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Intensive preoperative chemo-radiotherapy including hyperfractionated accelerated radiotherapy for locally far advanced (LAD) NSCLC
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CONCURRENT DAILY CARBOPLATIN PLUS THORACIC RADIOTHERAPY (TRT) IN UNRESECTABLE NONSMALL CELL LUNG CANCER (NSCLC) Yuji Kawaguchi, Kiyoyuki Furuse, Masaaki Kawahara, Nagahisa Kodama, Mitsumasa Ogawara, Shinji Atagi, Tatsuya Okada, Takao Kamimori, Mitsuhiro Yoshida, Mitsunobu Nakao, Masashi Yamada, Department of Internal Medicine, National Kinki-Central Hospital for Chest Diseases, Sakai, Osaka 591, Japan. Between Oct. 1992 and Apr. 1993 patients (pts) with locally advanced and unresectable stage I, III, NSCLC entered a trial of concurrent II, daily carboplatin plus TRT to determine efficacy and toxicity. Pts were treated with daily carboplatin 30 mg/m' by intravenous infusion 5 times a week(wk) with 3-wk(every other wk and every wk) and 4-wk schedule. 2Gy-daily TRT was done 5 times a week after carboplatin within an hour till total 50-6OGy. WHO grade ~3 hemotologic toxicity was not seen in 8 pts who were given carboplatin with every other week. 5 pts were treated with carboplatin during lst-3rd week. Grade 3 leukopenia was seen in one of them. Then 2 pts were treated with carboplatin during lst-4th week. Grade 3 leukopenia was one of two. seen in Non hematologic toxicities were mild except for grade in 3 pts of all. No treatment 3 esophagitis delays were required in any pts. Overall there was 8 PR of 15 eligible pts. Response rate was 53.3%. This combined modality treatment of NSCLC could be administered with acceptable toxicity. This regimen is under way for the treatment of elderly non-small cell lung cancer pts.
COMPARATIVE RETROGRADE STUDY OF POSTOPERATIVE CHEMOTEERAPY FOR NON-SMALL CELL LUNG CANCER Shigeki Sugiyama, K. Yamamoto, T. Yamaguti, S. Koyamd, T. Ikeya, T. Misaki. First Department of Surgery, Toyama Medical and Pharmaceutical University, Japan. Postoperative chemotherapy in lung cancer such as combined CDDP can be effective for a patient's survival. We tried to evaluate survival rates of postoperative chemotherapy of CEV(CDDP, VP-16, Epirubicin) vs. MAF(5-FU, ADM, MMC). From January 1982 to December 1990, 141 consecutive patients with histologically confirmed non-small cell lung cancer were divided into three groups: The first group of 72 patients had received no postoperative chemotherapy; The second group of 29 patients had received one to two cycles of RAF postoperatively. The third group of 40 patients had received CEV postoperatively. The median age of the 69 patients treated with preoperative chemotherapy was 62.5 years, and the male to female ratio was 1.7: 1. There is no statistical differentiation on the average age or the sex ratio for these groups. The five-year survival rates of stage I cases in the nonchemotherpic group, the CEV and the RAF group were 0.342, 0.464 group and 0.7, respectively. The five-year survival rates of stage III cases in each group were 0.25 and 0.357, respectively. As 0.066, regards patient survival, the CEV chemotherapy survival rates than superior group obtained did the other groups.
714
715
~xlRGEwpm,RADIonEvAFfFOR ITRAEGFERFACIORAEJWPHT~ EHxxG9uccARc~(~):DEFINITIVE~EcFpHpsEIISniQY. 'Blotta A.B.*,E?Jsutti L.*,PiuaG.C.O,C.&Vi.xi",Mas~illiM.",schi+ vinaM.',Cipolla D'Abruzzc G.^- *Rz&~th~,,~Ex@rjn~i+l Imnnology,
INTENslVE PREOPERATIVE CRFM~RAD10THERAPY INCLIJDUNG RVPFJlFRACl’I0NATF.D ACCRLERAlED RADIOTHERAPY FOR LOCALLY FAR ADVANCED (LAD) NSCXC. W.Eb&wdt, J&W&, G. Stamatk+R.Krmls& MshlschLL, M. stab& M.R_ Mltikr, L..Scbknger, G.Tlrml , M.R.N owraaaian, D. Grucbucbna , N. Konktzbo, and Ssaber. Dcpt Int. b&d. (Cancer Re.), Ensen Univenity Medii &boo& Enu $&many. Since Ml,63 p&&a (ptr) with LAD-NSCL4Z( mulkstinoeopy obl@tony) have been eatered into 111ongoing trkl with 3 cy&J ofckpktk (P) (60 m&n’
I~~,
'Rgpirology,S.~l~~Hrspital,Bol~;~S.MarinoGe-
rwalWspital-Italy wehave analyzed151pts. affectedby E%lc treated in tw@nqs fmn 1982ti1986;thefirst(85pts.) ~atibysurgeryandraditie=Wly (S&Q) frcm1982to1984, &the seca?d(66pts.1byStwr+TF (Trn sferFacti)fXm1935t~1986 (follonrup61Oyears).TF extzwztedfran lynphoid cellsof bealtybleeddaKns wlunlteers was achinistered firstly 3weeksaftertheendofradiotherapyatthe singledoseof2.108l~h~ s&sqwntly everythreewnt& forfiveyearsor at the cytespertitit; ~tisiteprogressicnofdisease.Tne~tsshaus: A) actusrial survivalby stage:S+Fxr:stageIl?@s.=atf/o; stqe II 22pts.ti; stageIII Eopts.=ll~S+Rxr+TF: stageI llpts.~,stageII~pts.-a, stage IIIEEpts.=31%. B) Timeatlrmgressionbyhistology: squanau~ cellca. &x-ox 1Chx. S+RXT;16m.S+FXT+TF 2Jmnths. (m.) &W; 26m. S+XT+'IF; C)FortJx imnnolcgical statusareevalUableswithPFX skintest51/ffi pts.of these36 werepositive zmd15 negative at thestartof therapy. 20/51pts.arrevalubl~ after3 injecticn: of these 8/ZQhaveincrease ofnzacticns, 7/2oncllchinge, and5/20decrease. At61OyearsOf'follaV up -NEE alive4/8ofthefirstgnxp,1/7ofthesecond, 0/50fthe last. We~ludethattheefficacyof'ITacfninistrationwas~~~in lcmgtermfollavuppts. ,with inpm%vmentofsumival andthetimeof pogressicnandtiePFlZ skirtestpointand thisbeneficial effectifthe mtivity is irxresd. After this result.5 Of the-Z&Ed fOllaVUp wehaves~in1993arsndanized~Sc~v-~St-~+~.
d1+7)MdoCetoporideQ(lMmdmdl3.~,qddf~ed~onc~~ sim~~~RTxlcFr(4SGy,l~~Ggt~icc~vitLin3w~lrr; PSOmghn’d 2+9of RTx, E 100 mgM d 4,5,6 of RTx) followed b ~medkstinoscopy and opelmtbm. 64 pta are cllmntiy off ~tmellt. THEIR CRARACTF,RISTIcs: m/f 48/l6 :a~ SS(31-67);PS1(0_1);lDa(~1medkstinll lymph node #tation invohxd) 36, mb 2a;sqmamons all cs 3% ukno u u, krge all wpkstic Ca 10. aESaTsIffa~eCR4;PR33,CRlPRss~MR16NC7;PDJ.TOXKXTY (WHO): kueopmir. 30 23%, 8 8%; infcctiolI 39 3% 40 3% tbromb+ cytqwk 3ONo 19%; dkrrba Jo 3%; 2 ptr dkd in septic sbocb. RESULTS after CTxIRti fbrtbcr sigeitlcant response hpmvement in 8 pb; Toxkity (WRO): kwopmk 30 37% 40 4%; thromboqtopenk Jo 10% 40 4%; aopblg& J”/40 41%. RESULTS after Op: (n-40) RO twection ntc 34 (83%)&R: 17(43%), Rl-rrrection 4, R2-tweetion 2; 1 euly postoperative de& 2 dekyed postoperative deaths; 12/40 tw. pts have rd8pscd so br (S CNS, 1 liver, 1 bone, i SU+~~LN, 1 lympb~giwh wcinom8ton Inn& 1 mediutinal ,l local). RESULTS of ti 64 “off&mtmcnt” m: VCR 17(27%): RO/NF.D17(27%),
pcR/NED34(53%); ovmllra&i&&
63H;‘truLmltmJtcomplet&
(medical reams) 4, PD during eh +/- RR 5; CR dboo&mwd 1;CTwRTx ~2;OP~2;~bk~~~L,rrutgdatlu4;med~ observation time 11 montba f6+-32+Umo~.nedkn swvival time of all ti 16 mo fti2+), m 16 mo (SC32+);IUb 26;lo &32+), pk _ dtb N,$D (‘,t$~t&kb jZmo(i+-32+). CONCLUSlONSz Tbk intcwive prtqerative prqam k toknbk mtd biik effective for bxallv fu ldvlacal &AD) NSCLC. A randomi& trkl with
713
CONCURRENT DAILY CARBOPLATIN PLUS THORACIC RADIOTHERAPY (TRT) IN UNRESECTABLE NONSMALL CELL LUNG CANCER (NSCLC) Yuji Kawaguchi, Kiyoyuki Furuse, Masaaki Kawahara, Nagahisa Kodama, Mitsumasa Ogawara, Shinji Atagi, Tatsuya Okada, Takao Kamimori, Mitsuhiro Yoshida, Mitsunobu Nakao, Masashi Yamada, Department of Internal Medicine, National Kinki-Central Hospital for Chest Diseases, Sakai, Osaka 591, Japan. Between Oct. 1992 and Apr. 1993 patients (pts) with locally advanced and unresectable stage I, III, NSCLC entered a trial of concurrent II, daily carboplatin plus TRT to determine efficacy and toxicity. Pts were treated with daily carboplatin 30 mg/m' by intravenous infusion 5 times a week(wk) with 3-wk(every other wk and every wk) and 4-wk schedule. 2Gy-daily TRT was done 5 times a week after carboplatin within an hour till total 50-6OGy. WHO grade ~3 hemotologic toxicity was not seen in 8 pts who were given carboplatin with every other week. 5 pts were treated with carboplatin during lst-3rd week. Grade 3 leukopenia was seen in one of them. Then 2 pts were treated with carboplatin during lst-4th week. Grade 3 leukopenia was one of two. seen in Non hematologic toxicities were mild except for grade in 3 pts of all. No treatment 3 esophagitis delays were required in any pts. Overall there was 8 PR of 15 eligible pts. Response rate was 53.3%. This combined modality treatment of NSCLC could be administered with acceptable toxicity. This regimen is under way for the treatment of elderly non-small cell lung cancer pts.
COMPARATIVE RETROGRADE STUDY OF POSTOPERATIVE CHEMOTEERAPY FOR NON-SMALL CELL LUNG CANCER Shigeki Sugiyama, K. Yamamoto, T. Yamaguti, S. Koyamd, T. Ikeya, T. Misaki. First Department of Surgery, Toyama Medical and Pharmaceutical University, Japan. Postoperative chemotherapy in lung cancer such as combined CDDP can be effective for a patient's survival. We tried to evaluate survival rates of postoperative chemotherapy of CEV(CDDP, VP-16, Epirubicin) vs. MAF(5-FU, ADM, MMC). From January 1982 to December 1990, 141 consecutive patients with histologically confirmed non-small cell lung cancer were divided into three groups: The first group of 72 patients had received no postoperative chemotherapy; The second group of 29 patients had received one to two cycles of RAF postoperatively. The third group of 40 patients had received CEV postoperatively. The median age of the 69 patients treated with preoperative chemotherapy was 62.5 years, and the male to female ratio was 1.7: 1. There is no statistical differentiation on the average age or the sex ratio for these groups. The five-year survival rates of stage I cases in the nonchemotherpic group, the CEV and the RAF group were 0.342, 0.464 group and 0.7, respectively. The five-year survival rates of stage III cases in each group were 0.25 and 0.357, respectively. As 0.066, regards patient survival, the CEV chemotherapy survival rates than superior group obtained did the other groups.
714
715
~xlRGEwpm,RADIonEvAFfFOR ITRAEGFERFACIORAEJWPHT~ EHxxG9uccARc~(~):DEFINITIVE~EcFpHpsEIISniQY. 'Blotta A.B.*,E?Jsutti L.*,PiuaG.C.O,C.&Vi.xi",Mas~illiM.",schi+ vinaM.',Cipolla D'Abruzzc G.^- *Rz&~th~,,~Ex@rjn~i+l Imnnology,
INTENslVE PREOPERATIVE CRFM~RAD10THERAPY INCLIJDUNG RVPFJlFRACl’I0NATF.D ACCRLERAlED RADIOTHERAPY FOR LOCALLY FAR ADVANCED (LAD) NSCXC. W.Eb&wdt, J&W&, G. Stamatk+R.Krmls& MshlschLL, M. stab& M.R_ Mltikr, L..Scbknger, G.Tlrml , M.R.N owraaaian, D. Grucbucbna , N. Konktzbo, and Ssaber. Dcpt Int. b&d. (Cancer Re.), Ensen Univenity Medii &boo& Enu $&many. Since Ml,63 p&&a (ptr) with LAD-NSCL4Z( mulkstinoeopy obl@tony) have been eatered into 111ongoing trkl with 3 cy&J ofckpktk (P) (60 m&n’
I~~,
'Rgpirology,S.~l~~Hrspital,Bol~;~S.MarinoGe-
rwalWspital-Italy wehave analyzed151pts. affectedby E%lc treated in tw@nqs fmn 1982ti1986;thefirst(85pts.) ~atibysurgeryandraditie=Wly (S&Q) frcm1982to1984, &the seca?d(66pts.1byStwr+TF (Trn sferFacti)fXm1935t~1986 (follonrup61Oyears).TF extzwztedfran lynphoid cellsof bealtybleeddaKns wlunlteers was achinistered firstly 3weeksaftertheendofradiotherapyatthe singledoseof2.108l~h~ s&sqwntly everythreewnt& forfiveyearsor at the cytespertitit; ~tisiteprogressicnofdisease.Tne~tsshaus: A) actusrial survivalby stage:S+Fxr:stageIl?@s.=atf/o; stqe II 22pts.ti; stageIII Eopts.=ll~S+Rxr+TF: stageI llpts.~,stageII~pts.-a, stage IIIEEpts.=31%. B) Timeatlrmgressionbyhistology: squanau~ cellca. &x-ox 1Chx. S+RXT;16m.S+FXT+TF 2Jmnths. (m.) &W; 26m. S+XT+'IF; C)FortJx imnnolcgical statusareevalUableswithPFX skintest51/ffi pts.of these36 werepositive zmd15 negative at thestartof therapy. 20/51pts.arrevalubl~ after3 injecticn: of these 8/ZQhaveincrease ofnzacticns, 7/2oncllchinge, and5/20decrease. At61OyearsOf'follaV up -NEE alive4/8ofthefirstgnxp,1/7ofthesecond, 0/50fthe last. We~ludethattheefficacyof'ITacfninistrationwas~~~in lcmgtermfollavuppts. ,with inpm%vmentofsumival andthetimeof pogressicnandtiePFlZ skirtestpointand thisbeneficial effectifthe mtivity is irxresd. After this result.5 Of the-Z&Ed fOllaVUp wehaves~in1993arsndanized~Sc~v-~St-~+~.
d1+7)MdoCetoporideQ(lMmdmdl3.~,qddf~ed~onc~~ sim~~~RTxlcFr(4SGy,l~~Ggt~icc~vitLin3w~lrr; PSOmghn’d 2+9of RTx, E 100 mgM d 4,5,6 of RTx) followed b ~medkstinoscopy and opelmtbm. 64 pta are cllmntiy off ~tmellt. THEIR CRARACTF,RISTIcs: m/f 48/l6 :a~ SS(31-67);PS1(0_1);lDa(~1medkstinll lymph node #tation invohxd) 36, mb 2a;sqmamons all cs 3% ukno u u, krge all wpkstic Ca 10. aESaTsIffa~eCR4;PR33,CRlPRss~MR16NC7;PDJ.TOXKXTY (WHO): kueopmir. 30 23%, 8 8%; infcctiolI 39 3% 40 3% tbromb+ cytqwk 3ONo 19%; dkrrba Jo 3%; 2 ptr dkd in septic sbocb. RESULTS after CTxIRti fbrtbcr sigeitlcant response hpmvement in 8 pb; Toxkity (WRO): kwopmk 30 37% 40 4%; thromboqtopenk Jo 10% 40 4%; aopblg& J”/40 41%. RESULTS after Op: (n-40) RO twection ntc 34 (83%)&R: 17(43%), Rl-rrrection 4, R2-tweetion 2; 1 euly postoperative de& 2 dekyed postoperative deaths; 12/40 tw. pts have rd8pscd so br (S CNS, 1 liver, 1 bone, i SU+~~LN, 1 lympb~giwh wcinom8ton Inn& 1 mediutinal ,l local). RESULTS of ti 64 “off&mtmcnt” m: VCR 17(27%): RO/NF.D17(27%),
pcR/NED34(53%); ovmllra&i&&
63H;‘truLmltmJtcomplet&
(medical reams) 4, PD during eh +/- RR 5; CR dboo&mwd 1;CTwRTx ~2;OP~2;~bk~~~L,rrutgdatlu4;med~ observation time 11 montba f6+-32+Umo~.nedkn swvival time of all ti 16 mo fti2+), m 16 mo (SC32+);IUb 26;lo &32+), pk _ dtb N,$D (‘,t$~t&kb jZmo(i+-32+). CONCLUSlONSz Tbk intcwive prtqerative prqam k toknbk mtd biik effective for bxallv fu ldvlacal &AD) NSCLC. A randomi& trkl with