Cisplatin-docetaxel induction plus concurrent 3-D conformal radiotherapy and weekly chemotherapy for locally advanced non-small cell lung cancer patients: a phase II trial.

Concurrent chemoradiotherapy (CHRT) is the standard of care for unresectable locally advanced stage III non-small cell lung cancer. However, the optimal combination remains unclear. The aim of this study was to evaluate the efficacy of 2 induction chemotherapy cycles (days 1 and 22) with docetaxel 75 mg/m(2) and cisplatin 75 mg/m(2) followed by concurrent chemotherapy (weekly docetaxel-cisplatin, 20 mg/m(2)) and 3-D conformal radiotherapy for 6 weeks (66 Gy/5 fractions per week/2 Gy per fraction). The primary endpoint was the response rate. Secondary objectives were toxicity, time to progression, and overall survival. Forty-four patients were included and 40 were eligible. The mean age was 60.5 years (range 40.7-72.1), and 75% had stage IIIB disease. Six patients underwent complete R0 resection including 2 pathologic complete responses after a planned intermediate evaluation. Thirty-three patients completed CHRT. The objective response rate was 65% (95% CI 50.2-79.8). Grade 3-4 hematologic and digestive toxicities were observed mainly during the induction phase. Grade 3 esophagitis (5%) was experienced during CHRT. With a median follow-up of 38.7 months, the median progression-free survival was 28.3 months (95% CI 11.0-35.0) and the median survival rate was 31.4 months. Cisplatin-docetaxel induction followed by concurrent 3-D conformal radiotherapy and weekly chemotherapy is a feasible protocol associated with a promising response rate and acceptable toxicity.

Surgical treatment of chronic pancreatitis. Report of 134 cases treated by resection or drainage.

One hundred thirty-four patients (123 men and 11 women) were operated on for chronic pancreatitis (69 pancreaticojejunostomies, 20 cytopancreaticojejunostomies, 22 left pancreatectomies, and 23 Whipple operations). Half of these patients were followed up for 5 years or more. Four patients died from cancer of the pancreas. The operative mortality rate was 4.2 percent after anastomosis, 13.5 percent after pancreatectomy, and 8.7 percent after a Whipple operation. Relief of pain was the main aim of operation. The rate of good results after pancreaticojejunostomy (85 percent) was higher than after resection (71 percent after right pancreatectomy or Whipple operation and 66.6 percent after left pancreatectomy). The mortality rate after 5 years 26 percent after anastomosis, 30 percent after Whipple operation, and 45 percent after left pancreatectomy. Alcoholic intake did not appear to influence the operative result but improved the quality of life of the patient. Postoperative complications are more common and more serious after resection than after anastomosis. If dilated, the common bile duct must be drained as well as the pancreatic duct after anastomosis. Whenever the pancreatic duct is dilated more than 8 mm it must be drained rather than resected.