Concurrent palliative chemoradiation leads to survival and quality of life benefits in poor prognosis stage III non-small-cell lung cancer: a randomised trial by the Norwegian Lung Cancer Study Group.

BACKGROUND: The palliative role of chemoradiation in the treatment of patients with locally advanced, inoperable non-small-cell lung cancer stage III and negative prognostic factors remains unresolved. METHODS: Patients not eligible for curative radiotherapy were randomised to receive either chemoradiation or chemotherapy alone. Four courses of intravenous carboplatin on day 1 and oral vinorelbin on days 1 and 8 were given with 3-week intervals. Patients in the chemoradiation arm also received radiotherapy with fractionation 42 Gy/15, starting at the second chemotherapy course. The primary end point was overall survival; secondary end points were health-related quality of life (HRQOL) and toxicity. RESULTS: Enrolment was terminated due to slow accrual after 191 patients from 25 Norwegian hospitals were randomised. Median age was 67 years and 21% had PS 2. In the chemotherapy versus the chemoradiation arm, the median overall survival was 9.7 and 12.6 months, respectively (P<0.01). One-year survival was 34.0% and 53.2% (P<0.01). Following a minor decline during treatment, HRQOL remained unchanged in the chemoradiation arm. The patients in the chemotherapy arm reported gradual deterioration during the subsequent months. In the chemoradiation arm, there were more hospital admissions related to side effects (P<0.05). CONCLUSION: Chemoradiation was superior to chemotherapy alone with respect to survival and HRQoL at the expense of more hospital admissions due to toxicity.

Low-grade non-Hodgkin's lymphoma in northern Norway: treatment, outcome, and prognostic factors.

AIM: All low-grade non-Hodgkin's lymphoma (LG-NHL) patients diagnosed and/or treated at our institution over a 10 year period were investigated with regard to treatment outcome and possible pre-treatment prognostic factors. PATIENTS AND METHODS: During the period 1986-1995, 169 consecutively registered patients with LG-NHL were retrospectively analyzed with regard to personal, treatment, and disease- specific characteristics. The median follow-up time was 52 months (5-132 months). All patients were diagnosed histologically according to the Keil classification system. Median age was 60 years (range 27-87 years), and the male:female ratio was 1.05: 1. RESULTS: The overall response rate was 77%, of which 66% were complete response (CR) and 11% partial response (PR). 5- and 10-year overall survival were 72% and 47%, respectively, and median overall survival was 8.3 years. 10-year overall survival for stage I, II, III, and IV were 86%, 65%, 33%, and 29%, respectively. For follicular lymphoma, 10-year survival was 52% and median survival 12.5 years. In univariate analysis, the following pre-treatment factors indicated a poor prognosis: advanced stage, general symptoms, bone marrow infiltration, poor performance status, tumor > or = 6 cm, low serum albumin, anaemia, and LDH > or = 540 U/l. In multivariate analysis, stage, performance status, tumor size, and anaemia were found to be independent prognostic factors for overall survival. CONCLUSIONS: The treatment strategy has proved successful for most patients with localised disease. Independent prognostic indicators for survival as stage, performance status, tumor size, and anaemia may be useful guides in deciding when and how to treat.

Vinorelbine/carboplatin vs gemcitabine/carboplatin in advanced NSCLC shows similar efficacy, but different impact of toxicity.

This randomised phase III study in advanced non-small cell lung cancer (NSCLC) patients was conducted to compare vinorelbine/carboplatin (VC) and gemcitabine/carboplatin (GC) regarding efficacy, health-related quality of life (HRQOL) and toxicity. Chemonaive patients with NSCLC stage IIIB/IV and WHO performance status 0-2 were eligible. No upper age limit was defined. Patients received vinorelbine 25 mg m(-2) or gemcitabine 1000 mg m(-2) on days 1 and 8 and carboplatin AUC4 on day 1 and three courses with 3-week cycles. HRQOL questionnaires were completed at baseline, before chemotherapy and every 8 weeks until 49 weeks. During 14 months, 432 patients were included (VC, n=218; GC, n=214). Median survival was 7.3 vs 6.4 months, 1-year survival 28 vs 30% and 2-year survival 7 vs 7% in the VC and GC arm, respectively (P=0.89). HRQOL, represented by global QOL, nausea/vomiting, dyspnoea and pain, showed no significant differences. More grade 3-4 anaemia (P<0.01), thrombocytopenia (P<0.01) and transfusions of blood (P<0.01) or platelets (P<0.01) were observed in the GC arm. There was more grade 3-4 leucopoenia (P<0.01) in the VC arm, but the rate of neutropenic infections was the same (P=0.87). In conclusion, overall survival and HRQOL are similar, while grade 3-4 toxicity requiring interventions are less frequent when VC is compared to GC in advanced NSCLC.

[Intrapleural fibrinolysis with streptokinase in th treatment of loculated empyema]. / Intrapleural fibrinolyse med streptokinase i behandlingen av lokulaere empyemer.

Intrapleural fibrinolytic treatment is increasingly used in patients with loculated empyema. In this paper, we report our experience with fibrinolytic therapy in eight patients with empyema not responding to drainage and antibiotics. Mean patient age was 47 (range 3-76), and mean duration of symptoms 14 weeks (range 1-24). The patients were treated with 250,000 IU streptokinase in four hours, 1-6 intrapleural instillations (except 50,000 IU for the child). Between 500 and 4,500 cc fluid was drained. Mean drainage time was 14 days (range 6-20). Mean time spent in hospital was 20 days (range 15-25). No microbiological agent was isolated in three patients. All patients recovered. One patient experienced a hypersensitivity reaction following streptokinase treatment for more than one week. Fibrinolysis with streptokinase should be used in patients with loculated empyema when drainage and antibiotics fail.