Concurrent palliative chemoradiation leads to survival and quality of life benefits in poor prognosis stage III non-small-cell lung cancer: a randomised trial by the Norwegian Lung Cancer Study Group.

BACKGROUND: The palliative role of chemoradiation in the treatment of patients with locally advanced, inoperable non-small-cell lung cancer stage III and negative prognostic factors remains unresolved. METHODS: Patients not eligible for curative radiotherapy were randomised to receive either chemoradiation or chemotherapy alone. Four courses of intravenous carboplatin on day 1 and oral vinorelbin on days 1 and 8 were given with 3-week intervals. Patients in the chemoradiation arm also received radiotherapy with fractionation 42 Gy/15, starting at the second chemotherapy course. The primary end point was overall survival; secondary end points were health-related quality of life (HRQOL) and toxicity. RESULTS: Enrolment was terminated due to slow accrual after 191 patients from 25 Norwegian hospitals were randomised. Median age was 67 years and 21% had PS 2. In the chemotherapy versus the chemoradiation arm, the median overall survival was 9.7 and 12.6 months, respectively (P<0.01). One-year survival was 34.0% and 53.2% (P<0.01). Following a minor decline during treatment, HRQOL remained unchanged in the chemoradiation arm. The patients in the chemotherapy arm reported gradual deterioration during the subsequent months. In the chemoradiation arm, there were more hospital admissions related to side effects (P<0.05). CONCLUSION: Chemoradiation was superior to chemotherapy alone with respect to survival and HRQoL at the expense of more hospital admissions due to toxicity.

[Decentralized special training in pulmonary medicine. A project using telemedicine]. / Desentralisert spesialistutdanning i lungesykdommer. Et prosjekt med bruk av telemedisin.

In arctic Norway, where there is a lack of specialists in pulmonary medicine two postgraduate students, already qualified as specialists in internal medicine at Tromsø Regional Hospital, applied to continue their training at their respective local hospitals. The regional hospital in Tromsø has a long tradition of telemedicine, with network links to local hospitals in the region, and is equipped for interactive consultation and the bilateral transmission of x-rays and video recordings, and digital transmission of x-rays. Accordingly, supported by their supervisor, the two postgraduate students applied to the committee for postgraduate education in pulmonary medicine to have a year's work at their respective local hospitals, supervised via the telemedicine facilities, accepted as equivalent to a six-month module of the normal syllabus. The project was approved and executed as planned. The registrars, who were responsible for pulmonary service at their local hospitals, served four days a month at the regional hospital, and their supervisor visited the local hospitals one day each month. All internal education at the regional hospital was made available by means of a weekly interactive televised link-up, x-rays being displayed on screen as transmitted digitally; bronchoscopies were shown by video, and ad hoc tutorials arranged as needed. Evaluated by the national committee, the project was found satisfactory, and the registrars were duly qualified.

Survival of Danish cancer patients 1943-1987. Lymphatic and haematopoietic tissues.

In Denmark, 6.6% of all malignant neoplasms among men and 5.5% among women occur in the lymphatic and haematopoietic tissues. Most are generalized when diagnosed, although lymphomas are sometimes confirmed to one region. Treatment has been predominantly by chemotherapy since the 1960s, and is often combined with radiation for lymphomas and myeloma. The five-year survival rates for non-Hodgkin's lymphoma improved by 20% between 1970 and 1987. An improvement in survival from Hodgkin's disease began earlier, with a relative five-year survival rate of about 30% in 1960 and of 72% in 1983-87. Survival was better for younger patients (< 50 years) with stage I-II disease, the relative five-year survival rates being 83-93% in 1983-87. For cases of leukaemia much of the improvement in survival rates was founded in 1960s on success in the treatment of childhood leukaemia (acute lymphatic leukaemia); the relative five-year survival rates for children under 10 years of age increased from 12% to 75-80%. Smaller improvements were seen in survival from other types of leukaemia, including the chronic forms. Thus, even for chronic lymphocytic leukaemia, which has a favourable prognosis but is regarded as incurable, improvements in survival rates were seen, which may be attributed to chemotherapeutic treatment or earlier diagnosis. It was not surprising that the dramatic improvement in survival rates coincided with the introduction of chemotherapeutic treatment regimes, as reported previously in clinical series. Acute and chronic cytotoxic side-effects are of concern, and, since both cytotoxic drugs and radiation are potent carcinogens, second primary cancers have been reported to be induced by treatment of cancers (Storm & Prener, 1985). The improvements in the survival rates for the haematopoietic malignancies, however, outweigh the de novo cancer risk related to therapy.