-658. Use of BCG as an immunostimulant in the surgical treatment of carcinoma of the lung. Cell-mediated immunity to cancer cells would appear to exert some control over the extension of tumour growth, and stimulation of this factor might result in increased survival after surgical treatment of the tumour. Of the various agents used as stimulators in experimental work, BCG would seem to be the most convenient to use in man. A single dose of BCG-Glaxo (500,000 organisms) was given subdermally 10 days after excision of lung carcinoma. The length of survival was used as the index of the effect of the BCG.Two trials were initiated, the first to study the safety of BCG and a survival study of 120 consecutive cases (60 used as controls). This is an interim report at two years of this trial. The main features at this stage show that the overall survival rate has increased from 38% in the controls to 52% in the BCG group. In the squamous-cell group survival has risen from 50% to 62% and, in those with positive nodes, from 33% to 53%. In the oat-cell group, two-year survival has risen from 11% in the controls to 50% in the BCG groups, though the numbers are small. Although encouraging, the results are not statistically significant.The second trial is a randomized trial in which five surgeons have taken part, and 500 consecutive cases of lung resection for carcinoma are documented (250 control and 250 BCG). It is too early for results to be assessed in this group.
BCG (Glaxo) (0 5 ml =5 X 106 organisms) was given subdermally to 250 patients ten days after resection of a lung carcinoma to stimulate the immune system. Increased activity of lymphocytes and macrophages could possibly result in the destruction of small extrapulmonary tumour deposits that were previously unidentified. The two-year survival of this group of patients was compared with 250 controls not receiving BCG after operation. A comparative analysis of the sex, histological types, and lymph node involvement in relation to the survivals occurring in these two groups showed that the administration of BCG by the method described produced a numerically greater survival rate, which was particularly noticeable in the women. None of these figures, however, is statistically significant. It would be unwise to draw any final conclusion until a five-year survey has been completed.That some immunological control over the growth of cancer cells in the body might be obtained by increasing the number and activity of lymphocytes and macrophages has been shown from experiments in animals undertaken by many investigators. Various agents-zymosan (Bradner et al 1958), phytohaemagglutinin (Oppenheim et al, (1965), Corynebacterium parvum (Halpern et al, 1966), oestrogen (Biozzi et al, 1957) Bacille Calmette-Guerin (BCG) (Old et al, 1959), and others-have been shown to be active stimulators for this purpose.Clearly whatever agent was used it or the stimulated lymphocytes and macrophages had to be carried to the neoplasm by the blood stream. Because of the relative ischaemia of most tumours, the agent or cells could therefore be brought into effective contact with only isolated or small agglomerations of tumour cells. It was thus mandatory that the main mass of tumour should be removed at operation and then the immunostimu-*Surgeons in the cardiothoracic surgical unit at Broadgreen Hospital taking part in this trial were:
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