Long-term survivors of small-cell lung cancer (SCLC): a French multicenter study. Groupe d'Oncologie de Langue Française.

BACKGROUND: The aim of this study was to analyze SCLC patients beyond 30 months, particularly their outcome, their way of life, and factors which could influence relapses, second-primary cancers and death. PATIENTS AND METHODS: Between January 1986 and May 1995, 263 SCLC patients who survived longer than 30 months were included from 52 French institutions. The analysis was performed on the 155 cases confirmed by a pathologic review. RESULTS: Physical, mental and psychological states were considered as normal at 30 months in respectively 70.3%, 87.7% and 67.7% of patients, not influenced by prophylactic cranial irradiation, number of chemotherapy cycles, CCNU or cisplatin. Therapeutic sequelae were neurological impairment (13%), pulmonary fibrosis (18%) and cardiac disorders (11%) at 30 months. Return to work was possible for 40% of patients in the first two years following diagnosis. Among 43 relapsing patients, 33 benefited from a second-line treatment. Their median survival was 12 months since retreatment, and seven patients have survived again longer than 30 months. Age > 60 at the time of diagnosis was found as an independent factor increasing the risk of relapse beyond 30 months (OR = 2.46, IC 95% (1.16-5.26), P = 0.01). The risk of relapse became less than 10% beyond five years. Twenty patients (13%) developed a second primary cancer in a mean time of 58.6 months. The risk of second primary cancer was increased by a number of chemotherapy cycles > 6 (OR = 3.25, IC 95% (1.08-9.8) P = 0.02) and by an age > 60 (OR = 2.92, IC 95% (1.07-7.97), P = 0.03). Five- and 10-year survival rates were respectively 68% and 44%. In these patients having reached a 30-month survival, three independent factors were predictive of a survival longer than five years: age < or = 60 at the time of diagnosis (OR = 2.85, IC 95% (1.23-6.6), P = 0.01), chest radiotherapy (OR = 3.1, IC 95% (1.28-7.69), P = 0.006) and absence of relapse (OR = 4.5, IC 95% (1.75-12.5), P = 0.002). This study suggests that: 1) therapeutic sequelae are rather mild, allowing return to work in 40% of patients; 2) relapsing 30-month survivors can benefit from second-line treatment; 3) SCLC cure can be achieved with a 10-year follow-up.

Superior vena cava stent placement: results with the Wallstent endoprosthesis.

PURPOSE: To assess the clinical success and short-term patency of the Wallstent endoprosthesis in the treatment of superior vena cava (SVC) syndrome. MATERIALS AND METHODS: Twenty-one 14-mm-diameter endoprostheses were implanted in 15 patients (mean age, 60 years) treated for SVC syndrome due to malignant compression (n = 14) or postirradiation fibrotic stenosis (n = 1) of the SVC. RESULTS: Immediate technical success was achieved in all patients. Two early complications occurred: retroperitoneal hemorrhage due to venous iliac tear and early stent thrombosis. In the 14 patients without early stent occlusion, stent placement resulted in complete relief of SVC syndrome; clinical success was 93%. SVC syndrome did not recur from 1 to 14 months, until the patient died (n = 11) or until the end of the study (n = 3). Helical CT showed a patent stent in five patients, respectively, at 3, 6, 8, 10, and 11 months. CONCLUSION: SVC stent placement has good clinical results and a high patency rate at short-term follow-up in patients with SVC syndrome.

[Treatment of respiratory insufficiency in mucoviscidosis]. / Traitement de l'insuffisance respiratoire de la mucoviscidose.

Cystic fibrosis respiratory disease leads to chronic respiratory insufficiency, pulmonary hypertension and cor pulmonale. Clinical evaluation must be helped by diurnal artérial gasometry and nocturnal saturation measure, especially in acute phase and during the weeks after respiratory infections. Treatment of hypoxemia is based on oxygenotherapy, but also on nasal nocturnal ventilation for patients waiting for a pulmonary transplantation. Association of them is able to conserve or enhance respiratory and nutritional status.

Cardiac angiosarcoma revealed by lung metastases.

Cardiac angiosarcoma is a rare tumour with very poor prognosis especially in patients with metastatic disease. We present the case of a 43 year old patient with angiosarcoma revealed by open lung biopsy for multiple pulmonary metastases. Cardiac symptoms were limited to a moderate pericarditis and no echocardiographic sign of heart tumour was observed. The clinical outcome was rapidly fatal despite chemotherapy. The cardiac primary tumour was diagnosed at autopsy. We emphasize the difficulties of diagnosing cardiac angiosarcoma and confirm the limited value of echocardiography for this diagnosis.

[Radon and primary bronchial cancer]. / Radon et cancer bronchique primitif.

Radon is a natural radioactive gas, with worldwide distribution, deriving from uranium decay products, which can be inhaled, weather in mining condition (extraction and management of uranium ores) or in domestic condition (in some high risk homes or geographic areas). The main epidemiologic studies on uranium mining workers have all confirmed an excess in relative risk of primary lung cancer. Epidemiologic studies on indoor exposure suggest a role of radon in the genesis of a certain number of primary lung cancer, although these results remain controversial and need to be confirmed. An overview of the main actual problems related to this bronchial carcinogen is presented in this paper.

[Significance of the level of carcinoembryonic antigen in the alveolar lavage fluid in cancerous and non-cancerous bronchopulmonary pathology]. / Signification des taux d'antigène carcino-embryonnaire dans le liquide de lavage alvéolaire en pathologie bronchopulmonaire cancéreuse et non cancéreuse.

In a prospective study the level of carcinoembryonic antigen (ACE) were simultaneously measured in plasma and bronchoalveolar lavage liquid (LBA), in fifteen patients suffering from bronchopulmonary cancer and fifteen patients suffering from non-malignant pulmonary disease. In these two groups the level of ACE in LBA liquid (cancer 8,990 +/- 4,050 ng/ml; controls 2,510 +/- 1,060 ng/ml) were clearly more elevated than the corresponding plasma levels (cancer 1,931 +/- 1,760 ng/ml; controls 8.2 +/- 2 ng/ml) and the plasma levels of ACE were more elevated in the cancer group; in the same group the ACE levels in the LBA liquid were more elevated in the tumour group (4,770 +/- 2,180 ng/ml versus 808 +/- 300 ng/ml). This study has also shown the elevated levels of ACE in the LBA liquid in patients suffering from chronic bronchial inflammation (2,510 +/- 1,060 ng/ml) and during the course of acute bacterial pneumonia. The contribution of the ACE level in LBA liquid in relation to the plasma levels in the diagnosis of bronchopulmonary cancer would thus appear to have no clinical value, but the exact relationships between the phenomenon of chronic bronchial inflammation and metaplasia of the bronchial epithelium merit further study.

[Diseases of the diaphragmatic area. Difficulties of the radiological diagnosis]. / La pathologie des confins du diaphragme. Difficultés du diagnostic radiologique.

Following a reminder of anatomy, the semiology of standard radiology and modern imaging methods is described. The authors then deal with the phrenic-supraphrenic thoracic pathologies (air and liquid effusions, neighbourhood atelectasis, etc.) and with the phrenic-infraphrenic pathologies (transdiaphragmatic hernias, hepatic pathology, subphrenic abscess and pleural effusions). In each of these chapters, the often complex elements of standard radiology and modern imaging methods are detailed.

[Chemoprophylaxis of tuberculosis]. / La chimioprophylaxie de la tuberculose.

Chemoprophylaxis of tuberculosis may be primary or secondary. Primary chemoprophylaxis is intended for infants and children with negative tuberculin tests and exposed to contagion, in order to avoid primary tuberculosis. It lasts for three months and consists of oral isoniazide in one single daily dose of 5 to 10 mg/kg. Secondary chemoprophylaxis applies to all subjects, but principally to children, with a tuberculin test that has recently become positive in the absence of BCG vaccination. Its purpose is to protect against clinical tuberculosis. It lasts for six months and consists of isoniazid combined with rifampicin.

[Current indications for thoracic imaging]. / Indications actuelles de l'imagerie thoracique.

The authors present all the chest imaging techniques that are currently available to pneumologists and detail their indications and advantages. They suggest that in each major chest disease clinicians should use the technique that is most useful to the diagnosis and least costly, thereby avoiding overlaps of expensive techniques.

[Diagnostic pitfalls, artefacts and difficulties of thoracic radiography]. / Les pièges, artefacts et difficultés diagnostiques de la radiographie thoracique.

The antero-posterior X-ray film of the chest is still a basic examination in everyday clinical practice. It supplies multiple data but reading of the image is difficult and requires much accuracy and method. In this review paper we examine all the artefacts, pitfalls and diagnostic problems we have encountered in many years of experience, irrespective of their cause (technical, iatrogenic) or origin (parietal, intrathoracic, pleural, vascular, gastrointestinal, mediastinal, pulmonary). We consider that all pneumologists should have in mind these problems when faced with doubtful or abnormal radiographs of the chest.

[Applications of a simple system of aid to medical decision-making with various patients in internal medicine: SELF]. / Applications d'un système simple d'aide à la décision médicale à différents sujets de médecine interne SELF.

Many medical decision helping systems are very complex and require expensive computers, which restricts their diffusion and limits their use to specialized people. The idea was to find a simplified system that any practitioner--even unaccustomed to microcomputing--would be able to use. Moreover, this system had to work on widely available and inexpensive microcomputers. SELF (system in fuzzy set) is this kind of system. It has been devised as a complete interactive system of medical decision help. It is entirely parameterized, allows any kind of application and works according to such rules as "if there is premise, then there is conclusion", tempered by a coefficient. The bases of knowledge are represented on a correspondence chart where columns materialize the premises (clinical signs, laboratory results, etc.) and horizontal lines all the diagnoses and therapeutic conclusions. The system includes proceedings that create, modify and update basic knowledge. It uses the fuzzy set rules to draw conclusions. SELF was first applied to the prescription of contraceptive methods, but it has now been tested in other specialties, such as gynaecology, pneumology, haematology and so forth. In every case, the reliability of the results obtained depends on the bases chosen by the creator himself. Owing to the general character of the system, one may regard it as being open to any user who would like to create his own applications.

[Surgery of microcellular bronchial cancer: retrospective multicenter study apropos of 110 cases]. / La chirurgie du cancer bronchique microcellulaire: étude multicentrique rétrospective à propos de 110 cas.

The results of a multicentric retrospective study of 110 cases of small cell bronchial cancer are reported. In 57 of these patients the histological diagnosis was unknown before surgery. Among the remaining 53 patients, 22 were operated upon immediately and 31 after chemo-and/or radiotherapy (12 full responders, 10 partial responders, 5 no change and 4 in relapse). Operative data were as follows: 100 excisions and 10 exploratory thoracotomies; 19 perioperative complications, including 12 deaths; excision considered complete in 78 cases; pericardial involvement in 14 cases; invasion of the hilar lymph nodes in 57 cases, of the mediastinal lymph nodes in 39 cases; positive bronchial section in 16 cases. Overall median survival was 13.8 months for all patients and 18.3 months (perioperative deaths excluded) for patients whose tumour had been excised. At the moment, 46 patients have relapsed with recurrence at the initial site of malignancy alone in 6 cases (13%) and both at this site and at one or several metastatic sites in 10 cases (21.7%). Nineteen patients have survived for more than 2 years. An analysis of the subgroups in this population showed that the longest survivals were obtained in patients who had undergone preoperative chemotherapy.

[Double-blind study of Biostim in the prevention of superinfection in patients with chronic bronchopathy]. / Etude en double aveugle du Biostim dans la prévention des surinfections des patiènts atteints de bronchopathie chronique.

In a multicenter trial conducted with patients suffering from chronic bronchopathy, Biostim, an immunomodulating compound of biological origin has been studied using the double-blind placebo-controlled method for prevention of respiratory tract infections. One hundred and ten patients from 10 french pneumology health centers entered the study. The treatment was administered at random in three sequences of 8 days a month for 3 months (2 mg/day the first month, 1 mg/day the second and third months). Patients were separated into 2 groups regarding severity of the disease: group I (non complicated chronic bronchitis); group II (obstructive chronic bronchitis with or without respiratory failure). Patients were examined during 6 months with a monthly appraisal of number, duration and treatment clinically defined infectious episodes. The study of propensity to infections with respect to severity of the disease in patients given placebo showed a significantly lower number of infectious episodes in group I when compared to group II. In the group I (patients suffering from simple chronic bronchitis), no significant difference could be noted between placebo and Biostim but, at all events, the low frequency of episodes makes it difficult to evidence a protective effect in such a group. In contrast, with patients presenting a high infectious risk (group II), one can observe in Biostim treated patients compared with placebo group a significant decrease of infectious episodes and a larger number of patients standing free of episodes throughout the whole period of trial. Tolerance to Biostim has revealed itself satisfactory.

[Microcellular bronchial cancer. Current general and therapeutic problems]. / Le cancer bronchique microcellulaire. Problèmes généraux et thérapeutiques actuels.

Small cell carcinomas constitute about 15-20% of all primary lung tumours. They are divided into oat cell and intermediate cell carcinomas. Pathognomonic neurosecretory granules have been detected in the cytoplasm of these cells by electron microscopy. Their ectodermic origin is now questioned by some authors. The treatment and prognosis of these carcinomas vary according to whether they are initially localized or diffuse. Chemotherapy in biphasic courses seems to be required to obtain complete remission. Mediastinal radiotherapy may help control the initial lesion. Surgery is no longer to be avoided in all cases. Small cell carcinomas are usually lethal, but their median survival time has increased over the last few years.

[Diagnosis of diffuse pneumopathies (author's transl)]. / Le diagnostic des pneumopathies diffuses. Nécessité d'une approche globale.

The authors analyze their proceeding in the etiological diagnosis of 40 diffuse pneumopathies in patients admitted to hospital. In 31 cases, diagnosis was made 10 times at the radioclinical stage, 14 times at the endoscopical stage, 6 times at the surgical stage, and once at autopsy. After, they analyze the problems of interpreting the data obtained at each stage, particularly the limited contribution of the X-ray, the necessity of discussing the anatomo-pathological diagnosis (the problem of fibrosis, of sarcoidosis reactions and of pneumoconioses). They insist on the multiplicity of tests to be done on each sample and on the importance of systematic research of K.B. Finally, all the difficulties in diagnosing toxic pneumopathies (whether iatrogenic or not) are recalled.