ABSTRACT
Context: Better locoregional control and increased overall survival by continuous hyper fractionated accelerated radiotherapy have been shown in unresectable nonsmall cell lung carcinoma (NSCLC). Dose escalation and neoadjuvant chemotherapy (NACT) along with continuous hyperfractionated accelerated radiotherapy week end-less (CHARTWEL) were also tried for improved survival. In this present study, we compared the results of NACT followed by CHARTWEL against NACT followed by conventional concurrent chemo-radiation therapy. Aims: The aim of this study is to compare the locoregional control and toxicities in NSCLC Stage IIIA and B in both arms. Settings and Design: Randomized, prospective single-institutional study with a study population comprising all locally advanced unresectable NSCLC patients enrolled in 2014 at our institute. Subjects and Methods: All enrolled patients were randomized into two arms-CHARTWEL and concomitant chemo-radiotherapy (CCRT), after three weeks of the fourth cycle of NACT. In CHARTWEL arm 30 patients received two-dimensional radiotherapy (RT) 58.5 Gy/39 fr/2.5 weeks while in CCRT arm 30 received 66 Gy/33 fr/6.5 weeks. Disease response was evaluated at 6 months and toxicity assessment during and after treatment completion. Data were analyzed using tools such as percentage, mean, Chi-square test and P value. Chi-square and P value was calculated by statistical online software (http://quantpsy.org). Results: 28% of patients in study arm and 20% in control arm had complete response at 6 months after RT. Locoregional disease control was observed in 44% in study arm and 32% in control arm of patients. There was no statistical difference in grades of toxicities or overall survival (OS)/disease-free survival except persistent esophagitis Grade III seen in two patients of study arm. Conclusions: Study suggests that CHARTWEL in combination with NACT is an effective strategy to treat patients with locally advanced lung cancer with the advantage of a smaller dose and shorter duration. Although large multivariate studies still needed
ABSTRACT
Este texto se baseia nas (e se articula com as) formulações teóricas de Bion. Focaliza as observações e conjecturas do analista, a mente do analista, adotando a ideia de que o germe de seus pensamentos, mesmo que equivocados, surge na relação entre analista e analisando. Apoiando-se fortemente no conceito de cesura, apresenta a conjectura imaginativa/teórica de uma intersecção dos tempos passado, presente e futuro, vivenciada na experiência em curso na sessão de análise. Essa intersecção de tempos remete quem a vivencia a sua própria história de vida e à possibilidade de "ser lançado" para um futuro, movimentos que podem ser evitados devido a incontáveis fontes de angústia, algumas apresentadas no texto. Quando o analista é capaz de tolerar essas angústias, ele encontra condições para formulações verbais favorecedoras do desenvolvimento mental da dupla. Das vivências infinitas, inefáveis, talvez o analista alcance a linguagem de achievement em sua interpretação.
This article is based on (and connects with) Bion's theories. It focuses on the analyst's remarks and beliefs, his mind, embracing the idea that his germs of thoughts, even when mistaken, arouse from the relationship between the analyst and the analyzed one. It is strongly supported by the censorship concept, showing imaginative/theoretical beliefs of an intersection of past, present and future times, experimented when the analysis sessions were happening. This time intersection take those who experiment it, back to his life history and to the possibility of being taken to the future, a number of actions that can be avoided due to countless anguish sources, some of them presented in the text. When the analyst is able to tolerate this anguish, he finds ways to verbal communication favoring the mental development of both. After endless experiences, ineffable ones, maybe the analyst finds the achievement language in his interpretation.
Este texto se basa (y se articula con las) formulaciones teóricas de Bion. Focaliza las observaciones y conjeturas del analista, la mente del analista, adoptando la idea de que el germen de sus pensamientos, aunque equivocados, surge en la relación entre analista y analizado. Apoyándose con fuerza en el concepto de cesura, presenta la conjetura imaginativa/teórica de una intersección de los tiempos pasado, presente y futuro, vivenciada en la experiencia en curso de la sesión de análisis. Esta intersección de tiempos remite a quien la vive a su propia historia de vida y a la posibilidad de "ser lanzado" para un futuro, movimientos que pueden ser evitados debido a incontables fuentes de angustia, algunas presentadas en el texto. Cuando el analista es capaz de tolerar esas angustias, encuentra condiciones para formulaciones verbales favorecedoras del desarrollo mental del dúo. De las vivencias infinitas, inefables, tal vez el analista alcance el lenguaje de achievement en su interpretación.
Ce texte se fonde sur (et s'articule aux) formulations théoriques de Bion. Il examine les remarques et conjectures de l'analyste, l'esprit de l'analyste, en adoptant l'idée que le germe de ses pensées, même si celles-ci ne sont pas correctes, apparaît dans le rapport entre l'analyste et l'analysant. En s'appuyant fortement sur le concept de césure, il présente la conjecture imaginative/théorique d'une intersection des temps passée, présent et futur, vécue dans l'expérience en cours dans la séance d'analyse. Cette intersection de temps, renvoie celui qui la vit à sa propre histoire de vie et à la possibilité "d'être lancé" vers un avenir. Ces mouvements peuvent être évités en raison de nombreuses sources d'angoisses, dont le texte présente quelques-unes. Lorsque l'analyste est capable de tolérer ces angoisses, il retrouve des conditions pour employer des formulations verbales qui favorisent le développement mental des deux. Appuyé sur des vécues infinies, ineffables, l'analyste atteint peut-être le langage d'achièvement dans son interprétation.