[Analysis of the efficacy and safety of gefitinib in the treatment of recurrent advanced non-small cell lung cancer in an expanded access program (EAP)].

OBJECTIVE: The aim of this study is to evaluate the efficacy and safety of Gefitinib in the treatment of Chinese patients with recurrent advanced non-small-cell lung cancer (NSCLC). METHODS: 120 patients were enrolled in this trial from September 2002 to March 2005, and 103 patients were evaluable. All patients were histologically or/and cytologically confirmed to have a locally advanced or metastatic NSCLC, and failed to previous standard treatments. The patients received orally 250 mg of Gefitinib once daily until the disease progression or intolerance to toxicity. First evaluation of response was undertaken one month after drug initiation, then every 2 or 3 months till disease progression. Each patient was followed up every 6 months untill death or end of follow-up. RESULTS: Among the 103 evaluable patients, the objective response rate was 18.4% (19/103), and the disease control rate was 51.5% (53/103). The median time to progression (mTTP) was 3 months (range: 0.2 approximately 40), the median survival time (MST) was 9.8 months (range: 0.5 approximately 51), the 1-, 2-, 3-year survival rates were 44.7%, 26.4% and 13.2%, respectively. The TTP of 41 patients was longer than 6 months with a MST of 25.5 months. The results of COX model analysis suggested that the patients with adenocarcinoma, rash and favourable performance status (PS) had longer TTP. The patients with favourable PS and well controlled disease had longer survival time. Adverse events included skin rash, dry skin, diarrhea and elevation of serum glutamate pyruvate transaminase (SGPT), and were usually mild. CONCLUSION: Gefitinib is effective in treatment of patient with recurrent advanced NSCLC. The patients with controlled disease may achieve a long survival, and the adverse reactions are mild and tolerable.

[Nadaplatin or cisplatin combined with paclitaxol in treatment for non-small cell lung cancer: a randomized controlled study].

OBJECTIVE: To investigate the therapeutic effect, long term survival and side effect on NSCLC patients treated with nadaplatin combined with paclitaxol and cisplatin combined with paclitaxol. METHODS: NSCLC patients with stage IIIB or IV were randomized into two groups in this prospective clinical study. TN group: nadaplatin 30 mg/m2 dl-3, paclitaxol 175 mg/m2 dl, repeated every 4 weeks. TP group: DDP 30 mg/m2 dl-3, paclitaxol 175 mg/m2 dl, repeated every 4 weeks. RESULTS: Sixty patients were enrolled and 57 were evaluable with 30 in TN group and 27 in TP group. The overall response rate were 43.3% vs. 48.1% (P = 0.716), and the disease control rate were 86.7% vs. 88.8% in TN and TP group (P = 0.799), respectively. The median survival time was 14.3 vs. 13.0 months, and the 1- and 2-year survival rate was 62.5% vs. 59.1%, 0% vs. 5.8% in TN and TP group (P = 0.839), respectively. The rates of neutropenia and thrombocytopenia were similar in TN and TP groups whereas more patients in TP group than in TN group suffered from anemia (38.5% vs. 17.5%, P = 0.001), nausea and vomiting (82.6% vs. 35.6%, P = 0.000), fatigue (35.9% vs. 14.1%, P = 0.000) and peripheral neurotoxicity (50.0% vs. 21.9%, calculated by case, P = 0.023). CONCLUSION: Nadaplatin combined with paclitaxol is an effective treatment regimen for NSCLC patients. When compared with similar regimen with cisplatin, the response rate and survival were similar; however, nadaplatin regimen shows some superiority as regards some treatment side effect.

Neoadjuvant chemotherapy followed by late-course accelerated hyperfractionated radiation therapy for locally advanced non-small-cell lung cancer: long-term results of a phase I/II clinical trial.

Toxicity, response, and long-term results of a definitive chemotherapy/radiation therapy (RT) protocol in patients with unresectable stage III non-small-cell lung cancer (NSCLC) were evaluated. Two cycles of cisplatin-based chemotherapy were delivered before RT, and another 2 cycles were added for patients who responded to the first 2 cycles of chemotherapy. The first course of radiation covered the primary lesion and elective nodal regions, given in 2 Gy per fraction, 5 days a week for a dose of 40 Gy. Late-course hyperfractionated accelerated RT was delivered to the gross tumor twice a day for an additional 27 Gy within 2 weeks, using 1.5 Gy per fraction. Fifty-three patients with unresectable stage IIIA (N2) and IIIB NSCLC were eligible for analysis. Twelve patients developed grade 3 neutropenia, and 3 patients developed grade 4 neutropenia. Grade 2 or 3 esophagitis was observed in 14 and 2 patients, respectively, and grade 2 or 3 pneumonitis was observed in 9 and 1 patient, respectively. Six patients developed grade 2 and 1 patient developed grade 3 late lung toxicity. The median survival time was 15.5 months. Twenty-six of 53 patients (49%) have died of locoregional progression inside the thorax. The distant metastasis rate was 59.5% (22 of 37 patients) for those who did not respond to chemotherapy and 18.8% (3 of 16 patients) for those who responded to chemotherapy (P = 0.006). Late-course hyperfractionated accelerated RT combined with induction chemotherapy was well tolerated and yielded long-term results that compare favorably with those of studies using 2 cycles of induction chemotherapy and conventional fractionated RT. However, local control was still discouraging.

Chemotherapy with concurrent brain and thoracic radiotherapy in brain-only metastases of treatment naive small-cell lung cancer: a phase II study.

To study the treatment outcomes of brain-only metastases from small-cell lung cancer (SCLC) at initial diagnose treated by chemotherapy with concurrent brain and thoracic radiotherapy (RT). From Jan 2004 to Jan 2009, 36 treatment-naïve SCLC patients with brain-only metastases in Sun yat-sen University were enrolled. Treatment contained initial EP chemotherapy with concurrent whole-brain radiotherapy (WBRT). EP regimen consisted of etoposide 100 mg/m(2) IV d1-3, cisplatin 80 mg/m(2) IV d1, repeated every 3 weeks. WBRT with total dose of 30 Gy in 10 fractions was started within 1 week from the beginning of chemotherapy followed by thoracic RT including 2 Gy once daily to a total dose of 60 Gy. Treatment responses were evaluated after 3 cycles of chemotherapy. EP regimen was given totally 6 cycles for no tumor progression. Thirty-four patients were evaluable. All of the 20 CNS symptomatic patients experienced symptoms relief. Objective responses in the brain and primary thoracic lesions were observed in 26 (76.5%, 16CR + 10PR) and 29 (85.3%, 23CR + 6PR) patients, respectively. The median survival time (MST) was 19.2 months, and the 1-and 2-year overall survival rates (OS) were 70.6 and 29.4%, respectively, in all patients. Patients with CR response had the longest MST of 21.9 months and 1-and 2-year OS of 93.8 and 43.8%, respectively. Treatment toxicity profiles were acceptable. The treatment strategy of concurrent chemotherapy with brain and thoracic RT might achieve promising survival outcomes comparable to limited-stage SCLC in initially diagnosed SCLC with brain-only metastases.

Triplet platinum-based combination sequential chemotherapy improves survival outcome and quality of life of advanced non-small cell lung cancer patients.

BACKGROUND: Maintenance chemotherapy is one strategy pursued in recent years with intent to break through the chemotherapy plateau for advanced non-small cell lung cancer (NSCLC). However, given the toxicity, platinum-based combinations are rarely given for this purpose. We carried out the present prospective study of triplet platinum-based combination sequential chemotherapy in advanced NSCLC to investigate if patients could tolerate and benefit from such intensive treatment. METHODS: From Dec 2003 to Dec 2007, 190 stage IIIB and IV NSCLC patients in Sun yat-sen University sequentially received the 3 platinum-based combination (TP- NP-GP) treatment (T: paclitaxol 175 mg/m2 d1; N: vinorelbine 25 mg/m2 d1 and 8; G: gemcitabine 1 g/m2 d1 and 8; P: cisplatin 20 mg/m2 d1-5; repeated every 3 weeks). Patients were followed up to at least 3 years to obtain survival data. Treatment toxicities and the quality of life (QOL) were assessed during the whole treatment. RESULTS: There were 187 patients evaluable. The TP, NP and GP response rates with sequential use were 42.8% (80/187), 41.1% (65/158) and 28.8% (21/73) respectively. Median survival time was 18.2 months and the 1, 2 and 3 year overall survival (OS) rates were 78.7%, 38.5% and 21.3%. Patients receiving>6 cycles of chemotherapy had significantly longer OS and TTP (MST 25.3 vs. 14.5 months, TTP 15.1 vs. 9.1 months). The QOL on the whole for the patients was improved after chemotherapy. CONCLUSIONS: The sequential chemotherapy strategy with triplet platinum-based combination regimens can improve the survival outcome and the quality of life of advanced non-small cell lung cancer patients.

[Efficacy of erlotinib on advanced non-small cell lung cancer].

BACKGROUND & OBJECTIVE: Erlotinib is a selective inhibitor of epidermal growth factor receptor (EGFR) tyrosine kinase, and has been used in treating advanced non-small cell lung cancer (NSCLC). This study was to evaluate the efficacy of erlotinib on advanced NSCLC, and observe the adverse events. METHODS: An open labeled, expanded access program (EAP) was conducted on 44 pathologically confirmed advanced NSCLC patients who had received at least one regimen. Erlotinib (150 mg) was orally administered daily till disease progression or intolerable adverse events developed. The efficacy was evaluated according to RECIS criteria; the adverse events were evaluated according to NCI criteria. RESULTS: In the 44 patients, the objective response rate was 27.3%, and the disease control rate was 65.9%û the median progression-free survival time was 4.5 months (0.9-8.1 months), and the median survival time was 13.7 months (9.2-18.2 months). Adverse events were generally mild (grade I or II), including skin rash (81.8%) and diarrhea (56.8%). One (2.3%) patient developed grade III elevation of serum glutamate pyruvate transaminase (SGPT). No grade IV drug-related adverse event occurred. CONCLUSION: Erlotinib is effective and safe for locally advanced or metastatic NSCLC patients who have failed previous chemotherapy.

[Primary breast lymphoma--a report of 27 cases with literature review].

BACKGROUND & OBJECTIVE: Primary breast lymphoma (PBL) is an uncommon disease with poor clinical outcome. This study was to investigate clinicopathologic features and optimal treatment of PBL. METHODS: Clinical records of 27 PBL patients, treated in Cancer Center of Sun Yat-sen University from 1976 to 2005, were reviewed. RESULTS: Of the 27 patients, 26 were women and 1 was man, with the age ranged from 12 to 84; 18 were at stage IE, 6 at stage IIE, and 3 at stage III/IVE; according to the WHO 2001 lymphoma classification system, 22 had B-cell lymphoma (including 17 cases of diffuse large B-cell lymphoma, 2 cases of mucosa-associated lymphoid tissue lymphoma, 1 case of marginal zone lymphoma, and 2 cases of unclassified B-cell lymphoma), 3 had peripheral T-cell lymphoma, and 2 had unclassified lymphoma. Of the 27 patients, 8 received mastectomy and chemotherapy, 12 received excision of the breast lesion and chemotherapy (the 5-year overall survival rates were 23% and 58%, P=0.006), 5 received chemotherapy alone, and 2 received lesion excision alone; 24 achieved complete remission (CR) after scheduled treatment, 1 achieved partial remission (PR), and 2 patients had progressive disease (PD). With a follow-up of 10 years and median 38 months, the 5-year overall and disease-free survival rates of the 27 patients were 47% and 23%, respectively. As to the 20 patients with high or moderate grade diseases (diffuse large B-cell lymphoma and peripheral T-cell lymphoma), the 5-year overall and disease-free survival rates were 48% and 27%, respectively. Sixteen patients had tumor relapse during the follow-up in the homolateral breast (6 cases), controlateral breast (4 cases), central nerve system (CNS) (3 cases), bone marrow (1 case), and lymph nodes (2 cases). CONCLUSIONS: The main subtypes of PBL are diffuse large B-cell lymphoma and peripheral T-cell lymphoma. The effect of radical operation is limited in PBL; the optimal sequence is lumpectomy followed by standard anthracycline-based regimens and radiotherapy. PBL tends to relapse to CNS, therefore, CT or MR image of CNS is necessary during follow-up.

[Responses of 109 adult soft tissue sarcoma patients to chemotherapy].

BACKGROUND & OBJECTIVE: The response of adult soft tissue sarcoma (STS) to chemotherapy is uncertain. This study was to evaluate the role of chemotherapy in treating adult soft tissue sarcoma. METHODS: Clinical data of 109 adult soft tissue sarcoma patients, treated with chemotherapy at Cancer Center of Sun Yat-sen University from Jan. 2000 to Dec. 2005, were analyzed. RESULTS: Of the 109 patients, 66 received palliative chemotherapy, 40 received adjuvant chemotherapy, and 3 received neoadjuvant chemotherapy. The overall response rate for first line chemotherapy was 22.7%. The median survival was 16.9 months. The 1-and 2-year survival rates were 63.6% and 33.3%. The patients with lung metastasis had a significantly longer median survival than those with liver metastasis did (25.1 months vs. 11.8 months, P<0.05). MAID and CYVADIC were the most commonly used first-line chemotherapy regimens; the response rates were 28.0% and 22.2%, respectively. When anthracycline and/or standard dose ifosfamide failed, the patients could still benefit from high dose ifosfamide (14.0 g/m(2)). The median survival was significantly shorter in the patients who got metastasis within 6 months after diagnosis than in those that got metastasis more than 6 months after diagnosis (11.8 months vs. 42.9 months, P=0.04). Of the 40 patients who received adjuvant chemotherapy, 16 developed progression during follow-up: 10 had relapse and 6 had distant metastasis. CONCLUSIONS: MAID and CYVADIC are two effective chemotherapy regimens for adult soft tissue sarcoma. We recommend to take a high dose ifosfamide when anthracycline and/or standard dose ifosfamide failed. The patients with liver metastasis are more resistant to chemotherapy than those with lung metastasis. Developing metastasis within 6 months after diagnosis is a poor prognostic factor.

[Intrapericardial infusion of etoposide and cisplatin in treating malignant pericardial effusion of non-small cell lung cancer].

BACKGROUND & OBJECTIVE: Pericardiocentesis and intrapericardial infusion of chemotherapeutic drugs is the main treatment of malignant pericardial effusion. This study was to observe the efficacy and side effect of intrapericardial infusion of etoposide (VP-16) and cisplatin (DDP) on malignant pericardial effusion of non-small cell lung cancer (NSCLC). METHODS: Twenty-eight NSCLC patients with malignant pericardial effusion were treated with pericardiocentesis and intrapericardial infusion of VP-16 (200-300 mg) and DDP (80-100 mg). Intravenous chemotherapy were given 2 weeks after the pericardiocentesis. RESULTS: The overall response(OR) rate of the first-time treatment of the 28 patients was 85.7%, with complete response (CR) rate of 71.4%; the OR rate of the second-time treatment was 100%. Only 4 patients needed second-time pericardiocentesis. Sixteen patients developed gastrointestinal tract reaction (mainly grade I-II), 12 developed myelosuppression (mainly grade I), and 1 showed mild abnormal of transaminase. For the 24 naïve patients, the overall survival time was 14 months for stage IIIB and 10.9 months for stage IV; whereas for the 4 patients with relapsed disease, the overall survival time was 6 months (from the time of relapse). CONCLUSION: Intrapericardial infusion of VP-16 and DDP is an effective treatment for malignant pericardial effusion of NSCLC.

[Efficacy of gefitinib on advanced non-small cell lung cancer in expanded access program (EAP)].

BACKGROUND & OBJECTIVE: Gefitinib is a selective inhibitor of epidermal growth factor receptor (EGFR) tyrosine kinase, and has been used in treating advanced non-small cell lung cancer (NSCLC). This study was to evaluate the efficacy of Gefitinib on advanced NSCLC, and observe adverse events. METHODS: An open labeled, expanded access program (EAP) was conducted. Pathologically confirmed advanced NSCLC patients who had progressed after systemic chemotherapy or was not suitable for systemic chemotherapy were eligible for this program. Gefitinib (250 mg) was orally administered daily till disease progression or intolerable adverse events developed. RESULTS: From Sep. 2002 to Mar. 2005, 120 patients were enrolled, and 103 of them were assessable for response. The objective response rate was 18.4% (19/103). The disease control rate was 51.5% (53/103). The median survival time was 6 months (0.5-33 months). Adverse events were generally mild (grade I or II), including skin rash (30.1%), dry skin (12.6%), and diarrhea (25.2%). Two (1.9%) patients developed grade III elevation of serum glutamate pyruvate transaminase (SGPT). No grade IV adverse event occurred. CONCLUSION: Gefitinib is effective in treating advanced NSCLC, and the adverse events are mild.

[Initial outcome of induction chemotherapy with weekly paclitaxel followed by three-dimensional conformal radiotherapy and concurrent weekly paclitaxel for stage III non-small cell lung cancer].

BACKGROUND & OBJECTIVE: The efficacy of radiotherapy alone on locally advanced non-small cell lung cancer (NSCLC) is poor. Although the combined modality of chemoradiotherapy and dose-escalation of radiotherapy have been the main trends, the optimal modality still remains unknown. This study was to evaluate the toxicity and efficacy of induction chemotherapy (ICT) followed by three-dimensional conformal radiotherapy (3D CRT) and concurrent weekly paclitaxel on unresectable NSCLC. METHODS: Stage III NSCLC patients with favorable conditions were treated with 2 to 4 cycles of carboplatin (AUC=5-6, d1) combined with paclitaxel (175 mg/m(2), d1), then followed by weekly paclitaxel (40 mg/m(2)) and concurrent 3D CRT within 3-4 weeks. The prescription dose was given as high as possible under the condition that V20 < or =31% and spinal cord dose < or =50 Gy. RESULTS: Thirty-one patients were enrolled. ICT was well tolerated. During the concurrent chemoradiotherapy, the treatment of 3 patients was ended ahead of the schedule because of severe pulmonary and heart toxicities; the treatment of 2 patients was delayed for 7 and 12 days because of fatigue. Myelosuppression was mild (16/31): all were grade 1-2 except 1 was grade 3. Lymphocytopenia was more obvious (29/31, grade 3 in 21). Three patients developed grade 3 radiation-induced esophagitis, and 2 developed grade 3-4 radiation-induced pneumonitis. Two developed grade 3 esophageal stricture. No grade 3-4 pulmonary fibrosis was observed. The overall response rate was 74.1%. The 1-, 2-, 3-year overall survival rates were 74.2%, 41.9%, and 34.6%, respectively, with the median survival time of 18.5 months. The 1-, 2-, 3-year local progression-freely survival rates were 64.5%, 32.3%, and 20.5%, respectively, with the median local progression-freely survival time of 14.3 months. CONCLUSIONS: The program of ICT followed by weekly paclitaxel and 3D CRT is accomplished in most of the favorable stage III NSCLC patients. The toxicity is tolerable, and the response rate is inspiriting.

[Long-term outcomes of 392 non-Hodgkin's lymphoma patients treated with pirarubicin based regimens].

OBJECTIVE: To analyse the effectiveness and toxicity of combined chemotherapy regimen containing pirarubicin (THP) in the treatment of non-Hodgkin's lymphoma (NHL). METHODS: Three hundred and ninety two patients with NHL were treated by THP containing regimen with or without involved field radiotherapy. The clinical characteristics, response, toxicity and long-term survival rates were analysed. RESULTS: The median age of the patients was 47 (5 - 87) years and 26.0% aged more than 60 years. 61.0% of the patients were males and 39.0% females. B-cell and T/NK cell NHL accounted for 68.4% and 23.2% respectively with 56.9% of diffuse large B cell lymphoma and 12.5% of peripheral T cell lymphoma. 92.6% of the patients were ECOG < 1, 63.2% in stage I + II, 84.7% with IPI score 0 - 2 and 25% with B symptoms, 93.9% (368/392) of the patients received CTOP (containing THP) regimen chemotherapy and among them 28.5% (112/392) plus involved field radiotherapy. Altogether 1598 courses were administered on 368 patients. The overall response rate was 88.5% (341/385) with a complete remission (CR) rate of 63.6%, major toxicity was myelosuppression with 12.8%, 1.0% and 1.5% of grade III - IV neutropenia, thrombocytopenia and anemia, respectively. G-CSF support was given for 553 courses (34.6%). Alopecia account for 19.8%. The incidence of mild cardiotoxicity was 5.8%. Treatment-related mortality was 1.6% (6/368). Median follow-up was 24 months. The 1, 3 and 5 year actuarial survival rates were 86.4% , 66.5% and 59.2%, respectively. Median survival time has not been achieved. CONCLUSION: The efficacy of THP based regimen CTOP for the treatment of aggressive NHL is promising. Further clinical trial is warranted.

[Paclitaxel and cisplatin combined with etoposide chemotherapy in non-small cell lung cancer with brain metastases].

BACKGROUND & OBJECTIVE: Chemotherapy has been rarely considered an important treatment modality for non-small cell lung cancer (NSCLC) with brain metastases (BM) because of the existence of blood-brain barrier (BBB). In the recent years,the studies about BBB suggest that many agents (such as paclitaxel, cisplatin) have increased permeability to BBB once BM occur. Therefore, we addressed the role of this combination with paclitaxel,etoposide, cisplatin (some effective agents to NSCLC) as front-line therapy in NSCLC with BM. METHODS: 20 chemotherapy-naive patients with documented BM from NSCLC and at least one evaluable extracerebral lesion were treated with paclitaxel (150 mg/m(2)) on day 1, etoposide (60 mg/m(2)) on day 1,3,5,and cisplatin (20 mg/m(2)) on day 1-5. The cycle was repeated every 28 days. RESULT: 17 patients were evaluated for response and 19 for toxicity. The intracranial objective response rate (ORR) was 41%,the extracranial ORR was 53%. Patients who responded for the brain also had a response at the extracerebral sites. Grade 3-4 myelosuppression occurred in 21% of the patients. The overall medican follow-up was 9 months. The medican survival time for the 9 died patients was 8.5 months. CONCLUSIONS: Paclitaxel and cisplatin combined with etoposide as front-line therapy in NSCLC with BM has some efficacy. The toxicity is mild. This combination chemotherapy seems to achieve responses similar to those for extracranial diseases, and further support the need for reconsideration of the role of chemotherapy in this setting.

[Whole-brain radiotherapy combined with COAPC regimen in patients with non-small cell lung cancer].

BACKGROUND & OBJECTIVE: The main treatment strategy of cancer patients with brain metastases was irradiation; while so far there were few researches concerning chemotherapy combined with radiotherapy for these patients. This study was designed to observe the therapeutic effect, toxicity, and survival of concurrent whole-brain radiotherapy (WBRT) combined chemotherapy with COAPC regimen in non-small cell lung cancer (NSCLC) patients with brain metastases. METHODS: A total of 45 NSCLC patients with brain metastasis received a course of COAPC regimen [cyclophosphamide 0.3 mg/m(2) i.v. d(1), vincristine 1.4 mg/m(2) i.v. d(1), doxorubicin 50 mg/m(2) i.v. d(1), cisplatin 20 mg/m(2) i.v. d(1-5), semustine 80 mg/m(2) PO d(1)] every 3-4 weeks. Whole-brain radiotherapy was administered on day 6 of the first course of chemotherapy using (60)Co at a dose of 2 Gy given in 5 fractions per week. Patients with brain lesions of 1-3 received WBRT at a dose of 40 Gy and then small field to a total dose of 60 Gy. Patients with brain lesions of more than 3 received WBRT at a total dose of 40 Gy. RESULTS: The treatment improved neurological symptoms in 80% of the patients. The response rates to brain lesions and primary lesions were 64.4% and 40.0%, respectively. The median survival time (MST) was 10 months. The 1-year and 5-year survival rates were 44.1% and 6.7%, respectively. The MST in the patients with brain metastasis was only 14 months,which was longer than the MST of 9 months in the patients with other metastasis sites(P=0.012). CONCLUSION: Concurrent WBRT and chemotherapy can be safely preformed for the patients with brain metastasis from NSCLC with a remarkable response rate and encouraging survival duration.

[Continuous-infusion high dose ifosfamide as salvage treatment for pre-treated soft tissue sarcoma].

BACKGROUND & OBJECTIVE: Adriamycin, dacarbazine and ifosfamide are three effective chemotherapy drugs in treating progressive soft tissue sarcoma. However, few regimen is effective for the patients who failed in treatment with prior Adriamycin and ifosfamide at standard dose. This study was designed to observe and evaluate the efficacy and toxicity of high dose ifosfamide(HDI) regimen on pre-treated soft tissue sarcoma. METHODS: Ten patients with advanced soft tissue sarcoma and 5 patients after surgical resection were treated with HDI administered by continuous infusion at a dose of 14 g/m2 per cycle over 6 days. All patients were pretreated with anthracycline +/- standard dose ifosfamide. RESULTS: An overall response rate of 40% was observed with 2 complete and 2 partial remission. In the follow up at 4-48 month, the overall median survival time was 21 +/- 3.29 months and the median response duration was 6 +/- 1.45 months. The major toxicity was myelosuppression. 45.9% patients experienced grade 3-4 neutropenia. CONCLUSION: HDI is an active salvage regimen in anthracycline +/- standard dose ifosfamide pretreated soft tissue sarcoma.

[Multivariate survival analysis for 423 patients with non-small cell lung cancer].

BACKGROUND & OBJECTIVE: Non-small cell lung cancer(NSCLC) is characterized by high incidence and poor prognosis in our country. New prognostic factors are needed to guide the treatment of patients with NSCLC. This study was designed to evaluate the characteristics and outcome in NSCLC patients who underwent completely surgical resection. METHODS: A total of 423 cases were analyzed using SPSS10.0 software. The survival differences were compared by univariate and multivariate analysis. RESULTS: The 5-year survival rate in this group was 46.98%. Multivariate analysis identified two poor prognostic factors: advanced TNM stage (P=0.003) and blood group B (P=0.02). Multivariate analysis also identified two better prognostic factors:adjuvant chemotherapy (P=0.04) and squamous histological type (P=0.005). The number of the risk factors (blood group B and non- squamous) were negatively related to prognosis according to multivariate analysis in stage III a NSCLC (the 5-year survival rates:43.5% vs 23.7% vs 4.0%, P< 0.001). CONCLUSION: Adjuvant chemotherapy maybe is beneficial to NSCLC patients who underwent completely surgical resection. Cox multivariate analysis demonstrates that evaluation of both histological type and blood-group has a significant prognostic effect in stage IIIa patients.

[Preliminary study on DHAP regimen for patients with relapsed and refractory non-Hodgkin's lymphoma].

BACKGROUND AND OBJECTIVE: The treatment of the patients with relapsed and refractory non-Hodgkin's lymphoma(NHL) remains difficult. It was reported that DHAP regimen(cisplatin + Ara-C + dexamthsone) was an effective salvage therapy, but there was no report about it in China. The current study was designed to observe the efficacy and toxicity of DHAP regimen for the patients with relapsed and refractory NHL. METHOD: Seventeen patients with relapsed and 10 with refractory intermediate or high grade NHL was involved in this study. These patients were treated with cytarabine 1 g/m2 intravenous(i.v.) every 12 hours on day 1 to 2, cisplatin 20 mg/m2 i.v. on day 1 to 4, dexamethone 40 mg i.v. on day 1 to 4. Four patients with CR after DHAP were followed by autologous peripheral blood stem cell transplantation(APBPCT). RESULTS: Overt responses to DHAP were seen in 12 patients (44.4%) including 8 complete responses(CR) (29.6%) and 4 partial responses (PR) (14.8%). The effective release time lasted a median of 4.8 months. Median survival time was 8.3 months. 1-year and 2-year survival rate were 30.8% and 19.3%, respectively. Myelosuppression was the major toxicity; 15 patients(57.7%) had grade III-IV neutropenia and 21 patients (80.8%) had grade III-IV thromcytopenia, but there was no treatment-related death. CONCLUSION: The authors conclude that DHAP regimen is an effective salvage therapy for the patients with relapsed and refractory NHL, but the remission duration time is short and long-term prognosis remains poor. High dose chemotherapy supported by APBPCT is necessary for improvement in long-term survival.

[Preliminary outcome for patients with relapsed or resistant advanced non-Hodgkin's lymphoma treated by EPOCH regimen].

BACKGROUND & OBJECTIVE: In the management of relapsed or refractory non-Hodgkin's lymphoma(NHL), there is still no standard salvage chemotherapy regimen so far. Potentiation of effectiveness and reduction of toxicity for some anti-cancer agents through continuous intravenous infusion were shown in some pre-clinical and clinical studies. The purpose of this study was to evaluate the efficacy and toxicity of EPOCH regimen. METHODS: A prospective phase II study of EPOCH regimen (doxorubicin/epirubicin,vincristine,etoposide over 96 hours infusion with bolus cyclophosphamade and oral prednisone) was administered to 26 patients with relapsed or refractory/resistant aggressive NHL. There were 20 patients (84.7%) among them treated by over 2 kinds of chemotherapy regimen with median regimen types of 2 (range,1-6 types) and median chemotherapy cycles of 8 (range,3-16 cycles) given for all patients. Fifteen patients (65.7%) were chemo-resistant recurrence. RESULTS: All the 26 patients were assessable. The response rate for the whole group was 50.0% with complete remission (CR) rate of 19.2%. Among the 7 patients with T-cell lymphoma and the 19 patients with B-cell lymphoma, the response rates were 28.6% and 57.9%,respectively. Major toxicity was myelosuppression with 34.8% and 8.7%incidence of grade III-IV neutropenia and thrombocytopenia respectively in all 46 cycles of EPOCH. Other toxicities were mild. CONCLUSION: EPOCH was effective for the patients with relapsed or refractory/resistant aggressive non-Hodgkin's lymphoma. Continuous infusion schedules of several chemotherapeutic agents may partially reverse chemo-resistance and reduce toxicity. EPOCH can be used as standard salvage regimen. Further clinical study is warranted.

[Clinical results of 295 patients with Hodgkin's disease treated by chemotherapy-predominant comprehensive modality].

BACKGROUND & OBJECTIVE: Hodgkin's disease (HD) is a chemo- and radio-sensitive hematologic malignancy. At present, improvement of cure rate, reduction of long-term toxicity, and maintenance of good quality of life are the major issues in the treatment of HD. The results of long term follow-up from Cancer Center, Sun Yat-sen University were analyzed retrospectively in terms of efficacy and late side effects in this article. METHODS: The results of 295 patients with histology-proven HD from 1970 to 2000, especially from 1980 to 2000 were analyzed. Meanwhile, multivariant analysis (COX model) was employed to determine the prognostic factor. RESULTS: A total of 295 HD patients were treated by chemotherapy-predominant comprehensive modality. The 5, 10, and 20 years overall survival for 295 HD patients were 63.5%, 55.8%, and 47.1%, respectively, with median survival time of 172.3 months (28-351.9 months) at the median follow-up time of 42.9 months (17-351.9 months). The 5, 10, and 20 years overall survival and disease-free survival were 79.6%, 74.5%, and 66.8% as well as 74.5%, 69.4%, and 69.4% respectively for the patients treated with regular chemotherapy and radiotherapy from 1980 to 2000. The incidence rate of late toxicities was low. Multivariate analysis demonstrated that age over 45-year-old, B symptoms and stage III/IV were the main prognostic factors (P = 0.000, P = 0.035, and P = 0.047) in this clinical study. The prognosis of the patients with stage I/II and nodular sclerosis was better in comparison to stages III/IV and other histologic subtypes. CONCLUSIONS: Chemotherapy-predominant combined with involved fields irradiation play an important role in HD treatment with promising long term survival and lower late toxicities. Further investigation for this simplified and convenient comprehensive modality is warranted.