RESUMEN
Both CAV (Cyclophosphamide, Doxorubicin, Vincristine) and PE (Cisplatin, Etoposide) are effective and non cross-resistant regimens in the treatment of SCLC. We designed a chemotherapeutic scheme including CAV and PE given in an alternating fashion with the following schedule: Cyclophosphamide 1000 mg/sm, Doxorubicin 50 mg/sm, Vincristine 2 mg/sm I.V. on day 1, alternated every 21 days with Cisplatin 20 mg/sm and Etoposide 80 mg/sm I.V. days 1-5 for 6 cycles. Following chemotherapy (CT) chest radiotherapy in patients (pts) with limited disease (LD) in complete response (CR) or partial response (PR) and prophylactic cranial irradiation (PCI) in CRs were given, 32 pts entered the study and 27 were evaluable: 9/27 (33.3%) had CR (8/15 with LD had CR) and 15/27 (55.5%) PR. The overall median survival was 53.71 weeks: 79.85 weeks for LD pts and 32.86 for ED.4 pts with LD were alive after 2 years and 2 of them are still alive without disease at 44 and 46 months. Toxicity was acceptable in all patients. Alternating chemotherapy with CAV and PE followed by chest and brain RT in responding LD pts is an effective induction treatment for SCLC although long-term survival still remains disappointing.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Encefálicas/secundario , Carcinoma de Células Pequeñas/terapia , Neoplasias Pulmonares/terapia , Neoplasias Encefálicas/prevención & control , Carcinoma de Células Pequeñas/tratamiento farmacológico , Carcinoma de Células Pequeñas/patología , Carcinoma de Células Pequeñas/radioterapia , Cisplatino/administración & dosificación , Terapia Combinada , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Etopósido/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/radioterapia , Masculino , Neoplasias del Mediastino/prevención & control , Neoplasias del Mediastino/secundario , Persona de Mediana Edad , Metástasis de la Neoplasia , Estadificación de Neoplasias , Dosificación Radioterapéutica , Vincristina/administración & dosificaciónRESUMEN
In order to evaluate the effects of incomplete resection or exploratory thoracotomy on survival, 75 patients with Stage III non small-cell lung cancer (NSCLC) were studied. Twenty-five subjects underwent incomplete resection, 25 had exploratory thoracotomy and 25 patients who were denied surgery served as controls. Standard radio-therapy and chemotherapy regimens were given to most patients. The 2-year survival rates were 14%, 7% and 9% following incomplete resection, exploratory thoracotomy or conservative treatment, respectively. The survival curve was significantly worse in the exploratory thoracotomy group than in the control group (p less than 0.05). Major complications occurred in 2 patients after incomplete resection (bronchopleural fistula; chylothorax) and in 3 patients following surgical exploration (atelectasis). Two post-operative deaths were recorded in the exploratory thoracotomy group. In conclusion, the survival rate at 2 years in patients with Stage III NSCLC is not modified by incomplete or exploratory surgery. Moreover, exploration seems to worsen the outlook of patients during the first 2 years from diagnosis.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/cirugía , Neumonectomía , Toracotomía , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Cuidados Paliativos , Neumonectomía/métodosAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Adenocarcinoma/tratamiento farmacológico , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carcinoma de Células Escamosas/tratamiento farmacológico , Cisplatino/administración & dosificación , Etopósido/administración & dosificación , Humanos , Ifosfamida/administración & dosificación , Persona de Mediana EdadRESUMEN
The over production of toxic oxygen species (TOS) by the phagocytic cells involved in inflammatory processes plays a crucial role in generating the immune defects which characterize both infections and neoplastic diseases. Since the thiol containing drugs, and N-acetylcysteine possess a high capacity for scavenging and inhibiting TOS, the question of whether these substances are able to protect, in vivo as well as in vitro, the function of lymphocytes isolated from the peripheral blood in patients suffering from chronic pulmonary diseases (CPD) was investigated. The lymphocytes isolated from healthy donors as well as those from CPD patients exposed in vitro to TOS showed a reduced viability and an impairment of functions in: (a) the ability to express HLA Class II and TAC antigens and (b) the capacity to stimulate and proliferate in allogenic (MLR) and autologous mixed lymphocyte reactions (AMLR). The presence of NAC or CAT blocked this toxicity. Cells isolated from healthy donors and patients following treatment with NAC were less sensitive to the in vitro toxicity of TOS.
Asunto(s)
Acetilcisteína/inmunología , Antioxidantes/inmunología , Enfermedades Pulmonares Obstructivas/inmunología , Linfocitos/efectos de los fármacos , Acetilcisteína/uso terapéutico , Anticuerpos Monoclonales/inmunología , Antioxidantes/uso terapéutico , Catalasa/inmunología , Antígenos HLA-D/inmunología , Humanos , Enfermedades Pulmonares Obstructivas/tratamiento farmacológico , Linfocitos/inmunología , FenotipoRESUMEN
Thirty-five small cell lung cancer (SCLC) patients were treated with combination chemotherapy including adriamycin, cyclophosphamide, etoposide (ACE). Out of 32 evaluable patients there were 21.9% complete responses and 53.1% partial responses with an overall median survival of 37 weeks (50 weeks for patients with limited disease and 34 weeks for patients with extended disease). Toxicity was generally well tolerated. In conclusion the ACE regimen results in being active and safe in the treatment of SCLC.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Pequeñas/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Adulto , Anciano , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Etopósido/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Fifty patients with advanced squamous cell carcinoma and adenocarcinoma of the lung having good prognostic features (performance status less than or equal to 2; weight loss less than or equal to 10%; age less than or equal to 70 years; absence of brain metastases; and no prior treatment) were treated on an outpatient basis with etoposide (120 mg/m2 on Days 1, 3, and 5) and cisplatin (60 mg/m2 on Days 1 and 2) every 21-28 days. One complete response and 14 partial responses were observed, with a median duration of response of 170 days and an overall median survival of 230 days. Toxicity was generally mild. Despite the high-dose cisplatin employed and the choice of patients with favorable prognostic factors in this study, results of this therapy remain disappointing.