Management of concurrent pleural effusion in patients with lymphoma: thoracoscopy a useful tool in diagnosis and treatment.

Pleural effusion represents a frequent feature both of Hodgkin's (HL) and non-Hodgkin's (NHL) lymphoma. The aims of the present study were: 1) to analyse the diagnostic accuracy of thoracoscopy as compared to pleural cytology in patients with lymphoma and concurrent pleural effusion; and 2) to evaluate the effectiveness of chemical pleurodesis with the tetracycline derivative, rolitetracycline. Seventeen patients with pleural effusion and concurrent lymphoma (10 NHL and seven HL) were studied. Analysis of pleural fluid revealed the presence of lymphoma cells in six cases (four NHL and two HL); histopathological examination of samples obtained by thoracoscopy was consistent with pleural infiltration by NHL in eight cases and by HL in six cases. Overall sensitivities of pleural cytology and histology were 35 and 82%, respectively. Following chemical pleurodesis, complete response was observed in five of the 17 cases (two NHL and three HL), partial response in four cases (two NHL and two HL), whereas failure was observed in the remaining eight cases. Two patients who had presented failure underwent subsequent pleurectomy by thoracotomy (one case of HL) or video-thoracoscopy (one case of NHL). Complete response was observed in both cases following this treatment. No major complication was recorded after chemical pleurodesis or pleurectomy. Thoracoscopy may be considered a useful tool to evaluate the involvement of pleural space in patients presenting with pleural effusion in the course of lymphoma. Chemical pleurodesis plays an important role in the palliative treatment of this condition. Further studies are necessary to assess the role of pleurectomy in the treatment of such patients.

A phase I study of gemcitabine and epirubicin for the treatment of platinum-resistant or refractory advanced ovarian cancer.

BACKGROUND: Gemcitabine is active in patients with otherwise resistant or refractory ovarian cancer. As the drug is well tolerated, studies using gemcitabine combined with other antineoplastic agents are needed. The aim of the study was to determine the maximum tolerated dose (MTD) of epirubicin combined with gemcitabine, with and without support of G-CSF. PATIENTS AND METHODS: Patients with platinum-resistant or refractory ovarian cancer were eligible. Gemcitabine (G) (starting dose 800 mg/m2 day 1 and 8; 200 mg/m2 escalation per level) and epirubicin (E) (starting dose 60 mg/m2 day 1; 15 mg/m2 escalation per level) were given every 21 days for four to six cycles. G-CSF (filgrastim 5 microg/kg/die) was given in case of grade 4 neutropenia (levels without support) or from day 9 up to leukocyte count > 10.000/mm3 after nadir (levels with support). Cohorts of three patients were enrolled at each level, and another three patients were planned, if one dose-limiting toxicity (DLT) was registered. MTD was determined first without and then with G-CSF. RESULTS: Four levels were studied (G 800 + E 60; G 1000 + E 60; G 1000 + E 75; G 1000 + E 75 + G-CSF) with four, four, three and three patients enrolled, respectively. DLT (grade 4 febrile neutropenia) was observed in two patients at level 3. Thus, G1000 + E 60 mg/m2 was the MTD without G-CSF. The addition of prophylactic G-CSF did not allow a further increase of the dose and grade 4 thrombocytopenia was the DLT at level 4. Non-hematological toxicity was mild. Grade 2 mucositis was reported in four patients. Among the 13 patients with measurable or evaluable disease, 3 partial responses were observed for an overall response rate of 23.1%. CONCLUSIONS: The combination of gemcitabine 1000 mg/m2 (day 1, 8) and epirubicin at 60 mg/m2 (day 1) is a feasible therapy. Grade 4 neutropenia is frequent and G-CSF support is often required. With prophylactic support of G-CSF, the DLT is thrombocytopenia.