Neoadjuvant chemoradiotherapy of stage III non-small-cell lung cancer.

Twenty to 30% of patients with non-small-cell lung cancer (NSCLC) in stage III are not resectable primarily with 5-year survival less than 10%. Since the majority of patients die from metastases, efforts have been made in the past to improve prognosis by application of neoadjuvant chemoradiotherapy regimens followed by subsequent resection. In a phase II study performed between 1993 and 1998, 93 patients in stage III (IIIA, 16%; IIIB, 84%) received an induction chemotherapy consisting of two cycles cisplatin (100 mg/m2) and vindesine (3 mg/m2) with subsequent sequential radiotherapy of 36 Gy. Sixty-five patients demonstrated partial or complete remission. Sixty underwent surgery; in 49 of them complete resection was possible. Five-year survival in the whole group was 24%, and that in the surgical cohort 39%. Six patients had no residual tumor. Postoperative N0 status was associated with a 5-year survival of 75%, and stage N1-3 with 13%. Thirty-day mortality was 7% postoperatively. Neoadjuvant chemoradiotherapy can significantly improve long-term survival in stage III NSCLC with an acceptable therapy-induced mortality.

Childhood psychopathology in families with multigenerational alcoholism.

The present study examined psychopathology in high-risk children (ages 8 to 18) from families with a multigenerational history of alcoholism and contrasted them with low-risk children from community control families. Similar rates of childhood disorders were found for the high- and low-risk groups whether or not the children lived with an alcoholic parent. These findings suggest that the increased psychopathology commonly reported for children of alcoholics arises from comorbidity within the extended family as a result of assortative mating. When comorbidity is reduced through the selection of families with only alcoholism, a different symptom picture emerges.

Cyclic-alternating versus response-oriented chemotherapy in small-cell lung cancer: a German multicenter randomized trial of 321 patients.

To test whether alternating chemotherapy is a favorable treatment modality in small-cell lung cancer (SCLC), 334 patients were randomized to receive either fixed cyclic-alternating treatment with ifosfamide/etoposide (IE), cyclophosphamide, doxorubicin, and vincristine (CAV), or response-oriented treatment with IE therapy up to maximal response and subsequently an immediate switch to CAV. In both arms, six cycles were given in 3-week intervals. After chemotherapy, patients with limited-stage disease received chest irradiation with 45 Gy. Prophylactic cranial irradiation with 30 Gy was applied to all complete responders. No maintenance therapy was given to patients with complete response. Minimum follow-up was 2 years. Of 321 assessable patients, the overall response rate was 70% for cyclic alternating and 77% for response-oriented treatment. Complete remission (CR) rates were 26% versus 26%. The median survival times were 9.7 months for cyclic-alternating versus 10.7 months for response-oriented treatment; the 2-year survival rates were 11% versus 9%. In limited-stage disease (LD) patients, there was a median survival of 12.5 months versus 12.3 months and a 2-year survival rate of 21% versus 18%. In extensive-stage disease (ED) patients, median survival was 8.5 versus 9.1 months, and the 2-year survival rate 3% versus 4%. From these results, we conclude that the cyclic-alternating treatment according to the hypothesis of Goldie et al has no advantage in comparison to a sequential treatment strategy with an immediate switch to a second-line protocol at the time no further response to first-line therapy is seen. Our major aim in the treatment of SCLC is to administer an active regimen at any time during the course of treatment regardless of whether sequential or alternating therapy is used.

[EPICO in the treatment of small cell bronchial cancer. 3. Intermediate analysis]. / EPICO für die Behandlung des kleinzelligen Bronchialkarzinoms. 3. Zwischenanalyse.

61 patients with untreated small cell lung cancer were treated with a combination of epirubicin 70 mg/m2, cyclophosphamide 1,000 mg/m2 and oncovin 2 mg every 3 weeks. The mean age of patients was 57 years. 51 patients were evaluable. 30 patients were classified to the stage limited disease, 21 patients to extensive disease. 9 complete and 23 partial remissions were achieved (remission rate 64%). The overall survival was 14 months, the mean survival of responders 16 months. 32 patients were alive at the end of the study. Performance status and extent of disease influenced significantly the result of treatment. The cytostatic activity of EPICO is comparable to three other drug combinations. The benefit of EPICO might be the lower cumulative toxicity of epirubicin and therefore enabling a longer duration of treatment.