Atelectasis: positive or negative prognostic factor on outcome of patients with non-small cell lung cancer?

PURPOSE: the aim of this study was to evaluate the influence of atelectasis (AT) on overall survival of patients with non small cell lung cancer (NSCLC). METHODS: the study included patients of both sexes with unresectable stage III and IV NSCLC with good performance status (PS) (ECOG ≤ 2). Patients were divided into two groups: with AT (AT+) and without AT (AT-): Factors analyzed included sex, age, histologic type, ECOG performance status, stage of disease and treatment modality. Overall survival was estimated according to Kaplan-Meier method, and multivariate analysis was used to identify independent prognostic factors. RESULTS: we evaluated 247 patients (83% males and 17% females); 47/247 (19%) of patients belonged to AT+ group. In this group 21% of patients had stage IIIA, 46% IIIB stage, and 33% IV stage. Overall survival was significantly longer in the AT+ group (15.23 vs. 9.03 months, p=0.001). AT+ patients in stages III and IV had significantly longer overall survival than AT- patients in the same stages (p=0.001, p=0.002, respectively). Multivariate analysis showed that atelectasis (p=0.001), stage of disease (p=0.001), and treatment modality (p=0.005) were independent prognostic factors associated with survival. CONCLUSION: atelectasis is favorable prognostic factor concerning overall survival in patients with NSCLC.

Aprepitant--where do we stand in the control of chemotherapy-induced nausea and vomiting?

Despite progress in the area of supportive care in oncology in the last two decades, nausea and vomiting continue to be significant side effects of cancer therapy. These symptoms can escalate over time and can result in patients' refusal to continue with chemotherapy. Introduction of serotonin (5-HT3) receptor antagonists was a major therapeutic advance in the treatment of chemotherapy-induced nausea and vomiting with enhanced efficacy when corticosteroids were added. However, these agents have limited protection in the acute phase of chemotherapy-induced nausea and vomiting with little or no effect over the delayed phase. The aim of this review was to introduce a new class of antiemetics, a selective high-affinity antagonist at human substance P neurokinin 1 (NK(1)) receptors-aprepitant. Its pharmacological characteristics as well as its efficacy are reviewed. Aprepitant appears to be well tolerated but, due to its inhibitory effect on cytochrome P450 isoenzyme 3A4, it can lead to significant drug interactions, resulting in need for dose modification of concomitant therapy. The addition of aprepitant to 5-HT(3) receptor antagonists and corticosteroids was found to be superior to the combination of 5-HT(3) receptor antagonists and corticosteroids alone in patients treated with highly and moderately emetogenic chemotherapy. Clinical trials with aprepitant and other antiemetic agents are warranted to determine a regimen that will ensure complete protection from both acute and delayed chemotherapy-induced nausea and vomiting, thus contributing to improved supportive care and patients' quality of life (QoL).

The influence of dexamethasone in the decrease of chemotherapy-induced nausea and vomiting.

PURPOSE: The aim of this study was to determine the influence of dexamethasone in the decrease of cisplatin and etoposide-induced nausea and vomiting in patients treated for lung cancer during and after 2 chemotherapy cycles. PATIENTS AND METHODS: The analysis included 60 patients with histologically proven lung cancer, who were divided in two groups. Group A consisted of 30 patients who received cisplatin and etoposide with standard antiemetic drugs: ondansetron [serotonin receptor antagonist (5-HT(3) antagonist)] and metoclopramide (dopamine receptor antagonist). Group B consisted of 30 patients who received the same chemotherapy regimen with the previous antiemetic therapy plus dexamethasone 8 mg intravenously (i.v.) per day during the 3 days of chemotherapy. During and after the 3-day therapy, patients filled in a questionnaire issuing adverse effects of chemotherapy concerning many symptoms including nausea and vomiting. The results were statistically processed. RESULTS: There was a significant decrease in the frequency and toxicity of nausea, acute and delayed vomiting in the group of patients who received antiemetic treatment with ondansetron, metoclopramide plus dexamethasone. CONCLUSION: Dexamethasone administered with 5-HT(3) antagonists and dopamine receptor antagonists significantly decreases the chemotherapy-induced nausea and vomiting.

[Sarcoidosis activity markers]. / Markeri aktivnosti sarkoidoze.

Sarcoidosis is a granulomatous multisystemic disorder, of unknown origin, that commonly affects young adults between 20-40 years of age. The disease usually manifests itself with changes in the chest which are radiologically visible in 90% of the patients in the form of bilateral hilar lymphadenopathy to interstitial infiltrates in the lungs and bronchi. Once the diagnosis of sarcoidosis has been established, the next step is to evaluate the activity and stadium of the disease. These activity markers include clinical, biochemical and immunological parameters. The clinical criteria include symptoms which indicate the clinical manifestation of sarcoidosis, as well as symptoms which are of prognostic importance for the further course of the disease: dry cough, dyspnea, erythema nodosum, posterior uveitis, polyarthralgia, myopathy, cardiac, renal or nervous system involvement, lymphadenopathy, skin lesions, splenomegaly, enlarged parotid and lacrimal glands, changes in chest x-ray and changes in pulmonary function tests. Biological criteria: biochemical markers in serum which are related to: macrophage and epithelioid cell activity, to lymphocyte activity, to granuloma activity and to collagen metabolism alterations; isotopic markers--67 gallium scan and cellular and soluble components in bronchoalveolar lavage fluid (BAL).