RESUMEN
The purpose of this study was to verify the kinetic response of the human marrow myeloid progenitor cells to the short term use of GM-CSF and its impact on the therapeutic activity of this three-drug cisplatinum containing regimen in non small cell lung cancer (NSCLC). Sixty patients with stage III-B and IV NSCLC were randomised to receive GM-CSF for 3 days, five days prior to the onset of chemotherapy. The chemotherapy regimen consisted of Mitomycin-C: 6 mg/m2 on day one, Ifosfamide: 2000 mg/m2 days 1 to 3, Mesna: 2000 mg/m2 days 1 to 3, Cisplatinum: 30 mg/m2 days 1 to 3, and was repeated every 4 weeks. All the patients received 30-50 Gy of radiotherapy to the primary and/or metastatic sites. There were positive correlations between stage of the disease, chemosensitivity of the tumor, number of chemotherapy cycles and overall survival (p=0.000). Administration of GM-CSF was an independent prognostic parameter in locally advanced and metastatic disease (p=0.041). In the GM-CSF receiving arm more courses could be given (117 versus 99, p=0.0415), and less courses were postponed (6 versus 22). In this arm, the mean of granulocyte nadir was higher (p=0.033) and mean time to granulocyte recovery became shorter (p=0.001) as the number of chemotherapy cycles increased. It was concluded that, dose intensification with GM-CSF prophylaxis is benefical in increasing the treatment tolerability by decreasing the intensity of granulocytopenia as well as providing rapid recovery.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Factor Estimulante de Colonias de Granulocitos y Macrófagos/uso terapéutico , Neoplasias Pulmonares/tratamiento farmacológico , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Cisplatino/administración & dosificación , Esquema de Medicación , Femenino , Células Madre Hematopoyéticas/patología , Humanos , Ifosfamida/administración & dosificación , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/radioterapia , Masculino , Mesna/administración & dosificación , Persona de Mediana Edad , Mitomicina/administración & dosificación , Proteínas Recombinantes , Tasa de SupervivenciaRESUMEN
PURPOSE: To test the accuracy of our treatment decisions for patients with inoperable non-small cell lung cancer (NSCLC) using a prototype decision-support system (DSS) and a prognostic index (PI). METHODS AND MATERIALS: To predict patient outcome and select optimal treatment, the systems protocol was tested retrospectively in 242 patients with Stage I-IV disease. The PI was determined in 184 patients with Stage I-IIIa,b disease. Survival was the final determinant of the accuracy of our treatment decisions. RESULTS: Until 1996 it was our treatment policy to treat all Stage III patients with radical intent unless they had symptoms requiring palliation. In 1997, after the palliation concept of the DSS and the PI were changed to include all Stage III disease, there was considerable discordance between the rates of palliative treatment indicated by the DSS and the PI (69% and 99%, respectively) as well as that observed in our practice (30% in the DSS group and 20% in the PI group, respectively). There was also a significant difference in survival between the patients in the low- and high-risk categories defined by the PI (median survival of 12 versus 6 months, respectively; p = 0.0001). In the group that received radical radiotherapy, there was also a significant difference in the duration of survival between the low- and high-risk groups (median survival of 12 versus 8 months, respectively; p = 0.01). In addition, the risk categories proved to be the most important predictor of survival in the patients receiving radiotherapy longer than 2 weeks (median survival of 12 versus 7 months, respectively; p = 0.0001). In high-risk patients, however, the duration of radiotherapy did not have a significant impact on survival (p = 0.25). CONCLUSION: Our data indicate that the PI is a useful method for selecting radical or palliative treatment modalities as well as for determining treatment duration.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Toma de Decisiones , Neoplasias Pulmonares/radioterapia , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/radioterapia , Carcinoma de Células Grandes/mortalidad , Carcinoma de Células Grandes/patología , Carcinoma de Células Grandes/radioterapia , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/radioterapia , Femenino , Humanos , Estado de Ejecución de Karnofsky , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Cuidados Paliativos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The reversal of anorexia and weight loss especially in patients with advanced cancer suffering from radiation treatment (RT) -related complications and debilitated furtherly during RT would be a welcome relief. The purpose of this study is to evaluate the feasibility of supportive treatment with megestrol acetate (MA) in our weight-losing cancer patients increasingly experiencing anorexia, smell, taste, and weight loss due to the additive adverse effects of RT +/- chemotherapy and how MA changes the additive role of the severity of RT reactions on such patients. From June 1997 to October 1998, 100 eligible patients were enrolled on a randomized, placebo-controlled clinical trial. Of the 100 patients, 46 received MA during RT and 4 after the end of the RT, and 50 received placebo for 3 months. Subjective parameters were assessed by a brief questionnaire form based on scoring from 1 to 5, according to the degree of the loss or change for each parameter of malnutrition, appetite, taste and smell developed by us. At the end of the study a statistically significant weight gain was achieved in the patient group receiving MA compared to the placebo group (+3 to +5 kg versus -3.7 to -5.9 kg, p=0.000). Significant improvements were seen in performance status (p=0.000), appetite (p=0.000), malnutrition (p=0.000), loss of taste (p=0.000) and smell qualities (p=0.02) in the MA group compared to the placebo group. In the MA group there was no statistically significant difference related to the weight changes according to the grade of either the acute or late RT effects (p=0.65 and 0.07, respectively). Whereas, in the placebo group a statistically significant additive effect of the acute and late RT effects was detected on weight loss (p=0.008 and 0.007, respectively). We observed no side-effects of MA in a 3-month time follow-up. The use of MA 480 mg/day during RT was effective in reversing anorexia and weight loss in spite of the acute RT effects, and helped most patients to well tolerate specific tumor therapy. Further evaluation of its mechanisms of action on RT-related adverse effects, tumor response relationships, and effect on patient survival are researched.
Asunto(s)
Anorexia/prevención & control , Antineoplásicos/efectos adversos , Acetato de Megestrol/uso terapéutico , Neoplasias/fisiopatología , Radioterapia/efectos adversos , Anorexia/etiología , Apetito , Femenino , Humanos , Masculino , Acetato de Megestrol/efectos adversos , Persona de Mediana Edad , Neoplasias/tratamiento farmacológico , Neoplasias/radioterapia , Trastornos Nutricionales/prevención & control , Placebos , Aumento de Peso/efectos de los fármacos , Pérdida de Peso/efectos de los fármacosRESUMEN
This retrospective study analyzed specifically the predicting factors for radioresponse and survival in 74 supratentorial astrocytoma patients. As a result of this study, cytoreduction in terms of ODs to T1 or T0 stage level or pre-RT T1 tumor stage along with radioresponse has a positive impact on long-term survival. It seems that radical radiotherapy should be the choice of treatment for the patients who had pre-RT T0 and T1 disease who were found more likely to respond to radiotherapy. This has not been reported previously and needs to be confirmed in larger trials.
Asunto(s)
Astrocitoma/radioterapia , Estadificación de Neoplasias , Tolerancia a Radiación , Neoplasias Supratentoriales/radioterapia , Adolescente , Adulto , Anciano , Astrocitoma/diagnóstico por imagen , Astrocitoma/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Neoplasias Supratentoriales/diagnóstico por imagen , Neoplasias Supratentoriales/patología , Sobrevivientes , Tomógrafos Computarizados por Rayos XRESUMEN
This trial was carried out to assess the response rate and survival benefit achieved, if any, by substitution of etoposide for doxorubicin and addition of methotrexate in combination with cyclophosphamide and vincristine in the treatment of 113 patients with small cell lung carcinoma (SCLC). Cyclophosphamide, etoposide, vincristine, methotrexate (CEV-M) yielded a response rate of 75% in localized disease (LD) and 63% in extensive disease (ED), versus 61% in LD and 52% in ED in the cyclophosphamide, doxorubicin, vincristine (CAV) arm. There was also a significant survival benefit for the responders in favor of CEV-M (21.7 +/- 3.8 months of median survival compared to 13.6 +/- 2.8 months in CAV arm) in patients with LD.