Paclitaxel and G-CSF in previously untreated patients with extensive stage small-cell lung cancer: a phase II study of the North Central Cancer Treatment Group.

Paclitaxel is an antimicrotubule agent that interferes with cell division. It has demonstrated promising single-agent activity against non-small-cell lung cancer. The purpose of this study was to evaluate the therapeutic effectiveness of paclitaxel in previously untreated patients with extensive stage small-cell lung cancer (SCLC). The study was designed as a two-stage phase II trial. All patients who entered received paclitaxel by intravenous infusion at a dose of 250 mg/m2 during 24 hours. Granulocyte colony stimulating factor was also provided to ameliorate neutropenia. Cycles were repeated at 21-day intervals. Patients who achieved a complete response received a maximum of 10 cycles of treatment, whereas those who achieved a partial response/regression continued treatment until progression or undue toxicity developed. Patients who progressed or maintained stable disease for six cycles were crossed over to cisplatin and etoposide. Forty-three patients entered the study and all were evaluable for analysis. Responses were observed in 23 (53%) of the patients. There was no significant difference in the response rates in patients with measurable or evaluable disease (13/23 versus 10/20, p = 0.76). At the time of analysis, 39 patients had progressed with a median time to progression of 95 days, and 39 patients had died with a median survival of 278 days. The 1-year achieved survival rate was 24%. Significant neutropenia (absolute neutrophil count <1,000/microl) occurred in 24 (56%) of the patients, but only 2 patients experienced severe infection (grade > or = 3), and there were no septic deaths. The results indicate that paclitaxel is active against SCLC. Myelosuppression was the main side effect in this patient population. Response duration was short (median = 3.4 months), which suggests that paclitaxel is not sufficient as a single agent. Further studies of paclitaxel in combination with other agents against SCLC are currently in progress within the North Central Cancer Treatment Group and other cancer treatment groups. Key Words: Paclitaxel-G-CSF-Small-cell lung cancer-North Central Cancer Treatment Group.

The relationship of different power settings and fiber geometries to thermal tissue damage created by the superpulse Nd:YAG laser.

We attempted to quantify the amount of thermal damage that was created to surrounding tissues when an incision was made with the superpulse neodymium:yttrium-aluminum-garnet (Nd:YAG) laser with the optical fiber in contact. Light micrographic studies of several incisions, at different laser power settings and with different fiber geometries, were made in the anterior abdominal wall of 16 Sprague-Dawley rats. The specimens were collected immediately postoperatively and at 48 hours postoperatively. Several laser power settings (2-50 W) and seven different optical fiber geometries were studied. The micrographs showed minimal damage (<0.1 mm) to surrounding tissues at all laser power settings in both the immediate and the 48-hour studies. The superpulse Nd:YAG laser with optical fiber contact limited laser thermal damage to the surrounding tissues to less than 0.1 mm in the range of power settings studied. Higher power settings minimally increased the damage. The geometries of the optical fiber created no significant alteration in thermal damage. The results suggest that the superpulse Nd:YAG laser creates both thermal and photodisruptive effects in tissue.

Comparison of tissue effects with sculptured fiberoptic cables and other Nd:YAG laser and argon laser treatments.

The use of a fiber optic cable in contact with tissue results in a complex thermal interaction between the cable and the tissue. The effect of the laser-tissue interaction was investigated using sculptured quartz fiber optic cables, sapphire contact rods, and bare fiber optic cables attached to the Nd:YAG laser. The laser-tissue effects of the Nd:YAG and argon lasers were compared. Examination of treated animals showed there to be a significant difference between immediate and 48-hour thermal effects. The sculptured fibers created significantly less tissue damage than the sapphire contact tips, the 0.6-mm bare fiber, or the argon laser with a 0.3-mm bare fiber either with or without contact. All Nd:YAG laser contact treatments were less damaging than the argon laser treatments.

Influence of scan and pathologic criteria on the specificity of cholescintigraphy: concise communication.

The influence of scan and pathological criteria on the specificity of cholescintigraphy was assessed by a prospective study of 211 patients with suspected acute cholecystitis who underwent cholescintigraphy. Sufficient data were available in all to confirm a final diagnosis. Cholescintigraphy was performed in the standard fashion using 5 mCi of Tc-99m disofenin. Sixty patients had acute cholecystitis, 64 had chronic cholecystitis, and 87 had no demonstrable gallbladder disease. As the scan and pathological criteria for acute cholecystitis were varied from strict to liberal, the sensitivity of cholescintigraphy decreased (100% to 95.3%), the specificity increased (85.1% to 98.6%, and the predictive value increased (68.4% to 96.8%). The use of strict scan and pathological criteria for acute cholecystitis obscures the advantages that accrue from such early detection of acute cholecystitis by cholescintigraphy, and thus are to be avoided. To understand the disparate opinions voiced in the literature, an appreciation is required for the effects of changes in criteria on the specificity and predictive value of cholescintigraphy.