Correspondence 569

Resection and Adjuvant Chemotherapy of Pulmonary Blastoma

A Case Report

rs. Novotny and Huiras recently published a case D report of adjuvant chemotherapy after surgery for pulmonary blas toma,' and the following supplemen- tary information may further illuminate this topic.

We have recently performed a comprehensive re- view of patients with pulmonary hlastoma, including a total of 202 cases. When evaluating the survival for pa- tients having different extents of resection, we observed that patients undergoing minor resections (wedge resec- tion, lobeclomy, and bilobectomy) (n = 76) had a better prognosis ( P = 01.0291) than patients undergoing pneu- monectomy (n == 321, probably because of differences in the extent of disease and tumor burden. With respect to adjuvant Chemotherapy after surgery, one adult (age 56 years)' and 9 children (age range, 2-7 year^)^-^ have previously been reported on. We compared the survival of these 10 patients receiving adjuvant chemotherapy, together with the case reported by Novotny and Huiras, with patients froin our literature review who had a com- plete resection without subsequent adjuvant treatment. The chemotherapy regimens employed were heteroge- neous, including combinations of vincristine, cyclophos- phamide, and actinomycin-D in five patients, and one patient each received: vincristine, doxorubicin, and acti- nomycin-I); two patients received: vincristine, cyclo- phosphamide, doxorubicin, etoposide, and cisplatin; vincristine, actinomycin-D, cyclophosphamide, cis- platin, doxorubirin, ifosfamide, arid etoposide; vincris- tine and actinorntycin-D; and cyclophosphamide, doxo- rubicin, etoposicle, and cisplatin, respectively. Six pa- tients received concurrent radiotherapy. The survival curves for the patients with and wthout adjuvant treat- ment following surgery are demonstrated in Figure 1. Median survival For patients with and without adjuvant treatment were 32 versus 16 months ( P = 0.0990). Based on this small, retrospective patient group, no firm con- clusions can be imade on the effectiveness of adjuvant treatment. An apparently better survival outlook for pa- tients receiving adjuvant treatmenl could also be attrib- uted to other potential prognostic variables in addition to the adjuvant treatment. Another confounding factor in such a retrospective analysis based on several case reports is that all subsequent relapses might have been treated with surgery, chemotherapy, radiotherapy, or a combination of these therapies.

We agree with Drs. Novotny and Huiras that a

Horda

FIGURE 1. Survival for patients with pulrnonaiy blastoma treated with radical resection, with (n = 11) or without (n = 10) adjuvant chemotherapy.

coordinated registry may be of benefit for patients with this rare disease. However, we believe the optimal way of accumulating information to optimize treat- ment may be to perform multiinstitutional treatments according to defined protocols to achieve a sufficient number of patients with this rare tumor, which has an estimated incidence of only 0.5% of all lung tumors.'

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Henrik Larsen, M.D. Jens Benn Sorensen, M.D.

Department of Oncology Finsen Center National University Hospital

Copenhagen, Denmark

e read with interest the article by Drs. Novotny W and Huiras on pulmonary blastoma (PB).' We would like to emphasize some topics to contribute to