Pasteurella multocida infection in a cirrhotic patient: case report, microbiological aspects and a review of literature.

Pasteurellosis is a zoonosis often caused by cat or dog bites or scratches, or by direct exposure to their secretions. Pasteurella multocida is the main pathogen involved in infections through domestic animal bites; generally a local infection characterized by its particular virulence with consequent rapid onset. Serious infection has also been reported in persons affected by comorbidity without domestic animal bite injuries. Here we report the case of a woman with lower limb exudating vesicular skin ulcers affected by liver cirrhosis, bilateral knee arthritis, septicemia with positive blood culture and synovial fluid culture for Pasteurella multocida. The etiology of Pasteurella multocida must be borne in mind in cases of sepsis in immunodeficient individuals, such as the cirrhotic patient, as well as exposure to domestic animals.

Vertebroplasty in the treatment of osteoporosis vertebral fractures: report on 52 cases.

BACKGROUND: Percutaneous vertebroplasty (PV) is largely employed in vertebral body compression fractures (VCF). PURPOSE: To evaluate the efficacy of PV on pain relief and functional status, and its complications rate. MATERIALS AND METHODS: A prospective observational study was conducted by the Division of Internal Medicine of St. Croce and Carle Hospital. INCLUSION CRITERIA: Diagnosis of osteoporosis, intense back pain, unresponsive to conservative treatment, associated with radiological evidence of recent VCF. Pain control and functional improvement were respectively assessed using Visual Analogue Scale (VAS) and Activity of Daily Living scale (ADL) on admission, 24 h after PV and at follow-up. PV complications were detected by an immediate computed tomography (CT) scan on the vertebra treated as well as the vertebrae above and below the treated level(s) and by CT chest scan to exclude pulmonary emboli. A magnetic resonance imaging (MRI) follow-up at 6 or 12 months was performed. RESULTS: Fifty-two (46 with primary osteoporosis) patients were enrolled (mean age 73.18 yr, range 44-92). Median follow-up was 20.4 months (range 6-24). Treated vertebrae were 124. VAS, mean value was 9.05 (range 6-10) before treatment, 5.95 (range 2-8) at 24 h after PV and 4.94 (range 2-9) at follow-up (p<0.001). Before PV, 18 patients (34.6%) were functionally impaired vs 8 patients (15.3%) at follow-up (p<0.003). Control MRI evidenced 9 (17.3%) new VCF adjacent and 13 (25%) non-adjacent to treated vertebras. There was one case of discitis. Seven cases (13%) of cement leakage in para-vertebral space were observed. CONCLUSION: PV is safe and effective in immediate pain reduction and functional improvement and at a median term follow-up.

Weekly chemotherapy with cisplatin and paclitaxel in advanced NSClC: a phase II study.

BACKGROUND: This phase II study was designed to assess the activity and toxicity of administration of the cisplatin/paclitaxel combination in advanced non-small cell lung cancer (NSCLC). METHODS: Eligibility criteria included: age up to 70 years, pathological diagnosis of NSCLC, inoperable disease or post-operative tumour recurrence, performance status < or =2, no severe co-morbidity, no previous chemotherapy, and informed consent. Treatment consisted of intravenous infusion of cisplatin, 25 mg/m2, and paclitaxel, 80 mg/m2, every week. Chemotherapy was continued until completion of a 22-week treatment plan, disease progression, persistent toxicity, or patient refusal. RESULTS: Forty-nine patients entered the study. They received a median of 14 cycles (range 0-22). For both drugs, the median dose-intensity was 75% of projected. Toxicity was generally acceptable, and never life threatening. Alopecia was the most common side effect, followed by anemia, leukopenia, and nausea/vomiting. Twenty patients responded (40.8% response rate), with three complete, pathologically documented responses. The estimated median time to progression was 35 weeks (95% CI: 29-41); the median survival time was 56 weeks (95% CI: not calculable), with a 2-year survival rate of 46.1%. CONCLUSIONS: When given on a weekly basis, the cisplatin/paclitaxel combination is well tolerated, active, and associated to remarkably long survivals.

Lung cancer: clinical presentation and specialist referral time.

Many textbooks describe symptoms and signs of lung cancer but refer to old series of patients. To update knowledge about lung cancer presentation, a study was carried out on 1,277 consecutive lung cancer patients, who were seen in a single Institution from January 1989 to October 2002. A set of 33 anthropometric, clinical, physical, laboratory, radiological, pathological and follow-up variables was prospectively recorded for all patients. In addition, information was obtained concerning symptoms of alarm (i.e. potential concern), times to specialist referral and the mix of symptoms at presentation. Patients were carefully followed-up and their subsequent clinical course was recorded. Casual discovery with absence of symptoms occurred more frequently towards the end of the study period and the prevalence of chest pain became less common. No other time-dependent changes were found in the presenting symptoms. Delay in specialist referral was longer when presentation was provoked by cough or by the occurrence of systemic symptoms, such as weight loss, anorexia and asthenia. Referral delay was longer towards the end of the study, perhaps related to an increase in the number of elderly patients with co-morbidities. Both alarm and prevalence symptoms were strong predictors of the clinical outcome, as found in both univariate analysis (favourable: casual discovery and chest infection; unfavourable: chest pain, dyspnoea, systemic symptoms and symptoms of local or systemic dissemination) and in multivariate analysis (favourable: chest infection). Early presentation of lung cancer is characterised by a specific symptomatic pattern. Knowledge of this pattern may help to improve the rate of early diagnosis.

Lung cancer in North-West Italy: demographic and clinical trends in a hospital-based population of 1277 patients.

This study intends to assess which demographic and/or clinical characteristics of lung cancer - if any - have changed during the last two decades in an Alpine area of North-West Italy. The study was carried out on 1277 consecutive lung cancer patients seen from January 1989 to October 2002 in a single institution. A set of 33 anthropometric, clinical, physical, laboratory, radiological and pathological variables was prospectively recorded for all patients. The date of diagnosis was used to divide the study population in quartiles of diagnostic age (period I: January 1989 to May 1992, 319 patients; period II: June 1992 to September 1995, 319 patients; period III: October 1995 to May 1999, 320 patients; period IV: June 1999 to October 2002, 319 patients). Patients were carefully followed up, and their subsequent clinical course recorded. The following variables showed a significant increasing trend over the years: patients' age, female sex, rate of ex-smokers, level of education, co-morbidity (both the number and the severity of previous pulmonary and extrapulmonary diseases), weight loss, liver enzymes and blood creatinine, carcinoembryonic antigen levels and the rate of adenocarcinomas. On the other hand, performance status, stage of disease, metastatic pattern, treatment modalities and survival expectancy did not change. Therefore, no diagnostic or therapeutic improvements occurring during the last 14 years had a visible impact on patients. It may be that the 'changing face' of lung cancer masked their effects.

Hematologic counts and clinical correlates in 1201 newly diagnosed lung cancer patients.

BACKGROUND: Many factors have prognostic significance in lung cancer. However, their practical value remains controversial except for stage of disease, performance status, and, perhaps, weight loss. METHODS: In the present study, counts of platelet (P), leukocyte (L), neutrophil (N), and hemoglobin serum content (Hb) were analyzed in 1201 new consecutive lung cancer patients. A set of 28 anthropometric, clinical, physical, laboratory, radiological, and pathological variables was prospectively recorded for all patients. Patients were carefully followed-up, and their subsequent clinical course recorded. RESULTS: Anemia, leukocytosis, and thrombocytosis were present in 56%, 32%, and 17% of patients, respectively. Correlation tests showed that P was significantly correlated with L, N and Hb (rs = 0.353, 0.352, and -0.295, respectively). Other significant associations were those between Hb and Karnofsky Performance Status (KPS) (rs = 0.232), weight loss (rs = -0.210), and serum protein (rs = 0.263). N and L were correlated with KPS (rs = -0.217 and -0.186), stage of disease (rs = 0.153 and 0.135) and number of metastasis (rs = 0.121 and 0.109). Univariate analyses of survival showed that: a) abnormal values of L were prognosticantly significant in adenocarcinoma (p < 0.0001); b) patients with Hb < 13 g/dL had significantly shorter survivals (p = 0.0002); and c) thrombocytosis was associated to a poor outcome in patients with adenocarcinoma and epidermoid cancers (p = 0.0061 and 0.0072, respectively). The multivariate model selected, in decreasing order of significance, the following variables: 1) stage of disease; 2) KPS; 3) neutrophils; 4) age; and 5) sex. CONCLUSION: This data indicates that only the leukocyte counts is an independent prognostic factors of survival in lung cancer.

Lung tumour markers in oncology practice: a study of TPA and CA125.

Several substances mark the course of lung cancer and may reliably help the clinician in decision-making. This is the first clinical study specifically designed to compare tissue polypeptide antigen and CA 125 tumour associated antigen. Three hundred and eighty-four new lung cancer patients (309 males) were studied at their first clinical presentation and then strictly followed-up. Anthropometric, clinical and laboratory data - including tissue polypeptide antigen and CA 125 tumour associated antigen serum levels - were prospectively recorded. A total of 1000 tissue polypeptide antigen and CA 125 tumour associated antigen serum assays (384 pre-treatment and 616 posttreatment assays) were performed. Both tissue polypeptide antigen and CA 125 tumour associated antigen correlated significantly with the T, N and M stage descriptors at diagnosis (Rho: 0.200, 0.203, 0.263 and 0.181, 0.240, 0.276, respectively), and then with the objective response to treatment (Rho: 0.388 and 0.207, respectively). A pleural neoplastic involvement was mainly associated to an increase of CA 125 tumour associated antigen (Rho: 0.397). Both tissue polypeptide antigen and CA 125 tumour associated antigen were strongly predictive of the patients' outcome, as assessed by the univariate analysis of survival (log-rank test: 37.24 and 29.01) and several Cox' proportional hazards regression models. The two marker tests are similarly helpful and appear complementary, given the low inter-marker correlation and their independent prognostic capability.

Serum biomarkers facilitate the recognition of early- stage cancer and may guide the selection of surgical candidates: a study of carcinoembryonic antigen and tissue polypeptide antigen in patients with operable non-small cell lung cancer.

OBJECTIVES: Copious literature shows that in lung cancer many serum markers, especially the cytokeratin degradation products, correlate with the extent of disease. In 1995, we suggested the possibility of predicting the resectability of non-small cell lung cancer by measuring the plasma level of the tissue polypeptide antigen, a marker of the cytokeratin family. This study was designed (1) to confirm the earlier data in a new prospective evaluation, (2) to comparatively assess another classic biomarker (ie, the carcinoembryonic antigen), and (3) to incorporate their results into the preoperative evaluation of non-small cell lung cancer. METHODS: We analyzed the database of a single institution over a 5-year period (1994-1998) in a community-based hospital and second referral level institution for a province of 500,000 people. The database included 124 consecutive patients (105 men) with pathologically documented lung cancer (50% with adenocarcinoma) accurately staged, clinically judged operable or potentially operable, and eventually operated on. Anthropometric, clinical, and laboratory data (including the carcinoembryonic antigen and tissue polypeptide antigen serum levels) and the results of a complex staging workup were prospectively recorded. Receiver-operating characteristic curves and diagnostic formulas were used for data analysis. RESULTS: Computed tomography of the thorax, upper part of the abdomen, and brain was the most accurate preoperative method to assess tumor resectability (receiver-operating characteristic area: 0.76, 95% confidence intervals: 0.67-0.86, P =.000; accuracy rate: 77%, confidence intervals: 69%-84%). Tissue polypeptide antigen was also predictive for tumor resectability (receiver-operating characteristic area: 0.62, 95% confidence intervals: 0.51-0.73, P =.035; accuracy rate at a threshold level of 110 U/L: 65%, 95% confidence intervals: 56%-73%). Carcinoembryonic antigen was diagnostic only at the extreme values of its distribution (accuracy rate at a level up to 10 ng/mL: 69%, 95% confidence intervals: 60%-77%). The probability of finding resectable disease at the time of the operation increased from 78% (baseline computed tomography-based probability) to 83% when the concentration of tissue polypeptide antigen was lower than 90 U/L and to 85% when the concentration of carcinoembryonic antigen was below 10 ng/mL. The probability of discovering an advanced disease increased from 68% (baseline computed tomography-based probability) to 89% when tissue polypeptide antigen levels were abnormal and to 100% when carcinoembryonic antigen concentrations were higher than 10 ng/mL. Conversely, the predictability of computed tomography was diminished by contrasting biomarker results, requiring further clinical investigations. CONCLUSIONS: Computed tomography remains the gold standard for the preoperative evaluation of non-small cell lung cancer, although it may significantly underestimate the real tumor extension. The addition of the easy and inexpensive tissue polypeptide antigen test (with or without carcinoembryonic antigen) is capable of correcting this underestimation and helps to decide whether to completely rely on computed tomography or order additional clinical investigations.

Lung tumor markers of cytokeratin origin: an overview.

Lung tumor markers fall into several categories including oncofetal proteins, structural proteins and their fragments, enzymes, membrane antigens, peptide and non-peptide hormones. Cytokeratins (CK) are well known structural proteins whose degradation gives rise to soluble fragments, measurable in the blood of patients and capable of cancer marking. Among them, Tissue Polypeptide Antigen (TPA), Tissue Polypeptide-Specific Antigen (TPS) and Cytokeratin-19-Fragments (Cyfra 21-1) are the most studied CK fragments' complexes. This article will review biological characteristics and clinical properties of these substances, emphasizing as their concentration in the peripheral blood might reflect the mass of tumor, the rate of cancer cell lysis, and other potentially unfavorable tumor characteristics. Assaying the concentration of CK fragments in the blood is an easy and effective way to assess lung cancer and monitor its clinical evolution.

Importance of weight loss definition in the prognostic evaluation of non-small-cell lung cancer.

In both clinical practice and scientific reporting, various definitions of weight loss (WL) are currently in use. A comparison of their efficiency would be appropriate. In this report, we describe the first clinical evaluation of different WL definitions. New consecutive non-small-cell lung cancer (NSCLC) patients (388) were prospectively studied at the Pulmonary Unit of 'S. Croce and Carle' Hospitals from 1995 to 1999. Multiple anthropometric, clinical and pathological data, along with eight WL-related variables, were analysed. Patients' length of survival was estimated using the Kaplan-Meier function and the Cox's multivariate regression. In univariate analysis, all WL variables were prognostically significant. Among them, total WL (i.e. the percent difference between the weight at diagnosis and the last weight recorded while in good health, dichotomised by the threshold level of 11%) was the most significant factor (Log-rank: 29.65, P=0.0000). The best Cox's model for survival prediction, constructed using all the available clinical information, included, in order of importance, the following three factors: stage of disease classification, performance status and total WL. Contrary to what one might expect, WL speedy was less predictive than WL quantity. Evidence from this study suggests that, while the loss of body weight is confirmed a significant prognostic factor in NSCLC, the value of this factor is partially dependent on its definition.

Anthropometric measurements in non-small-cell lung cancer.

There is evidence that malnutrition is an important cause of morbidity and mortality in lung cancer patients and may have an impact on the clinical course of disease. The simplest way to assess nutritional status at the patient's bedside remains recourse to anthropometric measurements. This study was carried out in order to assess the clinical and prognostic significance of triceps skinfold thickness (TST), arm circumference (AC), and wrist circumference (WC) in lung cancer. The patient population was a consecutive series of 388 patients seen for a newly diagnosed primary non-small-cell lung cancer during the last 4 years. A set of 22 anthropometric, clinical, physical, laboratory, radiological, and pathological variables was prospectively recorded for all patients. Patients were carefully followed up, and their subsequent clinical course was recorded. The median values of TST, WC and AC were 8 mm (range 2-25 mm), 18 cm (range 10-27 cm), and 25 cm (range 15-35 cm), respectively. In 107 patients (27.6% of the total) TST values were below the reference value, and 37 of these patients also had a pathologically low small circumference. In all, AC was below the normality range in 60 of the 388 subjects (15.5%). Among the three variables, the strongest relationships were those between AC and WC (r(s)=0.541), and between TST and AC (r(s)=0.521). Univariate analyses of survival showed that TST was strongly predictive of a better prognosis (P<0.001), while WC was unrelated to outcome (P=0.101). Patients with higher values of AC had significantly longer survival than patients with lower values (P<0.018). The multivariate model, in contrast, did not confirm the prognostic capability of any of the anthropometric measures. These data indicate that the anthropometric measures may be significant predictors of survival, although not independently of the other prognostic factors.

Prognostic significance of blood coagulation tests in lung cancer.

Previous studies have shown that activation of coagulation has an impact on the clinical course of lung cancer. This study was carried out to assess the potential prognostic significance of platelet count (P), prothrombin time (PT), partial thromboplastin time (PTT), anti-thrombin III (AT-III), fibrinogen (F), D-dimer (DD), factor II (F-II), factor VII (F-VII), factor X (F-X), protein C clotting (PCC), plasminogen (PL), and antiplasmin (AP) in 343 consecutive new lung cancer patients. A set of 32 anthropometric, clinical, physical, laboratory, radiological, and pathological variables was recorded prospectively for all patients. Patients were carefully followed-up, and their subsequent clinical course recorded. The most frequent abnormalities were of DD, F, and AT-III followed by F-VII, F-X, and F-II. Among the 12 clotting variables, the strongest relationships were those of F-II and F-X (Spearman rank (rs)=0.565), PT and F-VII (rs=0.562), F-VII and F-X (rs=0.514), PL and AP (rs=0.515), F and P (rs=0.490), AT-III and PCC (rs=0.476). Univariate analyses of survival showed that prolonged PT (p<0.043), and abnormally elevated DD (p<0.003), F (p<0.031), and P (p<0.047) were all associated with a poor prognosis. The multivariate model, however, did not confirm the prognostic significance of the coagulation factors. The results show subclinical activation of blood coagulation in lung cancer patients with early disease. In addition, clotting activation is confirmed as a predictor of survival, although not independently of other prognostic factors.

Cytokeratin-derived markers of lung cancer.

Various evaluation methods are available for aiding clinicians in lung cancer management. Some of these methods are highly specific. However, they are also invasive and burdened by non-negligible complication rates (e.g., mediastinoscopy); other methods are highly accurate and noninvasive, but require expensive equipment and well-trained personnel (e.g., PET scanning); others are fast, inexpensive and safe. However, their diagnostic yield is low and requires further clinical testing (an example of such tests is the chest-x-ray film). There is probably only one way to perform an easy, inexpensive, repeatable test, which is also fairly accurate and predictive. This is tumor marker testing, which--as a large and specialized literature shows--can be highly effective when based on a cytokeratin-derived marker assay.

Serum biomarkers of non-neuron-endocrine origin in small-cell lung cancer: a 16-year study on carcinoembryonic antigen, tissue polypeptide antigen and lactate dehydrogenase.

BACKGROUND: Biomarkers of non-neuron-endocrine origin are measured only occasionally in the sera of patients with small-cell lung cancer (SCLC). An exception to this rule is carcinoembryonic antigen (CEA), for which, however, there is no consistent evidence. Based on such a premise, we decided to review the Cuneo Lung Cancer Study Group 16-year-experience with non-neuron-endocrine markers in SCLC. METHODS: a total of 619 CEA, 621 tissue polypeptide antigen (TPA), and 616 lactate dehydrogenase (LDH) serum assays were obtained from 160 consecutive SCLC at diagnosis, during, and after treatment. Demographic, clinical, laboratory, and tumoral correlates were also available for another 25 pretreatment and 14 posttreatment variables. RESULTS: bivariate correlation analyses showed that LDH and TPA were significantly related to each other, and both of them were also correlated with disease extent, and treatment response. LDH correlation indexes were higher than that of TPA, especially those regarding the parameters of disease extent. CEA was correlated only with the category of treatment response. Receiver-operating characteristic (ROC) analysis confirmed the correlation between stage disease at diagnosis and both LDH (P = 0.000) and TPA (P = 0.002), while the treatment failure was better recognized by TPA (P = 0.000). In univariate analysis, both LDH and TPA were correlated with survival (P = 0.000 and 0.092, respectively); however, only LDH remained significant in multivariate analysis (P = 0.012). CONCLUSIONS: the evidence from this study does not suggest a routine CEA test in SCLC. LDH remains particularly useful and it should be kept in use. Finally, data on TPA is insufficient to advocate its systematic use in this type of malignancy.

Second-line chemotherapy for recurrent non-small cell lung cancer: do new agents make a difference?

After a certain degree of nihilism, chemotherapy has become the standard treatment for advanced and metastatic non-small cell lung cancer (NSCLC). The new chemotherapeutic drugs (vinorelbine, taxanes, gemcitabine, and irinotecan) and their associations with cisplatin have shown better response rates and survival in comparison with the standard regimens. This increase of survival is the main motive of the possible consideration of a second-line therapy in NSCLC patients. To this regard, the most promising drug may be docetaxel that, in a randomized trial comprising a best supportive care arm (BSC), documented a response rate of 7.6%, a longer median survival (31 weeks versus 21 of BSC), and a statistically better quality life. Other phase II studies obtained a response rate of 20% and 1-year survival of 40% using docetaxel. Also gemcitabine has shown interesting results in this setting, with a 19% response rate and a median and 1-year survival rate of 34 weeks and 45%, respectively. The activity of paclitaxel is not well defined because of conflicting results and deserves further investigations, while the efficacy of vinorelbine and irinotecan has been dismal. Large randomized trials comparing the treatment arm with best supportive care and a careful analysis of quality of life and cost-effectiveness will be needed to clarify the role of second-line therapy in advanced NSCLC.

Vinorelbine in elderly patients with inoperable nonsmall cell lung carcinoma: a phase II study.

BACKGROUND: Cancer in the elderly is becoming a complex and frequent issue. At least 30% of lung carcinomas are expected to arise each year in elderly patients, who often have significant comorbidity. The most appropriate treatment for this large portion of cancer patients remains unknown. The purpose of this Phase II trial was to make a comprehensive evaluation of the activity, toxicity, and tolerability of single-agent vinorelbine in elderly and relatively poorly performing patients with inoperable nonsmall cell lung carcinoma (NSCLC). METHODS: Patients age 70 years or older were eligible to participate in this trial if they had a pathologic diagnosis, a performance status lower than 4 (Eastern Cooperative Oncology Group [ECOG] scale), and gave informed consent. Vinorelbine was given intravenously (i.v.) at a dose of 25 mg/m(2) every week until progression, persistent toxicity, or refusal. RESULTS: Forty-six patients entered the study; their median age was 75 years (range, 70-83 years). Five patients never started on vinorelbine; 27 others had early treatment suspensions. The median number of weekly infusions was 5 (range, 0-28); the median dose intensity was 70% of projected. Toxicity was generally mild, mainly hematologic, and never life-threatening. ECOG performance status, body weight, and almost all the scores from the quality-of-life questionnaires remained constant during the first 6 weeks of treatment. Two patients obtained partial response, 10 patients had some tumor regression, and 26 had tumor stabilization. The estimated median time to progression was 19 weeks (quartile range, 11-23 weeks), and the median survival 34 weeks (quartile range, 16-63 weeks). CONCLUSIONS: In our group of patients who had poor prognoses, vinorelbine was well tolerated, moderately active, and capable of ensuring relatively long survival. It may represent a valuable therapeutic option for the treatment of nonresectable NSCLC in elderly patients.

Prognostic value of stage grouping and TNM descriptors in lung cancer.

STUDY OBJECTIVES: The International Staging System for Lung Cancer (ISSLC) was revised in 1997. Validation studies are numerous but include only selected surgical patients. This study aims to verify the following: (1) the reliability of the ISSLC in an unselected lung cancer population; (2) the likely improvement in prognostic capability of the new classification; and (3) the possibilities for further improvements. DESIGN: Analysis of a single institution database over a 16-year period from 1983 to 1998. SETTING: Community-based hospital and second referral level institution for a province of 500,000 people. PATIENTS: The study included 1,296 consecutive patients (1,117 men), with pathologically documented lung cancer (46% with squamous cell cancer), staged both clinically (77%) and pathologically (23%), and treated, for the most part, with chemotherapy (52%). INTERVENTIONS: Anthropometric, clinical, and laboratory data were recorded prospectively. Survival analysis was performed by the Kaplan-Meier method and Cox multivariate regression analysis. MEASUREMENT AND RESULTS: The 1997 revised ISSLC classification fit well with the cohort studied. Each stage and substage significantly differed from each other, except for stage IIA. In this stratum, there were only 13 patients. Comparing the 1986 and the 1997 classifications, no substantial differences were observed (log-rank statistics, 295 vs 293, respectively; p < 0.0001). Independent of the classification used, the Cox models were always highly predictive of the outcome. The only way to increase their efficiency was to replace the variable stage with the original TNM descriptors. CONCLUSIONS: Since grouping different TNM subsets into one stage is not really helpful, we might choose to use TNM descriptors in clinical practice and in research.

The difficult choice of chemotherapy in patients with unresectable non-small-cell lung cancer.

The aims of this study were: to assess the attitude of non-small-cell lung cancer (NSCLC) patients to being treated with chemotherapy, determining whether and how much it differs from that expressed by patients with benign diseases or by healthy people; and to investigate how the information received about the treatment may influence the patients' decisions. A three-item self-assessment questionnaire measuring willingness to be treated with chemotherapy and presented according to three different scenarios (with an optimistic, neutral, and pessimistic physician's presentation) was administered to 104 NSCLC patients, 129 other patients with respiratory diseases (RDP), 140 health care providers (HCP) and 120 students (STU). Guttman's coefficient of reproducibility confirms the hierarchical structure of the three scenarios ranging from an optimistic to a pessimistic view. Relative to the other groups, cancer patients showed: (a) a consistently higher degree of uncertainty about whether to accept or reject chemotherapy; (b) the lowest acceptance rate in the optimistic and neutral scenario and, in contrast, the highest in the pessimistic scenario; (c) the highest percentage of constant answers, independently of the scenario presented, particularly as regards the answers "I don't know" (NSCLC = 25%, RDP = 9%, HCP = 2%, STU = 5%) and "Yes, I accept" (NSCLC = 29%, RDP = 31%, HCP = 19%, STU = 16%). Answer patterns differed markedly between cancer patients, the HCP, and the STU group, and in most cases the difference was statistically significant at a confidence level of 0.001. The differences between NSCLC and RDP patients were less marked, and not always statistically significant. The choice between accepting and rejecting chemotherapy is very difficult for patients with NSCLC, much more so than for healthy people, and it is often independent of the way the information is provided.

Serum copper and zinc content in non-small cell lung cancer: abnormalities and clinical correlates.

This study was carried out in order to assess the potential prognostic significance of serum copper (SCL) and zinc levels (SZL) and the copper/zinc ratio in 145 consecutive patients, seen for a new lung cancer during the last 2 yrs. SCL and SZL, along with 26 other clinical parameters (anthropometric, clinical and laboratory variables) were prospectively recorded in all the patients. Mean SCL and SZL were, respectively, 140.4 micrograms.dL-1 (134.7-146.1, 95% confidence interval (CI), and 71.4 micrograms.dL-1 (66.8-75.9, 95% CI). Patients, 28%, showed abnormally elevated SCLs, and 57% of patients had abnormally low SZLs. The mean Cu/Zn ratio was 2.28 (2.10-2.46, 95% CI). Univariate analyses of survival showed that patients with either an SCL > 138 micrograms.dL-1 or an ZSL < 66 micrograms.dL-1 survived significantly shorter times (p = 0.03, log rank test). Elevated Cu/Zn ratios (> 2.075) were associated with a median survival of 25.39 weeks, as compared to the 40.85 weeks of subjects with lower ratios (p = 0.01). A multivariate analysis of survival (Cox's proportional hazards regression analysis) selected, in decreasing order of significance, the following variables: 1) stage of disease; 2) Eastern Cooperative Oncology Group performance status; 3) sex; 4) Cu/Zn ratio; 5) lymphocyte count; 6) histology; and 7) tissue polypeptide antigen levels. It is concluded that SCL, SZL and the Cu/Zn ratio are simple and inexpensive determinations, and do have some prognostic significance in lung cancer.

Efficacy of platinum-based regimens in non-small cell lung cancer. A negative report from the Cuneo Lung Cancer Study Group.

Combination chemotherapy with cytotoxic agents is the regular treatment for patients with advanced non-small cell lung cancer (NSCLC), good performance status, and no major clinical contraindications. Since the early 1980s, platinum-based chemotherapy is the cornerstone of this treatment, while combinations containing long-acting alkylating agents have been nearly abandoned, and represent a sort of historical treatment. Nevertheless, the real survival benefits of cisplatin are uncertain and still debated. To attempt an answer, the Cuneo Lung Cancer Study Group (CuLCaSG) carried out a clinical trial comparing a platinum (MVP) versus a non-platinum-based combination chemotherapy (MACC). The study comprised 156 patients with advanced NSCLC randomly assigned to the two treatment arms. MACC and MVP chemotherapies were given as originally described and continued until progression of disease, unacceptable toxicity, or refusal by the patient. For a medium of four cycles of MVP and three cycles of MACC, the median dose intensity (DI) reached was, respectively, 95% and 100% of the intended (P = 0.0132). In all, 27 objective responses (1 complete and 16 partial responses in patients allocated to MVP versus 10 partial responses of the MACC group) were observed. Median progression-free and global survivals were, respectively, 21 and 34 weeks for MVP and 20 and 31 weeks for MACC (non-significant differences). The treatment plan was found non-significant also multivariate analysis of survival. Toxicity was rather similar in the two arms, except for more severe neurological toxicity, anemia, thrombocytopenia, nausea, and vomiting in patients on MVP. Alopecia was more common after MACC. Subjective tolerance to treatment, and perception of physical and psychological well-being were rated similarly by patients of both groups. In conclusion, MVP was moderately more active than MACC, and showed a foreseeable and reversible toxicity, of a low-medium grade. However, this CuLCaSG study failed to substantiate any survival benefit from the use of platinum in combination with other cytotoxic agents.