5-year follow-up of cytotoxic chemotherapy as an adjuvant to surgery in carcinoma of the bronchus

Stott, H.; Stephens, R.; Fox, Wallace; Roy, Denis‐Claude

doi:10.1038/bjc.1976.139

Cited by 25 publications

(8 citation statements)

References 12 publications

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“…They can also cause increased morbidity especially when many of these patients are in poor general health. Nor is there any clear evidence that this approach improves survival (Stott et al, 1976).…”

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confidence: 99%

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Failure of specific active immunotherapy in lung cancer

Souter¹,

Gill²,

Gunning³

et al. 1981

Br J Cancer

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A randomized trial comparing routine follow-up with a treatment regimen aimed at increasing specific anti-tumour immunity has been carried out in 95 patients after total surgical excision of lung cancer (not small-cell). Treatment consisted of inoculation with an autologous irradiated suspension of tumour cells combined with a small dose of C. parvum given intradermally during convalescence. Although treatment was associated with virtually no side effects, there has been no apparent benefit and input to the trial has now stopped.

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confidence: 99%

“…WHILE surgical excision remains the cornerstone in the management of potentially curable cases of lung cancer, it is depressing to note that this most favourable group of patients has a 5-year survival rate of 25-30% (Stott et al, 1976).…”

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confidence: 99%

Failure of specific active immunotherapy in lung cancer

Souter¹,

Gill²,

Gunning³

et al. 1981

Br J Cancer

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“…Drug toxicity Details of drug toxicity have been reported previously (Stott et al, 1976). There were important differences between the series with respect to haematological toxicity, which occurred in 177 (73%) of the B patients compared with 86 (37%) of the C, 49 (20%) of the P patients having comparable episodes (Table V).…”

Section: Plan and Conduct Of The Studymentioning

confidence: 76%

“…The results at 5 years (Stott et al, 1976) of a Medical Research Council Working Party doubleblind study, planned in 1964, to find out whether 2 years of daily chemotherapy with busulphan or cyclophosphamide, compared with placebo, following surgical removal of bronchial carcinoma would suppress metastases and prolong survival, showed no benefit from either of these cytotoxic agents in the dosage schedules studied. Moreover, there was a high incidence of haematological toxicity to busulphan.…”

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confidence: 99%

Fifteen-year follow-up of all patients in a study of post-operative chemotherapy for bronchial carcinoma

1986

Lung Cancer

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Plan and conduct of the studyThe plan and conduct of the study were described in detail previously (Medical Research Council, 1971). In summary, after resection of all intrathoracic bronchial tumour, the patients were allocated at random to receive tablets of busulphan (B series), cyclophosphamide (C series), or indistinguishable placebos (P series) daily for 2 years. For the first 10 days following operation, all patients received 8 tablets in a single daily dose (B series 4 mg, C series 200 mg). Thereafter they received 6 tablets daily (B series 3 mg, C series 150 mg). However, after about the first year of intake to the study, these maintenance dosages were reduced from 6 to 3 tablets (B series 1.5 mg, C series 75 mg), because of an unexpectedly high incidence of toxicity. The 3 series were very similar with respect to sex, age, type of operation, bronchial site of tumour, histological type of tumour, and whether or not the resected lymphnodes were histologically involved.Each patient was reported on monthly during the first 3 years, 3-monthly up to 5 years, and annually thereafter. Total leucocyte and platelet counts and haemoglobin concentrations were measured every month during the first 2 years, and thereafter when requested by the clinician. The maintenance dose of tablets was controlled by the clinician from the results of the blood investigations and the dose was reduced if haematological toxicity was suspected.The study was conducted double-blind. The certified cause of death was obtained from the local centre and was verified from the death entries at the OPCS for all but 2 of the deaths.It is important to note that as the study was planned in 1964, some of the peri-operative staging procedures which would now be considered desirable were not required as a routine and when done were not necessarily reported. In particular, the following were not specifically requested as part of the protocol: recording recent weight loss, mediastinoscopy, isotope scans, liver function tests, marrow aspiration or biopsy, routine dissection of the mediastinal nodes at operation, or reporting the size of the tumour in the resected specimen.X3

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“…This applies to squamous-cell carcinoma in particular since chemotherapy has had only slight effect (Stott et al, 1976 with adjuvant radiotherapy have also been unsuccessful (Homan van der Heide et al, 1974).…”

Section: Discussionmentioning

confidence: 99%

Adjuvant immunotherapy with BCG in squamous-cell bronchial carcinoma. Immune-reactivity in relation to immunostimulation (preliminary results in a controlled trial)

Jansen

The

Gast

et al. 1978

Thorax

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(1978). Thorax, 33,[429][430][431][432][433][434][435][436][437][438] Adjuvant immunotherapy with BCG in squamous-cell bronchial carcinoma. Immune-reactivity in relation to immunostimulation (preliminary results in a controlled trial). Twenty-nine patients with, at operation, evidence of locally advanced primary squamous-cell bronchial carcinoma (stage II, UICC, Geneva, 1974) had lung resection to remove all the visible tumour. Postoperatively a randomly chosen group of 16 patients received adjuvant BCG immunostimulation by scarifications, while the control group received no adjuvant treatment. Follow-up studies were done from three to 23 months. Immune-reactivity in vivo with PPD and DNCB skin tests, and in vitro with E-rosetting tests and lymphocyte transformation tests with PHA, Con A, diphtheria toxoid, and PPD was monitored in 10 treated and in seven untreated patients. Recurrence rates decreased appreciably in the BCG-stimulated group after a six to 23 months' follow-up (p< 005). A pronounced increase in both in-vivo and in-vitro immune-reactivity went in parallel with a more favourable clinical outcome in the BCG-treated group. In these cases there was a significant increase in skin reactivity to PPD three months after surgery (p <0-025) and a statistically significant rise in lymphocyte reactivity to Con A (p< 05), diphtheria toxoid ( p<001), and PPD (p<0 05) but not to PHA 12 months after surgery. DNCB skin reactivity increased as well in the BCG-treated group, but the number of individuals was too small for statistical evaluation. Increase in immune responsiveness did not occur in the control group and appeared to be independent of the initial immune state of the patients. No differences were found in the numbers of E-rosetting lymphocytes in relation to immunotherapy. It is concluded that adjuvant BCG immunotherapy used in patients with minimal residual bronchial carcinoma improves the prognosis and a favourable clinical outcome is mirrored by an increase in cellular immune reactivity.

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5-year follow-up of cytotoxic chemotherapy as an adjuvant to surgery in carcinoma of the bronchus

Cited by 25 publications

References 12 publications

Failure of specific active immunotherapy in lung cancer

Failure of specific active immunotherapy in lung cancer

Fifteen-year follow-up of all patients in a study of post-operative chemotherapy for bronchial carcinoma

Adjuvant immunotherapy with BCG in squamous-cell bronchial carcinoma. Immune-reactivity in relation to immunostimulation (preliminary results in a controlled trial)

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