Daily low-dose cisplatin and concurrent thoracic irradiation for poor-risk patients with unresectable non-small-cell lung cancer

A pilot study was conducted to assess the efficacy and feasibility of daily low-dose cisplatin with concurrent thoracic irradiation for clinically unresectable non-small-cell lung cancer (NSCLC). Patients with inoperable NSCLC who had poor risk factors such as advanced age, poor performance status, poor lung function, or concomitant active malignancy were entered into the study. Low-dose cisplatin (6 mg/m2) was administered daily before concurrent thoracic irradiation (2 Gy/day; total dose of 60 Gy) was given. Twenty-five patients were registered. The majority of the patients had either stage IIIA (24.0%) or stage IIIB (60.0%) disease. Fifteen patients (60.0%) completed the planned treatment. Both chemotherapy and radiotherapy were stopped in 3 patients (12.0%) due to poor response, and 7 patients (28.0%) partly received radiotherapy alone as a result of their toxicity response. The proportion of total administered dose to planned dose was 90.9% for chemotherapy and 99.3% for radiotherapy, which were comparable to those in previous studies for LA-NSCLC patients without poor risk factors. Grade 3 leukopenia and neutropenia developed in 14 patients (56.0%) and 10 patients (40.0%), respectively, but grade 4 toxicity was not encountered. Grade 3 pneumonitis and esophagitis were observed in 4 patients (16.0%) and 2 patients (8.0%), respectively. The overall response rate was 60.0%. The median survival time was 22 months, and the 2-year survival rate was 50.3%. Daily low-dose cisplatin and concurrent thoracic irradiation were well tolerated even by poor-risk patients with NSCLC, and showed a therapeutic efficacy similar to that for good-risk patients.     

贝伐单抗联合化学药物治疗耐药晚期非小细胞肺癌

目的：探讨贝伐单抗联合化学药物治疗耐药晚期非小细胞肺癌（non—smallcelllung ca11cer,NSCLC）的疗效及安全性。方法：对2011年1月至2012年9月收治的9例耐药晚期NSCLC患者给予贝伐单抗联合化疗治疗,其中多西他赛联合贝伐单抗3例、培美曲塞二钠联合贝伐单抗5例、紫杉醇联合贝伐单抗1例。每例患者均完成2个周期以上治疗,观察其近期疗效及安全性。结果：9例患者中,3例部分缓解。无进展生存期2～12个月,总生存期4～16个月。主要不良反应有骨髓抑制、下肢静脉血栓、充血性心力衰竭、血压升高、消化道反应以及脱发。结论：贝伐单抗联合化疗治疗耐药晚期NSCLC取得较好疗效,毒性可以耐受。     

不同剂量调强放疗联合同步化疗对局部晚期肺癌患者生存期和毒副反应的影响

目的:探讨不同剂量调强放疗联合同步化疗对局部晚期肺癌患者生存期和毒副反应的影响。方法:选取96例确诊为局部晚期肺癌患者为研究对象,随机分为对照组（n=48）和观察组（n=48）。对照组采用62 Gy调强放疗联合PC同步化疗,观察组调整放疗剂量为50 Gy。记录患者临床一般资料。K-M分析绘制生存曲线,Log Rank [χ2]检验比较生存率,记录两组患者治疗1个月后毒副反应发生情况。结果:观察组和对照组患者缓解率无显著差异（75.00% vs79.17%, P>0.05）;观察组患者总生存率和无进展生存率均高于对照组（P<0.05）,中位生存时间显著长于对照组（P<0.05）。观察组骨髓抑制和放射性肺炎等放疗毒副反应发生率显著低于对照组（P<0.05）。结论:通过降低调强放疗剂量能够减轻患者毒副反应,提高患者生存期,联合同步化疗能够发挥良好的临床缓解效应。     

Expression of P-glycoprotein in hepatocellular carcinoma. A determinant of chemotherapy response

To characterize the P-glycoprotein (Pgp) expression in human hepatocellular carcinoma (HCC), we studied 101 cases of HCC treated with surgical resection without prior treatment. Pgp expression was detected immunohistochemically using 2 monoclonal antibodies (C494, C219) and correlated with pathologic features, survival, and p53 expression. Chemotherapy response was analyzed in a separate group of patients with inoperable HCC treated with systemic chemotherapy. Positive immunostaining was seen in 92% and 80% of the tumors with C494 and C219, respectively; bile canalicular type staining was seen in all positive tumors. Pgp expression was less extensive in the tumors than in the corresponding nontumorous liver tissue. Tumor Pgp expression with either antibody had no association with cellular differentiation, aggressive pathologic features, survival, or p53 overexpression. In patients with inoperable HCC, the chemotherapy response was significantly inversely related to Pgp expression with C494 and C219. Pgp was expressed in human HCC but was patchy and less extensive than in the nontumorous tissue. Response to systemic chemotherapy was inversely related to the level of Pgp expression in patients with inoperable tumors. Pgp expression in tumors not treated with chemotherapy was not associated with a more aggressive tumor phenotype or p53 overexpression and did not influence survival.     

同步推量加速调强放疗联合化疗治疗局部晚期非小细胞肺癌的前瞻性研究

目的:评估同步推量加速调强放疗联合化疗治疗局部晚期非小细胞肺癌的疗效和安全性。方法:采用同步推量加速调强放疗技术联合紫杉醇和卡铂同步化疗对48例新诊断Ⅲ期局部晚期非小细胞肺癌患者进行治疗;处方剂量包括肺部原发灶PTV1为69 Gy（2.3 Gy/F）,转移淋巴结PTV2为64 Gy（2.13 Gy/F）,亚临床病灶PTV3为60 Gy（2.0 Gy/F）。对放疗计划进行剂量学分析,并观察分析生存期、无进展生存期、客观缓解率和急性毒性反应。结果:48例患者均完成放化疗,PTV1、PTV2、PTV3的Dmean分别为（70.3±2.4）、（66.5±2.1）、（64.5±3.1） Gy。中位生存期为22.0个月,中位无进展生存期为17.0个月,客观缓解率为72.9%,1年生存率为78.7%,2年生存率为45.8%;未发现严重食管炎、肺炎和心脏毒性。结论:同步推量加速调强放疗技术联合化疗治疗局部晚期非小细胞肺癌是可行的,急性毒性反应可控,但仍需要进一步的随访评估远期毒性。     

Bone-marrow ablation and allogeneic marrow transplantation in acute leukemia

Thirty-three patients with acute leukemia (15 with lymphoblastic leukemia and 18 with myeloblastic leukemia) were entered into a program of high-dose radiochemotherapy followed by allogeneic bone-marrow transplantation. These patients were in various clinical stages of disease. Of 10 in complete hematologic remission at the time of transplantation, seven were alive without maintenance therapy at the time of evaluation, eight to 35 months after grafting; one was in relapse. Of 11 who received transplants during partial remission, six were in remission without further treatment eight to 33 months after transplantation. In 12 the disease was refractory to chemotherapy when preparation for transplantation was started, and only one of them was alive and free of disease after 10 months. Recurrent leukemia, graft-versus-host disease, viral pneumonia, and early therapy-related toxicity were the major causes of failure. High-dose chemotherapy and total-body irradiation followed by allogeneic marrow transplantation performed during complete or partial remission can produce long-term remission of acute leukemia.     

Use of etoposide, ifosfamide and cisplatin (EIP) for treatment of inoperable non-small cell lung cancer

Recent studies have pointed out that chemotherapy can prolong life in advanced inoperable cancer patients. A clinical study to evaluate response and toxicity of the combination of etoposide, ifosfamide and cisplatin (EIP) in the treatment of inoperable non-small cell lung cancer was performed. 25 patients entered the study. Treatment consisted of etoposide 120 mg/m2 given i.v. on days 1-3, ifosfamide 1.5 g/m2 given i.v. on days 1-5 with mesna protection and cisplatin 20 mg/m2 given i.v. on days 1-5. Cycles were repeated every 4 weeks for a maximum of 6 in responders. 16 (64%) patients responded to treatment, 13 (52%) reached partial and 3 (12%) complete remission. In two recurrent cases second remission was achieved after reinstitution of the EIP regimen. Median survival time was 13 months (range 7-48 months) for responders and 5 months (range 2-11 months) for non-responders. Overall treatment was well tolerated with granulocytopenia being the most frequent toxicity. The results are encouraging for further investigations. Application of higher doses of ifosfamide with colony stimulating factors protection is planned.     

Simultaneous radiochemotherapy in the treatment of inoperable, locally advanced head and neck cancers

The results of radiation therapy alone in locally advanced head and neck cancers are dismal with 5 year locoregional control rates not exceeding 15%. The addition of concomitant chemotherapy with cisplatin and more recently carboplatin has shown promising results. Twenty patients of inoperable stage III and IV oral or oropharyngeal cancers were treated with concomitant chemoradiation with carboplatin 300 mg/m2 i.v. on days 1, 21 and 42 of radiation therapy. Twelve (60%) patients had a complete remission. Thirteen patients were alive at a median follow up of 11 months. The treatment was well tolerated with only 2 patients requiring treatment interruptions for mucositis. Longer follow up would reveal any improvement in overall survival. The relative ease with which carboplatin/RT was administered suggests that other agents might be added as well.     

Długotrwała odpowiedź na leczenie azacytydyną pacjentki z ostrą białaczką szpikową z niekorzystnym profilem cytogenetycznym – prezentacja przypadku

Acute myeloid leukemia (AML) is the most common type of leukaemia found in adults and the number of disease cases increases with age. Despite the advances in the AML treatment, the results in patients over the age of 60 remain unsatisfactory.In this study we present the case of a 73-year-old female patient with an unfavourable cytogenetic profile, in whom we observe long-term response to azacitidine, after previous failures of classic polychemotherapy.In February 2010, a 70-year-old patient was admitted to the Department of Haematology USK in Bialystok on suspicion of AML. The patient was qualified for intensive chemotherapy regimen of daunorubicin (DNR) and cytarabine (Ara-C).Cytogenetic examination revealed the presence of double minutes – acentric fragments of extrachromosomal DNA, which is associated with resistance to standard chemotherapy. Induction chemotherapy was complicated by febrile neutropenia, pneumonia and episodes of atrial fibrillation. Due to the lack of remission and severe after-induction period, a brief reinduction chemotherapy with DNR and Ara-C was applied to obtain complete remission with incomplete regeneration (CRi).Due to the recurrence in October 2010, reinduction chemotherapy was given followed by two cycles of maintenance chemotherapy. After another relapse in February 2011 (23,6% blasts in the bone marrow), a chemotherapy regimen designed for refractory and relapsed leukaemia was given, without any effect. In April 2011, the patient began azacitidine treatment. By the end of March 2013, the patient received twenty-one treatment cycles. The twelfth cycle of chemotherapy was complicated by pulmonary embolism which was treated successfully. The complete blood count remains at normal values.Recent reports indicate a clear relationship processes such as epigenetic regulation of DNA methylation with leukaemogenesis. The use of hypomethylating drugs in AML is yielding promising results.     

Conventional-dose chemotherapy compared with high-dose chemotherapy plus autologous hematopoietic stem-cell transplantation for metastatic breast cancer. Philadelphia Bone Marrow Transplant Group

BACKGROUND: We conducted a randomized trial in which we compared high-dose chemotherapy plus hematopoietic stem-cell rescue with a prolonged course of monthly conventional-dose chemotherapy in women with metastatic breast cancer. METHODS: Women 18 to 60 years of age who had metastatic breast cancer received four to six cycles of standard combination chemotherapy. Patients who had a complete or partial response to induction chemotherapy were then randomly assigned to receive either a single course of high doses of carboplatin, thiotepa, and cyclophosphamide plus transplantation of autologous hematopoietic stem cells or up to 24 cycles of cyclophosphamide, methotrexate, and fluorouracil in conventional doses. The primary end point was survival. RESULTS: The median follow-up was 37 months. Of 553 patients who enrolled in the study, 58 had a complete response to induction chemotherapy and 252 had a partial response. Of these, 110 patients were assigned to receive high-dose chemotherapy plus hematopoietic stem cells and 89 were assigned to receive conventional-dose chemotherapy. In an intention-to-treat analysis, we found no significant difference in survival overall at three years between the two treatment groups (32 percent in the transplantation group and 38 percent in the conventional-chemotherapy group). There was no significant difference between the two treatments in the median time to progression of the disease (9.6 months for high-dose chemotherapy plus hematopoietic stem cells and 9.0 months for conventional-dose chemotherapy). CONCLUSIONS: As compared with maintenance chemotherapy in conventional doses, high-dose chemotherapy plus autologous stem-cell transplantation soon after the induction of a complete or partial remission with conventional-dose chemotherapy does not improve survival in women with metastatic breast cancer.     

IMRT with the use of simultaneous integrated boost in treatment of head and neck cancer: acute toxicity evaluation

Acute toxicity has been evaluated in head and neck cancer patients treated with intensity-modulated radiotherapy using simultaneous integrated boost (SIB-IMRT). The basis of the treatment protocol is an irradiation in 30 fractions with a total dose: 66 Gy to the region of macroscopic tumor, 60 Gy to the region of high-risk subclinical disease and 54 Gy to the region of low-risk subclinical disease. Between December 2003 and September 2005, 38 patients with carcinoma of different locations in the head and neck region were irradiated. Five patients underwent concurrent chemotherapy (weekly cisplatin). Acute toxicity was evaluated according to Radiation Therapy Oncology Group toxicity scale for skin, mucous membrane, salivary glands, pharynx and esophagus and larynx. All 38 patients completed the therapy without urgency of interruption due to acute toxicity of radiotherapy. No patient experienced grade 4 toxicity. More severe toxicity was observed in patients with concurrent chemotherapy. The results confirm that the irradiation according to our SIB-IMRT protocol is a therapy with acceptable toxicity and there is a space for radiobiological enhancement of this regimen by concurrent chemotherapy, e.g. weekly cisplatin.     

Intraperitoneal chemotherapy as treatment for ovarian carcinoma and gastrointestinal malignancies: the Memorial Sloan-Kettering Cancer Center experience)

Several different chemotherapy trials via either combined systemic and intraperitoneal or only via the intraperitoneal route were investigated. The administration of systemically and intraperitoneally infused 5-fluorouracil (5-FU) in patients with ovarial carcinoma did not shown in any patient a complete or partial remission, but showed severe side effects. In a patient with a metastasizing adeno carcinoma of the appendix this chemotherapy protocol led to a complete remission. Investigations with intraperitoneally infused cisplatin showed that 50% of all patients came into remission with tumor nodules less than 0.5 cm, but showed only 20% objective remissions in patients with tumor nodules greater than 0.5 cm. The intraperitoneal administration of mitoxantrone showed in several patients with cisplatin refractory ovarial carcinoma tumor remission with, however, severe local toxicity.     

血清CEA、 CYFRA21-1和SCC对晚期非小细胞肺癌化疗效果的评估价值

目的 探讨血清癌胚抗原(carcinoembryonic antigen,CEA)、细胞角蛋白19片段(cytokeratin fragment 19,CYFRA21-1)和鳞状上皮细胞癌抗原(squamous cell cancinomaantigen,SCC)对晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)化疗效果的评估价值.方法 选取2010年1月至2016年12月我院收治的94例诊断明确的初治晚期(Ⅲb～Ⅳ期)NSCLC患者,并选择同期于我院进行体检的健康者83例为对照组,给予NSCLC组患者含铂类全身化疗2周期,分别检测NSCLC组患者化疗前后及健康对照组的血清CEA、CYFRA21-1和SCC浓度水平.根据影像学的实体瘤疗效评价标准(response evaluation criteria in solid tumors,RECIST)判定化疗疗效,分为完全缓解(complete remission,CR)、部分缓解(partial remission,PR)、稳定(stable disease,SD)和进展(progressive disease,PD).探讨化疗前后血清CEA、CYFRA21-1和SCC水平变化与晚期NSCLC化疗效果的关系.结果 NSCLC组患者血清CEA、CYFRA21-1和SCC水平明显高于健康对照组(P＜0.05).NSCLC组化疗前腺癌组患者血清CEA水平明显高于鳞癌组患者(P＜0.05),鳞癌组患者血清CYFRA21-1、SCC水平明显高于腺癌组患者(P＜0.05).NSCLC组94例患者全身化疗2周期后CR0例,PR 36例(鳞癌14例,腺癌22例),SD 32例(鳞癌14例,腺癌18例),PD 26例(鳞癌11例,腺癌15例).鳞癌组PR患者化疗后血清CYFRA21-1、SCC水平较化疗前明显下降(P＜0.05),SD患者化疗后血清CYFRA21-1、SCC水平较化疗前无明显变化(P＞0.05),PD患者化疗后血清CYFRA21-1、SCC水平较化疗前明显升高(P＜0.05);腺癌组PR患者化疗后血清CEA水平较化疗前明显下降(P＜0.05),SD患者化疗后血清CEA水平较化疗前无明显变化(P＞0.05),PD患者化疗后血清CEA水平较化疗前明显升高(P＜0.05).结论 血清肿瘤标志物CEA、CYFRA21-1及SCC可分别作为晚期肺腺癌和肺鳞癌的化疗疗效和进展评估的敏感指标.     

Primary malignant lymphomas of the central nervous system: radiotherapy results in 12 cases

Twelve patients with primary lymphomas of the central nervous system were treated in the Department of Radiation Oncology, Yonsei University College of Medicine, between 1976 and 1987. There were seven males and five females ranging from 19 to 63 years of age. They had single (6 cases) or multiple (6 cases) discrete intracerebral nodules. All patients were treated with radiation therapy. Surgical resection was performed in five cases and intrathecal chemotherapy with methotrexate was performed in seven cases after radiotherapy. All patients except one had received whole brain irradiation with a median dose of 4000 cGy. The radiation dose for a primary tumor was 4800-6000 cGy (median 5560 cGy). Initial response to radiation was excellent with a 91.7% complete response rate, but late recurrences were noted and the median survival was 42.3 months. Intracranial recurrences were observed in two patients who received less than 4000 cGy to the whole brain without intrathecal chemotherapy. Although intracranial recurrence was not seen in the patients receiving intrathecal chemotherapy after radiation, a high incidence of necrotizing leukoencephalopathy was noted. High dose irradiation with a minimum of 4000 cGy to the whole brain and more than 5000 cGy to the primary tumor is recommended for the treatment of primary CNS lymphomas. Combined use of chemotherapy should be carefully attempted because of the increased toxicity.     

Correlation of histologic results with PET findings for tumor regression and survival in locally advanced non-small cell lung cancer after neoadjuvant treatment

CT cannot provide useful information in a timely manner after neoadjuvant treatment. To evaluate the role of (18)F FDG PET after neoadjuvant chemoradiation for early therapy response and its effect on survival as compared to histopathologic tumor response, findings in 32 patients were analyzed prospectively in an ongoing multicenter trial (LUCAS-MD).Inclusion criteria: histologically confirmed NSCLC stage IIIA/IIIB. Neoadjuvant treatment: 2-3 cycles with paclitaxel/carboplatin and a block of chemoradiation followed by surgery. Pretherapeutic staging: PET scan in addition to a spiral CT and/or MRI. Second PET scan after completion of neoadjuvant therapy prior to surgery. Documentation of lymph node involvement. Assessment of SUV and the metabolic tumor index for primary tumor and metastatic lymph nodes. Image fusion of PET with CT data followed by molecular radiation treatment planning. Evaluation of histologic regression grade and correlation with PET for primary tumor and each lymph node location.All patients (10/32) with complete response in lymph node metastases detected by PET prior to surgery, had no vital tumor cells (i.e. histologic regression grade/RG III, sensitivity 100%). In primary tumors showing complete response, the RG was IIb or III, in one patient IIa (false negative in PET). False positive findings in PET are due to inflammation (5 patients, histologically confirmed). Univariate analyses: actuarial tumor-specific survival for complete metabolic remission vs. incomplete remission after 24 months: 76 vs. 20% (p=0,0079); for RG III/IIb vs. RG IIa/I after 24 months: 63 vs. 36% (p=0,0123).(18)F FDG PET precedes CT in measuring the tumor response and may predict (long term) therapeutic outcome in stage III NSCLC. Histologic regression grade correlates well with metabolic remission as detected by PET.     

Therapeutic DC vaccination with IL-2 as a consolidation therapy for ovarian cancer patients: a phase I/II trial

While ovarian cancer (OvCa) responds well to surgery and conventional chemotherapy, a high recurrence rate of advanced OvCa is observed. In this phase I/II study, 10 OvCa patients with minimal residual disease were treated with autologous dendritic cells (DCs) and IL-2 to evaluate the safety and feasibility of this therapeutic strategy and to characterize the antigen-specific immune alterations induced through this treatment. Approximately 4 months after initial debulking and chemotherapy, patients received two subcutaneous doses of autologous monocyte-derived DCs pulsed with autologous tumor lysate and keyhole limpet hemocyanin (KLH) at 4-week intervals. After each DC inoculation, low-dose (200 mIU) IL-2 was introduced for 14 consecutive days as an immune adjuvant. The vaccination was well tolerated. In three out of 10 patients, the inclusion status after the initial therapy showed the maintenance of complete remission (CR) after DC vaccination for 83, 80.9 and 38.2 months without disease relapse. One patient with stable disease (SD) experienced the complete disappearance of tumor after DC vaccination, and this status was maintained for 50.8 months until tumor recurrence. In two patients with partial response (PR) was not responding to DC vaccination and their disease recurred. In the three patients with disease free long-term survival, significant immune alterations were observed, including increased natural killer (NK) activity, IFN-γ-secreting T cells, immune-stimulatory cytokine secretion and reduced immune-suppressive factor secretion after DC vaccination. Thus, in patients with NED status and increased overall survival, DC vaccination induced tumor-related immunity, potentially associated with long-term clinical responses against OvCa.     

Maintenance therapy with interferon-alpha 2b, cyclophosphamide, and prednisone in aggressive diffuse large cell lymphoma

Maintenance therapy in patients with aggressive malignant lymphoma using biological modifiers remains uncertain. We conducted a controlled clinical trial to evaluate the efficacy and toxicity of interferon-alpha 2b, cyclophosphamide, and prednisone as maintenance therapy in patients with aggressive diffuse large B cell lymphomas in complete remission after aggressive chemotherapy. In an intent-to-treat analysis, 169 patients were eligible for this study; the end points were event-free survival (EFS) and overall survival (OS). With a median follow-up of 49.3 months, no statistical differences were observed and actuarial curves at 5 years showed that EFS was 71% (95% confidence interval [CI], 63-79%) for patients who received maintenance compared to 63% (95% CI, 59-71%) for patients in control group (p = 0.05). No statistical differences were observed in OS between maintenance arm: 84% (95% CI, 78-89%) and control group 83% (95% CI, 77-88%) in control group (p = 0.2). All patients received the maintenance therapy as planned and in time, thus dose intensity was considered 1.0 in all cases. Acute toxicity was mild, and no delay or suspension of treatment was necessary. Late toxicity was not evident until now. We conclude that use of maintenance therapy combining interferon-alpha 2b, cyclophosphamide, and prednisone is not useful in patients with aggressive lymphoma if they had been treated with aggressive combined chemotherapy.     

经深静脉导管胸腔化疗治疗恶性胸腔积液护理体会

目的：总结经深静脉导管胸腔化疗治疗恶性胸腔积液的护理方法。方法：对56例大量恶性胸腔积液患者进行胸腔留置深静脉导管引流胸腔积液并注射丝裂霉素（MMC）、顺铂（DDP）治疗后,予以术前、术中、术后不同阶段的相应护理。结果：56例病人中,16例完全缓解,35例部分缓解,5例无效。结论：加强术前术中术后护理工作是提高手术成功率减少并发症的重要保证。     

Acute myeloid and lymphoblastic leukemia in adults. The course of the disease in 315 patients from one region, during a ten-year period

In a ten-year retrospective singlecenter study of a nonselected patient population, we describe our experience with an unchanged chemotherapy regimen for 264 patients with acute myeloid leukemia (AML) and 51 patients with acute lymphoblastic leukemia (ALL). In the AML group, 85 patients could not receive specific antileukemic treatment because of uncontrollable bleeding, infection or organ failure, but 179 were fit for remission-induction therapy with cytarabine and daunorubicin, resulting in complete remission in 79 patients. During treatment, 54 patients died of resistant disease or complications. The median duration of survival of the patients in complete remission was 18-24 months (n = 79) compared with 1-2 months for patients in partial or no remission (n = 100). As maintenance chemotherapy, thioguanine, cytarabine and daunorubicin were given for one year. In the ALL group 50 of 51 patients received remission-induction therapy with vincristine, prednisone and Adriablastin, resulting in complete remission in 39 of the patients. The median duration of survival of the patients in complete remission was nine months (n = 39) compared with 2-3 months for patients not in remission (n = 12). Central nervous system prophylaxis with intraspinal methotrexate and cranial irradiation was given, followed by methotrexate and Purinetol for three years as maintenance chemotherapy. The remission rate for AML and adult ALL was 44% and 78%, respectively. The major Cause of death after first complete remission was leukemic relapse in boths groups, with a median survival time after relapse of 3-4 months for 48 AML and six months for 30 ALL patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intensive short-term chemotherapy in patients with advanced breast cancer

Summary Aiming at a high complete remission rate with an intensive induction regimen, 27 patients with advanced breast cancer were given three cycles of VAC chemotherapy consisting of vinde-sine 3 mg/m² i.v. on days 1 and 12, adriamycin 40 mg/m² i.v. on days 1 and 12, and cyclophosphamide 200 mg/m² p.o. on days 3–6 and 14–17 together with medroxyprogesterone acetate (MPA) 1,500 mg p.o. daily during the induction phase and 1,000 mg p.o. thereafter until relapse. These VAC double cycles were repeated twice with 3-weekly intervals for a total induction period of 15 weeks. In responders, including no change, the chemotherapy was discontinued thereafter, and the patients were observed until relapse with a maintenance therapy of MPA 1,000 mg p.o. daily.A complete remission (CR) was achieved in 8 (29.6%) and a partial remission (PR) in 13 (48.2%) of the 27 patients (CR + PR 77.8%). A no change (NC) status was found in 6 patients (22.2%). There were no nonresponders. The median duration of the CR was 20 (5–42) months with two patients still in CR at 33 and 36 months, of the PR 8.3 (4–13.5) months, and of the NC 6.7 (2–13) months. The treatment was tolerated without life-threatening toxicity or interval prolongation by all patients. No dose-limiting cardiac toxicity was observed in these patients regularly controlled by left ventricular ejection fraction (LVEF). The high response rate of this intensive induction regimen warrants further investigation. Complete remission was achieved only in patients without previous chemotherapy, with marked tumor regression after the first chemotherapy cycle and when there was no extensive bone involvement.Abbreviations ADR Adriamycin - CK Creatinine kinase - CK-MB Cardiac muscle specific isoenzymes - CMF Cyclophosphamide, methotrexate, 5-FU - CNS Central nervous system - CR Complete remission - CYC Cyclophosphamide - DFI Disease-free interval - ECG Electrocardiogram - LMF Chlorambucil, methotrexate, 5-FU - LVEF Left ventricular ejection fraction - MPA Medroxyprogesterone acetate - NC No change - PD Progressive disease - PR Partial remission - VAC Vincristine, adriamycin, cyclophosphamide - VEC Vincristine, epirubicin, cyclophosphamide - VDS Vindesine - WBC White blood cell count