VACOP-B (Etoposide/Doxorubicin/Cyclophosphamide/Vincristine/Prednisolone/Bleomycin) Combination Chemotherapy for the Treatment of Intermediate and High Grade Non-Hodgkin's Lymphoma / 대한암학회지

PURPOSE: To determine the antitumor activity of VACOP-B regimen for advanced non- Hodgkin's lymphoma (NHL) in terms of complete response rate, disease free survival, and overall survival, to assess the toxicities of this regimen, and to analyze the prognostic factors influencing the treatment results.Patients and methods: Between Apr. 1991 and Aug. 1993, thirty-six previously untreated patients with the intermediate or high grade NHL were treated with VACOP-B (etoposide/doxorubicin/cyclophosphamide/vincristine/prednisolone/bleomycin) combination chemotherapy. In case of initial bulky disease or residual disease after chemotherapy, radiation therapy of involved field was added. RESULTS: Complete response (CR) was achieved in 69% (25/36) of the eligible patients after VACOP-B chemotherapy, and 5 of 11 patients who remained in partial response (PR) after chemotherapy achieved CR after additional radiation therapy of involved field, resulting in 83% (30/36) of CR rate. With a median follow-up of 47.2 months, the disease free survival was 1~42.1+ months, and its median was 24 months. The range of survival time was 7~49.1+ months, and the median survival time was not reached at this time. The projected 3-year survival rate was 70%. Leukopenia was observed in 43% of chemotherapy cycles and thrombocytopenia in 2.3%. However, no treatment-related death was observed. For non-hematologic toxicities, nausea and vomiting were observed in 58% of patients, stomatitis in 58%, peripheral neuropathy in 58%, pulmonary toxicity in 3% and congestive heart failure in 3%. These toxicities were tolerable and all reversible. The prognostic factors influencing the complete response rate were performance status of patient (p=0.026) and relative dose intensity of cyclophosphamide (p=0.013). CONCLUSION: VACOP-B regimen is an effective and tolerable regimen for the intermediate and high grade NHL. And long term follow-up and phase III study will be needed for evaluation of these results compared to previous other treatment modality.

A Case of Cushing's Syndrome Associated with Ectopic Corticotropin Production in Patient with Small-Cell Lung Cancer / 결핵

Small cell lung cancer(SCLC) is frequently associated with paraneoplastic syndromes, which occur in approximately 20% of patients at presentation. Clinical Cushing's syndrome secondary to ectopic ACTH production is uncommon, occurring in approximately 5% of all SCLC patients. However, biochemical evidence of hypercortisolism can be detected in up to 50% of patients. Patients with Cushing's syndrome from ectopic ACTH production show hypertension, weakness, hyperglycemia, and hypokalemic metabolic alkalosis, but differ from patients with classic Cushing's disease in that symptoms develop more rapidly. Ectopic ACTH production is associated with a poor response to chemotherapy, short survival, and a high risk of treatment-related complications. We report a case of Cushing's syndrome associated with ectopic corticotropin production in 59-year-old male patient with extensive stage of SCLC.

Comparison of Inhalation Scan and Perfusion Scan for the Prediction of Postoperative Pulmonary Function / 결핵

BACKGROUND: Because of the common etiologic factor, such as smoking, lung cancer and chronic obstructive Pulmonary disease are often present in the same patient. The preoperative prediction of remaining pulmonary function after the resectional surgery is very important to prevent serious complication and postoperative respiratory failure. 99mTc-MAA perfusion scan has been used for the prediction of postoperative pulmonary function, but it may be inaccurate in case of large V/Q mismatching. We compared 99mTc-DTPA radioaerosol inhalation scan with 99mTc-MAA perfusion scan in predicting postoperative lung function. METHOD: Preoperative inhalation scan and/or perfusion scan were performed and pulmonary function test were performed preoperatively and 2 month after operation. We predicted the postoperative pulmonary functions using the following equations. Postpneumonectomy FEV1=Preop FEV1x% of total function of lung to remain RESULTS: 1) The inhalation scan showed good correlations between measured and predicted FEV1, FVC and FEF25-75%. (correlation coefficiency; 0.94, 0.91, 0.87 respectively). 2) The perfusion scan also showed good correlations between measured and predicted FEV1, FVC and FEF25-75%. (correlation coefficiency; 0.86, 0.72, 0.97 respectively). 3) Among three parameters, FEV1 showed the best correlations in the prediction by lung scans. 4) Comparison between inhalation scan and perfusion scan in predicting pulmonary function did not show any significant differneces except FVC. CONCLUSION: The inhalation scan and perfusion scan are very useful in the prediction of postoperative lung function and don't make a difference in the prediction of pulmonary function although the former showed a better correlation in FVC.