A Dose Finding Study of Carboplatin and Gemcitabine in Advanced Non-Small Cell Lung Cancer

Abstract

The excellent activity of the cisplatin-gemcitabine combination and favorable toxicological profile of carboplatin are the basis of carboplatin-gemcitabine combination therapy for non-small cell lung cancer. We carried out a dose-finding study with the aim of establishing the maximum tolerated dose (MTD) of carboplatin on day 1 in combination with gemcitabine at the dose of 1000 mg/m2 on days 1 and 8 in a 21-day cycle. The starting dose level for carboplatin was the area under the concentration time curve (AUC) 4 mg/ml/min. 18 patients were treated and a dose limiting toxicity was observed in 2 cases at the level of AUC 6 mg/ml/min. AUC 5 mg/ml/min was considered as the MTD for carboplatin in our regimen. Notably, 7 objective responses were observed.     

Leiomyosarcoma of Nose a Very Rare Tumor Case Report: Unusual Case Leiomyosarcoma Inferior Turbinate

Leiomyosarcoma (LMS) accounts for approximately 7% of all soft tissue sarcomas and occurs most frequently in the gastrointestinal tract and uterus. In the head and neck, however, LMS makes up only 2.3%. LMS of the nasal cavity and Para nasal sinuses are very rare and only about 20 cases of LMS of the nose and Para nasal sinuses have been reported in the literature. Initially, LMS should be treated by extensive surgical excision, long-term follow-up is essential due to the high rate of local recurrence. Radiotherapy and chemotherapy are insufficient therapeutic approaches. Frequency of recurrence and prognosis depend on the tumor site.     

肺原发性软骨瘤1例报告

患者女性 ,３９岁 ,因体检发现右下肺肿块１０天入院 ,查体未见阳性体征 ,胸部ＣＴ示右下肺占位性病变。剖胸探查见右肺下叶约３ｃｍ×２ｃｍ灰白色肿块 ,切除送检。巨检 :右下肺叶切除标本 ,大小１３ｃｍ×１２ｃｍ×４ｃｍ ,距支气管断端１ｃｍ处肺组织内见一大小为２．５ｃｍ×２．５ｃｍ×２ｃｍ肿块 ,呈分叶状 ,境界清 ,似有包膜 ,切面灰白半透明状 ,实质性 ,质偏硬 ,支气管旁找到米粒至赤豆大淋巴结３枚。镜检 :肿瘤组织由分化成熟的软骨组织构成 ,瘤细胞小 ,圆形或星形 ,分布不均 ,胞浆淡染 ,核小圆形 ,固缩状 ,未见双核、多核或核分…     

Trabectedin in Advanced High-Grade Uterine Leiomyosarcoma: A Case Report Illustrating the Value of 18FDG-PET-CT in Assessing Treatment Response

We report the case of a 60-year-old woman with metastatic high-grade uterine leiomyosarcoma who achieved a delayed response to second-line therapy with the marine-derived drug trabectedin (Yondelis^®, PharmaMar). We used 2-deoxy-2-[¹⁸F] fluorodeoxyglucose (FDG)-positron emission tomography (PET-CT) imaging as a tool for response monitoring in parallel with conventional re-staging according to Response Evaluation Criteria in Solid Tumours (RECIST) using computed tomography (CT). We illustrate the role of serial ¹⁸FDG-PET-CT imaging in the functional assessment of tumour response. Three cycles after commencement of trabectedin treatment, a reduction of the maximum standardized uptake value (SUV_max) of the solid component of the pelvic mass was observed, indicating a cystic or necrotic response in the tumour to trabectedin. After 7 cycles of treatment, on ¹⁸FDG-PET-CT there was clear evidence of ongoing disease improvement: the solid pelvic components were at worst stable, with an unchanged SUV_max, and possibly marginally reduced in size, while the pulmonary metastases had further reduced in size and become FDG negative; the bony metastases were stable. After a total of 13 cycles of treatment, administered over 13 months, the patient showed signs of progression on an ¹⁸FDG-PET-CT scan. The safety profile of trabectedin remained manageable, showing no evidence of cumulative toxicity and being associated with a preserved quality of life. This report illustrates potential limitations of RECIST in response assessments and the critical role of serial ¹⁸FDG-PET-CT imaging in assessing response to trabectedin treatment. Therefore, we propose that ¹⁸FDG-PET-CT may improve the assessment of response to trabectedin in selected patients.Key words: Sarcoma, Trabectedin, Delayed response, ¹⁸FDG-PET-CT, Uterine leiomyosarcoma     

巨大原发性肺软骨瘤1例

1临床资料患者,女,40岁,查体发现右下肺肿物1周入院。既往体健。体格检查:体温正常,脉搏、血压、呼吸均无异常。胸壁无压痛,双肺呼吸运动对称,触觉语颤对称,叩诊呈清音,听诊双肺呼吸音稍粗,未闻及干、     

Metastatic Primary Leiomyosarcoma of the Pancreas to the Liver: Report of a Surgically Treated Case

Purpose

The aim of this study was to evaluate the role of stereotactic body radiotherapy (SBRT) as adjuvant therapy for resected pancreatic adenocarcinoma with close or positive margins.

Methods

Between September 2006 and January 2010, 24 patients were treated with adjuvant SBRT following surgical resection. Eight (33.3%) patients had close margins of 1?C2.5?mm to the retroperitoneal, vascular structures, and periduodenal adipose tissue. Sixteen (66.7%) patients had positive margins at retroperitoneal margin and vascular structures. Twenty-three patients received 24?Gy (20?C24?Gy) in one fraction, and one had 30?Gy in three fractions. The median target volume was 11?cc (4.5?C30?cc). Eighteen patients were treated with the Cyberknife? Robotic Radiosurgery System and six patients were treated with Trilogy? intensity-modulated radiosurgery. Kaplan?CMeier survival analyses were used to estimate freedom-from-local-progression (FFLP), and overall survival (OS) rates. PET/CT or CT was used to monitor disease recurrence following SBRT.

Results

The median follow-up for all patients was 12.5?months (1.4?C39.5?months), and among surviving patients it was 16.3?months (2?C39.5?months). The FFLP rates at 6?months, 1 and 2?years were 94.7%, 66%, and 44%, respectively. Overall, FFLP was achieved in seven (87.5%) patients with close margins, and 10 (62.5%) with positive margins. After SBRT, 19 patients resumed or started a 6-month course of gemcitabine-based chemotherapy at a median interval of 18?days (range, 9?C31?days) post-SBRT. The median OS was 26.7?months and the 1- and 2-year OS rates were 80.4% and 57.2%, respectively. Of the 24 patients, 12 (50%) developed distant metastases of whom two (25%) had close margins and 10 (62.5%) had positive margins. Ten patients (41.7%) were free of progression at last follow-up (range, 3?C39.5?months). Three patients (12.5%) had grade 1?C2 acute GI toxicities, and two patients (8.3%) had grade 1 and 2 late toxicities. No patients experienced grade 3 or 4 toxicity, including bowel perforation, secondary to SBRT.

Conclusions

Our data suggest that adjuvant SBRT for resected pancreatic cancer can be achieved with minimal toxicity. This shorter treatment course allowed initiation of systemic chemotherapy shortly after the completion of SBRT.     

Single-Agent Gemcitabine vs. Carboplatin-Gemcitabine in Advanced Breast Cancer: A Retrospective Comparison of Efficacy and Safety Profiles

Background

Single-agent gemcitabine is a moderately effective compound in metastatic breast cancer (mBC) treatment. Carboplatin is frequently used in addition to gemcitabine to improve tumor responses, but with an unclear effect on survival outcomes. In this study we evaluated the antitumor efficacy and safety profiles of gemcitabine and carboplatin-gemcitabine in mBC patients.

吉西他滨联合卡铂治疗中老年晚期非小细胞肺癌36例临床疗效观察

目的：观察吉西他滨（GEM）联合卡铂（CBP）治疗中老年晚期非小细胞肺癌（NSCLS）的临床疗效及毒副作用。方法：36例中老年NSCLS患者,采用GC方案,GEM1．0／m^2,静脉滴注,d1、8;CBP 400mg（Auc 6）,静脉滴注,d1,每21～28天为一个周期,化疗3个周期。结果：完全缓解（CR）3例,部分缓解（PR）13例,有效率（CR＋PR）44．4％（16／36）,主要不良反应为血液学毒性,Ⅲ～Ⅳ级白细胞和血小板减少分别为22．2％和2．78％。胃肠道反应轻微。结论：吉西他滨联合卡铂治疗中老年晚期非小细胞肺癌,疗效较好,毒性小,耐受性好。     

Efficacy of First-line Chemotherapy Affects the Second-Line Setting Response in Patients with Advanced Non-Small Cell Lung Cancer

Background: Chemotherapy is the mainstay of treatment for the majority of patients with advanced nonsmall cell lung cancer (NSCLC) without driver mutations and many receive therapies beyond first-line. Secondline chemotherapy has been disappointing both in terms of response rate and survival and we know relatively little about the prognostic factors. Materials and Methods: One thousand and eight patients with advanced NSCLC who received second-line chemotherapy after progression were reviewed in Shanghai PulmonaryHospital, China, from September 2005 to July 2010. We analyzed the effects of potential prognostic factors on the outcomes of second-line chemotherapy (overall response rate, ORR; progression free survival, PFS; overall survival, OS). Results: The response and progression free survival of first-line chemotherapy affects the ORR, PFS and OS of second-line chemotherapy (ORR: CR/PR 15.4%, SD 10.1%, PD2.3%, p<0.001; PFS: CR/PR 3.80 months, SD 2.77 months, PD 2.03 months, p<0.001; OS: CR/PR 11.60 months, SD 10.33 months, PD 6.57 months, p=0.578, p<0.001, p<0.001, respectively). On multivariate analysis, better response to first-line therapy (CR/PR: HR=0.751, p=0.002; SD: HR=0.781, p=0.021) and progression within 3-6 months (HR=0.626, p<0.001), together with adenocarcinoma (HR=0.815, p=0.017), without liver metastasis (HR=0.541, p=0.001), never-smoker(HR=0.772, p=0.001), and ECOG PS 0-1 (HR=0.745, p=0.021) were predictors for good OS following secondline chemotherapy. Conclusions: Patients who responded to first-line chemotherapy had a better outcome after second-line therapy for advanced NSCLC, and the efficacy of first-line chemotherapy, period of progression, histology, liver metastasis, smoking status and ECOG PS were independent prognostic factors for OS.     

A Case of Locally Advanced Chondroblastoma in the Proximal Humerus

A 13-year-old male was referred to our institute presentingwith a large mass and pain in his left shoulder.     

Case Report: A Patient with Primary CNS Lymphoma Treated with Temozolomide to Complete Response

We report the case of a 72-year-old woman with primary CNS lymphoma of the mid-brain and pons who had a complete response to oral temozolomide chemotherapy. She initially presented in early 2001 with several weeks of progressive memory loss and unresponsiveness. Because of her age and impaired renal function, she was a poor candidate for whole-brain radiotherapy or systemic high-dose methotrexate. After treatment with two cycles of temozolomide, restaging MRI revealed no evidence of disease. Her mental status improved significantly over this time. Temozolomide may represent a promising new drug for the treatment of primary CNS lymphoma.     

Synchronous Primary Adenocarcinoma and Ancient Schwannoma in the Colon: An Unusual Case Report

Gastrointestinal schwannomas are uncommon stromal tumors of the intestinal tract and colon schwannomas are extremely rare. We report a rare case of ascending colon schwannoma with associated synchronous adenocarcinoma of the sigmoid colon. A 68-year-old man presented with a 20-day history of bleeding per rectum. Colonoscopy revealed a mass of 4.2 cm in diameter with endoluminal protrusion in the sigmoid colon and a second submucosal tumor in the ascending colon. Surgical intervention was suggested and ileo-hemicolectomy was done. Microscopically, the submucosal tumor of 4 cm in diameter showed features of schwannoma with degenerative change (ancient schwannoma). Lesional cells were positive for S100p and negative for actin, desmin, CD34, CD117, and pankeratin. The mass showed features of an invasive moderately differentiated adenocarcinoma. Colon schwannoma is a rare submucosal tumor, and the incidental occurrence with adenocarcinoma has not been well described in the literature.Key words: Schwannoma, Ancient schwannoma, Gastrointestinal tract, Adenocarcinoma     

Comparison of Single Agent Gemcitabine and Docetaxel in Second-Line Therapy for Advanced Stage Non-Small Cell Lung Cancer in a University Hospital in Turkey

Purpose: To compare the efficacy and toxicity of gemcitabine versus docetaxel in a second-line setting of nonsmall cell lung cancer (NSCLC) patients previously treated with platin-based combination chemotherapy. Materials and Methods: We retrospectively evaluated the medical records of 57 patients treated with single agent gemcitabine or docetaxel in second-line setting of advanced NSCLC who received one prior platinumbased therapy. Results: The mean age was 56.7±8.39 years with 55 ( 96.5%) males and two (3.5%) females. Forty of them received docetaxel and 17 gemcitabine. The mean number of chemotherapy cycles was 6.8±4.0 in the gemcitabine group, while it was 4.6±3.0 in the docetaxel group. Overall response rates were 8% and 12% (P=0.02) for gemcitabine and docetaxel, respectively. The median survival time was 22 versus 21 months for gemcitabine and docetaxel, respectively. The median times to progression were 8 and 5 months. There was no difference between the two groups in terms of incidence of adverse affects (40% vs 47.1%). All of the hematological side effects were grade 1/2. No major toxicity was encountered necessitating stopping the drug for either group. Conclusions: Treatment with gemcitabine demonstrated clinically equivalent efficacy with a significantly improved safety profile compared with those receiving docetaxel in the second-line setting for advanced NSCLC in this study. Based on these results, treatment with gemcitabine should be considered a standard treatment option for second-line NSCLC.     

立体定向放疗联合吉西他滨治疗局部晚期胰腺癌

目的：观察立体定向放疗联合吉西他滨治疗局部晚期胰腺癌的临床疗效。方法40例晚期胰腺癌患者根据治疗方案分为观察组和对照组,观察组23例行立体定向放疗序贯吉西他滨化疗,对照组17例行吉西他滨化疗。比较观察2组患治疗结束后的疗效。结果观察组疾病控制率为65.22%,明显高于对照组的29.41%,差异有统计学意义（P ﹤0.05）。肿瘤直径治疗后均有所减小,而观察组减少更为明显,差异有统计学意义（P ﹤0.05）。观察组患者1 a 生存率及死亡患者存活时间均明显高于对照组,差异均有统计学意义（P 均﹤0.05）。结论立体定向放疗联合吉西他滨化疗能够有效控制晚期胰腺癌患者的病情,并延长其生存时间。     

局部晚期非小细胞肺癌合并重症混合性感染个案分析

局部晚期非小细胞肺癌患者由于病情复杂及自身状况较差, 是重症或混合性感染高发人群, 主要原因为多存有重症感染的高危因素, 包括长期吸烟史、常罹患糖尿病、慢性阻塞性肺病, 肺阻塞及膨胀不良等造成肺部自洁功能下降, 以及外科手术、放疗、化疗等相关治疗和药物对机体造成的免疫抑制等。肺癌合并重症感染临床表现多样, 原因机制复杂, 病情进展迅速, 预后差。临床治疗上缺乏完善的疗效评价体系, 存在临床及影像学上变化不同步, 同时需与多种疾病相鉴别。现介绍天津医科大学附属肿瘤医院肺部肿瘤科2011年3月收治的1例经多学科综合治疗的局部晚期非小细胞肺癌合并重症混合性感染的病例。该患者化疗过程中出现重症混合性肺感染, 经综合治疗后效果较佳。同时探讨肺癌合并重症混合性感染的鉴别诊断和治疗规范。