[Epidemiology and delays in the management of 355 patients with lung cancer]. / Epidémiologie et délais de prise en charge de 355 patients atteints de cancer bronchique.

BACKGROUND: The epidemiology of patients with lung cancer in a Seine-Saint-Denis hospital are reported, as well as causes of diagnostic and therapeutic delays in their management. MATERIAL AND METHODS: Retrospective analysis of cases diagnosed from January 1, 1997 to December 31, 2003. RESULTS: Of 355 cases, 15.8% were women; the average age was 62 +/- 11. Mean smoking history was 50 +/- 24 pack years. Women were more likely to be non-smokers than men (16% and 1% respectively, p < 0.01) and were more likely to present at a young age (under the age of 50: 26.8% and 13.7% respectively, p < 0.05). Among women, adenocarcinoma was more frequent (41% vs. 25%, p < 0.05), and often presented with stage IV disease (74%). Squamous cell carcinoma occurred more frequently with increasing age (18.7% vs. 32.2% before and after the age of 60, p < 0.01). The median pre hospital, diagnostic and treatment delays were respectively 30, 10 and 9 days, the global delay from first symptom to treatment was 62 days. Surgery increased therapeutic delay by 20 days. CONCLUSION: Our results are complementary to those found in KBP-2000-CPHG study. Young women are diagnosed at a late stage. Influence of delays on prognosis is not proved and require others studies.

[Home chemotherapy for lung cancer: a five year retrospective study]. / Chimiothérapie à domicile du cancer bronchique. Etude rétrospective sur cinq ans.

INTRODUCTION: We present the results of a five year retrospective study of chemotherapy delivered at home for patients suffering from non-small cell lung cancer. METHODS: In partnership with "hospital at home" we have developed mechanisms to improve safety: secured prescriptions, treatments confirmations transmitted by fax, designed specific chemotherapy file and approval of family doctor prior to administration. RESULTS: We treated 74 patients and administered 401 injections of which 72% were for Vinorelbine and 28% for Gemcitabine. These protocols corresponded to day 8 injections for Cisplatin-based double drug therapies in 47% of cases and to weekly single drug chemotherapies in 53%. CONCLUSIONS: Constraints regarding medical staff availability were exceeded by many advantages: better hospital bed management, guaranteed treatment, improvements in patients' quality of life and strengthening of links between hospital and community.

[Generalized BCG infection after intravesical instillations of Calmette-Guerin bacillus]. / BCGite généralisée après instillations intravésicales de bacilles de Calmette-Guérin.

BCG has been disappointing as immunotherapy of numerous cancers, but it has been clinically successful in the intravesical treatment of bladder carcinomas sparing the muscle coat; it has indeed become the reference treatment for this type of cancer. However, complications are repeatedly reported, including generalized BCGitis. We report such a case with positive BCG culture. From the cases already published there emerges a homogeneous and often subacute clinical presentation suggestive of an ordinary pathogen. Bacteriology is not very helpful, even when recent techniques are used, and therefore the diagnosis rests on the context and, when samples are taken, on suggestive histological findings. To discuss the physiopathology of BCGitis--generalized immune reaction or multifocal BCG proliferation--is not useless since treatment depends on it. It is probable that these 2 mechanisms working together can be incriminated justifying the prescription of both antibiotics and corticosteroids. When this is done, the prognosis seems to be favourable in most patients. Yet a strict respect of contra-indications and a very careful subsequent radiotherapy should reduce the risks.