Weekly paclitaxel / carboplatin with concurrent thoracic radiation followed by paclitaxel / carpoplatin consolidation for postoperative stage II and IIIA non-small-cell lung cancer

Recent studies have suggested the superiority of concurrent chemoradiotherapy and the efficacy of paclitaxel/carboplatin in adjuvant non-small-cell lung cancer [NSCLC]. In view of those results, we conducted this phase II trial to examine the safety and efficacy of administration of radiosensitizing paclitaxel/carboplatin weekly with concurrent thoracic radiation therapy [XRT] followed by consolidation paclitaxel/carboplatin for stage II and IIIA NSCLC. Patients with resected NSCLC, pathological stage II or IIIA, Nl-N2 with or without positive margin received paclitaxel/carboplatin weekly during thoracic radiotherapy. All patients received 50.4Gy in 28 fractions for 6 weeks [1.8Gy/d, 5 days/wk]. A boost of 10.8Gy in six fractions was given for extracapsular nodal extension or positive margin. Four weeks after radiotherapy, the patients received two courses of consolidation paclitaxel/carboplatin every 3 weeks. Treatment compliance was acceptable, with 96% compliance for radiation therapy and 92% for chemotherapy completion. The median duration of follow-up was 30 months. The 3-year actuarial survival and progression-free survival rates were 56% and 44%, respectively. Loco-regional failure was a component of first failure in 24% of patients. Toxicities were acceptable. The results of this study suggest that weekly paclitaxel/carboplatin concurrent with radiotherapy is safe and acceptable adjuvant treatment for stage II and IIIA resected NSCLC patients. A randomized phase III trial comparing this treatment regimen with standard therapy seems warranted

New concepts in treatment of post-dural puncture headache: Tetracosactide vs. tetrazepam

We investigated the effect of tetracosactide hexa-acetate vs tetrazepam as therapeutic agent for treatment of post-dural puncture headache [PDPH]. Thirty patients with PDPH were randomly allocated to receive either tetracosactide 1 mg IM [group A, n=15] or oral tetrazepam 1.2 mg/kg [group B, n=15]. Severity of headache [VAS scale], neck rigidity, nausea and vomiting were recorded before treatment and at intervals after treatment. The need for supplementary management as hydration, analgesics or epidural blood patch was also recorded. Our results suggest that tetrazepam has a superior effect compared to tetracosactide in controlling PDPH. It also alleviates neck rigidity and vomiting in a statistically significant way. The drug is also cheap, easy to use and has minimal side effects