Interstitial Lung Disease Associated with Combination Chemotherapy of Oxaliplatin, 5-Fluorouracil, and Leucovorin / 대한소화기학회지

Oxaliplatin with 5-fluorouracil plus leucovorin (FOLFOX) has become the standard treatment in patients with colorectal cancer. Among known toxicities induced by oxaliplatin, hematological, gastrointestinal and neurological toxicities are common. However, acute pulmonary toxicity associated with oxaliplatin is unusual. One case of interstitial lung disease associated with the FOLFOX protocol is reported here.

Interstitial Lung Disease Associated with Combination Chemotherapy of Oxaliplatin, 5-Fluorouracil, and Leucovorin / 대한소화기학회지

Oxaliplatin with 5-fluorouracil plus leucovorin (FOLFOX) has become the standard treatment in patients with colorectal cancer. Among known toxicities induced by oxaliplatin, hematological, gastrointestinal and neurological toxicities are common. However, acute pulmonary toxicity associated with oxaliplatin is unusual. One case of interstitial lung disease associated with the FOLFOX protocol is reported here.

A Comparison of Gemcitabine in Two Doses for Stage III or IV Non-small Cell Lung Cancer : a Multi-Institutional Phase II Study

PURPOSE : Since the combination of cisplatin plus gemcitabine (CG) had a significant survival advantage for the treatment of patients with chemotherapynaive advanced or metastatic non-small cell lung cancer (NSCLC), CG combination have been evaluated with different schedules. However, the best schedule is still unclear. We designed to compare the efficacy and toxicity of CG combination chemotherapy in two different doses of gemcitabine (1,000 or 1,250 mg/m2 3-weekly). MATERIALS AND METHODS : We randomized patients with stage III or IV NSCLC into either gemcitabine 1,250 mg/m2 or gemcitabine 1,000 mg/m2. Patients received cisplatin 60 mg/m2 intravenously on day1 of each 3-week cycle. Gemcitabine was administered intravenously on days 1 and 8 of each 3-week cycle. RESULTS : From April 2002 until July 2004, 125 patients were enrolled from four university hospitals (55 patients in the gemcitabine 1,000 mg/m2 arm and 70 patients in the gemcitabine 1,250 mg/m2 arm). Response rates were not significantly different in both arms (56.4% vs. 55.7%). However, grade 3 neutropenia was significantly lower in gemcitabine 1,000 mg/m2 arm compared to gemcitabine 1,250 mg/m2 arm (11.0% vs. 15.8%). No differences in non-haematologic toxicities in both arms except anorexia were observed. The median survival was 13.4 months for gemcitabine 1,000 mg group compared with 15.8 months for gemcitabine 1,250 mg group. There were no statistically significant differences in survival between the groups. CONCLUSION : For stage III or IV non-small cell lung cancer, combination chemotherapy with gemcitabine 1,000 mg/m2 showed equivalent response rate with lesser neutropenia and anorexia compared to treatment with gemcitabine 1,250 mg/m2

Usefulness of autofluorescence bronchoscopy for detecting bronchial premalignant lesions / 대한내과학회지

BACKGROUND: Autofluorescence bronchoscopy (AFB), when used as an adjunct to conventional white light bronchoscopy (WLB) improves the bronchoscopist's ability to localized small intraepithelial lesions. Current study was undertaken to evaluate prevalence of preinvasive intraepithelial lesions (dysplasia II-III and CIS) and efficacy of additional AFB system to WLB in comparison with WLB alone. METHODS: In patients with suspicion of lung cancer or follow-up ones with known lung cancer, WLB (Pentax; BP 3500, Japan) and AFB (Richard Wolf, Germany) were done and all subjects with endoscopic abnormalities underwent biopsies from January 2005 to December 2005. RESULTS: 169 patients (134 suspected to have lung cancer radiologically, 18 with known lung cancer, and 17 with initial abnormal WLB visual findings) were enrolled. Overall preinvasive intraepithelial lesions were detected in 6.5% (11 persons). Biopsy based sensitivity of WLB+AFB and WLB alone for detecting preinvasive intraepithelial lesions was 77.8% compared with 22.2% (relative ratio 3.5, 95% CI 0.93-13.24). Corresponding specificity was 56.9% compared with 89.2% (relative ratio 0.64, 95% CI 0.54-0.75). The positive predicitve value was 6% and 3%, and the negative predictive value was 94% and 87%, respectively, for WLB+AFB and WLB alone. CONCLUSIONS: WLB+AFB was superior to WLB alone in detecting preinvasive intraepithelial lesions, but general use of AFB as a screening tool seems to be limited in suspected or known lung cancer group because of low prevalence. It is necessary of further study for precise indication for AFB among the lung cancer risk groups.

Multimodality Treatment Based on Induction Chemotherapy for Stage III NSCLC

PURPOSE : The aim of this study was to validate the effect and the feasibility of induction chemotherapy in patients with locally advanced non-small cell lung cancer (NSCLC) on multimodality treatment. MATERIALS AND METHODS : From January 2002 to December 2003, 84 chemonaive patients with Stage III NSCLC, median age of 64 years, ECOG perfomance satus 0, 1, or 2, and without other comorbid disease were enrolled this study and received chemotherapy every 3 weeks. After two or three cycles of induction chemotherapy (gemcitabine with cisplatin), patients were reevaluated by chest CT and then underwent resection, radiotherapy, further chemotherapy, or observation. RESULTS : Overall clinical responses were seen in 43 (57%) of the 76 assessable patients. Response rates were 61% and 53% in patients with stage IIIA and IIIB disease, respectively. Twenty-eight patients out of initially unresectable 70 patients (19 of 32 stage IIIA and 9 of 38 stage IIIB) after induction chemotherapy seemed to be resectable. Operation was done in 23 out of 32 patients who achieved clinically resectable stage after induction chemotherapy and 20 (87%) resections were complete and 3 were incomplete including 1 case of open & closure. Thirty-two patients were treated with chest radiation after chemotherapy. Eighteen patients were treated with chemotherapy upto 6 cycles and 6 patients refused further treatment after induction chemotherapy. Median follow up of all patients was 16.2 months, median survival was 16 months, and estimated disease progression free interval was 11 months. Survival and disease progression free interval were different with between induction chemotherapy followed by complete resection subgroup and followed by radiation therapy subgroup (24 vs. 14 months, p=0.04). Grade 3/4 neutropenia and thrombocytopeina were noticed in 29% and 10%, respectively and one chemotherpy related death was also noticed. CONCLUSION : Induction chemotherapy followed by surgery with or without adjuvant radiation might be the recommendable management to improve the survival in locally advanced NSCLC with feasible toxicity