% of the patients after chemotherapy and in 75%--after radiotherapy or chemo- and radiotherapy. Marked responses to therapy were noted in single administration of chemotherapeutic drugs at large doses (leukopenia below 2000 cells/microliter, vomiting) or in irradiation of the thoracic cavity at single doses of 3-6 Gy (esophagitis). The authors recommended to plan chemo- and radiotherapy at mean doses in patients with the primary SVCCS, in a localized process or distant metastases, not threatening the patient's life. In the secondary SVCCS developing after chemotherapy, a method of choice is radiotherapy using single doses of 4-6 Gy, 5-8 fractions.

Electronmicroscopic study of 35 small-cell lung carcinomas showed these to be a group of lung carcinomas having different histogenesis (cytogenesis). Apart from carcinoma without signs of differentiation, this group also includes squamous-cell carcinoma, adenocarcinoma, apudoma and mixed carcinoma with various differentiation of tumour cells. A certain correlation between the ultrastructural features of the tumour and its susceptibility to the treatment is established. Small-cell carcinomas consisting of undifferentiated cells are most susceptible. A relatively good prognosis can be expected when a variant with the endocrine differentiation of tumour cells is treated. Tumours interpreted light microscopically as small-cell carcinoma but ultrastructurally identified as having squamous-cell differentiation, or as adenocarcinoma and mixed carcinoma have the least favourable prognosis after treatment.

The paper presents a review of up-to-date literature on the problems of morphological heterogeneity of small cell lung cancer, clinico-morphological parallels, main prognostic factors and rationale for application of radiation therapy in the complex treatment of the disease. The authors also discuss their own findings on 208 cases, with 170 of them having localized tumor. Superfractionated irradiation of a locoregional zone with 1.2 Gy thrice a day was conducted at the initial stage of treatment (total dose--46.8 Gy). As a result, complete regression was obtained in 65.5% and partial regression in 34.5%. All patients with localized tumor survived six months after radiation chemotherapy, 58.5%--12 months, and 57.1%--24 months.

The paper is concerned with the results of gamma-beam therapy of 120 patients with inoperable lung cancer using the fractionation of a common daily dose of 2-2.2 Gy into 2 equal fractions as a variant of super-fractionated irradiation used in clinical practice. The direct and short-term therapeutic results were improved: a complete tumor regression rate determined by x-ray was 26.7%, a 2-year survival rate 19.2%. In the group of patients who were irradiated by the commonly used methods, the same values were lower. Improved tolerance of therapy with fractionation of a common daily dose was noted.

In spite of a direct effect obtained in radiotherapy of lung cancer, tumor growth often resumes afterwards, metastases appear, all these causing death of most patients within the first 1-2 yrs. It is worth nothing that a considerable number of patients die from tumor recurrences in the absence of generalization. Therefore a question arises as to the therapeutic tactics for such patients, including the potentialities and appropriateness of repeated irradiation. The efficacy of repeated radiation therapy of 100 patients with lung cancer was analysed. Direct improvement was noted in 44% of x-ray findings and in 77% of clinical findings. The patients' mean survival rates were 29.7-2.6 mos. after the 1st course of treatment and 17.2 +/- 2.5 mos. after repeated irradiation. Short- and longterm results showed correlation, i.e. in x-ray improvement the mean survival after the 2nd course was 23.5 +/- 4 mos. whereas in its absence it was 13.5 +/- 4 mos. It was established that the longer the interval between the therapeutic courses the more probable an increase in a survival period after repeated radiation exposure. After 2 radiotherapy courses all the patients developed radiation pneumosclerosis of varying degree pathological rib fractures were marked in 4 patients and tumor regression in 5 patients. A conclusion has been made that repeated radiation therapy of lung cancer patients is of palliative nature.

A study was made of immediate and short-term results of multifractionated radiotherapy of 120 patients with inoperable lung cancer. On discontinuation of radiotherapy the frequency of complete and pronounced tumor regression was significantly higher in radiosensitive small-cell lung carcinoma whereas during radiation exposure the correlation between a degree of tumor regression and tumor histological structure was absent as a result of an increase in the number of primary local cure in patients with squamous-cell and glandular carcinoma. A study of short-term therapeutic results confirmed the efficacy of the use of multifractionated irradiation in all main histological types of lung cancer.

The data on surgical and combined treatment of 52 cases of small cell lung cancer are presented and the end results are evaluated. The findings on survival time make the case for surgery as a component of combined treatment of tumor. The best results were obtained in cases of stage I and II tumor, absence of metastases into intrathoracic lymph nodes, tumor invasion limited to bronchopulmonary lymph nodes or the root of the lung, intermediate cell pattern of small cell lung cancer and surgery followed by chemotherapy.

Of 240 patients irradiated for metastatic brain tumors 4 died 4.5-60 h after the first session of irradiation at doses of 1.7-6 Gy. A clinicomorphological analysis showed that the main cause of death was acute microcirculatory disturbance in cerebral tissues with the formation of new hemorrhagic microfoci associated with severe disorders of cerebral tissues as a result of their involvement by far-advanced tumors.

A study on the advantages offered by a "prophylactic" cranial irradiation in cases of localized small cell cancer of the lung has been conducted at the Center since April of 1981. The report deals with preliminary results on tolerance and immediate reactions of the brain obtained on the basis of 25 cases. A good tolerance of doses ranging 25-30 Gy was recorded. Acute reactions followed gamma therapy in 32% which, however, did not prevent the completion of the full course of prophylactic irradiation. Neurologic symptoms developed after cranial irradiation in 3 cases; this was interpreted as a possible post-radiation encephalopathy. Metastasis was found in one case. The results suggest that the study be continued.

The report presents the results of cranial irradiation of 44 small cell lung cancer patients with clinically-identified intracranial metastases and 40 patients for metastatic spread prevention. Whole brain irradiation was carried out with single doses of 2-4 Gy (total dose--30-40 Gy) in both groups 5 times weekly. Patients irradiated for metastasis prevention revealed a 3.3-fold decrease in intracranial metastasis frequency and a good post-treatment tolerance. In the other group, radiation failed to reach tumor lesions in 20%; treatment produced a poor effect in 30%. There was a correlation between survival time, initial expansion of process and tumor response to primary treatment. No relationship was observed between survival time and procedure and duration of cranial irradiation. Prophylactic irradiation may be beneficial in responders to therapy. However, randomized research into the effectiveness of preventive irradiation and possible radiation injury to cranial and brain tissues is required, particularly, in patients responding to primary treatment by complete regression of localized tumor.

Altogether 31 patients aged 36-66 were given gamma-beam therapy for metastases of small cell pulmonary carcinoma to the brain. Before irradiation 12 patients received chemotherapy alone, 17 chemotherapy and irradiation of a primary focus and 2 surgery followed by chemotherapy. Simultaneously with a primary tumor brain metastases were found in 6 out of 7 patients. Brain involvement in 24 patients occurred 2.5-26.4 mos. after initiation of treatment. The presence of brain metastases was confirmed by the clinical symptoms, the electroencephalography and computerized tomography data. Brain irradiation in most of the patients was done in the presence of dehydration therapy. Twenty-four patients received a complete preplanned therapeutic course, in the other 7 patients treatment had to be interrupted because of the aggravation of symptoms. A complete regression of different brain symptoms was observed in 60-100% of the cases, the improvement of the focal symptoms and the state of the higher nervous activity was observed in a somewhat less percentage of the cases. Six out of 24 patients lived for 1 year and longer after irradiation of brain metastases. The results of this study have shown that brain metastases of small cell pulmonary carcinoma respond to radiotherapy. The dose of 30-40 Gy is sufficient to do away with severe neurological symptoms in most of the patients.

A comparative evaluation of treatment results was carried out in two groups of patients with small-cell lung cancer; in group 1, patients received radiation and chemotherapy simultaneously (68 cases) while in group 2 chemotherapy was followed by radiation (67 cases). Complete remission was observed in 62% in group 1. In group 2, it was 7% immediately after chemotherapy to soar up to 46% following radiation treatment. Radiation-induced pneumosclerosis was roentgenologically detected in all those followed up and presented with symptoms in 12.5% and 27.6% in groups 1 and 2, respectively. The frequency of distant metastasis in patients with complete and partial remission was identical in both groups. Metastasis-free period was significantly longer in complete remission patients as compared to those with partial remission; it was still longer in chemotherapy responders in group 2. The procedure involving sequential chemo- and radiation treatment should be preferred.

The study was concerned with description of roentgenologic semeiotics of central and peripheral small cell lung cancer in 141 patients receiving chemoradiation therapy. The frequency of carcinoma metastasis into intrathoracic lymph nodes was high. Small cell lung cancer showed a good response to conservative treatment, which, in particular, manifested itself in regression of metastases into intrathoracic lymph nodes.

The effectiveness of polychemotherapy (platidiam + chemoradiation treatment) for extensive cancer of the esophagus, stomach and lung was studied in 71 patients. Response rate in esophageal cancer patients after platidiam, methotrexate and prospidin was 31%, which increased to 65% after irradiation. In stomach cancer patients treated with platidiam, 5-fluorouracil and vincristine, antitumor effect was registered in 30% and a 50% regression of tumor following radiotherapy--in 37%. In small cell lung cancer group, chemotherapy (platidiam + cyclophosphamide + vincristine) was effective in 37.5% and in 83% when combined with radiotherapy.

The report deals with an analysis of the results of treatment of 84 patients suffering small cell lung cancer. Four regimens of combination chemotherapy as well as radiation were used. Complete plus partial regression rates ranged 18-81% (mean-42%) following chemotherapy and 73-87% after radiation treatment. Platidiam-containing schemes proved most effective. Prophylactic cranial irradiation was followed by increased survival. A correlation between extent of tumor and effectiveness of treatment was established.

Objective response of small cell lung cancer to different modalities of chemo-and radiation chemotherapy was recorded in 68-94% while complete regression of tumor--in 22-50% of a total of 166 cases. Complete regression was registered in approximately 33% of cases of localized tumor process and in 16% of cases of expanded process. The survival median for different treatment modalities was 13.7-22.5 months in cases of complete regression and 8.7-12.4 months for partial regression. The cyclophosphamide + adriamycin + methotrexate treatment scheme proved effective in 87% of localized tumor (complete regression--27%). As a result of treatment with the said drugs plus radiation, objective response was obtained in 95%, with complete regression being registered in 68% of the latter group. Therefore, radiation should be an indispensable component of treatment for small cell lung cancer. A two year relapse- and metastasis--free period was observed in 18% cases of localized process and a five year period--in 9%.