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1.
Int J Biometeorol ; 60(11): 1753-1760, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27094916

ABSTRACT

The incidence of geomagnetic storms may be associated with changes in circulatory physiology. The way in which the natural variations of the geomagnetic field due to solar activity affects the blood pressure are poorly understood and require further study in controlled experimental designs in animal models. In the present study, we tested whether the systolic arterial pressure (AP) in adult rats is affected by simulated magnetic fields resembling the natural changes of a geomagnetic storm. We exposed adult rats to a linear magnetic profile that simulates the average changes associated to some well-known geomagnetic storm phases: the sudden commencement and principal phase. Magnetic stimulus was provided by a coil inductor and regulated by a microcontroller. The experiments were conducted in the electromagnetically isolated environment of a semi-anechoic chamber. After exposure, AP was determined with a non-invasive method through the pulse on the rat's tail. Animals were used as their own control. Our results indicate that there was no statistically significant effect in AP when the artificial profile was applied, neither in the sudden commencement nor in the principal phases. However, during the experimental period, a natural geomagnetic storm occurred, and we did observe statistically significant AP increase during the sudden commencement phase. Furthermore, when this storm phase was artificially replicated with a non-linear profile, we noticed a 7 to 9 % increase of the rats' AP in relation to a reference value. We suggested that the changes in the geomagnetic field associated with a geomagnetic storm in its first day could produce a measurable and reproducible physiological response in AP.


Subject(s)
Arterial Pressure , Magnetic Fields , Animals , Male , Rats, Wistar
2.
Rev Mal Respir ; 27(5): 421-30, 2010 May.
Article in French | MEDLINE | ID: mdl-20569874

ABSTRACT

BACKGROUND: Lung cancer in the elderly is considerably increasing in frequency, representing a public health issue. Those patients are underrepresented in clinical trials and probably not optimally treated. METHODS: We performed a survey of the management and the outcome of lung cancer patients aged 70 and more in France between August 2002 and September 2003 according to age categories (70-74, 75-79 and > or =80 years). One thousand six hundred and twenty-seven patients were analysed for descriptive data and 1595 for survival. RESULTS: Median age was 75 (70-96) and male:female ratio was 4.26 with a decrease across the age categories from 5.1 to 3.0. Tobacco-linked comorbidities were frequent. The median value of Charlson's index was 2. About 58% had a performance status (PS) 0 or 1, 30% a PS 2 and 12% a PS>2. The proportion of never-smokers (11.6%) increased significantly with age categories. Regarding imaging procedures, as much as 83.3% of the patients had at least a chest CT-scan and a brain CT-scan (or MRI) and an abdominal ultrasound or CT-scan. Best Supportive Care (BSC) as only treatment was administered to 16.1% of the patients. Among patients specifically treated, 22.9% were operated, 21.8% received mediastinal irradiation and 71.5% chemotherapy. Overall, median survival time was 9.14 months with 23.5% deaths occurring before 3 months. Low category of age, good PS, non-smoking and high body mass index (BMI) were favorable independent prognostic factors of survival. Age, PS and tobacco smoking were prognostic of early death. CONCLUSIONS: A large majority of elderly lung cancer patients in France are managed like younger counterparts regarding diagnostic procedures and treatment. Age remains an independent prognostic factor as well for overall survival as for early death.


Subject(s)
Lung Neoplasms , Aged , Aged, 80 and over , Female , France , Health Care Surveys , Humans , Lung Neoplasms/mortality , Lung Neoplasms/therapy , Male , Prospective Studies , Survival Rate
3.
J Fr Ophtalmol ; 31(5): 527-32, 2008 May.
Article in French | MEDLINE | ID: mdl-18641587

ABSTRACT

We report the observation of a 55-year-old man in subtotal remission of a bronchial T2 N2 M1 adenocarcinoma. He consulted for left ocular redness, attributed to a foreign body. The patient presented a left iridal metastasis of bronchial carcinoma, a left frontal cerebral metastasis, and mediastinal evolutionary recovery. External radiotherapy of 30 Gy in ten fractions was immediately begun, followed by second-line chemotherapy. Local anatomical and functional recovery was fast. The patient then required two external radiotherapy courses on new extraocular lesions. The patient died 10 months after the ocular metastasis diagnosis. In the event of iridal metastasis, it is necessary to carry out a complete examination of both eyes, to question the patient, to search for a primary tumor and other metastases, and to rapidly implement radiotherapy of the entire ocular sphere (30 Gy in ten fractions).


Subject(s)
Adenocarcinoma/pathology , Bronchial Neoplasms/pathology , Iris Neoplasms/secondary , Neoplasm Metastasis/pathology , Bronchial Neoplasms/drug therapy , Bronchial Neoplasms/radiotherapy , Combined Modality Therapy , Fatal Outcome , Functional Laterality , Humans , Iris Neoplasms/drug therapy , Iris Neoplasms/pathology , Iris Neoplasms/radiotherapy , Male , Middle Aged
4.
Rev Mal Respir ; 24(5): 645-52, 2007 May.
Article in French | MEDLINE | ID: mdl-17519819

ABSTRACT

BACKGROUND: The authorities advocate a minimalist attitude towards the follow-up of resected bronchial carcinoma (clinical examination and chest x-ray). A survey showed that 70% of French respiratory physicians have chosen to use the CT scanner and often endoscopy. The published data are equivocal and are often based on retrospective studies. Lung cancer is a good model for a study of post-operative surveillance. Recurrences often occur in easily observed areas, they may be detected while still asymptomatic and are sometimes potentially curable. Second primary tumours may develop at the same site. METHODS: The Intergroupe Francophone de Cancerologie Thoracique (IFCT) has initiated a trial comparing simple follow-up (clinical examination, chest x-ray) with a more intensive follow-up (CT scan, fibreoptic bronchoscopy). The surveillance will take place every 6 months for 2 years and then annually until 5 years. EXPECTED RESULTS: The main aim is to determine whether intensive follow-up improves patient survival. The opposite question is equally important. If an expensive and demanding follow-up does not affect the chances of cure these results will influence our practice.


Subject(s)
Carcinoma, Non-Small-Cell Lung/surgery , Lung Neoplasms/surgery , Bronchoscopy/economics , Fiber Optic Technology , Follow-Up Studies , Humans , Neoplasm Recurrence, Local/diagnosis , Neoplasms, Second Primary/diagnosis , Physical Examination/economics , Population Surveillance , Quality of Life , Radiography, Thoracic/economics , Survival Rate , Tomography, X-Ray Computed/economics
5.
Rev Mal Respir ; 24(9): 1099-106, 2007 Nov.
Article in French | MEDLINE | ID: mdl-18176386

ABSTRACT

BACKGROUND: The purpose of this epidemiologic survey was to describe the management of second-line therapy for patients with stage IIIB-IV non-small cell lung carcinoma (NSCLC) following docetaxel-cisplatin as first-line therapy. METHODS: Between June 2003 and December 2004, 265 patients were enrolled. The data registered were the choice of cytotoxics, the safety profile, the efficacy and the clinical benefit. RESULTS: Two hundred and sixty one patients were treated with docetaxel-cisplatin as a first-line regimen and 181 received a second line. This second line was a single agent regimen in 58% of cases and a gemcitabine based treatment in 60.8%. The main criterion for the choice of second-line therapy was the safety profile in 34.3% of cases. The overall response rate was 16.6% after the second line and clinical benefit was reported in 43.6% of patients. CONCLUSION: In more than 2/3 of patients with NSCLC the docetaxel-cisplatin combination leaves the opportunity to give a second-line treatment, providing satisfying results in terms of clinical benefit. In this study gemcitabine was the most widely prescribed second-line treatment, mainly as a single agent.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms/drug therapy , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/therapeutic use , Carcinoma, Non-Small-Cell Lung/pathology , Cisplatin/administration & dosage , Docetaxel , Female , Humans , Longitudinal Studies , Lung Neoplasms/pathology , Male , Middle Aged , Taxoids/administration & dosage
6.
Ann Oncol ; 17(9): 1412-7, 2006 Sep.
Article in English | MEDLINE | ID: mdl-16790516

ABSTRACT

BACKGROUND: Brain metastases (BM) considerably worsen the prognosis of non-small-cell lung cancer (NSCLC) patients. The usefulness and choice of chemotherapy remain uncertain in this indication since these patients are excluded from most clinical trials. We conducted a phase II study to determine the efficacy and tolerability of up-front chemotherapy with association of temozolomide and cisplatin in NSCLC patients with BM. PATIENTS AND METHODS: Fifty NSCLC patients with BM received temozolomide (200 mg/m(2)/day for 5 days every 28 days) and cisplatin (75 mg/m(2) at day 1 of each cycle), up to six cycles, followed by whole brain radiotherapy (WBRT). An evaluation was carried out every two cycles and after WBRT. WBRT was performed earlier in case of progressive disease at any time or stable disease after cycle 4. RESULTS: Eight objective responses were achieved (16%). Overall median survival was 5 months. Median time to progression was 2.3 months. Ten patients (20%) presented a grade 3/4 neutropenia and 11 patients (22%) presented a grade 3/4 thrombopenia. CONCLUSION: This study demonstrates a lack of efficacy of up-front chemotherapy with association of temozolomide and cisplatin in these patients. Nevertheless, it supports the feasibility of chemotherapy before brain radiotherapy in NSCLC patients with BM.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Brain Neoplasms/radiotherapy , Brain Neoplasms/secondary , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/radiotherapy , Lung Neoplasms/drug therapy , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Cisplatin/administration & dosage , Cisplatin/adverse effects , Dacarbazine/administration & dosage , Dacarbazine/adverse effects , Dacarbazine/analogs & derivatives , Female , Humans , Lung Neoplasms/pathology , Male , Middle Aged , Temozolomide , Treatment Outcome
7.
Br J Cancer ; 94(10): 1383-8, 2006 May 22.
Article in English | MEDLINE | ID: mdl-16641911

ABSTRACT

A multicentre, single-arm, phase II trial designed to determine the efficacy of single-agent vinflunine in patients with advanced non-small-cell lung cancer (NSCLC) previously treated with a platinum-based regimen. The objectives were to assess efficacy in terms of tumour response rate (primary end point), duration of response, progression-free survival (PFS) and overall survival (OS), and to evaluate the toxicity associated with this treatment. Patients with advanced NSCLC with progressive disease having failed prior platinum-based first-line treatment for advanced disease. Five responses out of the 63 treated patients were documented by WHO criteria and validated by an independent panel review (IRP), yielding a response rate of 7.9% (95% CI: 2.6-17.6) in the intent-to-treat analysis and 8.3% (95% CI: 2.8-18.4) in the evaluable population. Disease control was achieved in 35 out of 60 evaluable patients (58.3%). The median duration of response (complete response+partial response), according to modified WHO criteria was 7.8 months (95% CI: 4.6-NR). Median PFS was 2.6 months (95% CI: 1.4-3.8), and the median survival was 7.0 months (95% CI: 5.8-9.2). Grades 3-4 neutropenia was reported in 50% of patients; febrile neutropenia was observed in two patients (3.2%); grades 3-4 myalgia and grade 3 constipation were experienced by 10 (15.9%) and six (9.5%) of patients, respectively. Constipation was manageable, non-cumulative and could be prevented with laxative prophylaxis. The encouraging results from this phase II study with vinflunine warrant further investigations in phase III trials as second- or first-line treatment of advanced non-small-cell lung carcinoma, as a single agent or in combination with other active drugs.


Subject(s)
Antineoplastic Agents, Phytogenic/therapeutic use , Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms/drug therapy , Vinblastine/analogs & derivatives , Adult , Aged , Carboplatin/therapeutic use , Carcinoma, Non-Small-Cell Lung/pathology , Cisplatin/therapeutic use , Dose-Response Relationship, Drug , Female , Humans , Lung Neoplasms/pathology , Male , Maximum Tolerated Dose , Middle Aged , Neoplasm Staging , Salvage Therapy , Survival Rate , Vinblastine/therapeutic use
8.
Lung Cancer ; 51(3): 347-55, 2006 Mar.
Article in English | MEDLINE | ID: mdl-16469410

ABSTRACT

In this phase II study, gemcitabine and vinorelbine were combined at suboptimal doses for weekly administration in advanced non-small cell lung cancer (NSCLC). The primary objectives were to determine objective response rate (ORR) and time to progression (TTP). Secondary endpoints were safety and overall survival. Chemonaive patients with histologically or cytologically confirmed stage IIIB or IV NSCLC received vinorelbine (25 mg/m2) immediately followed by gemcitabine (800 mg/m2) once each week (on day 1) for 6 months without rest. From May 1998 to May 1999, 40 patients were enrolled (85% males; 70% stage IV) with a median age of 65.5. A total of 478 doses were administered, with a median of 9 per patient (range 2-72). The ORR was 27.5% (95% CI, 15.1-44.1%). The median TTP was 3.5 months (95% CI, 2.9-4.4 months). At a median follow-up of 6.5 months, the median survival was 11.6 months, and survival rates at 1 and 2 year(s) were 47.5% and 15.8%, respectively. The most common grade 3/4 hematologic toxicity was neutropenia, in 70% of patients, with febrile neutropenia in 28%. The most common grade 3/4 non-hematologic toxicity was transaminase elevation, in 22.5% of patients, which was transient and reversible. The other most prominent toxicities were, unexpectedly, pulmonary and cardiac toxicities. Based on these results, weekly, long-term administration of gemcitabine-vinorelbine appears to be an active regimen in NSCLC that warrants further investigation.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Non-Small-Cell Lung/drug therapy , Deoxycytidine/analogs & derivatives , Lung Neoplasms/drug therapy , Vinblastine/analogs & derivatives , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Deoxycytidine/administration & dosage , Disease Progression , Female , Humans , Male , Middle Aged , Survival Rate , Treatment Outcome , Vinblastine/administration & dosage , Vinorelbine , Gemcitabine
9.
Ann Oncol ; 16(4): 602-10, 2005 Apr.
Article in English | MEDLINE | ID: mdl-15741225

ABSTRACT

BACKGROUND: This multicenter, randomized, phase III study compared the efficacy, including progression-free survival (PFS), and safety of gemcitabine-docetaxel (GD) combination versus cisplatin-vinorelbine (CV) in the treatment of advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Chemonaive patients with stage IIIB or IV NSCLC were treated with GD (gemcitabine 1000 mg/m(2) days 1 and 8 plus docetaxel 85 mg/m(2) day 8, every 3 weeks for eight cycles) or CV (cisplatin 100 mg/m(2) day 1 plus vinorelbine 30 mg/m(2), days 1, 8, 15 and 22, every 4 weeks for six cycles). RESULTS: A total of 311 patients were enrolled (155 GD and 156 CV). Neither PFS nor overall survival differed significantly between the two arms (median PFS 4.2 and 4 months; median survival 11.1 and 9.6 months; 1-year survival 46% and 42%, for GD and CV, respectively). For the GD arm compared with the CV arm, the hazard ratio for PFS was 1.04 [95% confidence interval (CI) 0.83-1.32], and for overall survival, it was 0.90 (95% CI 0.70-1.16). Objective response rates did not differ significantly (31% for GD, 35.9% for CV). Myelosupression, emesis and frequency of febrile neutropenia were less pronounced on the GD arm, whereas fluid retention and pulmonary events were more pronounced. The CV arm experienced a higher number of serious adverse events and a lower compliance with the protocol. There was no quality of life (QoL) difference between arms. Median time to definite impairment of health-related QoL was 153 and 168 days in GD and CV arms, respectively. CONCLUSIONS: There was no advantage in PFS with GD compared with CV; however, the CV regimen had higher rate of toxic events, mainly myelosuppression. The herein, non-platinum-containing regimen could be considered as a rational alternative to the cisplatin-based doublet.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Carcinoma, Non-Small-Cell Lung/drug therapy , Cisplatin/administration & dosage , Deoxycytidine/analogs & derivatives , Lung Neoplasms/drug therapy , Vinblastine/analogs & derivatives , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Carcinoma, Non-Small-Cell Lung/secondary , Cisplatin/adverse effects , Deoxycytidine/administration & dosage , Deoxycytidine/adverse effects , Docetaxel , Female , Hematologic Diseases/chemically induced , Humans , Lung Neoplasms/secondary , Male , Middle Aged , Survival Analysis , Taxoids/administration & dosage , Taxoids/adverse effects , Vinblastine/administration & dosage , Vinblastine/adverse effects , Vinorelbine , Gemcitabine
10.
Ann Oncol ; 16(1): 90-6, 2005 Jan.
Article in English | MEDLINE | ID: mdl-15598944

ABSTRACT

BACKGROUND: Taxotere (docetaxel) at the dose of 75 mg/m(2) every 3 weeks is a standard therapy for pretreated non-small-cell lung cancer (NSCLC). The aim of this study was to evaluate the safety profile of two schedules of docetaxel administration (every 3 weeks versus weekly) in patients with pretreated NSCLC. PATIENTS AND METHODS: From February 2000 to February 2001, 125 patients with locally advanced or metastatic NSCLC were randomised after failure of a previous platinum-based regimen to receive either docetaxel 75 mg/m(2) administered every 3 weeks (Dq3w) or docetaxel 40 mg/m(2) given weekly for 6 weeks followed by 2 weeks of rest (Dqw). Safety evaluations focused on grade 3-4 neutropenia, febrile neutropenia, nausea-vomiting and asthenia. RESULTS: Patients' characteristics were well balanced between arms. The most common National Cancer Institute Common Toxicity Criteria (NCI-CTC) grade 3-4 toxicity was neutropenia, which occurred in 48.4% of Dq3w patients versus 15.9% of Dqw patients (P=0.001). In addition, febrile neutropenia were observed in 6.5% of patients in Dq3w versus 0% in Dqw. Grade 3-4 asthenia was more frequent in Dqw. Other non-haematological toxicities were very rare. Regarding efficacy, there was a trend towards a better disease control rate in Dq3w: 32.2% versus 25.4% in Dqw. Median time to progression and survival were rather similar in both arms, respectively: 2.1 months (range 2-3.2) and 5.8 months (range 4.0-7.0) in Dq3w and 1.8 months (range 1.6-2.3) and 5.5 months (range 3.7-6.6) in Dqw. CONCLUSIONS: While both schedules had a favourable safety profile, a significant lower rate of severe neutropenia was observed in the weekly arm. Both regimens had similar efficacy. The weekly regimen could be considered as a good alternative for patients at risk of severe neutropenia.


Subject(s)
Antineoplastic Agents, Phytogenic/administration & dosage , Antineoplastic Agents, Phytogenic/therapeutic use , Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms/drug therapy , Taxoids/administration & dosage , Taxoids/therapeutic use , Adult , Aged , Antineoplastic Agents, Phytogenic/adverse effects , Asthenia/chemically induced , Carcinoma, Non-Small-Cell Lung/pathology , Disease Progression , Docetaxel , Drug Administration Schedule , Female , Humans , Infusions, Intravenous , Lung Neoplasms/pathology , Male , Middle Aged , Nausea/chemically induced , Neutropenia/chemically induced , Survival Analysis , Taxoids/adverse effects , Vomiting/chemically induced
11.
Rev Pneumol Clin ; 60(5 Pt 2): 3S60-7, 2004 Nov.
Article in French | MEDLINE | ID: mdl-15536356

ABSTRACT

Chemotherapy of advanced non-small cell lung cancers is based on cisplatin, which prolongs survival. However, the high toxicity of double-type combinations including cisplatin warrants the search for alternatives. New anti-cancer cytotoxic agents exhibit improved efficacy-toxicity ratio. Bitherapy, without cisplatin and with new molecules, provides hope of improvement in survival without deterioration in quality of life. Several randomised trials, already published or presented with mature results, suggest that certain bitherapies with new cytostatic agents are an alternative to the classical cisplatin-based bitherapies. The recent modifications in the guidelines of the American Association of Clinical Oncology take into account these recent results by admitting that "chemotherapy without cisplatin can be used as an alternative to the first-line platin-based chemotherapies". This brief review of the literature underlines the methodological questions raised by the publication of randomised studies essentially assessing gemcitabine-vinorelbine or gemcitabine-taxane combinations, by confronting them with either mono-chemotherapies or reference chemotherapy based on cisplatin. The assessment criteria selected in such studies are discussed.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Non-Small-Cell Lung/drug therapy , Deoxycytidine/analogs & derivatives , Lung Neoplasms/drug therapy , Vinblastine/analogs & derivatives , Carcinoma, Non-Small-Cell Lung/pathology , Deoxycytidine/administration & dosage , Docetaxel , Humans , Lung Neoplasms/pathology , Neoplasm Staging , Paclitaxel/administration & dosage , Taxoids/administration & dosage , Vinblastine/administration & dosage , Vinorelbine , Gemcitabine
13.
Ann Oncol ; 15(1): 38-44, 2004 Jan.
Article in English | MEDLINE | ID: mdl-14679117

ABSTRACT

BACKGROUND: The survival benefit associated with first-line chemotherapy in advanced lung cancer led to the need for second-line chemotherapy. Docetaxel (Taxotere) has proven efficacy in both settings. This study evaluated the safety and efficacy of two doses of docetaxel in patients with non-small-cell lung cancer who had failed first-line platinum-based chemotherapy. PATIENTS AND METHODS: In total, 182 patients from 24 French centres were randomised and treated with either docetaxel 75 mg/m(2) (arm A) or 100 mg/m(2) (arm B) every 3 weeks. Baseline characteristics were well balanced, except more patients in arm A had metastatic disease (91.4% versus 78.7%) and therefore the median number of sites involved for arm A was three compared with two for arm B. RESULTS: Median time to treatment failure was 1.34 months [95% confidence interval (CI) 1.28-1.64] for arm A and 1.64 months (95% CI 1.34-2.62) for arm B. Median overall survival was 4.7 months (95% CI 3.8-5.9) for arm A versus 6.7 months (95% CI 4.8-7.1) for arm B. According to a blinded expert panel, disease control was achieved in 35 (43.8%) patients in arm A and 39 (49.4%) patients in arm B. More patients in arm B experienced grade 3-4 neutropenia (B: 72.7% versus A: 44.0%), asthenia (B: 20.2% versus A: 10.8%) and infection (B: 6.7% versus A: 2.2%). Three treatment-related deaths were reported in each arm. CONCLUSIONS: The optimal docetaxel dosage in this second-line setting is 75 mg/m(2), as it has a more favourable safety profile and on balance a similar efficacy to the 100 mg/m(2) dose.


Subject(s)
Antineoplastic Agents, Phytogenic/adverse effects , Antineoplastic Agents, Phytogenic/therapeutic use , Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms/drug therapy , Taxoids/adverse effects , Taxoids/therapeutic use , Adult , Aged , Antineoplastic Agents, Phytogenic/administration & dosage , Carcinoma, Non-Small-Cell Lung/pathology , Disease Progression , Docetaxel , Dose-Response Relationship, Drug , Female , Humans , Infusions, Intravenous , Lung Neoplasms/pathology , Male , Middle Aged , Neoplasm Recurrence, Local , Neutropenia/chemically induced , Safety , Survival Analysis , Taxoids/administration & dosage , Time Factors , Treatment Failure , Treatment Outcome
14.
Rev Mal Respir ; 21(5 Pt 3): 8S70-8, 2004 Nov.
Article in French | MEDLINE | ID: mdl-15803540

ABSTRACT

INTRODUCTION: There are few data on primary bronchial carcinoma in France. We report here the results of the study KBP 2000-CPHG in which there were 1868 patients aged 70 or more and 338 aged 80 or more. METHODS: We compared the patients under 70 (Group I) with those aged 70 or more (Group II) as well as with the details of the over 80's. RESULTS: Group II included significantly more women (17.4% vs 15.2%; p = 0.04), non-smokers (11.2% vs 5.3%; p<0.0001), patients of poor performance status (24.2% vs 14.5%; p<0.0001) and squamous carcinomas (44.5% vs 37.8%; p<0.001) than Group I, but fewer adenocarcinomas (27.2% vs 31.5%; p = 0.009) and as many small cell carcinomas (15.9% vs 16.9%; p = 0.32). In Group II there were less stage III and IV tumours (75.1% vs 78.1%; p = 0.0005) more symptomatic treatment (23.2% vs 6.1%) and radiotherapy alone (12.8% vs 3.8%; p < 0.0001). The results were similar beyond 80 years. On multivariate analysis age, performance status and stage appeared to be independent variables in the choice of curative or symptomatic treatment. CONCLUSIONS: Age alone is not therefore a limiting factor in the choice of treatment.


Subject(s)
Lung Neoplasms/epidemiology , Age Factors , Aged , Aged, 80 and over , Female , France , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/therapy , Male
15.
Rev Mal Respir ; 20(5 Pt 1): 691-9, 2003 Nov.
Article in French | MEDLINE | ID: mdl-14631248

ABSTRACT

INTRODUCTION: There are few data on primary bronchial carcinoma in France. We report here the results of the study KBP 2000-CPHG in which there were 1868 patients aged 70 or more and 338 aged 80 or more. METHODS: We compared the patients under 70 (Group I) with those aged 70 or more (Group II) as well as with the details of the over 80's. RESULTS: Group II included significantly more women (17.4% vs 15.2%; p=0.04), non-smokers (11.2% vs 5.3%; p<0.0001), patients of poor performance status (24.2% vs 14.5%; p<0.0001) and squamous carcinomas (44.5% vs 37.8%; p<0.001) than Group I, but fewer adenocarcinomas (27.2% vs 31.5%; p=0.009) and as many small cell carcinomas (15.9% vs 16.9%; p=0.32). In Group II there were less stage III and IV tumours (75.1% vs 78.1%; p=0.0005) more symptomatic treatment (23.2% vs 6.1%) and radiotherapy alone (12.8% vs 3.8%; p<0.0001). The results were similar beyond 80 years. On multivariate analysis age, performance status and stage appeared to be independent variables in the choice of curative or symptomatic treatment. CONCLUSIONS: Age alone is not therefore a limiting factor in the choice of treatment.


Subject(s)
Carcinoma, Non-Small-Cell Lung/epidemiology , Carcinoma, Small Cell/epidemiology , Lung Neoplasms/epidemiology , Age Factors , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Non-Small-Cell Lung/radiotherapy , Carcinoma, Small Cell/pathology , Carcinoma, Small Cell/radiotherapy , Epidemiologic Studies , Female , France/epidemiology , Humans , Incidence , Lung Neoplasms/pathology , Lung Neoplasms/radiotherapy , Male , Multivariate Analysis , Sex Factors , Smoking/adverse effects
18.
Rev Mal Respir ; 19(6): 727-34, 2002 Dec.
Article in French | MEDLINE | ID: mdl-12524492

ABSTRACT

INTRODUCTION: The College of General Hospital Respiratory Physicians have conducted a study aimed at a better understanding of the details and modalities of management of patients suffering from bronchial carcinoma in general hospitals in France. MATERIALS AND METHODS: A prospective epidemiological study was carried out on all the new cases of histologically proven bronchial carcinoma seen in general hospitals in the year 2000. The data were collected by a standardised questionnaire. RESULTS: 137 centres of investigation identified 5 667 patients, mean age 64.3 years, of whom 16% were women. 7.2% of patients were non smokers (with an incidence of 32.3% non-smokers among the women) and 40.3% were ex-smokers. Histologically 16.9% were small cell carcinomas, 40% squamous carcinomas (43.1% among the men, 23.4% among the women, p<0.0001), 30.1% adenocarcinomas (27.2% among the men, 45.3% among the women, p<0.0001). 77.1% of non small cell carcinomas were stages III and IV, and 66.8% of small cell carcinomas were disseminated, with no difference between the sexes. CONCLUSION: Respiratory physicians in general hospitals manage more than a quarter of the cases of bronchial carcinoma seen annually in France. The number of women affected is high with a significant percentage of non-smokers and adenocarcinomas.


Subject(s)
Carcinoma, Non-Small-Cell Lung/therapy , Carcinoma, Small Cell/therapy , Hospitals, Community/statistics & numerical data , Lung Neoplasms/therapy , Practice Patterns, Physicians'/statistics & numerical data , Aged , Epidemiologic Studies , Female , France , Humans , Male , Middle Aged , Prospective Studies , Pulmonary Medicine/statistics & numerical data , Sex Factors , Smoking/adverse effects
19.
Cancer Radiother ; 5(4): 452-63, 2001 Aug.
Article in French | MEDLINE | ID: mdl-11521393

ABSTRACT

CONTEXT: The 'Standards, Options and Recommendations' (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French cancer centres and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the management of stage I and II non small cell lung carcinoma treated by radiotherapy alone. METHODS: Data were identified by searching Medline and personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to independent reviewers, and to the medical committees of the 20 French cancer centres. RESULTS: The main recommendations for the management of stage I and II non small cell lung carcinoma treated by radiotherapy alone are: 1) The curative external irradiation with a continual course is an alternative to surgery only in the case of medically inoperable tumors or because the patient refuses surgery; 2) The external irradiation of the primary tumor only without the mediastinum could be proposed in peripheral stage IA. In proximal stage IA and IB, external irradiation should be carried out only as part of prospective randomised controlled trials comparing a localised irradiation of the primary tumor with a large irradiation of the mediastinum and the primary tumor. The treated volume must include the macroscopic tumoral volume with or without the microscopic tumoral volume and with a security margin from 1.5 to 2 cm; 3) There is a benefit to delivering a total dose in the primary tumor higher than 60 Gy in so far as the proposed irradiation, taking into account the respiratory function, does not increase the likelihood of severe adverse events due to radiation; and 4) The change in fractionation, the radiochemotherapy combination, the endobronchial brachytherapy with high dose rate alone or with external irradiation could be proposed only as part of prospective controlled trials for tumors classified as stage IB or II.


Subject(s)
Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Non-Small-Cell Lung/radiotherapy , Lung Neoplasms/pathology , Lung Neoplasms/radiotherapy , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Brachytherapy/methods , Brachytherapy/standards , Carcinoma, Non-Small-Cell Lung/mortality , Clinical Protocols/standards , Combined Modality Therapy , France/epidemiology , Humans , Lung Neoplasms/mortality , Middle Aged , Neoplasm Staging , Patient Selection , Prognosis , Radiotherapy/methods , Radiotherapy/standards , Radiotherapy Dosage , Research Design/standards , Treatment Outcome
20.
Ann Oncol ; 12(7): 957-62, 2001 Jul.
Article in English | MEDLINE | ID: mdl-11521802

ABSTRACT

BACKGROUND: Although the average age of lung cancer patients is increasing, many elderly patients remain undertreated, mainly because of the fear of higher treatment toxicity in this category of patients. We conducted a study to evaluate the efficacy and tolerability of a combination therapy with carboplatin (C) and etoposide phosphate (EP) in elderly patients with Small-Cell Lung Cancer (SCLC). PATIENTS AND METHODS: Previously untreated patients older than 70 years with stage IIIB/IV SCLC received a combination of EP (100 mg/m2 D1, D2, D3) and C (D1, dose calculated according to the Calvert formula). Response rate, survival and toxicity were assessed. RESULTS: Thirty-eight patients (mean age 76 years, range 70-88 years) received a total of 162 cycles. Eighteen patients (47%) received the six scheduled cycles. Thirty patients were evaluable for efficacy (2 CR and 20 PR). The median survival was 237 days and the one-year probability of survival was 26%. The most common adverse effect was transient grade 3 or 4 neutropenia, observed during 57% of evaluable cycles, while five episodes of febrile neutropenia also occurred, with one fatal (bacteremia). It is noteworthy that no renal or liver toxicity was observed, and no mucitis was noted. Unfortunately, a relatively high proportion of patients died shortly after the start of the study. Although most deaths seemed unrelated to the treatment, the possibility of its exacerbatory effect on comorbidities, especially cardiovascular, cannot be excluded. CONCLUSION: The two-drug regimen of carboplatin and etoposide phosphate is feasible in most elderly patients with an acceptable toxicity, and the overall results suggest that patients even older than 70 years may benefit from full treatment. Therefore, consideration should be given to offering active treatment to most patients with SCLC, regardless of age but with special attention paid to comorbidities.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Small Cell/drug therapy , Lung Neoplasms/drug therapy , Age Factors , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Carboplatin/administration & dosage , Etoposide/administration & dosage , Etoposide/analogs & derivatives , Female , Humans , Male , Organophosphorus Compounds/administration & dosage , Survival Analysis , Treatment Outcome
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