Carboplatin and etoposide followed by once-daily thoracic radiotherapy in limited disease small-cell lung cancer: unsatisfactory results.

AIMS AND BACKGROUND: There has been a trend to replace cisplatin with carboplatin in the treatment of small-cell lung carcinoma. The goal of the present study was to determine the efficacy of carboplatin and etoposide followed by thoracic radiotherapy in patients with previously untreated limited disease small-cell lung carcinoma. METHODS: From February 2001 to March 2007, 47 patients with limited disease small-cell lung cancer were enrolled in the study. Etoposide, 100 mg/m2, was administrated intravenously on days 1-3 in combination with carboplatin, AUC 6, on day 1 every 21 days for 6 cycles. In cases considered to have non-progressive disease following induction chemotherapy, thoracic radiotherapy was given with in a once daily fraction of 2.0 Gy, 5/wk, up to 50-60 Gy. RESULTS: Forty-one patients were evaluated. Median age was 62 (range, 40-78), 88% of patients were male. ECOG PS was 0-1 in 38 patients. Seven of the 41 patients (17.5%) had pleural effusion (one malignant) and 7 patients (17.5%) had involved supraclavicular lymph nodes. Ninety percent of patients had elevated serum lactate dehydrogenase levels. Median follow-up was 13.5 mo. A total of 209 cycles of chemotherapy was administered (median, 6; range, 1-6). Thoracic irradiation was given to 33 patients. The overall response rate to combined modality on an intention-to-treat basis was 73%. Median survival time was 13.7 months (95% CI, 10.3-17.1), and median progression-free survival was 9.5 months (95% CI, 8.6-10.4). Two- and four-year overall survival was 23% and 7%, respectively. Grade 3-4 neutropenia and leukopenia were the most common adverse events and occurred in 46.0% and 24.0% of the patients, respectively. Six (14%) patients experienced febrile neutropenia. Three patients (7%) died of sepsis and neutropenic fever. Non-hematological toxicities were mild. CONCLUSIONS: Carboplatin and etoposide chemotherapy followed by thoracic radiotherapy in LD-SCLC appears to be unsatisfactory.

Evaluation of clinical data and antibody response following influenza vaccination in patients with chronic obstructive pulmonary disease.

The present study investigated the antibody response against influenza vaccine and also the efficacy of vaccination on clinical findings in patients with Chronic Obstructive Pulmonary Disease (COPD) following influenza vaccination. A total of 82 cases with COPD (44 cases as vaccinated and 38 cases as unvaccinated) were evaluated clinically and 21 healthy volunteers were also included in the study as a control group. Influenza (A and B) Ig M and Ig G parameters were analyzed quantitatively in blood samples of the vaccinated group and healthy volunteers by ELISA method once before vaccination and one month and one year after vaccination. The presence of dyspnoea, increased sputum production and/or purulence were accepted as criteria of acute exacerbation. The number of hospital presentations was significantly lower in the vaccinated group and higher in severe cases with COPD in unvaccinated group. Vaccinated cases in the study group experienced significantly fewer episodes of pneumonia, hospitalization and intensive care. Quantitative influenza (A and B) antibody IgG levels significantly increased in these patients as well. In conclusion, seasonal influenza vaccination with the trivalent influenza split virion vaccine especially in severe or very severe COPD patients who need hospitalization was evaluated as beneficial in clinical use.