ABSTRACT
<p><b>BACKGROUND AND OBJECTIVE</b>How to prolong progression free survival (PFS) and overall survival (OS) of patients with small cell lung cancer (SCLC) has been one of the hottest issues. We retrospectively reviewed our data to compare the survival of immediate with delayed topotecan after first-line therapy in SCLC.</p><p><b>METHODS</b>In our retrospective study, 53 patients with SCLC were divided into two groups as follow: patients receiving topotecan-containing regimen as maintenance/consolidation (maintenance/consolidation chemotherapy group) and salvage chemotherapy (salvage chemotherapy group). The Log-rank test was used to assess the difference in OS between two groups. Cox regression model was used for the multivariable analysis of independent prognostic factors.</p><p><b>RESULTS</b>Twenty-nine patients received topotecan as maintenance/consolidation treatment, whereas 24 patients salvage chemotherapy. The response rates were 51.7% and 41.7%, respectively. The median survival time were 20 months and 27 months respectively (P = 0.89). Multivariate Cox regression analyses identified sex and stage as independent prognostic factors.</p><p><b>CONCLUSION</b>Efficacy of first-line therapy was improved by topotecan maintenance/ consolidation treatment, which did not result in any significant survival benefits in SCLC.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Antineoplastic Agents , Therapeutic Uses , Lung Neoplasms , Drug Therapy , Mortality , Retrospective Studies , Small Cell Lung Carcinoma , Drug Therapy , Mortality , Topotecan , Therapeutic Uses , Treatment OutcomeABSTRACT
Objective To evaluate the toxicity and efficacy of induction chemotherapy(ICT)followed by three-dimensional conformal radiotherapy(3 DCRT)plus concurrent weekly paclitaxel for inoperable non-small cell lung cancer(NSCLC). Methods Patients with stage Ⅲ NSCLC in favorable conditions were treated with 2 to 4 cycles of carboplatin(AUC=5-6,d1)combined with paclitaxel(175 mg/m2,d1),then followed by weekly paclitaxel(40 mg/m2)and concurrent 3DCRT within 3-4 weeks.The prescription dose of radiotherapy was given as high as possible while total lung V20≤31% and total dose of the spinal cord ≤50 Gy. Results ICT was well tolerated.During the concurrent chemoradiotherapy,the treatment of 4 patients was ended ahead of the schedule because of severe pulmonary and cardiac toxicities:the treatment of 2 patients was delayed for 7 and 12 days because of fatigue.Leucopenia(33/56)was in grade 1-2 except 1 patient in grade 3.Lymphocytopenia was severe(54/56,42 in grade 3).Three patients developed grade 3 acute radiation-induced esophagitis.and 3 developed grade 3-4 radiation-induced pneumonitis.There was one patients each who developed grade 2,3,and 4 late esophagealdamage,respectively.Nine developed grade 2 pulmonary fibrosis.The overall response rate was 69.7%.The 1-year overall survival rate was 72.3%.The 1-year local progression-free survival rate was 62.7%. Conclusions The schedule of ICT followed by weekly paclitaxel and concurrent 3DCRT can be well tolerated by most of the favorable patients with stageⅢ NSCLC.and the toxicity is tolerable. Results of this study are encouraging, though long-term results should be followed up.
ABSTRACT
Objective To study P-glycoprotein(P-gp),the mdr-1 gene product,expression and response to pirarubicin containing regimen in recurrent and metastatic breast carcinoma.Methods P-gp expression in 40 postoperative patients with recurrent and metastatic breast carcinoma was detected by SABC immunohistochemical method.The patients were treated with combination regimen of cyclophosphamide,pirarubicin and 5-fluorouracil.The correlation between P-gp expression and chemotherapeutic response was analyzed.Results The positive rate of P-gp expression in patients with lung or liver metastasis was higher than that in skin or lymphnode metastasis(P=0.049);The overall response rate was 52.5% in 40 patients;The responserate 84.2% of the P-gp negative group was higher than that 33.3% of the P-gp positive group(P
ABSTRACT
<p><b>BACKGROUND</b>To evaluate the efficacy and toxicity of concomitant chemoradiotherapy in patients with brain metastases from non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>Thirty patients suffering from NSCLC with brain metastasis were prospectively included in this study. Twenty-four patients had neurological symptoms and an ECOG performance index between 0 and 3. Treatment consisted of concomitant whole brain radiotherapy (WBRT) with a dose of 30 Gy in 15 fractions, followed by a local boosted dose of 20 Gy in 10 fractions for those that the number of the remained lesions were less than 3, or by WBRT with a total dose of 50 Gy for those that the number of the remained lesions were more than 3. Concomitant chemotherapy of FVP regimen with floxuridine 600 mg/(m²*d), teniposide 60 mg/(m²*d), cisplatin 20 mg/(m²*d) on d1 to d5,repeating every 3 or 4 weeks. The response was evaluated by brain CT or MRI after WBRT and 2 cycles of chemotherapy being completed.</p><p><b>RESULTS</b>All the patients completed WBRT and concomitant chemotherapy including 68 cycles (2 to 4 cycles for each patient). The follow-up rate was 93.3% with a median survival duration of 11.3 months. Total response rate was 46.7%, with CR for 2 and PR for 12. Specific evaluation of brain response demonstrated CR for 8 patients, and PR for 10 patients (the objective brain response rate, 60.0% ). The objective primary disease response rate was 18% for 22 cases of previously untreated primary NSCLC. Other specific evaluation of metastases included 1 PR patient in 6 patients with lung metastases, 3 CR patients and 4 PR patients in 17 patients with lymph node metastases, 1 PR patient with liver metastases, and 1 PR patient with eye metastasis. Twenty four patients with neurological symptoms benefited improvements to different extent. The main adverse effects were myelotoxicity, nausea/vomiting, constipation and alopecia. Grade III and IV toxicities were observed as following: leucopenia (19.1%), anemia (10.3%), thrombocytopenia (7.4%), nausea/vomiting (4.4%), diarrhea (2.9%), alopecia (5.9%), glutamio oxaloacetic transaminase (GOT) and glutamio pyruvic transaminase (GPT) elevation (1.5%). Dehydration therapy was needed at 2 weeks after WBRT in all patients.</p><p><b>CONCLUSIONS</b>Concomitant WBRT plus FUDR+VM-26+DDP chemotherapy is tolerable in NSCLC patients with brain metastases and the short term response is comparable to the results of others.</p>