Characteristics and Prognostic Analysis of 69 Patients With Pulmonary Sarcomatoid Carcinoma.

BACKGROUND: Pulmonary sarcomatoid carcinoma (PSC) is a rare malignancy. METHODS: A total of 69 patients with PSC treated at a single institution in southern China with long-term follow-up were evaluated in this study. We analyzed the clinical characteristics, immunohistochemical profiles, epidermal growth factor receptor mutation status, K-RAS mutation status, treatments, and prognosis. RESULTS: PSC mainly occurred in young male patients with a history of smoking. Most patients received multimodality treatments and the majority had early-stage disease. The median survival time was 19.1 months, and the 5-year survival rate was 17.4%. The patients without distant metastasis, with normal or higher body mass index (≥18.5), with normal hemoglobin, with smaller tumor size (≤4 cm), and those who received complete resection had significantly better overall survival (P<0.05). The patients with pleomorphic carcinoma had much worse prognosis. In a Cox regression model, M stage, pathology, and having received a complete resection were independent prognostic factors (P<0.05). CONCLUSIONS: PSC is a unique lung malignancy with poor prognosis. Patients receiving complete resection had better prognosis, likely a reflection of early-stage disease. Neither neoadjuvant nor adjuvant chemotherapy improved patient survival for those with early-stage disease. The retrospective design and small sample size limited the generalizability. Future multicenter collaborations may be necessary to determine the optimal treatment.

Primary lymphoepithelioma-like carcinoma of salivary gland: sixty-nine cases with long-term follow-up.

BACKGROUND: Lymphoepithelioma-like carcinoma (LELC) in the salivary glands is a rare but unique malignancy. METHODS: Sixty-nine patients with salivary gland LELC with long-term follow-up were reviewed for this study. RESULTS: There were 52 cases in the parotid gland and 17 cases in the submandibular gland. All patients underwent complete tumor excision, 41 underwent neck dissection, and 39 received postoperative radiotherapy. The 5-year, 10-year, and 15-year overall survival (OS) rates were 90%, 75%, and 54%, respectively. Patients with higher neutrophil/lymphocyte ratio (NLR ≥ 4.0) and advanced stage (stage III and IV) had significantly poorer OS. Patients who received postoperative radiotherapy had significantly better relapse-free survival (RFS). In multivariate analysis, stage, NLR, and neck dissection were associated independently with OS, whereas stage and postoperative radiotherapy were associated independently with RFS. CONCLUSION: Salivary gland LELC is a rare malignancy with a better prognosis that partially attributes to surgery with neck dissection and postoperative radiotherapy. Preoperative NLR is an independent prognostic factor.

Triplet platinum-based combination sequential chemotherapy improves survival outcome and quality of life of advanced non-small cell lung cancer patients.

BACKGROUND: Maintenance chemotherapy is one strategy pursued in recent years with intent to break through the chemotherapy plateau for advanced non-small cell lung cancer (NSCLC). However, given the toxicity, platinum-based combinations are rarely given for this purpose. We carried out the present prospective study of triplet platinum-based combination sequential chemotherapy in advanced NSCLC to investigate if patients could tolerate and benefit from such intensive treatment. METHODS: From Dec 2003 to Dec 2007, 190 stage IIIB and IV NSCLC patients in Sun yat-sen University sequentially received the 3 platinum-based combination (TP- NP-GP) treatment (T: paclitaxol 175 mg/m2 d1; N: vinorelbine 25 mg/m2 d1 and 8; G: gemcitabine 1 g/m2 d1 and 8; P: cisplatin 20 mg/m2 d1-5; repeated every 3 weeks). Patients were followed up to at least 3 years to obtain survival data. Treatment toxicities and the quality of life (QOL) were assessed during the whole treatment. RESULTS: There were 187 patients evaluable. The TP, NP and GP response rates with sequential use were 42.8% (80/187), 41.1% (65/158) and 28.8% (21/73) respectively. Median survival time was 18.2 months and the 1, 2 and 3 year overall survival (OS) rates were 78.7%, 38.5% and 21.3%. Patients receiving>6 cycles of chemotherapy had significantly longer OS and TTP (MST 25.3 vs. 14.5 months, TTP 15.1 vs. 9.1 months). The QOL on the whole for the patients was improved after chemotherapy. CONCLUSIONS: The sequential chemotherapy strategy with triplet platinum-based combination regimens can improve the survival outcome and the quality of life of advanced non-small cell lung cancer patients.

Primary pulmonary lymphoepithelioma-like carcinoma: fifty-two patients with long-term follow-up.

BACKGROUND: Pulmonary lymphoepithelioma-like carcinoma (LELC) is a rare kind of cancer. METHODS: In this study, the authors evaluated 52 patients with pulmonary LELC who had long-term follow-up. Clinical characteristics, tumor markers, epidermal growth factor receptor (EGFR) mutation status, treatments, and outcomes were analyzed. RESULTS: Pulmonary LELC mostly affected young, nonsmoking patients. Most patients were in early or locally advanced stages and received multimodality treatment. Serum levels of neuron-specific enolase and cytokeratin 19 fragment 21-1 were elevated in 11 of 20 patients and 10 of 16 patients, respectively. Mutational analysis of EGFR was done in 11 patients, and all were wild type. The median overall survival (OS) for all the patients was not reached, and the 2-year and 5-year OS rate was 88% and 62%, respectively. The patients with early tumor stage, normal serum lactate dehydrogenase level, normal serum albumin level, without lymph node metastasis, and those who underwent complete resection had significantly better OS (P < .05); and the serum albumin level was an independent prognostic factor in a Cox regression model (P = .005). For all patients who underwent complete resection, whether or not they received adjuvant chemotherapy did not affect OS (P > .05); whereas, for patients with stage IIIA disease who underwent complete resection, adjuvant chemotherapy was correlated with a significantly better prognosis (P < .05). CONCLUSIONS: Pulmonary LELC obviously is a distinct entity of lung cancer that has a better prognosis, because patients with LELC can receive multimodality treatment, and LELC has biologic behavior similar to that of nasopharyngeal carcinoma. The current results indicated that future collaborative efforts are needed to determine the optimal treatment methods for this uncommon malignancy.

Chemotherapy with concurrent brain and thoracic radiotherapy in brain-only metastases of treatment naive small-cell lung cancer: a phase II study.

To study the treatment outcomes of brain-only metastases from small-cell lung cancer (SCLC) at initial diagnose treated by chemotherapy with concurrent brain and thoracic radiotherapy (RT). From Jan 2004 to Jan 2009, 36 treatment-naïve SCLC patients with brain-only metastases in Sun yat-sen University were enrolled. Treatment contained initial EP chemotherapy with concurrent whole-brain radiotherapy (WBRT). EP regimen consisted of etoposide 100 mg/m(2) IV d1-3, cisplatin 80 mg/m(2) IV d1, repeated every 3 weeks. WBRT with total dose of 30 Gy in 10 fractions was started within 1 week from the beginning of chemotherapy followed by thoracic RT including 2 Gy once daily to a total dose of 60 Gy. Treatment responses were evaluated after 3 cycles of chemotherapy. EP regimen was given totally 6 cycles for no tumor progression. Thirty-four patients were evaluable. All of the 20 CNS symptomatic patients experienced symptoms relief. Objective responses in the brain and primary thoracic lesions were observed in 26 (76.5%, 16CR + 10PR) and 29 (85.3%, 23CR + 6PR) patients, respectively. The median survival time (MST) was 19.2 months, and the 1-and 2-year overall survival rates (OS) were 70.6 and 29.4%, respectively, in all patients. Patients with CR response had the longest MST of 21.9 months and 1-and 2-year OS of 93.8 and 43.8%, respectively. Treatment toxicity profiles were acceptable. The treatment strategy of concurrent chemotherapy with brain and thoracic RT might achieve promising survival outcomes comparable to limited-stage SCLC in initially diagnosed SCLC with brain-only metastases.

[Immediate versus delayed topotecan after first-line therapy in small cell lung cancer].

BACKGROUND AND OBJECTIVE: How to prolong progression free survival (PFS) and overall survival (OS) of patients with small cell lung cancer (SCLC) has been one of the hottest issues. We retrospectively reviewed our data to compare the survival of immediate with delayed topotecan after first-line therapy in SCLC. METHODS: In our retrospective study, 53 patients with SCLC were divided into two groups as follow: patients receiving topotecan-containing regimen as maintenance/consolidation (maintenance/consolidation chemotherapy group) and salvage chemotherapy (salvage chemotherapy group). The Log-rank test was used to assess the difference in OS between two groups. Cox regression model was used for the multivariable analysis of independent prognostic factors. RESULTS: Twenty-nine patients received topotecan as maintenance/consolidation treatment, whereas 24 patients salvage chemotherapy. The response rates were 51.7% and 41.7%, respectively. The median survival time were 20 months and 27 months respectively (P = 0.89). Multivariate Cox regression analyses identified sex and stage as independent prognostic factors. CONCLUSION: Efficacy of first-line therapy was improved by topotecan maintenance/ consolidation treatment, which did not result in any significant survival benefits in SCLC.

[Analysis of the efficacy and safety of gefitinib in the treatment of recurrent advanced non-small cell lung cancer in an expanded access program (EAP)].

OBJECTIVE: The aim of this study is to evaluate the efficacy and safety of Gefitinib in the treatment of Chinese patients with recurrent advanced non-small-cell lung cancer (NSCLC). METHODS: 120 patients were enrolled in this trial from September 2002 to March 2005, and 103 patients were evaluable. All patients were histologically or/and cytologically confirmed to have a locally advanced or metastatic NSCLC, and failed to previous standard treatments. The patients received orally 250 mg of Gefitinib once daily until the disease progression or intolerance to toxicity. First evaluation of response was undertaken one month after drug initiation, then every 2 or 3 months till disease progression. Each patient was followed up every 6 months untill death or end of follow-up. RESULTS: Among the 103 evaluable patients, the objective response rate was 18.4% (19/103), and the disease control rate was 51.5% (53/103). The median time to progression (mTTP) was 3 months (range: 0.2 approximately 40), the median survival time (MST) was 9.8 months (range: 0.5 approximately 51), the 1-, 2-, 3-year survival rates were 44.7%, 26.4% and 13.2%, respectively. The TTP of 41 patients was longer than 6 months with a MST of 25.5 months. The results of COX model analysis suggested that the patients with adenocarcinoma, rash and favourable performance status (PS) had longer TTP. The patients with favourable PS and well controlled disease had longer survival time. Adverse events included skin rash, dry skin, diarrhea and elevation of serum glutamate pyruvate transaminase (SGPT), and were usually mild. CONCLUSION: Gefitinib is effective in treatment of patient with recurrent advanced NSCLC. The patients with controlled disease may achieve a long survival, and the adverse reactions are mild and tolerable.

[Brain radiotherapy combined with sequential chemotherapy in non-small-cell lung cancer patients with brain metastases.].

BACKGROUND: Brain irradiation is the traditional treatment for NSCLC patients with brain metastases, whereas combined with chemotherapy is the nowadays treatment direction. Since sequential/maintenance chemotherapy has shown promising results in advanced NSCLC, we carried out the study to explore the role of sequential chemotherapy combined with brain radiotherapy in patients with brain metastases. METHODS: Treatment naive NSCLC patients with brain metastases sequentially received the 3 chemotherapy regimens TP-NP-GP. The TP regimen consisted of Paclitaxol 175 mg/m(2) d1, Cisplatin 20 mg/m(2) d1-5. The NP regimen consisted of Nevalbine 25 mg/m(2) d1 and 8, Cisplatin 20 mg/m(2) d1-5. The GP regimen consisted of Gemcitabine 1 g/m(2) d1 and 8, Cisplatin 20 mg/m(2) d1-5. All regimens were repeated every 3 weeks. Each regimen was executed for at least 2 cycles and no more than 4 cycles. RESULTS: The response rates of TP, NP and GP sequentially used were 41.2%, 35.6% and 27.8% respectively for the out brain lesions and 60.8% for the brain lesions combining with brain irradiation. Median survival time was 14.7 months and the 1, 2 and 3 year overall survivals were 67.8%, 20.6% and 1.3% respectively. CONCLUSIONS: The 3rd generation regimen-based sequential chemotherapy combined with WBRT was effective for NSCLC patients with brain metastasis with an encouraging survival and acceptable tolerability.

[Weekly Paclitaxel and Cisplatin in the Treatment of Elderly Advanced Non-small Cell Lung Cancer.].

BACKGROUND: Lung cancer is one of the most common cancers in the world. The number of elderly lung cancer patients is expected to rapidly increase. Therefore, the management of elderly lung cancer patients is becoming a major challenge in the field of oncology. This study was to evaluate the efficacy and safety of weekly paclitaxel (PTX) and cisplatin (DDP) as the first-line chemotherapy on advanced NSCLC patients of more than 70 years old. METHODS: Fifty chemotherapy-naive patients with advanced NSCLC more than 70 years old were administrated weekly paclitaxel and pisplatin regiment: PTX 80 mg/m(2) intravenous infusion for 1 h, d1, d8 (given routine premedications before PTX), DDP 20 mg/m(2) intravenous infusion, d1, d8, every 21 days. RESULTS: Total 50 patients were enrolled, and 48 patients were evaluable for response. The ORR (overall response rate) was 39.6%; median survival time (MST) was 14.8 months; One year survival rate was 58.3%. Most common adverse events were leucopenia (60%), anemia (62%), nausea and vomiting (30%), alopecia (100%). There were no chemotherapy-related deaths. CONCLUSIONS: The patients of advanced NSCLC more than 70 years old can tolerate weekly paclitaxel and cisplatin and can get benefit from this regiment.

[Efficacy of erlotinib on advanced non-small cell lung cancer].

BACKGROUND & OBJECTIVE: Erlotinib is a selective inhibitor of epidermal growth factor receptor (EGFR) tyrosine kinase, and has been used in treating advanced non-small cell lung cancer (NSCLC). This study was to evaluate the efficacy of erlotinib on advanced NSCLC, and observe the adverse events. METHODS: An open labeled, expanded access program (EAP) was conducted on 44 pathologically confirmed advanced NSCLC patients who had received at least one regimen. Erlotinib (150 mg) was orally administered daily till disease progression or intolerable adverse events developed. The efficacy was evaluated according to RECIS criteria; the adverse events were evaluated according to NCI criteria. RESULTS: In the 44 patients, the objective response rate was 27.3%, and the disease control rate was 65.9%û the median progression-free survival time was 4.5 months (0.9-8.1 months), and the median survival time was 13.7 months (9.2-18.2 months). Adverse events were generally mild (grade I or II), including skin rash (81.8%) and diarrhea (56.8%). One (2.3%) patient developed grade III elevation of serum glutamate pyruvate transaminase (SGPT). No grade IV drug-related adverse event occurred. CONCLUSION: Erlotinib is effective and safe for locally advanced or metastatic NSCLC patients who have failed previous chemotherapy.

[Responses of 109 adult soft tissue sarcoma patients to chemotherapy].

BACKGROUND & OBJECTIVE: The response of adult soft tissue sarcoma (STS) to chemotherapy is uncertain. This study was to evaluate the role of chemotherapy in treating adult soft tissue sarcoma. METHODS: Clinical data of 109 adult soft tissue sarcoma patients, treated with chemotherapy at Cancer Center of Sun Yat-sen University from Jan. 2000 to Dec. 2005, were analyzed. RESULTS: Of the 109 patients, 66 received palliative chemotherapy, 40 received adjuvant chemotherapy, and 3 received neoadjuvant chemotherapy. The overall response rate for first line chemotherapy was 22.7%. The median survival was 16.9 months. The 1-and 2-year survival rates were 63.6% and 33.3%. The patients with lung metastasis had a significantly longer median survival than those with liver metastasis did (25.1 months vs. 11.8 months, P<0.05). MAID and CYVADIC were the most commonly used first-line chemotherapy regimens; the response rates were 28.0% and 22.2%, respectively. When anthracycline and/or standard dose ifosfamide failed, the patients could still benefit from high dose ifosfamide (14.0 g/m(2)). The median survival was significantly shorter in the patients who got metastasis within 6 months after diagnosis than in those that got metastasis more than 6 months after diagnosis (11.8 months vs. 42.9 months, P=0.04). Of the 40 patients who received adjuvant chemotherapy, 16 developed progression during follow-up: 10 had relapse and 6 had distant metastasis. CONCLUSIONS: MAID and CYVADIC are two effective chemotherapy regimens for adult soft tissue sarcoma. We recommend to take a high dose ifosfamide when anthracycline and/or standard dose ifosfamide failed. The patients with liver metastasis are more resistant to chemotherapy than those with lung metastasis. Developing metastasis within 6 months after diagnosis is a poor prognostic factor.

[Nadaplatin or cisplatin combined with paclitaxol in treatment for non-small cell lung cancer: a randomized controlled study].

OBJECTIVE: To investigate the therapeutic effect, long term survival and side effect on NSCLC patients treated with nadaplatin combined with paclitaxol and cisplatin combined with paclitaxol. METHODS: NSCLC patients with stage IIIB or IV were randomized into two groups in this prospective clinical study. TN group: nadaplatin 30 mg/m2 dl-3, paclitaxol 175 mg/m2 dl, repeated every 4 weeks. TP group: DDP 30 mg/m2 dl-3, paclitaxol 175 mg/m2 dl, repeated every 4 weeks. RESULTS: Sixty patients were enrolled and 57 were evaluable with 30 in TN group and 27 in TP group. The overall response rate were 43.3% vs. 48.1% (P = 0.716), and the disease control rate were 86.7% vs. 88.8% in TN and TP group (P = 0.799), respectively. The median survival time was 14.3 vs. 13.0 months, and the 1- and 2-year survival rate was 62.5% vs. 59.1%, 0% vs. 5.8% in TN and TP group (P = 0.839), respectively. The rates of neutropenia and thrombocytopenia were similar in TN and TP groups whereas more patients in TP group than in TN group suffered from anemia (38.5% vs. 17.5%, P = 0.001), nausea and vomiting (82.6% vs. 35.6%, P = 0.000), fatigue (35.9% vs. 14.1%, P = 0.000) and peripheral neurotoxicity (50.0% vs. 21.9%, calculated by case, P = 0.023). CONCLUSION: Nadaplatin combined with paclitaxol is an effective treatment regimen for NSCLC patients. When compared with similar regimen with cisplatin, the response rate and survival were similar; however, nadaplatin regimen shows some superiority as regards some treatment side effect.

[Primary breast lymphoma--a report of 27 cases with literature review].

BACKGROUND & OBJECTIVE: Primary breast lymphoma (PBL) is an uncommon disease with poor clinical outcome. This study was to investigate clinicopathologic features and optimal treatment of PBL. METHODS: Clinical records of 27 PBL patients, treated in Cancer Center of Sun Yat-sen University from 1976 to 2005, were reviewed. RESULTS: Of the 27 patients, 26 were women and 1 was man, with the age ranged from 12 to 84; 18 were at stage IE, 6 at stage IIE, and 3 at stage III/IVE; according to the WHO 2001 lymphoma classification system, 22 had B-cell lymphoma (including 17 cases of diffuse large B-cell lymphoma, 2 cases of mucosa-associated lymphoid tissue lymphoma, 1 case of marginal zone lymphoma, and 2 cases of unclassified B-cell lymphoma), 3 had peripheral T-cell lymphoma, and 2 had unclassified lymphoma. Of the 27 patients, 8 received mastectomy and chemotherapy, 12 received excision of the breast lesion and chemotherapy (the 5-year overall survival rates were 23% and 58%, P=0.006), 5 received chemotherapy alone, and 2 received lesion excision alone; 24 achieved complete remission (CR) after scheduled treatment, 1 achieved partial remission (PR), and 2 patients had progressive disease (PD). With a follow-up of 10 years and median 38 months, the 5-year overall and disease-free survival rates of the 27 patients were 47% and 23%, respectively. As to the 20 patients with high or moderate grade diseases (diffuse large B-cell lymphoma and peripheral T-cell lymphoma), the 5-year overall and disease-free survival rates were 48% and 27%, respectively. Sixteen patients had tumor relapse during the follow-up in the homolateral breast (6 cases), controlateral breast (4 cases), central nerve system (CNS) (3 cases), bone marrow (1 case), and lymph nodes (2 cases). CONCLUSIONS: The main subtypes of PBL are diffuse large B-cell lymphoma and peripheral T-cell lymphoma. The effect of radical operation is limited in PBL; the optimal sequence is lumpectomy followed by standard anthracycline-based regimens and radiotherapy. PBL tends to relapse to CNS, therefore, CT or MR image of CNS is necessary during follow-up.

[Efficacy of gefitinib on advanced non-small cell lung cancer in expanded access program (EAP)].

BACKGROUND & OBJECTIVE: Gefitinib is a selective inhibitor of epidermal growth factor receptor (EGFR) tyrosine kinase, and has been used in treating advanced non-small cell lung cancer (NSCLC). This study was to evaluate the efficacy of Gefitinib on advanced NSCLC, and observe adverse events. METHODS: An open labeled, expanded access program (EAP) was conducted. Pathologically confirmed advanced NSCLC patients who had progressed after systemic chemotherapy or was not suitable for systemic chemotherapy were eligible for this program. Gefitinib (250 mg) was orally administered daily till disease progression or intolerable adverse events developed. RESULTS: From Sep. 2002 to Mar. 2005, 120 patients were enrolled, and 103 of them were assessable for response. The objective response rate was 18.4% (19/103). The disease control rate was 51.5% (53/103). The median survival time was 6 months (0.5-33 months). Adverse events were generally mild (grade I or II), including skin rash (30.1%), dry skin (12.6%), and diarrhea (25.2%). Two (1.9%) patients developed grade III elevation of serum glutamate pyruvate transaminase (SGPT). No grade IV adverse event occurred. CONCLUSION: Gefitinib is effective in treating advanced NSCLC, and the adverse events are mild.

[Initial outcome of induction chemotherapy with weekly paclitaxel followed by three-dimensional conformal radiotherapy and concurrent weekly paclitaxel for stage III non-small cell lung cancer].

BACKGROUND & OBJECTIVE: The efficacy of radiotherapy alone on locally advanced non-small cell lung cancer (NSCLC) is poor. Although the combined modality of chemoradiotherapy and dose-escalation of radiotherapy have been the main trends, the optimal modality still remains unknown. This study was to evaluate the toxicity and efficacy of induction chemotherapy (ICT) followed by three-dimensional conformal radiotherapy (3D CRT) and concurrent weekly paclitaxel on unresectable NSCLC. METHODS: Stage III NSCLC patients with favorable conditions were treated with 2 to 4 cycles of carboplatin (AUC=5-6, d1) combined with paclitaxel (175 mg/m(2), d1), then followed by weekly paclitaxel (40 mg/m(2)) and concurrent 3D CRT within 3-4 weeks. The prescription dose was given as high as possible under the condition that V20 < or =31% and spinal cord dose < or =50 Gy. RESULTS: Thirty-one patients were enrolled. ICT was well tolerated. During the concurrent chemoradiotherapy, the treatment of 3 patients was ended ahead of the schedule because of severe pulmonary and heart toxicities; the treatment of 2 patients was delayed for 7 and 12 days because of fatigue. Myelosuppression was mild (16/31): all were grade 1-2 except 1 was grade 3. Lymphocytopenia was more obvious (29/31, grade 3 in 21). Three patients developed grade 3 radiation-induced esophagitis, and 2 developed grade 3-4 radiation-induced pneumonitis. Two developed grade 3 esophageal stricture. No grade 3-4 pulmonary fibrosis was observed. The overall response rate was 74.1%. The 1-, 2-, 3-year overall survival rates were 74.2%, 41.9%, and 34.6%, respectively, with the median survival time of 18.5 months. The 1-, 2-, 3-year local progression-freely survival rates were 64.5%, 32.3%, and 20.5%, respectively, with the median local progression-freely survival time of 14.3 months. CONCLUSIONS: The program of ICT followed by weekly paclitaxel and 3D CRT is accomplished in most of the favorable stage III NSCLC patients. The toxicity is tolerable, and the response rate is inspiriting.

[Intrapericardial infusion of etoposide and cisplatin in treating malignant pericardial effusion of non-small cell lung cancer].

BACKGROUND & OBJECTIVE: Pericardiocentesis and intrapericardial infusion of chemotherapeutic drugs is the main treatment of malignant pericardial effusion. This study was to observe the efficacy and side effect of intrapericardial infusion of etoposide (VP-16) and cisplatin (DDP) on malignant pericardial effusion of non-small cell lung cancer (NSCLC). METHODS: Twenty-eight NSCLC patients with malignant pericardial effusion were treated with pericardiocentesis and intrapericardial infusion of VP-16 (200-300 mg) and DDP (80-100 mg). Intravenous chemotherapy were given 2 weeks after the pericardiocentesis. RESULTS: The overall response(OR) rate of the first-time treatment of the 28 patients was 85.7%, with complete response (CR) rate of 71.4%; the OR rate of the second-time treatment was 100%. Only 4 patients needed second-time pericardiocentesis. Sixteen patients developed gastrointestinal tract reaction (mainly grade I-II), 12 developed myelosuppression (mainly grade I), and 1 showed mild abnormal of transaminase. For the 24 naïve patients, the overall survival time was 14 months for stage IIIB and 10.9 months for stage IV; whereas for the 4 patients with relapsed disease, the overall survival time was 6 months (from the time of relapse). CONCLUSION: Intrapericardial infusion of VP-16 and DDP is an effective treatment for malignant pericardial effusion of NSCLC.

Neoadjuvant chemotherapy followed by late-course accelerated hyperfractionated radiation therapy for locally advanced non-small-cell lung cancer: long-term results of a phase I/II clinical trial.

Toxicity, response, and long-term results of a definitive chemotherapy/radiation therapy (RT) protocol in patients with unresectable stage III non-small-cell lung cancer (NSCLC) were evaluated. Two cycles of cisplatin-based chemotherapy were delivered before RT, and another 2 cycles were added for patients who responded to the first 2 cycles of chemotherapy. The first course of radiation covered the primary lesion and elective nodal regions, given in 2 Gy per fraction, 5 days a week for a dose of 40 Gy. Late-course hyperfractionated accelerated RT was delivered to the gross tumor twice a day for an additional 27 Gy within 2 weeks, using 1.5 Gy per fraction. Fifty-three patients with unresectable stage IIIA (N2) and IIIB NSCLC were eligible for analysis. Twelve patients developed grade 3 neutropenia, and 3 patients developed grade 4 neutropenia. Grade 2 or 3 esophagitis was observed in 14 and 2 patients, respectively, and grade 2 or 3 pneumonitis was observed in 9 and 1 patient, respectively. Six patients developed grade 2 and 1 patient developed grade 3 late lung toxicity. The median survival time was 15.5 months. Twenty-six of 53 patients (49%) have died of locoregional progression inside the thorax. The distant metastasis rate was 59.5% (22 of 37 patients) for those who did not respond to chemotherapy and 18.8% (3 of 16 patients) for those who responded to chemotherapy (P = 0.006). Late-course hyperfractionated accelerated RT combined with induction chemotherapy was well tolerated and yielded long-term results that compare favorably with those of studies using 2 cycles of induction chemotherapy and conventional fractionated RT. However, local control was still discouraging.

[Long-term outcomes of 392 non-Hodgkin's lymphoma patients treated with pirarubicin based regimens].

OBJECTIVE: To analyse the effectiveness and toxicity of combined chemotherapy regimen containing pirarubicin (THP) in the treatment of non-Hodgkin's lymphoma (NHL). METHODS: Three hundred and ninety two patients with NHL were treated by THP containing regimen with or without involved field radiotherapy. The clinical characteristics, response, toxicity and long-term survival rates were analysed. RESULTS: The median age of the patients was 47 (5 - 87) years and 26.0% aged more than 60 years. 61.0% of the patients were males and 39.0% females. B-cell and T/NK cell NHL accounted for 68.4% and 23.2% respectively with 56.9% of diffuse large B cell lymphoma and 12.5% of peripheral T cell lymphoma. 92.6% of the patients were ECOG < 1, 63.2% in stage I + II, 84.7% with IPI score 0 - 2 and 25% with B symptoms, 93.9% (368/392) of the patients received CTOP (containing THP) regimen chemotherapy and among them 28.5% (112/392) plus involved field radiotherapy. Altogether 1598 courses were administered on 368 patients. The overall response rate was 88.5% (341/385) with a complete remission (CR) rate of 63.6%, major toxicity was myelosuppression with 12.8%, 1.0% and 1.5% of grade III - IV neutropenia, thrombocytopenia and anemia, respectively. G-CSF support was given for 553 courses (34.6%). Alopecia account for 19.8%. The incidence of mild cardiotoxicity was 5.8%. Treatment-related mortality was 1.6% (6/368). Median follow-up was 24 months. The 1, 3 and 5 year actuarial survival rates were 86.4% , 66.5% and 59.2%, respectively. Median survival time has not been achieved. CONCLUSION: The efficacy of THP based regimen CTOP for the treatment of aggressive NHL is promising. Further clinical trial is warranted.

[Paclitaxel and cisplatin combined with etoposide chemotherapy in non-small cell lung cancer with brain metastases].

BACKGROUND & OBJECTIVE: Chemotherapy has been rarely considered an important treatment modality for non-small cell lung cancer (NSCLC) with brain metastases (BM) because of the existence of blood-brain barrier (BBB). In the recent years,the studies about BBB suggest that many agents (such as paclitaxel, cisplatin) have increased permeability to BBB once BM occur. Therefore, we addressed the role of this combination with paclitaxel,etoposide, cisplatin (some effective agents to NSCLC) as front-line therapy in NSCLC with BM. METHODS: 20 chemotherapy-naive patients with documented BM from NSCLC and at least one evaluable extracerebral lesion were treated with paclitaxel (150 mg/m(2)) on day 1, etoposide (60 mg/m(2)) on day 1,3,5,and cisplatin (20 mg/m(2)) on day 1-5. The cycle was repeated every 28 days. RESULT: 17 patients were evaluated for response and 19 for toxicity. The intracranial objective response rate (ORR) was 41%,the extracranial ORR was 53%. Patients who responded for the brain also had a response at the extracerebral sites. Grade 3-4 myelosuppression occurred in 21% of the patients. The overall medican follow-up was 9 months. The medican survival time for the 9 died patients was 8.5 months. CONCLUSIONS: Paclitaxel and cisplatin combined with etoposide as front-line therapy in NSCLC with BM has some efficacy. The toxicity is mild. This combination chemotherapy seems to achieve responses similar to those for extracranial diseases, and further support the need for reconsideration of the role of chemotherapy in this setting.

[Multivariate survival analysis for 423 patients with non-small cell lung cancer].

BACKGROUND & OBJECTIVE: Non-small cell lung cancer(NSCLC) is characterized by high incidence and poor prognosis in our country. New prognostic factors are needed to guide the treatment of patients with NSCLC. This study was designed to evaluate the characteristics and outcome in NSCLC patients who underwent completely surgical resection. METHODS: A total of 423 cases were analyzed using SPSS10.0 software. The survival differences were compared by univariate and multivariate analysis. RESULTS: The 5-year survival rate in this group was 46.98%. Multivariate analysis identified two poor prognostic factors: advanced TNM stage (P=0.003) and blood group B (P=0.02). Multivariate analysis also identified two better prognostic factors:adjuvant chemotherapy (P=0.04) and squamous histological type (P=0.005). The number of the risk factors (blood group B and non- squamous) were negatively related to prognosis according to multivariate analysis in stage III a NSCLC (the 5-year survival rates:43.5% vs 23.7% vs 4.0%, P< 0.001). CONCLUSION: Adjuvant chemotherapy maybe is beneficial to NSCLC patients who underwent completely surgical resection. Cox multivariate analysis demonstrates that evaluation of both histological type and blood-group has a significant prognostic effect in stage IIIa patients.