Multiple primary lung cancers.

Data on 50 patients with multiple separate primary carcinomas of the lung are presented. Eighteen had synchronous tumors and 32 had metachronous tumors, the intervals between diagnoses varying from 4 months to 16 years. Histologic patterns in the two different carcinomas were the same in 31 patients, most commonly epidermoid, and they were different in 19 patients. The problems involved in establishing the diagnosis of multiple primary lung cancers, the choice of treatment, and the expectation for survival are discussed.     

Aggressive surgical treatment of multiple primary lung cancers

A case of triple primary lung cancers--squamous cell carcinoma, adenocarcinoma and large-cell carcinoma--is presented. Surgical treatment comprised, respectively, left pneumonectomy, partial resection of the right upper lobe and completion right upper lobectomy. The postoperative courses were uneventful and the patient remains well, with no sign of recurrence, 20 months after the third operation.     

Multiple primary cancers involving the lung.

Of 150 consecutive patients with resectable bronchogenic carcinoma, 11 were found to have multiple primary tumours of the respiratory tract. Five patients had more than one primary tumour of the lung and six had previously received treatment for carcinoma of the larynx. In the same group of 150 patients, 14 had one or more cancers involving other organs. The appearance of a new solitary lung lesion in a patient with another cancer demands special attention to determine the exact diagnosis and to decide upon the best method of treatment. Physicians should be aware that such a lung lesion may represent a new primary lung cancer rather than a metastasis. The criteria are defined for the pathological definition of two separate primary tumours in these cases.     

Results of surgical treatment of synchronous multiple primary lung carcinomas

Four male patients with synchronous multiple lung carcinoma were operated on. In one patient both tumours were adenocarcinomas; both were bronchioloalveolar carcinomas in a second patient. In a third patient the tumours were adenocarcinoma and bronchioloalveolar carcinoma while in the fourth patient an adenocarcinoma and a squamous cell carcinoma were present. One patient was asymptomatic and free from carcinoma at follow-up examination 11 years and 7 months after the operation. The other three died of pulmonary carcinoma 11 months, 1 year 3 months and 9 years 8 months postoperatively.     

Multiple primary lung cancers. The importance of early diagnosis and survival after a new surgical excision

In a series of 1.025 consecutive resections for bronchogenic carcinoma, 68 patients developed a second primary lung cancer identified as the first site of recurrence (median interval of 38 months). Thirty-nine patients (57%) were asymptomatic (detection by chest-X-Ray (N: 28] or sputum cytology (N: 11) and 22 had one or more symptoms. A reoperation was possible in 50% (N: 34) of all patients with an operative (30 day) mortality of 14.7% (5/34) as compared to 3.5% (26/1.025) for the first procedure. Cumulative survival following the second resection was 33% at 5 years while no inoperable patient survived longer than three years. Clinical presentation of the second carcinoma is a significant prognostic variable since no symptomatic patient survived more than two years while 30% of the asymptomatic group survived 5 years (p less than 0.021).     

Multiple primary cancers in surgically resected lung cancer patients

Among 337 cases of surgically resected lung cancer from April 1977 to March 1984, there were 24 cases (7.12%) of multiple primary cancers including 22 cases of double cancer and one case each of triple and quadruple cancer. They consisted of 17 males and 7 females and the patient age at the time of the lung resection ranged from 32 to 81 years old (average: 67.4). In double cancer cases, the most common site of the other primary cancer was the lung (9 cases), followed by the stomach (5 cases), the colon (4 cases), the pancreas (2 cases), and there was one case each of the salivary gland and the skin. The cases of triple and quadruple cancer involved multiple primary lung cancer associated with mammary and esophageal cancer, respectively. There were 14 synchronous and 8 metachronous cases. The histology of lung cancer in 13 cases of double cancer was adenocarcinoma in 6, squamous cell carcinoma in 2, large cell carcinoma in 3, small cell carcinoma in 1, and adenosquamous cell carcinoma in 1. The histology of 11 cases of double or triple primary lung cancers was squamous cell carcinoma in 17, adenocarcinoma in 5, and large cell carcinoma in 1. In 24 cases 19 lobectomies, 4 pneumonectomies and one partial resection of the lung was performed for the first primary lung cancer. All cancer lesions of other organs apart from the lung were also surgically resected.(ABSTRACT TRUNCATED AT 250 WORDS)     

Results of surgical treatment for lung cancer

A review is presented of 233 patients who were surgically treated for bronchial carcinoma during a five-year period. The survival time was determined in relation to operative procedure and to cell type and anatomic extent of the tumours. Staging according to the TNM classification gave five-year survival rates of 51.6% in Stage I, 12.0% in Stage II and 8.4% in Stages III-IV. Among the Stage I cases, tumours classified as T1N0M0 were associated with longer survival than were T1N1M0 or T2N0M0 tumours. It is concluded that the stage of the disease as defined by TNM classification should be regarded as the most important prognostic factor.     

The results of immunotherapy as an adjunct to the surgical treatment of primary lung cancers

A total of 263 primary non-small cell lung cancer patients resected in our Institute from March, 1978 to October, 1984 were utilized in order to evaluate the efficacy of transfer factor (TF) immunotherapy as an adjunct to surgical treatment and TF was significantly effective to cases with stage I diseases, but not to stages II, III and IV diseases, indicating that TF could only suppressed micrometastasis existing at the time of surgery. In order to improve the further results of immunotherapy as an adjunct to surgical treatment, we analyzed cytotoxic activity against autologous lung cancer and K562 leukemia cells in tumor bearing hosts. Furthermore, we studied the effect of interleukin 2 (IL2) activated lymphocyte dialysate on cytotoxic activity against lung cancer cells. When 3 different sources of lymphocytes including peripheral blood lymphocytes (PBL) regional lymphnode cells (LNC) and tumor infiltrating lymphocytes (TIL) were incubated with IL2 for 8 days at 37 degrees C in 5% CO2 atmosphere, relatively high cytotoxic activity was demonstrated with 2 major different patterns in PBL, LNC and TIL including one systemic predominant and the other local predominant patterns, suggesting that IL2 might be a local or systemic possible immunotherapeutic reagent. Finally, we stimulated lymphocytes from household contact family members with IL2 and MMC treated lung cancer cells. These in vitro modulated T-lymphocytes demonstrated considerable cytotoxic activity against the target cells which were used as in vitro sensitization. The dialysate of these in vitro stimulated cells showed specific activity on cytotoxicity against lung cancer cells and might be a possible reagent in stead of TF for clinical trial.     

Synchronous primary lung cancers: prevalence in surgical material and clinical implications.

BACKGROUND--The prevalence of synchronous primary lung neoplasms in surgical resection specimens was assessed. The associated clinical features and prognostic implications were investigated. METHODS--All surgical resections for lung cancer performed during seven years were reviewed. Synchronous tumours were defined by the presence of more than one tumour mass in the lung, by differences in histological subtype, by the presence of separate bronchial origins, or by differences in DNA stemlines. Clinical data were abstracted from case notes and information from the tumour registry. RESULTS--Just under 2% of all surgical specimens in the study period contained more than one primary carcinoma. The patients did not differ clinically from the general population of patients having surgery for lung cancer. The overall prognosis was poor (mean survival 27 months) but was significantly better for patients with synchronous squamous carcinomas (mean survival 49 months). CONCLUSION--Synchronous primary lung carcinomas are associated with a poor prognosis except in patients having tumours only of squamous histological type.