Subject(s)
Dyspnea/drug therapy , Ethics, Medical , Morphine/therapeutic use , Neoplasms/complications , Alprazolam/therapeutic use , Codeine/therapeutic use , Diazepam/therapeutic use , Dyspnea/physiopathology , Humans , Infusions, Intravenous , Promethazine/therapeutic use , Randomized Controlled Trials as TopicABSTRACT
Simultaneous chemotherapy and radiotherapy was evaluated in 13 patients with inoperable, limited stage squamous cell lung cancer. The chemotherapeutic agents bleomycin, methotrexate, 5-fluorouracil, vinblastine, and cisplatin were administered on days 1 and 5 of two treatment cycles given 5 weeks apart. Radiation therapy was given in three 2-week cycles, the first two starting on the second day of each chemotherapy cycle and the third starting 3 weeks after the second course of radiation. The total dose was 5000-5500 rad (50-55 Gy) in 180 rad fractions. The objective response rate (complete response + partial response) was 85%, with 38% complete responders. Median survival was 7 months with two patients surviving 34 months, one with disease and one disease-free. Treatment toxicity was predominantly hematopoietic and renal. Two patients died with massive pulmonary hemorrhage while receiving treatment and a third patient died of acute respiratory failure 1 month after completing therapy. The severe toxicity and the failure to obtain long duration tumor control makes this regimen unsuitable for future use.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Squamous Cell/drug therapy , Lung Neoplasms/drug therapy , Aged , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Carcinoma, Squamous Cell/radiotherapy , Clinical Trials as Topic , Combined Modality Therapy , Humans , Lung Neoplasms/radiotherapy , Male , Middle Aged , PrognosisABSTRACT
Four cancer patients with intractable pain received continuous morphine infusions in doses of 15-275 mg/h for a time period ranging from 4 to 27 days. Serum morphine concentrations were determined periodically following adjustments in infusion rates. As doses were changed and continued at static hourly rates, serum morphine concentrations were relatively constant 20 hours and beyond the time of the respective change, thus suggesting morphine elimination half-lives of less than or equal to 4 hours. High doses did not influence the time required to achieve steady-state concentrations. Steady serum morphine concentrations corresponded with hourly morphine doses in a parallel manner. High interpatient variabilities in clearances and steady-state serum morphine concentrations were noted. These data suggest that at morphine infusions up to 275 mg/h elimination pathways permit handling of increasing concentrations of morphine without nonlinear blood level increases. Also, marked interpatient and intrapatient variations in patient dose requirements were noted.
