Antineutrophil cytoplasmic antibodies and their relationship with disease activity and presence of staphylococcal superantigens in nasal swabs in patients having granulomatosis with polyangiitis: results of a study involving 115 patients from a single center.

OBJECTIVE: Antineutrophil cytoplasmic antibodies (ANCAs) are considered a risk factor for granulomatosis with polyangiitis (GPA) exacerbation, especially when staphylococcal superantigens (SAgs) are present in nasal swabs. Their role in monitoring disease activity remains controversial. This study determined the relationship of ANCAs with disease activity and presence of SAgs in GPA patients. METHODS: Among a total of 115 GPA patients hospitalized in the period 2009-2016, we investigated the presence of SAgs and ANCA concentration. Blood samples and nasal swabs were taken at each visit (referred further to as episodes). Disease activity was assessed using the Birmingham Vasculitis Activity Score (BVAS). RESULTS: We analyzed 362 episodes. ANCAs were detected in 215 (59.4%), while SAgs were detected in 126 (34.8%) episodes. We found a significant correlation between the presence of ANCAs and disease activity (p = 0.0032), as well as between their level and GPA severity (r = 0.25363, p = 0.000001). We also determined that an ANCA values ≥ 138 Ru/ml were an indicator of active disease with high specificity and low sensitivity (84.4% and 37.3%, respectively). The relationship between ANCA presence and the presence of SAgs was not confirmed; however, when SAgs were analyzed based on the different types, ANCA levels were found to be significantly higher in the group with SAg type B (p = 0.031). CONCLUSIONS: There was no detectable evidence for the association between ANCA level and the presence of SAgs. Although monitoring ANCA levels as a marker of disease activity may be clinically relevant, GPA management cannot proceed on the basis of ANCA levels alone. Key Points • ANCA concentration usually correlates with GPA activity, although in half of patients, ANCAs persist despite effective treatment and clinical remission. • ANCA values of 138 Ru/ml seem to be an indicator of active disease with high specificity, but low sensitivity. • Although there is a relevance for ANCA monitoring as a marker of disease activity, GPA management cannot be based on ANCA levels alone. • The suspected clinical correlation between ANCA formation and SAg presence in nasal swabs is not obvious and requires further investigations.

Pneumothorax in Patients with Pulmonary Langerhans Cell Histiocytosis.

INTRODUCTION: Pneumothorax often develops in pulmonary Langerhans cell histiocytosis (PLCH), but some patients take a long time to be correctly diagnosed. OBJECTIVES: This study assessed the frequency of pneumothorax in PLCH and analysed the role of chest computed tomography (CT) in the prompt diagnosis. PATIENTS AND MATERIAL: Of the 90 patients with PLCH seen from 2000 to 2015, 29 (32%) had pneumothorax as the initial finding. In this group, 18 (62%) patients were diagnosed within 1 month, whereas the diagnosis was delayed for 4-120 months in 11 (38%) patients. RESULTS: Patients who had pneumothorax as the initial sign of PLCH tended to be younger (mean age 27.7 ± 7.92 vs. 39.9 ± 13.21 years; P = 0.0001), male (69% vs. 43%; P = 0.028), smoked less (mean pack/years 8.4 ± 6.85 vs. 19 ± 17.16; P = 0.003), and had a significantly lower mean FVC (77.96 ± 19.62 vs. 89.47 ± 21.86% pred.; P = 0.015) and FEV1 (68.6 ± 19.93 vs. 79.4 ± 21.48% pred.; P = 0.03 than patients who had no pneumothorax. Recurrent pneumothorax was diagnosed more frequently in the group with a delayed diagnosis (82% vs. 39%; P = 0.02). CT was performed in all of the patients who were diagnosed promptly, but in none of the patients with a delayed diagnosis. CONCLUSIONS: Patients who had pneumothorax as the initial sign of PLCH were younger, more frequently men, and had greater respiratory impairment than those who had no pneumothorax. CT in patients with pneumothorax led to a correct diagnosis of this disease.

Cryptogenic Organizing Pneumonia: IL-1ß, IL-6, IL-8, and TGF- ß1 Serum Concentrations and Response to Clarithromycin Treatment.

Cryptogenic organizing pneumonia (COP) is a distinct clinicopathological entity with unknown etiology. Inflammatory cytokines play a role in the development of the disease. The present study was performed to assess the correlation between concentrations of IL-1ß, IL-6, IL-8, and TGF-ß1 in the serum with response to clarithromycin (CAM) treatment in patients with COP. A total of 39 patients with COP were enrolled in to this study. An oral dose of 500 mg CAM was administered to all of the patients twice daily for 3 months. A complete response was noticed in 31 (80 %) of patients, and 8 (20 %) patients failed to respond to treatment. The concentration of cytokines were assessed by ELISAs before and after treatment. CAM treatment was associated with decreases in serum IL-6 (3.8 pg/mL [IQR 0.9-11.8] vs. 1.1 pg/mL [IQR 0.2-3.1]; p = 0.004), IL-8 (13.6 pg/mL [IQR 9.8-17.5] vs. 8.1 pg/mL [IQR 6.2-13.2]; p = 0.004), and TGF-ß1 (37.1 ng/mL [IQR 31.7-46.2] vs. 25.7 ng/mL [IQR 22-41.7];p = 0.0001), which was particularly notable in the responders. We conclude that IL-6, IL-8, and TGF-ß1 may play a role in the pathogenesis of COP, as their decreased concentrations were associated with a positive response to CAM treatment.

Pulmonary Function Abnormalities in Regard to Age at the Time of Diagnosis of Hypersensitivity Pneumonitis.

Hypersensitivity pneumonitis (HP) is a complex syndrome caused by exaggerated immune response to inhalation of a variety of organic particles in susceptible individuals. In this study we assessed the relationship between age at the time of diagnosis and the degree of functional and radiological changes in HP. The diagnosis of HP was made on the basis of a combination of clinical symptoms, medical history, serological tests, radiologic evidence of diffuse lung disease, and absence of other identifiable causes of lung disease. We reviewed the records of 111 patients (68 women) diagnosed with HP over a period of 18 years (1995-2013). The patients were stratified into 3 age-groups: <30, 30-49, and ≥50 years old. The commonest cause of HP was avian antigens (56.8 %). Dyspnea was present in 97.3 % of patients, weight loss in 54.7 % of patients, and respiratory insufficiency in 24.3 % of patients. Lung fibrosis in chest computed tomography was found in 35.1 % of patients. Lung function was impaired more seriously in the youngest age-group, with lung diffusing capacity for carbon monoxide (DLCO) <40 % in 69.2 % of these patients. Restrictive pattern was present in 92.3 % of patients in this group, as compared with the 41.0 % in the whole cohort. In this group, desaturation in the six minute walk test also was most notable, amounting to a median of 11 %. In conclusion, diagnosis of HP at young age is predictive of a more severe clinical course of disease, with lung fibrosis and higher disturbances in pulmonary function.

Bronchial hyperreactivity in sarcoidosis patients: correlation with airflow limitation indices.

UNLABELLED: Bronchial hyperreactivity (BHR) in sarcoidosis has been reported in 5 to 83% of patients, but the relationship between BHR and airway functional status being unclear. The aim of the study was to assess the prevalence and degree of BHR in a group of pulmonary sarcoidosis patients and how BHR does relate to the functional status of airways. MATERIAL AND METHODS: 56 consecutive sarcoidosis outpatients (26 f, 30 m) were included. There were 14 (25%) patients in stage I, 32 (57.1%) patients in stage II and 10 (17.9%) patients in stage III. In all patients the standard evaluation included a history, physical examination, chest radiogram, serum ACE activity and lung function assessment were done. The provocation challenge test with doubling concentrations of histamine was performed in all patients using the standardized protocol recommended by the ERS. RESULTS: 4 patients (7%) were restrictive, airway obstruction was detected in 7 (12.5%) cases. Up to 32% of patients had maximal expiratory flows at low lung volumes below the lower limit of normal (LLN). The histamine challenge test results: in 9 cases (16%) the fall in FEV1 was < 20% of the baseline; mean PC20H (n = 47) was 5.7 +/- 5.9 mg/mL, range: 0.56-26.7 mg/mL. The challenge test was regarded as positive (PC20H < or = 8 mg/mL) in 71.4% of the group. BHR expressed as ln(PC20H) correlated weakly but significantly with FEV1, FEV1%VC, MMEF and PEF. CONCLUSION: BHR occurs frequently in sarcoidosis patients and should be considered especially in patients with airflow limitation.

p53 and HER2/neu expression in relation to chemotherapy response in patients with non-small cell lung cancer.

The aim of the study was to investigate a relation between p53 and HER2/neu expression in resected lung tumors and the response of those tumors to neoadjuvant chemotherapy. The study population included 67 consecutive patients with non-small cell lung cancer (NSCLC) in stage II or III who were operated on at the Institute of Tuberculosis, Warsaw, Poland, between 20 April 2001 and 10 March 2003. All patients received two cycles of chemotherapy consisting of cisplatin and vinorelbine prior to the operation. The response to therapy was assessed as complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD), on the basis of CT scans performed before and after neoadjuvant chemotherapy. p53 and HER2/neu protein expression were evaluated by immunohistochemistry (IHC) using antibodies against p53 (clone PAb 1801, Novocastra) and against HER2/neu (Dako) in paraffin-embedded specimens of tumors. A response to therapy (CR+PR) was observed in 27 patients, while 40 patients (SD+PD) were regarded as resistant to therapy. Resistance was observed significantly more often in tumors above 3 cm in diameter. p53 expression was found in 16 tumors (23.9%) and HER2/neu in 26 tumors (38.8%). We observed a nonsignificant tendency to chemoresistance in tumors with HER-2/neu overexpression and also in tumors with p53 overexpression. If we consider HER-2/neu and p53 together, chemoresistance was observed statistically significantly more often when one or both markers were positive (p<0.05). This significance was independent of tumor size.

[Invasive aspergillosis in autopsy material of patients treated at the Institute of Tuberculosis and Chest Diseases during the years 1993-2000]. / Inwazyjna aspergiloza w materiale autopsyjnym u chorych leczonych w Instytucie Gruzlicy i Chorób Pluc w latach 1993-2000.

The aim of this paper is an analysis of clinical documentation and results of autopsy of 21 patients (pts) who died of invasive aspergillosis (IA) in the Institute of Tuberculosis and Chest Diseases in years 1993-2000 and the assessment of predisposing factors for IA. In 17 pts IA was the main and in other 4 only an accessory cause of death. All pts were treated with corticosteroids and/or cytostatic drugs--because of lung cancer (11 pts), cancer in other site (2 pts), haematologic disorders (2 pts), Wegener's granulomatosis (1 pt), polymyositis (1 pt), idiopathic pulmonary fibrosis (1 pt) and other diseases (3 pts). In 15 out of 21 pts granulocytopenia was revealed (from 0.008 x 10(9)/L to 0.82 x 10(9)/L) on an average one month before death. In 15 pts IA was limited to the lungs, in 6 others there were also fungal lesions in brain, kidneys, liver, spleen and heart. Pts with disseminated form of IA had significantly lower granulocyte count and were treated with higher doses of corticosteroids than others. Immunosuppressive drugs and granulocytopenia can be regarded as predisposing factors. Fatal course of IA depended also on the late diagnosis.

[Telepathology in diagnostic consultations for controversial neoplastic growths in the lung--personal experience]. / Telepatologia w konsultacyjnej diagnostyce kontrowersyjnych rozrostów nowotworowych pluc--doswiadczenia wlasne.

The authors assessed the diagnostic accuracy of the static telepathology (sTP) for practical consultations in the controversial pulmonary oncology cases. The short characteristics of the diagnostic cases is included. We reported the results of 6 difficult clinico-pathological cases submitted to Dept Quantitative Pathology [DQP] for consultations (5F and 1M, age: 26-68 yrs). Digital images of histological or cytological samples were captured at DQP and transmitted to telepathologist (TPat) in Thoraxklinik, Heidelberg or AFIP, Washington DC. Simultaneously, the same slides (or with a paraffin block) were mailed to TPats for re-evaluation with the conventional microscope (dgn-zwPat). The controversial cases presented 2 types of diagnostic problems: 1/rare entities, 2/common difficulties in the routine work of pathologist, but with indefinitely proved diagnosis. The first group encounters TPat diagnoses as follows: * case A: pulmonary plasma cell granuloma with lymphoidal interstitial infiltrates [LIP]--preleukemia; * case B: microfoci of early metastases of benign uterine leiomyoma; * case D: small cell carcinoma spreading along pleura. The second group included: * case C: invasive epidermoidal carcinoma in bronchus; *case E: probably metastatic adenocarcinoma of colon; *case F: synchronous or metastasising 2 lung tumours sharing NE morphology or NE immunohistochemical features. There was very high concordance between referring pathologist (ref-Pat) diagnoses and TPat diagnoses as well as a consensus in zw-TPat diagnoses. In 2 cases the conceptual problem was solved by TPat. Telepathology offered a support or improved the quality of the final diagnosis. The implementation of sTP remarkably reduced the time of consultations and allowed to present the diagnostic problems to the international group of experts.

[Plastic bronchitis and mucoid impaction--uncommon disease syndromes with expectoration mucus plugs]. / Plastyczne zapalenie oskrzeli i zaczopowanie sluzem--rzadkie zespoly chorobowe przebiegajace z wykrztuszaniem odlewów oskrzelowych.

Mucoid impaction and plastic bronchitis are relatively rare disorders caused by the formation of obstructive airway plugs. We observed from February 1999 to June 2000 seven patients with mucoid impaction and one with plastic bronchitis. In the group of mucoid impaction there were 4 patients with bronchial asthma and 3 without history of lung disease. At the admission to hospital all patients suffered from cough, chest pain and effort dyspnea. Two of them expectorated during cough "bronchial casts". The chest X-ray of 5 patients revealed atelectasis of one of the lung's lobes and diffuse opacities in 2 others. In 4 cases during bronchoscopy one bronchus and in another three--numerous bronchi were obstructed with mucoid casts. Removing of the casts caused both the improvement of the patients' condition and withdrawal of atelectasis in 4 cases. In 5 patients the final diagnosis was allergic bronchopulmonary aspergillosis and in two mucoid impaction in the course of asthma without aspergillosis. Plastic bronchitis was observed in 44 years old man, who expectorated white, branching, bronchial casts for three months. On admission he was in respiratory failure. The chest X-ray revealed diffuse alveolar infiltrates and HRCT glass-ground opacities in both lungs and bronchiectasis in the middle lobe. The bronchofiberoscopy disclosed diffuse tracheobronchitis with casts occluding the middle lobe bronchus. Microscopic examination of the removed casts showed aggregates of mucus, macrophages, neutrophils and cells of respiratory epithelium. Precipitins against Aspergillus fumigatus were not found. Staphyloccocus coagulase (-) was cultured from urine and sputum specimens. We administered Vancomycin with Netylmycin, acetylocysteine, oxygen therapy and humid inhalation and the patient recovered. HRCT made six months after admission revelated total withdrawal of glass-ground opacities. The pathogenesis of plastic bronchitis in this case was unclear.

Fatal infection in patients treated for small cell lung cancer in the Institute of Tuberculosis and Chest Diseases in the years 1980-1994.

The study was performed to explore the frequency of infections present at death and infection as the main cause of death (fatal infection - FI) in 845 consecutive patients (pts) treated for small cell lung cancer (SCLC) at the Institute of Tuberculosis and Chest Diseases in Warsaw, in the period 1980-1994. Diagnosis of infection was based on clinical signs and symptoms, the presence of new lesions on the chest X-ray, microbiological tests and/or autopsy examination. All cases of fungal infection, Pneumocystis carinii pneumonia (PCP) and tuberculosis were proved by autopsy and microscopic examination (including special staining). FI was diagnosed if no progression of cancer was noted and no other complications occurred. Infection was present at the time of death in 116 patients (13.7%) and FI was the cause of death in 39 of them (4.6%). Nine patients died from fungal infection, eight from bacterial infection, seven from PCP and two from tuberculosis. In 13 cases the aetiology of infection found at autopsy was not determined. All FI patients received chemotherapy and corticosteroids, 16 of them also had radiotherapy on the tumour and mediastinum. Thirty-two out of 35 patients had leucopenia. The risk of death from infection was greater in patients above 60 years of age. Patients in bad performance status died of infection significantly earlier than others (P<0.05).

[Cytomegalic disease as a cause of disseminated lung lesions in an immunosuppressed patient]. / Cytomegalia jako przyczyna masywnych zmian rozsianych w plucach u chorego w immunosupresji.

A case of disseminated lesions in the lungs was diagnosed just during autopsy as cytomegalic infection. 54-year old patient treated since 10 years because of lymphoplasmacytoid lymphoma of low malignancy was admitted to Institute of Tuberculosis with suspicion of miliary tuberculosis. The high temperature, pemphigus--like skin lesions and disseminated lesions in the chest X-ray appeared immediately after succeeding chemotherapy. Tuberculous bacilli. Aspergillus fumigatus and Pneumocystis carinii were not found in examined materials (BALF, blood, urine, skin and mucous lesions). Patient died after 3 days and typical lesions of cytomegalovirus infection were found only after autopsy in macroscopic picture of the lungs.

[The relation between lymphocyte profile in BALF and the course of sarcoidosis based on short term observation]. / Zaleznosc miedzy zawartoscia limfocytów w BALF a krótkotrwala obserwacja przebiegu sarkoidozy.

The aim of this study was to assess how the extent of the number and percentage of lymphocytes in BALF and also the CD4 to CD8 ratio can help to predict the short outcome in sarcoidosis. Material consisted of 74 patients, 39 men and 35 women in the age from 23 to 58 years. 11 patients had chest lesions in stage I, 43 in stage II and 20 in stage III. Clinical markers of activity (fever, erythema nodosum) were present in 22 cases. Extrathoracic lesion were present in 31 and abnormal pulmonary function in 30. In all patients BAL was done before treatment and lymphocyte count, percentage and CD4/CD8 ratio was calculated. 50 patients were treated with corticosteroids and 24 were observed without treatment. After 6-12 month of observation regression of sarcoid lesions was observed in 46 of 50 patients treated with corticosteroids and in 17 out of 24 patients observed without treatment. There were no differences in lymphocyte count and percentage in BALF and in the short term outcome between group treated with corticosteroids and without treatment. The patients in whom regression of lesions was observed have however significantly higher CD4/CD8 ratio than others.

[Pulmonary sarcoidosis diagnosed in 2 cases suspected to be neoplasms]. / Sarkoidoza pluc rozpoznana w 2 przypadkach podejrzanych o nowotwór.

Two young patients suspected of neoplasms were admitted to Thoracic Surgery Department of Institute of Tuberculosis in first case (35-years old woman) chest x-ray showed atelectasis of upper right lobe, enlarged lymph nodes of mediastinum and right hillium-lymphoproliferative process was suspected. Repeated bronchoscopies revealed narrowing of upper right bronchus and in biopsy--granulomas with small focus of necrosis were found. Tuberculosis was not excluded. During short antituberculous treatment progression of lung lesions and enlarged supraclavicular lymph node were observed. Following biopsy confirmed sarcoidosis. Treatment with prednisone was successful. In second case the chest x-ray showed large masses in both lungs suspected of seminoma metastases. Lung biopsy made during thoracotomy revealed sarcoidosis.

[Pulmonary thromboembolism as the main or secondary cause of death in patients treated for small cell lung cancer]. / Zatorowosc plucna jako glówna lub dodatkowa przyczyna zgonu chorych leczonych z powodu drobnokomórkowego raka pluca.

The aim of this study was to assess the frequency of pulmonary thromboembolism in small cell lung cancer (SCLC) patients (pts) treated in the Institute of Tuberculosis and Chest Diseases in the years 1980-1994. The second aim was to assess whether the occurrence of thromboembolism is connected with the progression of cancer. Pulmonary thromboembolism was recognised in 17 out of 845 pts (2.01%) treated for small cell lung cancer, that is in 2.01% of pts. The frequency of thromboembolism was 8% among patients in which autopsy was done. Pulmonary thromboembolism occurred in 7 pts during progressive disease but also in 9 with partial or complete regression of SCLC. The potential role of chemo- and radiotherapy in the development of thromboembolism in the last group was discussed.

[Usefulness of analyzing ANCA changes for diagnosis of Wegener's granulomatosis]. / Przydatnosc oznaczania miana ANCA dla diagnostyki ziarniniakowatosci Wegenera.

UNLABELLED: ANCA were described in 1982 as sensitive and specific markers for active Wegener's granulomatosis (WG). We analysed the results of ANCA test performed in 298 patients hospitalized in Institute of Tuberculosis and Lung Diseases in the period 1990-1998 because of different symptoms and syndromes of respiratory system which could be symptoms of WG. Presence of c-ANCA, p-ANCA and other not well defined types of ANCA in the titer greater than 1:40 in the serum was regarded as positive result of test. We found it in 60 patients. In 47 WG pts ANCA were present in 40 of 42 pts with active disease and 1 of 5 in remission. Further 19 positive results were found in a group of 251 patients with other diseases: 1 of 4 pts with Churg-Strauss syndrome, 1 of 2 with pulmonary renal syndrome, 5 of 28 with connective tissue diseases, 1 of 21 with tuberculosis, 1 of 23 with sarcoidosis, 1 of 6 with histiocytosis, 3 of 11 with hypersensitivity pneumonitis, 1 (lymphoma) of 34 with neoplasms, 1 of 20 with pulmonary fibrosis, 1 of 8 with cardiac failure, 1 of 5 with pleural fluid, 1 of 10 pneumoconiosis and toxic reactions (after furagin), 1 of 6 with BOOP. Sensitivity of ANCA test in our material is 87%, specificity = 95%, and positive prevalence accuracy is 68%. It means that 32% of the patients with positive results could be inappropriate treated as WG. CONCLUSION: ANCA test could be not used as a screening test. Results of ANCA test alone cannot be used as basis for treatment. ANCA test is a helpful tool in diagnosing of WG.

[Infection as a main or additional cause of death in patients treated for small cell lung cancer]. / Zakazenia jako glówna lub dodatkowa przyczyna zgonu u chorych leczonych z powodu drobnokomórkowego raka pluca.

The aim of this study was to analyse the frequency of infection as a cause of death in small cell lung cancer (SCLC) patients. Our material consisted of 845 unselected SCLC patients, 246 women and 599 men, aged 29-78 years, treated between 1980-1994 in the Institute of Tuberculosis in Warsaw. 479 patients had limited and 366 extensive disease. 530 were in good (0-2) and 315 in bad (3-4) performance status. 784 patients died. Autopsy was done in 211 patients. Infection was regarded as a main cause of death in 39 patients (4.6%) and as a coexistent cause in 77 (9.1%). At the time of death from and/or with infection in 16 patients complete remission and in 27 partial remission of cancer was confirmed. The risk of death from and/or with infection was not related to the age and sex or to the performance status of patients and to extension of cancer. The risk of death from and/or with infection in the first 3 months of treatment was however greater for patients in bad performance status and with extensive disease and later (after 3rd months) for patients in good performance status and with limited disease.

[Pneumonia and panophthalmitis as first signs of pneumococcal endocarditis]. / Zapalenie pluc i wnetrza galki ocznej jako pierwsze etapy pneumokokowego zapalenia wsierdzia.

A case of pneumonia associated with pneumococcal endocarditis of bicuspid aortic valve complicated by pneumococcal meningitis and panophthalmitis successfully treated by antibiotics and late valve replacement was described.

[Changes in the respiratory system of patients with rheumatoid arthritis--personal observations]. / Zmiany w ukladzie oddechowym u chorych na reumatoidalne zapalenie stawów--obserwacje wlasne.

13 patients with RA admitted to our Institute with symptoms of respiratory involvement were described. Taking under consideration pulmonary function tests, radiological findings and histological examinations, we recognised 7 cases with interstitial lung disease, 3 cases with recurrent respiratory infection with bronchiectasis, 1 case with pleuritis, 1 with Caplan's syndrome and 1 with alveolar haemorrhage. The role of RF, and treatment with gold in the development of interstitial lung disease, as well as character of physiologic abnormalities concerning the small airways and its potential connection with bronchiolitis were discussed.

[The pattern of small cell lung carcinoma in autopsy (based on material of the Pathology Department, National Institute of Tuberculosis and Lung Diseases in Warsaw]. / Autopsyjny obraz raka drobnokomórkowego, (na podstawie materialu Zakladu Patomorfologii IGiChP w Warszawie).

The aim of this study was to review autopsy findings in small cell lung carcinoma (SCLC) patients (pts)--in order to assess the distribution of the disease at the time of death and to analyse the pattern of SCLC in relation with different therapeutic modalities. The pattern of autopsy findings was assessed in 100 pts SCLC: 85 pts after treatment with chemotherapy, with or without chest and cranial irradiation; and 15 pts without any therapy. The primary tumours were present in 59% pts (50 of 85), the residual tumour deposits were diagnosed in 32% (27 of 85) pts. The significant difference in the rate of locoregional disease was found between pts given chemotherapy and pts after combined therapy. The tumours occurred significantly more frequently in pts after chemotherapy, than in pts after chemotherapy with irradiation on the chest (75% and 41% respectively, p = 0.03). The chest irradiation with chemotherapy caused less frequent occurrence of the residual tumours than chemotherapy alone (48% and 20%, respectively, p = 0.026). The rate of brain metastases was significantly higher in pts given chemotherapy than in pts treated with chemotherapy and chest irradiation or chemotherapy and curative brain irradiation (90%, 67% and 36% of 50 cases, respectively). Distant metastases were distributed in the same pattern in both studied groups. The distribution of metastases was not dependent on the disease extent at the time of diagnosis.