Evaluation of Response to Immune Checkpoint Inhibitor Monotherapy or Combination with Chemotherapy for Patients with Advanced Non-small Cell Lung Cancer and High PD-L1 Expression / 中国肺癌杂志

BACKGROUND@#Immunotherapy represented by immune checkpoint inhibitors (ICIs) has been widely used in the treatment of lung cancer. There are controversies in clinical practice for patients with advanced non-small cell lung cancer (NSCLC) and high programmed cell death-ligand 1 (PD-L1) expression receiving ICIs monotherapy or combination chemotherapy.@*METHODS@#This study retrospectively analyzed the clinical data of 49 patients with advanced NSCLC and high PD-L1 expression. Immunohistochemistry was performed with 22C3 antibody, and the expression level of PD-L1 was evaluated according to tumor proportion score (TPS). Objective response rate (ORR) and progression free survival (PFS) were compared by groups of different clinical characteristics.@*RESULTS@#ORR of monotherapy and combination therapy group was 47.1% (8/17) and 43.8% (14/32), respectively, without statistical difference (P=0.825). The median PFS of monotherapy and combination therapy group was 8.0 months and 6.8 months, respectively, without statistical difference (P=0.502). Statistical analysis of predictors of immunotherapy for the patients showed first-line immunotherapy had better ORR than subsequent immunotherapy (12/19, 63.2% vs 10/30, 33.3%, P=0.041), however no difference in PFS. And there were no differences in ORR or PFS among groups of age, gender, smoking status, performance status (PS), pathological type, tumor size and tumor-node-metastasis (TNM) stage.@*CONCLUSIONS@#The therapeutic effect is similar between ICIs monotherapy and combination chemotherapy for patients with advanced NSCLC and high PD-L1 expression. ORR of first-line immunotherapy was better in patients with advanced NSCLC and high PD-L1 expression. The optimal treatment for this population remains further prospective clinical studies.

Lucio's phenomenon: exuberant case report and review of Brazilian cases

Abstract Lucio’s phenomenon is an uncommon reaction characterized by severe necrotizing cutaneous lesions that occurs in patients with Lucio’s leprosy and lepromatous leprosy. It is considered by some authors as a variant of type 2 or 3 reaction. Death can occur because of blood dyscrasia or sepsis. Precipitating factors include infections, drugs and pregnancy. We report a 31-year-old female patient exhibiting both clinical and histopathological features of lepromatous leprosy and Lucio’s phenomenon presenting favorable response to treatment. We complement our report with a literature review of the Brazilian cases of Lucio’s phenomenon published in Portuguese and English.

In Vitro Synergistic Effects of Antimicrobial Combinations on Extensively Drug-Resistant Pseudomonas aeruginosa and Acinetobacter baumannii Isolates

BACKGROUND: Extensively drug-resistant (XDR) Pseudomonas aeruginosa and Acinetobacter baumannii are a threat to hospitalized patients. We evaluated the effects of antimicrobial combinations on XDR P. aeruginosa and A. baumannii isolates. METHODS: P. aeruginosa and A. baumannii isolates, which were resistant to all antibiotics except colistin (CL), were collected from eight hospitals in Korea. Genes encoding metallo-beta-lactamases (MBLs) and OXA carbapenemases were detected by PCR in eight P. aeruginosa and 30 A. baumannii isolates. In vitro synergy of antimicrobial combinations was tested by using the checkerboard method. RESULTS: Minimum inhibitory concentrations of beta-lactams, aminoglycosides, and fluoroquinolones were very high, while that of CL was low for majority of XDR P. aeruginosa and A. baumannii isolates. Antimicrobial combinations including Imipenem (IPM)-CL, ceftazidime (CAZ)-CL, and rifampin (RIF)-CL exerted only additive/indifferent effects on majority of XDR P. aeruginosa isolates. Proportions of XDR A. baumannii isolates that showed synergistic and additive/indifferent inhibition after treatment with antimicrobial combinations used are as follows: IPM-ampicillin-sulbactam (AMS), 17% and 80% isolates, respectively; IPM-rifampin (RIF), 13% and 81% isolates, respectively; IPM-CL, 13% and 87% isolates, respectively; and RIF-COL, 20% and 73% isolates, respectively. Significant proportion (19%) of XDR P. aeruginosa isolates produced MBLs, and majority (82%) of A. baumannii isolates produced either MBLs or OXA-23. CONCLUSIONS: Our results suggest that combinations of IPM-AMS, IPM-RIF, IPM-CL, and RIF-CL are more useful than individual drugs for treating 13-20% of XDR A. baumannii infections.

Evaluation and management of high-risk gestational trophoblastic neoplasm / 中国癌症杂志

Background and purpose:Gestational trophoblastic neoplasm (GTN) is a spectrum of disease arising from trophoblastic cells, and the majority of patients with GTN have favorable outcome because of the sensi-tivity to chemotherapy. While the cure rate for high-risk patients is still 70% to 80% as a result of drug resistance and disease recurrence. This study aimed to evaluate the clinical characteristics and outcome of patients with high-risk GTN.Methods:The clinical records of patients with high-risk GTN treated in Obstetrics and Gynecology Hospital of Fudan University from Jan. 2003 to Jan. 2013 were analyzed and reviewed retrospectively from the aspect of different treatment.Results:Fifty-one patients with high-risk GTN were admitted to this hospital. Among 51 high-risk GTN patients, 46 patients were evaluated retrospectively and 5 patients were excluded for incomplete treatments. Of the 46 patients with high-risk GTN, 27 patients were treated by chemotherapy alone, 19 patients received chemotherapy and adjuvant surgical therapy. Forty-four patients received EMA-CO (VP-16+Act-D+MTX/VCR+CTX) as a ifrst-line chemotherapy, 81.82% (36/44) had complete remission and 8 patients developed resistance to EMA-CO. EMA-EP (VP-16+Act-D+MTX/VP-16+cisplatin) was used as second-line chemotherapy for the 8 patients resistant to EMA-CO, 6 patients (2 underwent adjuvant surgical therapy) achieved remission and 2 patients died as a result of drug-resistance and disease progression. For the remaining 2 patients, one was treated by 5-FU+KSM and pulmonary resection, and the other was treated by MTX for misdiagnosis as ectopic pregnancy and then converted to EMA-CO for the pathological diagnosis of choriocarcinoma after surgery. Both of them achieved complete remission. Ultimately, 95.65% (44/46)patients achieved complete remission. Among the 19 patients who underwent adjuvant surgical therapy, 94.70% (18/19) patients achieved complete remission after chemotherapy and adjuvant surgery, and the remaining one patient died of disease progression.Conclusion:Standard combination chemotherapy is crucial in the treatment of high-risk GTN. The role of adjuvant surgery in the management of high-risk GTN should not be underestimated.

Case for diagnosis

We report the case of a 81-year-old female patient who had a two-year history of violet-colored erythematous tumors on both legs. Histopathological and immunohistochemical examinations confirmed the diagnosis of primary cutaneous large B-cell lymphoma, leg type. This rare, cutaneous lymphoma affects predominantly elderly females. Clinically, patients present with tumoral lesions on one or both legs (worst prognosis). Diagnosis is based on clinical, histopathological and immunohistochemical findings. The strong expression of BCL2, BCL6, MUM-1 and CD20, and the positivity for Ki67 antigen confirm the diagnosis. R-CHOP chemotherapy regimen (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) is the most widely accepted treatment.

Comparison of therapeutic G-CSF cycles and prophylactic G-CSF cycles in patients receiving paclitaxel and carboplatin combination chemotherapy for ovarian cancer: A retrospective study report / Journal of Rural Medicine

<b>Objective:</b> The aim of the present study was to investigate the differences between therapeutic granulocyte-colony stimulating factor (G-CSF) cycles and prophylactic G-CSF cycles in patients receiving paclitaxel and carboplatin combination chemotherapy for ovarian cancer.<br><b>Material and Method:</b> Medical records of 15 women who received paclitaxel and carboplatin combination chemotherapy for ovarian cancer between January 2003 and December 2012 were analyzed retrospectively. All 15 patients completed 6 cycles of paclitaxel and carboplatin as the first-line chemotherapy. The complications were compared between therapeutic G-CSF cycles and prophylactic G-CSF cycles.<br><b>Results:</b> The number of chemotherapy cycles correlated with the ratio of prophylactic G-CSF cycles. It was considered that earlier prophylactic G-CSF injections were chosen due to a gradual decrease in WBC and neutrophil counts. The WBC and neutrophil counts were significantly higher in prophylactic G-CSF cycles than in therapeutic G-CSF cycles. However, there were no significant differences in the intervals of chemotherapy, delay of chemotherapy, and incidence of febrile neutropenia between the therapeutic G-CSF and prophylactic G-CSF cycles.<br><b>Conclusion:</b> Prophylactic G-CSF injections were not effective in preventing the incidence of febrile neutropenia in patients receiving paclitaxel and carboplatin combination chemotherapy for ovarian cancer.

Comparison of Therapeutic G-CSF Cycles and Prophylactic G-CSF Cycles in Patients Receiving Paclitaxel and Carboplatin Combination Chemotherapy for Ovarian Cancer: A Retrospective Study Report / Journal of Rural Medicine

<b>Objective:</b> The aim of the present study was to investigate the differencesbetween therapeutic granulocyte-colony stimulating factor (G-CSF) cycles and prophylacticG-CSF cycles in patients receiving paclitaxel and carboplatin combination chemotherapy forovarian cancer.<br><b>Material and Method:</b> Medical records of 15 women who received paclitaxel andcarboplatin combination chemotherapy for ovarian cancer between January 2003 and December2012 were analyzed retrospectively. All 15 patients completed 6 cycles of paclitaxel andcarboplatin as the first-line chemotherapy. The complications were compared betweentherapeutic G-CSF cycles and prophylactic G-CSF cycles.<br><b>Results:</b> The number of chemotherapy cycles correlated with the ratio ofprophylactic G-CSF cycles. It was considered that earlier prophylactic G-CSF injectionswere chosen due to a gradual decrease in WBC and neutrophil counts. The WBC and neutrophilcounts were significantly higher in prophylactic G-CSF cycles than in therapeutic G-CSFcycles. However, there were no significant differences in the intervals of chemotherapy,delay of chemotherapy, and incidence of febrile neutropenia between the therapeutic G-CSFand prophylactic G-CSF cycles.<br><b>Conclusion:</b> Prophylactic G-CSF injections were not effective in preventingthe incidence of febrile neutropenia in patients receiving paclitaxel and carboplatincombination chemotherapy for ovarian cancer.

The clinical evaluation of EOF5 regimen, the combination of epirubicin, oxaliplatin and 5-day continuous infusion of 5-FU, for patients with advanced/metastatic gastric cancer / 中国癌症杂志

Background and purpose:Although there is still no standard ifrst line chemotherapy regimen for metastatic gastric cancer (MGC), the doublet and triplet regimens containing platinum and lfuorouracil were most popular worldwidely. The ECF regimen is the classical and one of the most popular treatment choices in this setting, while the marrow suppression, the renal toxicity and poor compliance inhibits its usage. In order to improve its efifcacy and tolerability, this study conducted 2 phaseⅡ trials by modified ECF regimen, the EOF5 regimen (substituting cisplatin with oxaliplatin, shortening the continuous infusion period to 120 h), to treat patients with MGC since 2004. This paper reported the comprehensive results of the 2 studies.Methods:All the patients who enrolled in our previous2 phaseⅡ trials and received EOF5 as ifrst line treatment entered this study. Each patient received the treatment of epirubicin 50 mg/m2 iv d1, oxaliplatin 130 mg/m2 iv gtt d1 and 5-FU 375-425 mg/m2·d-1 civ 120 h, and repeated every 3 weeks. Efifcacy was analyzed every 6 weeks.Results:A total number of 178 patients (all were metastatic patients but 2 advanced patients with unresectable lesions) were included into this study. One hundred and seventy patients were evaluable, and 7 patients (3.9%) achieved complete response (CR), 76 patients (42.7%) achieved partial response (PR), 46.6% patients achieved overall response rate (ORR, CR+PR), and the cases of stable disease (SD) and progressive disease (PD) were 69 (38.8%) and 18 (10.1%), respectively. The median progress free survival (PFS) and overall survival (OS) were 6.0 months (95%CI: 5.2-6.8) and 12.6 months (95%CI: 8.9-16.3), 1-year and 2-year survival rate were 50.9% and 28.0%, respectively. Grade 3, 4 toxicity including: leucopenia (23.0), neutropenia (38.8%), anemia (6.5%), thrombocytopenia (23.5%), nausea/vomiting (14.1%), and peripheral neuropathy toxicity (1.2%). Among 75 patients who received second line treatment, the median survival from second line treatment was 8.0 months (95%CI: 4.8-11.2).Conclusion:EOF5 regimen is a highly effective regimen with moderate and manageable toxicity, and it providesa suitable alternative for the ifrst-line treatment of MGC.

A Case of Primary Thyroid Lymphoma Originated from Thyroid Gland / 대한이비인후과학회지

We present a case of a 53-year-old woman with a rapidly growing neck mass. She had one-year history of hypothyroidism associatied with Hashimoto thyroiditis. She had noticed progressive dyspnea with rapid enlargement of the thyroid gland over a month. An incisional biopsy of the thyroid gland for combined pathology and immunohistochemistry revealed diffuse large B cell non-Hodgkin's lymphoma. A combined chemotherapy including cyclophosphamide, doxorubicin, vincristine, prednisone plus rituximab (R-CHOP) was initiated, which dramatically shrunk the tumor and completely resolved the compression symptoms within a few days. Here we report on a case of thyroid lymphoma with a review of the relevant literature.

Combined chemotherapy and intra-arterial chemotherapy of retinoblastoma / 소아과

PURPOSE: Retinoblastoma (RB) is the most common primary malignant intraocular tumor in children. Although systemic chemotherapy has been the primary treatment, intra-arterial chemotherapy (IAC) represents a new treatment option. Here, we performed alternate systemic chemotherapy and IAC and retrospectively reviewed the efficacy and safety of this approach. METHODS: Patients diagnosed with intraocular RB between January 2000 and December 2011 at Severance Children's Hospital, Yonsei University, were reviewed. Before February 2010, the primary treatment for RB was chemotherapy (non-IAC/CTX). Since February 2010, the primary treatment for RB has been IAC (IAC/CTX). External beam radiotherapy or high-dose chemotherapy were used as "last resort" treatments just prior to enucleation at the time of progression or recurrence during primary treatment. Enucleation-free survival (EFS) and progression-free survival were assessed. RESULTS: We examined 19 patients (median age, 11.9 months; range, 1.4 to 75.6 months) with a sum of 25 eyes, of which, 60.0% were at advanced Reese Ellsworth (RE) stages. The enucleation rate was 33.3% at early RE stages and 81.8% at advanced RE stages (P=0.028). At 36 months, EFS was significantly higher in the IAC/CTX group than in the non-IAC/CTX group (100% vs. 40.0%, P=0.016). All 5 patients treated with IAC achieved eye preservation, although most patients were at advanced RE stages (IV-V). CONCLUSION: Despite the limitation of a small sample size, our work shows that an alternative combined approach using IAC and CTX may be safe and effective for eye preservation in advanced RB.

Effectiveness of MT regimen in treatment of acute monocytic leukemia and its relationship with karyotype / 白血病·淋巴瘤

Objective To evaluate the effectiveness and side effect of MT regimen (mitoxantrone plus teniposide) in inductive chemotherapy and explore the relationship between the effectiveness and karyotype. Methods 33 patients with acute monocytic leukemia were divided into two groups according to the treatment history or risk status according to cytogenetics MRC criteria. Group A (n=23) and B (n=10) were primary treatment and no remission following one course of DA (daunorubicin plus cytarabine) or HDA (Harringtonine,daunorubicin plus cytarabine) regimen,respectively. According to MRC criteria,group C (n=29) and D (n=4) were intermediate and adverse group. All the cases received two courses MT regimen chemotherapies to induce remission. The results and side effects were analysed. Results The complete remission rate and effective rate in group A and B were 83 % (19/23) and 60 % (6/10),91 % (21/23) and 70 % (7/10) respectively. The complete remission rate and effective rate in group C and D was 83 % (24/29) and 25 % (1/4),88 % (26/29) and 50 % (2/4) respectively. In complex cytogenetic group and 11q23 abnormal without complex cytogenetic group,CR rate was 0 (0/3) and 100 % (4/4). The time point,count of WBC nadir and the duration of WBC were less than 1×109/L is (7±3) day after chemotherapy,(0.4±0.2)×l09/L,(8±5) day. Chemotherapy related mortality was 0. Conclusion MT regimen was highly effective and safe in inducing remission in acute monocytic leukemia,including the cases which achieved no remission following one course of DA or HDA regimen. The effectiveness of MT regimen relates to the cytogenetics. MT regimen may be highly effective in cases with 11q23 abnormal and poor effective in cases with complex cytogenetic.

K-ras status and efficacy of cetuximab-containing regimen in the treatment of patients with metastatic colorectal cancer / 中国癌症杂志

Background and purpose: Cetuximab-containing regimen has been increasingly applied in the treatment of patients with metastatic colorectal cancer. Simultaneously, the predictive factors of outcome for cetuximab have been thoroughly researched. The aim of this study was to evaluate the relationship between K-ras status and efficacy of cetuximab containing regimen in the treatment of patients with metastatic eolorectal cancer. Methods: Between March 2006 and June 2008, twenty-seven patients with metastatic colorectal cancer were treated with cetuximab in combination with chemotherapy. The K-ras mutation status [wild-type (wt) or mutation (nat)] was examined by polymerase chain reaction (PCR) and direct sequencing. The influence of K-ras mutation status on efficacy of cetuximab-containing regimen was analyzed. Results: For 27 patiants in this cohort, K-ras wt was detected in 55.6% (15/27) cases and K-ras mt in 44.4% (12/27) cases. Statistically significant differences were found between the patients with K-ras wt and K-ras mt in terms of overall response rate (ORR) (66.7% vs 25.0%,P=0.035) and progression-free survival (PFS) (8 months vs 4 months, P=0.0028). However, there was no significant difference in overall survival (OS) (19 months vs 12 months, P>0.05). The most common treatment-related adverse effect was skin reaction, with incidence rate of 80.0% and 66.7% (P>0.05), respectively. No treatment related death was observed. Conclusion: K-ras mutation status is a predictive factor of good efficacy of cetuximab-containing regimen in the treatment of patients with metastatic colorectal cancer. Patients with K-ras wt could benefit from cetuximab in combination with chemotherapy.

Randomized, Multicenter, Phase III Trial of Heptaplatin 1-hour Infusion and 5-Fluorouracil Combination Chemotherapy Comparing with Cisplatin and 5-Fluorouracil Combination Chemotherapy in Patients with Advanced Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Heptaplatin (Sunpla) is a cisplatin derivative. A phase IIb trial using heptaplatin resulted in a 34% response rate with mild nephrotoxicity. We conducted a randomized phase III trial of heptaplatin plus 5-FU compared with cisplatin plus 5-FU in patients with advanced gastric cancer. MATERIALS AND METHODS: One hundred seventy-four patients (heptaplatin, n=88; cisplatin, n=86) from 13 centers were enrolled. The eligibility criteria were as follows: patients with pathologically-proven adenocarcinoma, chemonaive patients, or patients who had received only single adjuvant chemotherapy, and who had a measurable or evaluable lesion. On day 1, heptaplatin (400 mg/m2) or cisplatin (60 mg/m2) was given over 1 hour with 5-FU (1 gm/m2) on days 1~5 every 4 weeks. RESULTS: At the time of survival analysis, the median overall survival was 7.3 months in the 5-FU + heptaplatin (FH) arm and 7.9 months in the 5-FU + cisplatin (FP) arm (p=0.24). Of the FH patients, 34.2% (complete response [CR], 1.3%; partial response [PR], 32.9%) experienced a confirmed objective response compared with 35.9% (CR 0%, PR 35.9%) of FP patients (p=0.78). The median-time-to-progression was 2.5 months in the FH arm and 2.3 months in the FP arm. The incidence of neutropenia was higher with FP (28%) than with FH (16%; p=0.06); grade 3~4 nausea and vomiting were more frequent in the FP than in the FH arm (p=0.01 and p=0.05, respectively). The incidence of increased proteinuria and creatininemia was higher with FH than with FP; however, there was no statistical difference. There were no treatment-related deaths. CONCLUSION: Heptaplatin showed similar effects to cisplatin when combined with 5-FU in advanced gastric cancer patients with tolerable toxicities.

Curative effect of synchronous radiochemotherapy in medium-term and advanced cervical carcinoma / 肿瘤研究与临床

Objective To investigate the curative effect of synchronous radio-chemotherapy in medium-term and advanced cervical carcinoma. Methods 168 cases of medium-term and advanced cervical carcinoma were selected. The treatment group(grout A) included 84 pathologically verified cases of stage Ⅱ～Ⅳ cervical carcinoma. Each patient was given DDP with hydration at the dose of 40 mg/m2 intravenously.The treatment cycle was performed once every week for 3--4 circles. Radiotherapy was given at the same time. 60Co was used for external radiation with a total dose of 50 Gy, 192 Ir afterloading unit was used for brachytherapy at the dose of 7 Gy per week at point A with a total dose of 42 Gy. The control group (group B)included 84 cases of cervical carcinoma at the same stage in the corresponding period who received radiotherapy only.Short-term effect ,2-year survival rate and complications were observed. Results Effective rate was 92.85 %(78/84) in group A and 79.76 %(67/84) in group B respectively 3 months after radiotherapy, showing a significant difference(χ2 =6.10,P <0.05). 2-year survival rate was higher in group A (83.95 %) than in Group B(60.98 %) (χ2 =9.4,P<0.05). Local recurrent and distant metastasis were lower in Group A than Group B. In group A, there were tolerable bone marrow inhibition and reaction of digestive tract. Conclusion Synchronous radiotherapy and chemotherapy can remarkably improve the survival rate of medium-term and advanced cervical carcinoma. The application of DDP is effective and safe,and its side effect can be accepted by patients, but the long-term effect needs further observation.

Significance of tamoxifen (TAM) in the combination chemotherapy of human multidrug-resistant bile duet carcinoma cell line / 肿瘤研究与临床

Objective To investigate the significance of tamoxifen in the combination chemotherapy of human multidrug-resistant bile duct carcinoma cell line (QBC939/ADM) and its mechanism. Methods The QBC939/AI)M was established, through exposure to gradually increased and the high and low alternated concentration of ADM persistently. The QBC939 and the QBC939/ADM were effected by single ADM, MMC, VDS or jointly with TAM. Drug sensitivity was measured by MTT. Growth cycle and apoptosis were performed by FCM. The level of their P-gp was detected by IHC. The content of ADM in the human cholangiocarcinoma cell line QBC939 was observed by FCM. Results The inhibitive rate of ADM, MMC, VDS to QBC939/ADM was rather lower than to QBC939. With the use of TAM, their chemotherapy effects were apparently enhanced and the apoptosis ratio increased comparably. The IHC results showed that the level of P-gp on the QBC939/ ADM was overexpressed, and the content of ADM in the QBC939/ADM group was much lower. Effected with the high content of TAM(10 μmol/L), the level of P-gp on the QBC939/ADM was decreased, with the content of ADM in the QBC939/ADM group increased comparably. TAM could both improve the chemotherapy effects of the two types of the cell, but the effect of the QBC939/ADM group was more apparent. Conclusion TAM can enhance the depressant effect of chemotherapy to both the two types of the cell, and increase the content of ADM in the QBC939/ADM group. TAM can be combined with the overexpressed P-gp.

The Efficacy of an Induction Chemotherapy Combination with Docetaxel, Cisplatin, and 5-FU Followed by Concurrent Chemoradiotherapy in Advanced Head and Neck Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was performed to determine the feasibility and safety of the use of induction chemotherapy combined with docetaxel, cisplatin, and 5-fluorouracil (TPF) followed by concurrent chemoradiation therapy for locally advanced squamous cell carcinoma of the head and neck (SCCHN). MATERIALS AND METHODS: The patients, that were initially not treated for locally advanced SCCHN, underwent three cycles of induction chemotherapy every 3 weeks at a dose of 70 mg/m2 docetaxel D1, 75 mg/m2 cisplatin D1, 1000 mg/m2 5-FU D1-4, and subsequently received concurrent chemoradiation therapy. RESULTS: Forty-nine patients were enrolled in this study and forty-three of the patients completed the treatment. The median duration of follow-up was 18 months (range, 6~39 months). All of the patients had stage III (26.5%) or IV (73.5%) squamous cell carcinoma. After sequential therapy, a complete response and partial response was seen in 28 (65.2%) and 13 (30.2%) patients, respectively. The overall response rate was 95.4%. Overall survival and progression-free survival (PFS) at 2 years were 88.7% and 69.7%, respectively. Grade 3~4 neutropenia occurred in 42.2% of the patients and grade 4 thrombocytopenia in 1 cycle (0.7%). Two patients (4.1%) died during the induction chemotherapy due to pneumonia and a subdural hemorrhage, respectively. The group of patients over 65 years of age showed a significant lower dose intensity than that of patients under 65 years of age, but PFS was not significantly different between two groups (p=0.105). CONCLUSION: TPF induction chemotherapy followed by concurrent chemoradiotherapy showed a high level of CR and moderate treatment-induced toxicity. Adequate dose modification in elderly patients should be considered to maintain efficacy and avoid treatment-related toxicity.

The efficacy of paclitaxel based combination chemotherapy in recurrent endometrial cancer / 부인종양

OBJECTIVE: This study was performed to evaluate the efficacy of paclitaxel based combination chemotherapy by response rate and survival time in the treatment of recurrent endometrial cancer. METHODS: From May 1995 to February 2004, 27 out of 301 cases of endometrial cancer treated at the Asan Medical Center in Seoul were recurrent. We identified 11 patients treated with paclitaxel based combination chemotherapy and 7 patents treated with other combination chemotherapy, and then retrospectively estimated the survival times from the chemotherapy after recurrence to the death or last visit. RESULTS: The non-paclitaxel based combination chemotherapy group showed partial response in 1 case (14.3%) and disease progression in 4 (57.1%). In contrast, the paclitaxel group showed 7 cases (63.6%) of partial response. The median survival time for total study patients was 18.0 months, 22.0 months for paclitaxel group and 15.0 months for the non-paclitaxel group, the difference being statistically significant (p=0.047). Side effect of chemotherapy such as leukopenia, neutropenia and thrombocytopenia showed no difference between the two groups. CONCLUSION: Paclitaxel-based combination chemotherapy may be the first-line chemotherapeutic agent in recurrent endometrial cancer patients if it's more effective than other combination chemotherapy in prolonging survival times.

Malignant Mixed Mullerian tumors of the ovary: The result of Platinum-based combination chemotherapy following the cytoreductive surgery / 부인종양

OBJECTIVE: The purpose of this study was to review the therapeutic results and the clinical outcome of the patients treated with optimal cytoreductive surgery and platinum-based chemotherapy for malignant mixed mullerian tumors (MMMTs) of the ovary. The evaluate the role of such treatments in ovarian MMMTs. METHODS: A retrospective analysis was performed with medical records that nine patients underwent complete surgical staging from February 1993 to January 2004 at Asan Medical Center, Korea. Seven patients received IP (ifosfamide/cisplatin) chemotherapy as a first-line chemotherapy and the other patients received other platinum-based combination chemotherapy. Demographic data, pathologic findings, treatment and survival time were studied. RESULTS: Nine patients diagnosed with MMMTs of the ovary after optimal cytoreductive surgery. The International Federation of Gynecology and Obstetrics stages for the 9 women were none stage I, 1 stage II, 6 stage III, 2 stage IV. The median survival time of all patients was 41 months (1-76 months). The overall survival rate was 55.5% at 1 year and 40% at 2 years. CONCLUSION: Malignant mixed mullerian tumors of the ovary grow very rapidly and are usually in advanced stages when diagnosed. But our results of clinical experience for platinum-based combination chemotherapy after optimal cytoreductive surgery could be a standard treatment for ovarian MMMTs.

A Case of Primary Esophageal Small Cell Carcinoma with Intraperitoneal Multiple Lymph Node Metastasis / 대한소화기내시경학회지

Two cases of esophageal small cell carcinoma were reported on for the first time in 1952. There have been only a few published series on the patients with esophageal small cell carcinoma, and only 19 cases have been reported in Korea. As in the case of small cell carcinoma of the lung, the esophageal small cell carcinoma is known to show rapid progression and early metastasis. Yet much remains to be uncovered about the clinical features, optimal treatment and natural history of this disease. We report here on a case of primary esophageal small cell carcinoma with intraperitoneal multiple lymph node metastasis. The size of the tumor was markedly decreased by combination chemotherapy.

Combination Chemotherapy of Heptaplatin, Paclitaxel and 5-Fluorouracil in Patients with Advanced Gastric Cancer: a Pilot Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To evaluate the efficacy and toxicity of heptaplatin, paclitaxel, and 5-fluorouracil combination chemotherapy in patients with advanced gastric cancer. MATERIALS AND METHODS: Between July 2002 and September 2003, nineteen patients were enrolled in this study. Paclitaxel 135 mg/m(2) iv on day 1, heptaplatin 400 mg/m(2) iv on day 2 and 5-fluorouracil 800 mg/m(2) on day 2~4 were administered and the regimen was repeated every 3 weeks. RESULTS: The median age of the patients was 60 years (range: 32~74) and the most common sites of metastasis were liver and lymph nodes. In the 16 evaluated patients, the overall response rate was 43.8%, but this was without any complete response. The median time to disease progression was 3.93 months (range: 0.26~8.1) and the median response duration for the 7 responding patients was 3.83 months (range: 1.48~6.07). The median overall survival for 19 patients was 7.01 months (range: 0.26~17.44). A median of 3 cycles (range: 1~7) and a total of 65 cycles were administered and evaluated for toxicity. The most common hematologic toxicities were NCI grade I/II anemia (47.7%), neutropenia (9.2%) and thrombocytopenia (6.2%). The most common non-hematologic toxicities more than grade II were nausea/vomiting (30.8%/9.2%). One elderly patient with ECOG 2 had a life- threatening complication of pneumonia. CONCLUSION: The combination of heptaplatin, paclitaxel, and 5-fluorouracil showed significant activity and favorable toxicity profiles in patients with advanced gastric cancer. However, one elderly patient who had poor performance experienced a life-threatening toxicity/complication. Our results suggest that the efficacy of this combination chemotherapy can be maximized when administered to the patients with good performance status. Further studies with large numbers of patients and long-term follow-up study will be needed.