A small randomized phase III single-center trial on postoperative UFT administration in patients with completely resected non-small cell lung cancer.

Our objective was to clarify the efficacy of UFT administration after the complete resection of non-small cell lung cancer (NSCLC) at a single-center institution, avoiding the biases produced by interinstitutional differences. A total of 30 patients who underwent the complete resection of NSCLC at our hospital between 1987 and 2001 were randomly assigned to a control group or to a UFT group (400 mg/day for 2 years). Thirteen patients were assigned to the control group and 17 patients were assigned to the UFT group. The overall survival rate, disease-free survival rate, patient compliance and adverse effect of the UFT treatment were then analyzed. The overall survival and disease-free survival rates of the UFT group were superior to those of the control group. Four patients in the UFT group received medication for 24 months and 14 patients were treated for more than 3 months. No severe adverse effects were observed. Seven patients suffered a relapse in the control group. Two patients suffered a relapse in the UFT group, but the relapse occurred after the discontinuation of UFT administration. We conclude that the administration of UFT as an adjuvant therapy prolonged the overall survival and disease-free survival rates of patients after the resection of NSCLC in a small study performed at a single institution. Interinstitutional differences, particularly operating procedures, should be carefully considered when performing large multicenter clinical studies.

Micrometastasis in the bone marrow of patients with lung cancer associated with a reduced expression of E-cadherin and beta-catenin: risk assessment by immunohistochemistry.

BACKGROUND: The presence of disseminated tumor cells in bone marrow is considered to be a premetastatic state, which is called micrometastasis. To evaluate the relationship between micrometastasis and cellular adhesion molecules in the primary lesion, E-cadherin and beta-catenin were immunohistochemically investigated. Methods. Fifty-eight patients with non-small cell lung cancer who underwent a complete resection were entered into this study. Tumor cells in bone marrow aspirates were detected by immunohistochemistry using cytokeratin (CK) 18. Immunohistochemical studies of E-cadherin and beta-catenin were performed in the corresponding primary tumor. RESULTS: CK-positive cells were detected in the bone marrow aspirates from 27 of 58 patients. A reduced expression of the E-cadherin and beta-catenin was found in 16 (27.6%) and in 22 (37.9%) of 58 patients, respectively. In 26 cases with a reduced expression of E-cadherin and/or beta-catenin, 16 cases had CK-positive cells, whereas 11 of 32 cases with normal expression of both factors had CK-positive cells (P=.0392). The patients with micrometastasis demonstrated an earlier recurrence (P =.0642) and a significantly poorer survival (P =.0437) than those without such cells. CONCLUSIONS: Micrometastasis in the bone marrow might be a significant predictor of poor prognosis, and a reduced expression of E-cadherin and beta-catenin are important determinants for the metastatic capability of individual cancer cells.

Chemotherapy for small cell lung cancer in patients over 80 years old.

BACKGROUND: Elderly cancer patients sometimes are not considered candidates for standard chemotherapy. We evaluated the efficacy of chemotherapy for small cell lung cancer (SCLC) in patients aged over 80 years old. PATIENTS AND METHODS: We retrospectively analyzed the records of 10 SCLC patients over 80 years old. Six of them had received carboplatin and etoposide intravenously, two had etoposide orally, and two had only supportive care. RESULTS: Seven of the 8 patients treated with chemotherapy responded partially and the median survival time was 281 days. Despite the toxicity of the chemotherapy, the performance status was improved in 5 out of 8 treated patients and the cancer-related symptom was relieved in all treated patients for at least one month during and/or after chemotherapy. CONCLUSION: Chemotherapy is indicated for SCLC patients even aged over 80 years. The quality of life is improved by chemotherapy, although the survival time may not be prolonged significantly.