Molecular subtyping reveals immune alterations associated with progression of bronchial premalignant lesions

Bronchial premalignant lesions (PMLs) are precursors of lung squamous cell carcinoma, but have variable outcome, and we lack tools to identify and treat PMLs at risk for progression to cancer. Here we report the identification of four molecular subtypes of PMLs with distinct differences in epithelial and immune processes based on RNA-Seq profiling of endobronchial biopsies from high-risk smokers. The Proliferative subtype is enriched with bronchial dysplasia and exhibits up-regulation of metabolic and cell cycle pathways. A Proliferative subtype-associated gene signature identifies subjects with Proliferative PMLs from normal-appearing uninvolved large airway brushings with high specificity. In progressive/persistent Proliferative lesions expression of interferon signaling and antigen processing/presentation pathways decrease and immunofluorescence indicates a depletion of innate and adaptive immune cells compared with regressive lesions. Molecular biomarkers measured in PMLs or the uninvolved airway can enhance histopathological grading and suggest immunoprevention strategies for intercepting the progression of PMLs to lung cancer.

[Preventing lung cancer]

Lung cancer is one cancer for which preventative measures can be most effective. Unfortunately the strategies developed, in particular in terms of smoking, whether with regard to primary prevention, treatment by healthcare professionals or regulations, are insufficient or poorly adapted.

Intrapulmonary IFN-beta gene therapy using an adenoviral vector is highly effective in a murine orthotopic model of bronchogenic adenocarcinoma of the lung

Given previous work showing that an adenoviral vector expressing IFN-beta (Ad.IFNbeta) was highly effective in eradicating i.p. mesothelioma tumors, the antitumor efficacy of this agent was evaluated in an orthotopic model of bronchogenic adenocarcinoma of the lung. These transgenic mice have a conditionally expressed, oncogenic K-rasG12D allele that can be activated by intratracheal administration of an adenovirus expressing Cre recombinase (Ad.Cre). K-rasG12D mutant mice were given Ad.Cre intranasally to activate the oncogene. Mice were then given 10(9) plaque-forming units of a control vector (Ad.LacZ) or Ad.IFNbeta intranasally 3 and 4 weeks later, a time when lung tumors had been established. Cells derived from K-ras-mutated lung tumors were also grown in the flanks of mice to study mechanisms of therapeutic responses. In two separate experiments, untreated tumor-bearing mice all died by day 57 (median survival, 49 days). Ad.LacZ-treated mice all died by day 71 (median survival, 65 days). In contrast, 90% to 100% of mice treated with Ad.IFNbeta were long-term survivors (>120 days; P < 0.001). In addition, immunity to re-challenge with tumor cells was induced. In vitro and flank tumor studies showed that Ad.IFNbeta induced direct tumor cell killing and that depleting natural killer or CD8+ T cells, but not CD4+ T cells, with antibodies attenuated the effect of Ad.IFNbeta. These studies, showing remarkable antitumor activity in this orthotopic lung cancer model, provide strong preclinical support for a trial of Ad.IFNbeta to treat human non-small cell lung cancer.

[Early lung cancer detection with low-dose CT: an update]

Lung cancer is the leading cause of death from malignancy. Due to a lack of early symptoms patients usually undergo therapy at advanced tumor stages when prognosis is poor. Feasibility studies of low-dose spiral CT screening of heavy smokers have shown that many small, resectable lung cancers can be diagnosed at early stages using simple diagnostic algorithms based on size and attenuation of detected pulmonary nodules with a small proportion of invasive procedures for benign lesions. Preliminary results of repeat screening confirms small size and favourable stage distribution of detected cancers, using even simpler diagnostic algorithms: additional diagnostic procedures are only required in new or growing nodules whereas follow-up with low-dose CT is sufficient in nodules that appear unchanged to exclude slow growth. However, mortality reduction by lung cancer screening with low-dose CT has yet to be demonstrated. Several randomised controlled trials are under way to assess possible mortality reduction by comparison of mortalities in a screening group and a control group. It is hoped that through international cooperation data from these trials can be pooled to allow for statistically significant conclusions as early as possible.

Occupational and environmental causes of bronchogenic carcinoma

Occupational and environmental carcinogens account for an important minority of cases of bronchogenic carcinoma. From a public health perspective, it is important to characterize occupational and environmental carcinogens and to define disease risk to reduce preventable lung cancer. From a clinician's perspective, it is important to distinguish individual cases of occupational lung cancer from nonoccupational cases, because cancer acquired from work may be compensable through worker's compensation claims and litigation. Important carcinogens include asbestos, radon daughters, diesel exhaust, and metals. Epidemiologic investigations identify excess cases of lung cancer in populations exposed to carcinogens. Experimental animal and ex vivo human research provide complementary information supporting causal relationships between exposure and carcinogenesis. Clinical challenges include proving that a given case of lung cancer is due to an occupational exposure. Research challenges include determining safe exposure thresholds. Only a small percentage of all chemicals used in industry have been extensively analyzed for their carcinogenic potential. Scientific and regulatory information about pulmonary occupational and environmental health and safety is available from several important agencies and organizations, including the Occupational Safety and Health Administration, the National Institute for Occupational Safety and Health, the International Agency for Research on Cancer, the American Lung Association, and the Environmental Protection Agency.

Screening for asymptomatic early bronchogenic carcinoma with low dose CT of the chest

BACKGROUND

Survival of patients with lung carcinoma is very poor, particularly for patients with advanced disease. There are no early clinical symptoms, and screening with chest radiography has not been recommended. Computed tomography (CT) is superior to radiography for detection of pulmonary nodules but usually is associated with relatively high radiation exposure. Recently, accuracy of low dose CT has been shown to be similar to conventional dose CT. The goal of the current study was to assess the findings of low dose CT of the chest in heavy smokers.

METHODS

More than 700 heavy smokers (> 20 pack years; age: > 40 years) underwent unenhanced low dose CT of the chest. Detected nodules were classified according to their density (soft tissue, calcified, fat) and size (< 6 mm, 6-10 mm, > 10 mm). In nodules larger than 10 mm with no CT features to suggest a benign lesion, histology was obtained.

RESULTS

In approximately 40% of smokers, nodules smaller than or equal to 10 mm were detected. None was resected. In less than 3% of individuals, lesions larger than 10 mm were detected; 8 were bronchogenic carcinoma. All eight carcinomas were resectable. Lesions for which no histology was obtained were followed with low dose CT.

CONCLUSIONS

Low dose CT detected 8 bronchogenic carcinomas in more than 700 heavy smokers. All eight were resectable. Pulmonary nodules measuring up to 10 mm were found in 40% of smokers. The significance of these small lesions has remained unclear.

[Chemoprevention of bronchogenic carcinoma]

Lung cancer is the leading cause of cancer-related deaths in many developed countries. Understanding its carcinogenesis is critical for the development of rational approaches to cancer prevention. The concept of chemoprevention is based on the idea that the diffuse injury of the respiratory epithelium results from chronic carcinogen exposure. Chemoprevention agents should reverse or suppress the development of premalignant and malignant changes by different mechanisms. In the future, the clinical application to risk groups of patients could lead to substantially decreased frequency of the lung cancer. The results of ongoing trials are eagerly awaited.

Molecular events in bronchogenic carcinoma and their implications for therapy

Lung cancer patients suffer a 15% overall survival despite advances in chemotherapy, radiation therapy and surgery. This unacceptably low survival rate is due to the usual finding of advanced disease at diagnosis. Detecting preneoplastic lesions and determining which invasive lesions are prone to metastasize or recur can be formidable tasks. Understanding the molecular events that occur during the multistep process of bronchogenic carcinogenesis may make these tasks more surmountable. Approaches leading to identification of patients susceptible to cancer formation include detection of poor metabolizers of carcinogens, those unable to repair genetic alterations, those with activated oncogenes or inactivated tumor suppressor genes, and those at risk of poor outcomes. Detection may be achieved at the cellular, chromosomal, genetic, or protein level. Novel therapies can then be developed that prevent tumor initiation into and promotion through the multistep carcinogenesis pathway, conversion from preneoplastic into invasive malignancies, and progression into metastasis or recurrences. Therapeutic success of chemoprevention can be followed by changes in molecular marker levels. Blockade of activated tumor-promoting oncogenes or replacement of inactivated tumor-suppressing or apoptosis-promoting genes can be achieved by gene therapy. Development of these novel molecular diagnostic and therapeutic strategies could result in prevention of cancer formation or at least prolongation of disease-free survival.

[Neuropsychological effects of preventive CNS irradiation in adult tumor patients]

Prophylactic cranial irradiation (PCI) has led to marked prolongation of survival, but also to intellectual and neuropsychological retardation in children with ALL. PCI has also been conducted in adult patients with small-cell bronchial carcinoma in the stage of minimal disease or with breast cancer. There are no studies assessing cognitive or other neuropsychological consequences of PCI in adult cancer patients. We report on a longitudinal prospective study of the effects of PCI on five major neuropsychological domains (intelligence, concentration, attention, memory and psychomotor performance). We report on our ongoing study, in which up to now 11 patients with small-cell lung cancer undergoing PCI have been investigated. Patients are assessed immediately before therapy started as well as 4 weeks and 3 months after onset of PCI. The used instruments are Standard Progressive Matrices (SPM), d2 Concentration Test, Minimental State, Verbal Learning Test and Psychomotor Tests (Steadiness, Aiming, Tapping, Tracking, Pursuit Rotor Test). Although our sample is small, results indicate that there is no evidence for a decrease in neuropsychological abilities in adults after three months. This is in contrast to the observed results after PCI in children. As compared to baseline measures, differences in memory, intelligence, concentration and attention were marginal over time. Moreover the progress of motor performance skills showed no clear tendency.

[Education of personnel in the diagnosis and therapy of bronchial and pulmonary carcinoma]

The education of staff that works on diagnostics and treatment of bronchopulmonal carcinoma should be continuous process. It has to include staff from preventive health care structures and also pedagogists, social welfare workers, psychologists and others who make contact with citizens, and educational institutions and so on. In other hand, education must include all health professionals who work on early detection and early treatment of patients with bronchopulmonal carcinoma. There is a problem to find the best way for conducting education. It is suggested that it should be duty of a team of different experts. Team members would be chosen and structured according to criteria which would be by consensus. The procedure of reform must be conducted methodologically correctly and according to common fixed criteria. There is tendency that some steps of education reform on the High school of Medicine and education of the third level have to be done immediately, in transitive time, because the vacuum and failures in education make the errors through the whole life. It is very important to point out underlay the special and the addition education, the making plans and programs of the staff education and suggestion of emergency actions of reform of education on lung diseases in transitive period, regard of war suffering, human resources, equipment and technical possibilities.

[Prevention of bronchial and pulmonary carcinoma]

Malignant neoplasms, and especially CA of bronchi and lungs, are major health and social problem, regard of frequency, as well as duration of treatment, and place among leading causes of death. Among all types of malignant neoplasms, CA of bronchi and lungs correlates directly with tobacco consumption and environmental risk'factors, such as industrial pollutants of the human micro and macro environment. Author presents specific preventive programmes of CA of bronchi and lungs, as well as the evaluation programme of integrated national activities in reduction of malignant neoplasms.

Long-term survival of patients with lung cancer from a defined geographical area before and after radiological screening

In the County of Uppsala, Sweden, a general health survey including a chest roentgenogram was operational from the late 1960s until the end of June, 1985. The screening was offered every 2 years and participation was about 70%. From the local cancer registry all cases of lung cancer during the period 1980-1990 aged 75 or less were obtained and their survival and mode of discovery investigated. Only WHO I-IV and undifferentiated cancers verified histologically were included. Twenty-eight cancers (11.5%) were discovered in the survey and these patients had a very good prognosis compared to those who presented with symptoms. During the health survey there were 35 of 244 (14.3%) who survived more than 4 years, and after the survey this figure was 34 out of 265 (12.8%), a nonsignificant difference. Survival for patients with squamous cell carcinoma or adenocarcinoma discovered in the health survey was much improved, and for these two groups combined the 4-year survival was 41.7% compared to 10.3% for those discovered by symptoms (P < 0.001). Thus, survival of patients with lung cancer of squamous cell or adenocarcinoma types can be improved by screening, but unfortunately, only few of the cancers will be discovered in this way, so the total impact of screening will be small.

[Bronchopulmonary precancerous conditions and tumors--risk groups from the occupational medicine viewpoint]

Risk groups with regard to bronchopulmonary precancerous and tumor diseases of occupational origin can be deduced from current occupational disease statistics. Most prominent are those working with asbestos. Each year about 250 asbestos-associated bronchial carcinomas and 400 mesotheliomas are recognized and compensated; the tendency is increasing. Because of the long latency time, the frequency peak will probably be reached in about 15 years in spite of the prohibition of asbestos usage. The second place is probably taken by malignomas among the underground uranium mine workers in Thuringia and Saxony (SDAG Wismut). Next come bronchial carcinomas with silicosis (carcinoma in scar tissue) after exposure to chromium(VI) and arsenic compounds as well as various other chemicals and metals. Dose-activity relationships are significant for all occupational carcinogenic agents, as there are also often syncancerogenic influences (especially smoking). From the data on previous loading, high risk groups, for example, among the insulation workers exposed to asbestos or uranium miners in the so-called "wild years", can be defined. A suitable screening method for the detection of bronchopulmonary tumors in the early stages has not yet been established. Medical checkups for the respective risk groups concentrate on the early X-ray detection of circular foci. As shown by recent studies, cytological sputum diagnosis, (fluorescence) bronchoscopy, and BAL cytology must be employed much more frequently in the high risk groups so that the prognostically more favorable stages of preneoplasm and carcinoma in situ can be detected and possibly treated curatively. These procedures are currently reaching a considerably higher sensitivity with the help of modern molecular biology techniques (e.g. detection of tumor-associated genetic changes and gene products). This contributes to an improvement in surveillance examinations with increasing detection of the curable early forms of tumors. However, only the further development of primary prevention, i.e. the greatest possible minimization or, if possible, total elimination of contact with carcinogenic agents and the consequent control of occupational protection will lead to a drastic reduction in the occupational risk of cancer.

Biomarker assessments in asbestos-exposed workers as indicators for selective prevention of mesothelioma or bronchogenic carcinoma: rationale and practical implementations

In the first part of this study we have shown how the serum levels of four selected tumour markers, namely tissue polypeptide antigen (TPA), carcino-embryonic antigen (CEA), hyaluronic acid (HA) and ferritin, display patterns characteristic of mesothelioma (M) or bronchogenic carcinoma (BC) in asbestos-exposed workers, and we hypothesize that the differences in marker patterns correspond to differences in carcinogenesis mechanisms. In a preliminary study, we found these specific marker patterns in 5/19 exposed workers of whom only one demonstrated any radiological signs of disease. Thus these specific marker patterns may be early events, occurring long (possibly years) before the classical radiological signs of exposure to asbestos. Accordingly they afford an optimal opportunity for prevention which should be adapted to the carcinogenesis mechanism as it is revealed by the marker pattern; it is aimed at antagonizing free radical carcinogenesis in all persons with TPA levels in excess of 100 U/l or Ferritin in excess of 400 ng/ml, and at inhibiting chemical carcinogenesis in those having elevated CEA levels (over 3 ng/ml). The mechanisms involved in these inhibitory processes are described and discussed, as well as the practical implementations that proceed from them. A prevention trial is now being started among 300 active and retired workers of an asbestos-cement works in northern France; the design of the study is presented. This prevention programme should be maintained over many years and holds a strong potential for reducing the untoward effects of exposure to asbestos.

Diagnosis of bronchial carcinoma on sections of paraffin-embedded sputum. Sensitivity and specificity of an alternative to routine cytology

The diagnostic accuracy of sputum cytology for the diagnosis of bronchial carcinoma using paraffin-embedded, serially sectioned and hematoxylin and eosin-stained specimens was tested in 4,297 sputum samples from 1,889 patients, 219 of whom had bronchial carcinoma. The diagnostic sensitivity depended mainly on the number of investigated samples and was 85.4% with three sufficient sputa. The sensitivity was not influenced by the histologic types, location or TNM stage of the tumor. The specificity of the method was 99.5%. In three cases localization of sputum cytologically diagnosed bronchial carcinomas was not possible immediately (occult carcinomas, pTx); in two of these cases the bronchial carcinomas were located during follow-up. The third patient died without verification of the cytologic diagnosis. According to our results, sputum cytology on serial sections is a valuable instrument for mass screening of high-risk groups for the early detection of bronchial carcinoma. Lower sensitivities of sputum cytology in mass screening programs for the early diagnosis of lung cancer are discussed critically.

Biomarker assessments in asbestos-exposed workers as indicators for selective prevention of mesothelioma or bronchogenic carcinoma: rationale and practical implementations

Asbestos-associated malignancies are one of the major industrial hazards of recent decades and will continue to be so until beyond the end of the century. It has been estimated that, in the United States alone, there will be 131,200 cancer deaths as a result of asbestos exposure. At present the early lesions are detected radiologically, by which time intervention is no longer effective. The aim of this study was to test the value of a battery of serum biomarkers in the early detection of malignancy and in distinguishing between the early stages of mesothelioma and bronchogenic carcinoma. Many of the biomarkers had no discriminating value but on the basis of four such markers (namely TPA, CEA, HA and ferritin) it has been possible to distinguish between the late stages of the two malignancies and asbestosis. The results are discussed in terms of their possible application to the detection of early pre-malignant lesions in a screened population of asbestos-exposed persons, with the aim of attempting to prevent cancer death in such early detected cases.

The role of prophylactic lung cancer irradiation in patients (with stage M1 disease) without chest symptoms

The outcome with prophylactic lung cancer irradiation (PLCI) in persons with stage M1 disease but without chest symptoms was assessed in a retrospective review of 68 cases. Eighteen individuals (group A) received PLCI while 50 did not (group B). Median survival was similarly short (4 and 2 months, respectively) in group A and B. Twenty-one patients were evaluable concerning subsequent symptomatic local tumor progression (SLTP) based on clinical and radiographic manifestations. Three of 16 (19%) group B patients experienced SLTP, whereas none of the five in group A did (p = 0.26). Median survival was nine months in the latter and four months in the former patient set. The results suggested that, although PLCI may not enhance survival, it could promote a better quality of remaining life in these particular persons.

[Surgical experience of bronchogenic early squamous cell carcinoma detected by sputum cytology in lung cancer screening]

Eighty-one patients of roentgenologically occult lung cancer (all men, and squamous cell carcinoma) were detected by sputum cytology in lung cancer screening of "Miyagi Program". Sixty-seven patients were resected surgically, and sixty-four of them underwent absolutely curative resection. In fifty-six patients, carcinoma did not penetrate the bronchial wall, and all of them were free from lymph node involvement. In eleven patients, carcinoma penetrated the bronchial wall, and three of them were proved to have lymph node involvement. For that reason, carcinoma which did not penetrate the bronchial wall and was free from lymph node involvement, was defined as early squamous cell carcinoma. Fourty-two early squamous cell carcinoma were located on segmental or more proximal bronchi, but twelve were located on subsegmental or more peripheral bronchi. Five-year survival of fifty-six patients with early squamous cell carcinoma were 91.8%, seven of fifty-six early squamous cell carcinoma patients were multicentric, which were detected synchronously in four cases, postoperatively in two cases, and both synchronously and postoperatively in one case. Two of three postoperatively detected cases were resected surgically and alive without cancer. These results indicate the validity of surgical treatment for roentgenologically occult squamous cell carcinoma. As the most serious prognostic problem is multicentricity, careful localization of primary lesion and postoperative intensive follow-up should be considered.

Lung cancer: the American view

Bronchogenic carcinoma is a major public health problem in the United States, and the leading cancer killer in both men and women. In the early 1970s, the National Cancer Institute (NCI) sponsored multicentre clinical trials to assess the effects of screening by sputum cytology testing and serial chest X-ray examinations on lung cancer mortality in high-risk male smokers. Although more lung cancers were detected, more early stage 1 cancers were resected, and 5 year survival rates were improved in the screened populations than in unscreened controls, there were nearly equal numbers of advanced cancers, and mortality rates were not significantly different. Thus, mass screening to detect early lung cancer has not been pursued as public policy in the United States. In the 1980s, emphasis has shifted to efforts at lung cancer prevention through educational programs aimed at smoking prevention and cessation. In 1984, the NCI adopted a national goal of reducing lung cancer mortality by 50% by the year 2000. Strategy to achieve this is an intensive behaviour modification program to encourage a social climate for smoking abstinence, prevent initiation of smoking among children and adolescents and supply educational materials and encouragement through health care workers and community-based programs.

[The effect of mass chest x-ray on early detection of bronchial cancer]

On 30.6.1983, mass radiographic screening was abandoned despite objections to the effect that it offered the only chance of detecting carcinoma of the lung at an early stage. In a retrospective analysis of our patient material comprising 1.010 patients with bronchial carcinomas seen within the period between 1.1.1980 to 31.12.1986, we investigated the question as to whether these objections might not be justified. Four hundred and thirty-seven patients seen prior to 30.6.1983 were compared with 537 patients examined after this date, on the basis of the following parameters: age - sex - symptomatology - cancer stage - histology - treatment. After stopping mass radiographic screening, an increase in age and symptomatic tumour findings was observed, and thus a shift towards more advanced stages of carcinoma. A relative decrease in the number of squamous cell carcinomas, and a relative increase in the number of adenocarcinomas were observed. All the parameters in the patients identified at mass radiographic screening were comparable with those seen in patients identified incidentally. In comparison with symptomatic patients, those identified by mass radiography screening more frequently presented with earlier tumour stages, and the lesions were more frequently resectable. All in all, over a period of three and one-half years, mass radiographic screening revealed 23.8% of all cancers of the lung, and 36.8% of all resectable lesions. After the abandonment of mass radiographic screening, an increase in more advanced and symptomatic tumours was observed.

Contribution of radon and radon daughters to respiratory cancer

This article reviews studies on the contribution of radon and radon daughters to respiratory cancer and proposes recommendations for further research, particularly a national radon survey. The steady-state outdoor radon concentration averages 200 pCi/m3, and indoor levels are about 4 times higher. The primary source of radon in homes is the underlying soil; entry depends on multiple variables and reduced ventilation for energy conservation increases indoor radon levels. Occupational exposures are expressed in units of radon daughter potential energy concentration or working level (WL). Cumulative exposure is the product of the working level and the time exposed. The unit for cumulative exposure is the working level month (WLM). The occupational standard for radon exposure is 4 WLM/year, and 2 WLM/year has been suggested as a guideline for remedial action in homes. Epidemiologic studies show that miners with cumulative radon daughter exposures somewhat below 100 WLM have excess lung cancer mortality. Some 3% to 8% of miners studied have developed lung cancer attributable to radon daughters. All of the underground mining studies show an increased risk of lung cancer with radon daughter exposure. All cell types of lung cancer increased with radon exposure. If radon and smoking act in a multiplicative manner, then the risk for smokers could be 10 times that for nonsmokers. The potential risk of lung cancer appears to be between 1 and 2 per 10,000/WLM, which yields a significant number of lung cancers as some 220 million persons in the United States are exposed on average to 10 to 20 WLM/lifetime.

[New developments in mass roentgen studies]

Since 1984 in the GDR the persons older than 40 years are summoned to participate in the mass X-ray examinations in a two-year sequence. The risk groups of tuberculosis are called up at shorter intervals, this also concerns younger people. To this belong patients with silicosis, so-called "healthy carriers of lesions", persons with contacts to patients suffering from tuberculosis, diabetics and the staff of tuberculosis hospitals and pathological institutes. Furthermore, persons working in national education, kindergartens and cattle-breeding are particularly controlled. Patients with chronic diseases of the respiratory tract need our increased attention.

[Is annual X-ray examination of the chest still justified in industrial medicine?]

Between 1975 and 1979, 137.526 annual X-ray examinations of the chest were performed among the employees of a large Paris administration. Fifty-four cases of tuberculosis, 28 cases of sarcoidosis, 10 cases of bronchial carcinoma and 26 miscellaneous chest diseases were detected. This study confirms the inadequacy of radiological examination for detecting chronic obstructive bronchopulmonary conditions. The small proportion of tuberculosis (0.39 p.1000) and bronchial carcinoma (0.07 p.1000) revealed by this method suggests that it should be reserved to high risk patients.

[Cancer prophylaxis: gain or risk? (author's transl)]

One of the most important measures for the improvement in curative cancer therapy, stagnant during 25 years, will be a cancer prophylaxis as extensive, intensified and directed as possible. Seventy percent of all the cancerous diseases are produced by seven cancer species. Of these seven species, four are appropriate for a promising cancer prophylaxis: the mammary, uterine and intestinal catzinoma in women, the intestinal carcinoma in men. Risks as well as improvements concerning prophylaxic examination for cancer of the breast or prostatic carcinoma are discussed in detail.

[Postoperative prevention of recurrence with intrapleural Corynebacterium parvum in patients with stage I and II bronchial carcinomas. Ludwig lung cancer study I]

The Ludwig Lung Cancer Group was created in 1977. Participants are from Austria, Denmark, Germany, Norway, Sweden, Switzerland, and Yugoslavia. 400 patients are randomized yearly. The clinical trial I investigating the role of C. parvum intrapleurally as adjuvant therapy in operable non-small cell lung cancer patients has been closed in February 1979 with a total accrual of 475 patients. The average follow-up time for these cases is approximately 8 months. It is early to make any definitive comparisons of the treatment groups (C. parvum versus placebo). However, it is possible to identify a few high-risk patient groups. Preliminary indications are that surgical T- and N-stage, type of resection, histological type of tumor as well as degree of tumor dedifferentiation (central histology review) are prognostic factors with regard to disease-free interval and survival. In the same, the disease-free interval appears to become shorter for patients experiencing high fever after C. parvum administration. The Ludwig Lung Cancer Group offers a sharp tool for investigating the possible role of adjuvant therapies in non-small cell lung cancer and for gathering new information on the biology of the disease.

[Respiratory tract diseases, their health-political importance and trends]

The diseases of the respiratory organs are defined and classified according to the 8th revision of the international classification of the diseases. The acute forms are above all represented by the infections of the respiratory tract. They are the problem No. 1 in health politics, since the most frequent exemptions from work are given on their account. A transition into chronic diseases of the respiratory tract is not infrequent. Among the causes of death the diseases of the respiratory system occupy the 3rd place, the chronic forms are an essential cause of early invalidity. Among the chronic diseases of the respiratory organs considerable shifts to the unspecific side took place. The tuberculosis is vastly reduced. The methods practised in its combat and the graduated, well functioning system of specialised outpatient institutions and hospitals proved as a very suitable instrumentarium also for the combat against the unspecific diseases of the respiratory organs. Three main groups increasingly demand our attention: bronchial carcinoma, chronic obstructive lung disease and the professionally conditioned diseases of the respiratory organs. Their combat demands a broad partnership with the physicians of the "first line", the factory health service and the internists. For this purpose the description of the own possibilities is necessary.