Lung Cancer: Squamous Cell with Pleural Effusion and Unresectable Mediastinal Nodes
Squamous Cell with Pleural Effusion and Unresectable Mediastinal Nodes
Caucasian male, age 54, presented 08/04/95 with five cm perihilar squamous cell lung cancer. At upper lobectomy, tumor extended to the mainstem bronchial resection margin, extended to pleura, involved two of ten nodes, and extended as bulky unresectable nodes into the mediastinum. Patient was treated with postoperative radiotherapy of 6840 cGy to bulky adenopathy with concurrent 5-FU infusion and cisplatin. During radiotherapy, BRM with cyclical equine conjugated estrogen and medroxyprogesterone acetate was begun as described in Case 3. Vitamin E 400 IU tid and cimetidine 300 mg qid were also begun.
Three months later the patient reported refractory cough and shortness of breath. CT scan reported bulky residual adenopathy. LASA-P serologic marker was 20.3 (nl < 20). At this time the first of four irridium-192 endobronchial implants were performed for symptomatic disease compressing bronchus. Thoracentesis of a large symptomatic effusion was also performed. Eight months later the fourth endobronchial implant delivering 1000 cGy at 1/2 cm was delivered with repeat thoracentesis of a symptomatic pleural effusion.
Six months later (4/2/97) IL-2 immunotherapy was begun with 5.5 million units nightly plus melatonin 50 mg at bed time and DHEA 50 mg twice a day. NK% at this time was 16. By six months later, NK % had risen to 55. There were subsequent ten NK determinations more than 40.
On 11/3/98, the patient’s tolerance to IL-2 had deteriorated, and he elected to discontinue IL-2. In only two months after the first thoracentesis for symptomatic effusion, the LASA -P marker was observed to have risen during two months from 16.4 to 29.4. During this same two months, NK% had dropped from 44 to 22, and NK function from 508 to 51 (nl 20-250). Restarting IL-2 and testosterone injection 200 mg in oil was associated with a drop of LASA-P from 29.4 to 14.6 and rise in NK% from 22 to 46 and NK function – to 339.
Three and one half years after thoracotomy for unresectable tumor, and three years after thoracentesis for symptomatic effusion, and after peaks of LASA-P well above normal were observed, the patient leads a vigorous lifestyle doing some work as a mason and maintaining a Karnovsky score of 100.
Authors’ comments: The persistent elevation of LASA-P supports the scanographic and endoscopic diagnoses of failed regional control necessitating multiple endobronchial implants. Patient’s persistent clinical remission during well documented elevation of NK% suggests active sinecommitant immunity.