Initial management of small-cell lung cancer (limited- and extensive-stage) and the role of thoracic radiotherapy and first-line chemotherapy: a systematic review.

Background: Patients with limited-stage (ls) or extensive-stage (es) small-cell lung cancer (sclc) are commonly given platinum-based chemotherapy as first-line treatment. Standard chemotherapy for patients with ls sclc includes a platinum agent such as cisplatin combined with the non-platinum agent etoposide. The objective of the present systematic review was to investigate the efficacy of adding radiotherapy to chemotherapy in patients with es sclc and to determine the appropriate timing, dose, and schedule of chemotherapy or radiation for patients with sclc. Methods: The medline and embase databases were searched for randomized controlled trials (rcts) comparing treatment with radiotherapy plus chemotherapy against treatment with chemotherapy alone in patients with es sclc. Identified rcts were also included if they compared various timings, doses, and schedules of treatment for patients with es sclc or ls sclc. Results: Sixty-four rcts were included. In patients with ls sclc, overall survival was greatest with platinum-etoposide compared with other chemotherapy regimens. In patients with es sclc, overall survival was greatest with chemotherapy containing platinum-irinotecan than with chemotherapy containing platinum-etoposide (hazard ratio: 0.84; 95% confidence interval: 0.74 to 0.95; p = 0.006). The addition of radiation to chemotherapy for patients with es sclc showed mixed results. There was no conclusive evidence that the timing, dose, or schedule of thoracic radiation affected treatment outcomes in sclc. Conclusions: In patients with ls sclc, cisplatin-etoposide plus radiotherapy should remain the standard therapy. In patients with es sclc, the evidence is insufficient to recommend the addition of radiotherapy to chemotherapy as standard practice to improve overall survival. However, on a case-by-case basis, radiotherapy might be added to reduce local recurrence. The most commonly used chemotherapy is platinum-etoposide; however, platinum-irinotecan can be considered.

Guideline for the Initial Management of Small Cell Lung Cancer (Limited and Extensive Stage) and the Role of Thoracic Radiotherapy and First-line Chemotherapy.

AIMS: We investigated the efficacy of adding radiotherapy to chemotherapy in patients with extensive stage small cell lung cancer (ES-SCLC) and the appropriate timing, dose and schedule of treatment for patients with ES-SCLC or limited stage SCLC (LS-SCLC). MATERIALS AND METHODS: The guideline was developed by Cancer Care Ontario's Program in Evidence-Based Care and by the Lung Cancer Disease Site Group through a systematic review of randomised controlled trials. KEY RECOMMENDATIONS: In patients with LS-SCLC (stage I, II and III), the addition of thoracic radiotherapy to standard chemotherapy is recommended. However, there is no clear evidence to inform definitive recommendations for optimal timing, sequential versus concurrent therapies and optimal dose or regimen. In patients with LS-SCLC, etoposide-cisplatin is the preferred regimen for adults who are being treated with combined modality therapy with curative intent. In patients with ES-SCLC (stage IV), there is insufficient evidence to recommend the addition of thoracic radiotherapy to standard chemotherapy as a standard practice for survival benefit; however, it could be considered on a case-by-case basis to reduce local recurrence. In patients with ES-SCLC, a platinum agent plus etoposide is the preferred regimen for adult patients who are being treated with combined modality therapy. Cisplatin and irinotecan represents an alternative treatment option to this, but is associated with increased rates of adverse events such as diarrhoea.

Reduction of disruptively loud voice volume using a "tok-back" device.

This study addressed the disruptively loud voice volume of three adult mentally retarded subjects. A reduction in voice volume was affected through the use of the "tok-back" device, a crescent-shaped device made of lightweight plastic, which when fitted over the face covers the mouth and ears and provides feedback on sounds emitted. In Experiment 1, the tok-back was used with two subjects as an aversive consequence to disruptive screaming. The tok-back was placed over the face after each scream and remained in place until the end of a specified period of quiet. Using a multiple baseline across settings design with each subject, results showed a substantial reduction in screaming following the implementation of the tok-back condition. A multi-element design was used in Experiment 2 to compare the effects of baseline, cueing and tok-back conditions on percent of correct responses, responses given in a soft volume, to simple conversational questions with the third subject. Results showed the tok-back condition to result in a higher percent of correct responding then did either the baseline or cueing conditions.

MtDNA sequencing from zooplankton after long-term preservation in buffered formalin.

Molecular genetic analysis of zooplankton has been slowed by the usual practice of preservation and storage of samples in dilute formalin solutions, which are not always adequately buffered for pH. We report here the determination of DNA sequences for Meganyctiphanes norvegica (Crustacea, Euphausiacea) preserved and stored in buffered formalin for up to 25 years. Specifically designed molecular protocols for DNA extraction and PCR amplification yielded valid sequence data for short (approximately 100-200 bp) regions of the mitochondrial cytochrome b (mtCYB) gene for individual euphausiids. Critical aspects of our approach include: extended extraction and proteinase-K digestion to maximize DNA yield; use of protocols requiring short DNA fragments; design of species-specific PCR primers to minimize risks of contamination by exogenous DNA; and comparison with published DNA sequences for the same gene and species. We conclude that the yield of DNA and the success of subsequent molecular analyses depend primarily on the length of time the tissue has been exposed to formalin and the pH of the solution. Zooplankton samples intended for molecular analysis should preferably be preserved and maintained in ethanol or deep-frozen, but long-term storage in buffered formalin does not preclude some types of molecular genetic analysis.

A multielement analysis of contingent versus contingent-interrupted music.

A multielement design was employed to evaluate the comparative effects of contingent music and contingent-interrupted music procedures. Two profoundly mentally retarded children who attended a community day training center participated. During the contingent music procedure, access to brief periods of listening to music was contingent upon the display of a specified criterion of appropriate behavior. Alternately, during the contingent-interrupted music procedure, access to music was provided at the beginning of the session, and it remained on until an inappropriate behavior occurred. The two procedures were implemented to decrease crying and increase unsupported sitting. The multielement design required that each procedure and a baseline condition be alternated across sessions. Results demonstrated that the contingent-interrupted music procedure was more effective for both reducing crying and increasing proper sitting. Implications for research with music as a reinforcer were discussed.

Application of immersion reflectometry to the study of interference layers.

The reflectance of a thin film changes upon immersion in a transparent dielectric liquid. By use of spectrophotometry, the changes in reflectance at the wavelengths where maximum or minimum reflectance occurs have been characterized for a variety of optical combinations including both transparent and absorbing films and substrates. The complications and ambiguities of interpretation for each system and the effects of multilayer structure have been examined. Reversal of the direction of observation is discussed as one means to distinguish between absorption and inhomogeneity in the film.