Treatment of limited small-cell lung cancer with concurrent etoposide/cisplatin and radiotherapy followed by intensification with high-dose cyclophosphamide: a Southwest Oncology Group study.

Between March 1986 and May 1988, the Southwest Oncology Group enrolled 58 previously untreated patients with limited small-cell lung cancer on a treatment program that administered high-dose cyclophosphamide (150 mg/kg) as late intensification. Treatment consisted of induction chemo-radiotherapy, (weeks 1 to 11), consolidation chemotherapy (weeks 11 to 18), and intensification (week 18). Median age was 61.5 years. Eighty-nine percent of patients had a Southwest Oncology Group (SWOG) performance status of 0-1. Twenty-one patients completed all prescribed treatments. There were seven treatment-related deaths, four as a result of intensification. Fifty-six patients are available for response analysis. Thirty-two patients achieved a complete remission (CR) (57%) and fifteen achieved a partial remission (PR) (26%). Median survival for all patients is 11.1 months. Among the 21 patients who received intensification, nine remain alive in a CR with a median survival of 27 months. This sequence of treatments was not associated with a survival advantage for the group as a whole, possibly because of the toxicity of induction and consolidation treatment and the delayed administration of high-dose cyclophosphamide.

Colonoscopy in the diagnosis of unexplained rectal bleeding.

Colonoscopy, done to elucidate the cause of obscure rectal bleeding not diagnosable on the basis of previous proctoscopic and barium-enema examinations, resulted in a 17 per cent diagnostic yield in this series. Eighteen of 105 patients were found to have lesions: three had carcinomas, six had polyps, eight had colitis, and one had proctitis. When bleeding had been demonstrated by the physician, there was a higher diagnostic yield (22.5 per cent) than when bleeding was reported only by the patient (5.9 per cent). Descriptions of the bleeding by the patients were found to be somewhat unreliable. Sixteen of the 18 lesions revealed by the colonoscope were in the left colon. It is suggested that the basic work-up for undiagnosed rectal bleeding should include history, physical examination, sigmoidoscopy, and barium-enema study. When no diagnosis is found, subsequent work-up must be individualized. When bleeding has been demonstrated to originate from the colon, colonoscopic examination should be performed.

Metastatic adenocarcinoma from the lung occurring as occult gastrointestinal bleeding.

We believe this is the first reported case of metastatic carcinoma of the lung occurring with occult gastrointestinal bleeding. Most small bowel metastatic tumors of various primaries are asymptomatic and are usually diagnosed at emergency operation. Since the prognosis is generally poor, operative resection should be conservative.