Search

Meta-analysis is a statistical method allowing an evaluation of the direction and quantitative importance of a treatment effect observed in randomized trials which have tested the treatment but have not provided a definitive conclusion. In the present review, we discuss the methodology and the contribution of meta-analyses to the treatment of advanced-stage or metastatic non-small-cell lung cancer. In this area of cancerology, meta-analyses have provided determining information demonstrating the impact of chemotherapy on patient survival. They have also helped define a two-drug regimen based on cisplatin as the gold standard treatment for patients with a satisfactory general status. Recently, the meta-analysis method was used to measure the influence of gemcitabin in combination with platinium salts and demonstrated a small but significant benefit in survival, confirming that gemcitabin remains the gold standard treatment in combination with cisplatin.

We report a case of sarcoidosis with mediastinal and pulmonary localizations associated with diffuse antineutrophil cytoplasmic antibodies (c-ANCA). This led to discuss the differential diagnosis with vascularitis and the specificity of c-ANCA in Wegener's granulocytosis.

The purpose is to determine the response to, and toxicity of docetaxel (Taxotère) in patients with inoperable non small cell lung cancer (NSCLC), previously untreated. Seventy patients with stage IIIB or IV NSCLC were treated by 100 mg/m2/ 3 weeks of docetaxel until tumor progression or severe toxicity. Premedication with diosmine and prednisolone was given in all patients: 66/70 were eligible and 55/70 were assessable for antitumoral activity. Median age: 63 years, WHO performans status 0-1: 83%, stage IV: 96%. For eligible patients, 17/66 (26%) achieved an objective response: 1 complete response and 16 partial response (IC 95% = 15-36). With a median follow-up of 23.4 months (range 14.9-28.7), for evaluable patients, the median response duration was 8 months, the median time to progression 4 months, and the median survival time 10 months. The median number of administered cycles is 5 (range 1-12). The estimate one year survival rate was 47%. Seventy-six patients presented neutropenia (grade 3-4); febrile neutropenia was observed in 7% of cycles. Non haematological toxicities are: fluid retention related to docetaxel (2.9%), diarrhea (6%), nausea-vomiting (4%), asthenia (3%), nail changes (6%). Docetaxel (Taxotère) administered at 100 mg/m2/3 weeks has relevant clinical activity in previously untreated NSCLC with a acceptable toxicity.

Purpose: Determine the response to, and toxicity of docetaxel (Taxotere) in patients (pts) with inoperable non-small-cell lung cancer (NSCLC) previously treated with platinum-containing chemotherapy., Patients and Methods: Twenty-seven patients with stage IIIB or IV NSCLC, having received one platinum-containing regimen were treated with 100 mg/m2/3 weeks of docetaxel until tumor progression or severe toxicity. Premedication with prednisolone and diosmin was given in all patients. Antitumoral activity was assessable in 21/27 pts. Median age: 52 years; WHO performance status 0-1: 77% pts, stage IV disease: 63% pts., Results: 6/21 eligible pts (24%) achieved a partial response to treatment [C.I 95%: 5.6-42]. Median time to progression: 2.9 months, median survival: 8.5 months with a median follow-up of 23.7 months (range: 13.5-27). Hematologic toxicity: grade 3-4 neutropenia: 75% pts, febrile neutropenia: 11% cycles. Non hematologic toxicities: fluid retention, rash, alopecia, sensory neuropathy, asthenia, and nail changes., Conclusion: Docetaxel (Taxotere) administered at 100 mg/m2/3 weeks has relevant clinical activity against platinum treated NSCLC pts. Neutropenia is the main toxicity.

We report a case of interstitial pneumonia found by a woman who suffered from a gastroesophageal reflux unamenable to usual treatments. The HR-tomographic discovery of a tone esophagus lead to a manometric study. The association of high autoantibodies levels and radiographic and manometric data were characteristic of esophageal and pulmonary scleroderma.

Docetaxel, a new chemotherapeutic agent, has demonstrated activity in non-small cell lung cancer and breast cancer. Toxicities associated with treatment using docetaxel include hypersensitivity reactions and fluid retention, which can be prevented by pretreatment with corticosteroids. We describe herein two cases of acute interstitial pneumonitis after administration of docetaxel to patients suffering from metastatic non-small cell lung cancer. A pulmonary toxicity of docetaxel from an hypersensitivity reaction is likely because of symptoms course, radiological demonstration of an interstitial pneumonitis, lack of an infectious etiology and of clinical response to antibiotic treatment, and rapid recovery with corticosteroids. This unusual pulmonary toxicity has been rarely described with docetaxel, as transient pulmonary infiltrates have been observed during treatment with paclitaxel. The possibility of an hypersensitivity pneumonitis must be taken into account when a patient with docetaxel treatment presents pulmonary infiltrates.

Cognitive performance is predictive of functional status, morbidity and mortality in the elderly. In the SYST-EUR study, the Vascular Dementia Project run on 3,111 subjects 60 years old and over, with isolated systolic hypertension, has shown that the cognitive status as measured by the MMSE was inversely correlated with systolic blood pressure (p < 0.001) and age (p < 0.001) and positively correlated with the level of education (p < 0.001). It is significantly lower in patients with cardiovascular complications (p = 0.0001). Moderate alcohol consumption is linked to a higher MMSE score in women (p < 0.001) but not in men. In this study, the incidence of dementia is low and significantly related to the baseline value of the MMSE score and further analysis will show the influence of the treatment of systolic hypertension with calcium antagonists as first step on this incidence.

A 52-year-old man presented with a two month history of left sided chest pains related to a pleurisy which showed an 18 per cent eosinophilia on pleural aspiration. He was hospitalised one month later and at that stage was very dyspnoeic and there was a bilateral pleural effusion associated with a significant pericardial effusion causing compression. A pleuro-pericardial drainage eased the patient's symptoms. The pleural fluid showed an 87 per cent lymphocytosis and a complete diagnostic work up was negative thus a diagnosis of idiopathic eosinophilic pleurisy with an associated pericarditis was made. Steroid therapy was instituted using half a milligram per kilo and this led to a rapid functional improvement and no recurrence of the effusions were noted. The treatment was progressively stepped down over the next five months and the patient's condition was satisfactory without any recurrence at nine months.

Objectives of the Study: Pilot study to assess high-dose rate (HDR) brachytherapy as sole treatment for limited endobronchial non-small cell lung carcinomas., Inclusion Criteria: Proximal non-small cell lung cancer in a not previously irradiated area, with a maximal diameter of 1 cm, no visible tumor on CT scan, lack of other treatment options in patients with severe, chronic respiratory failure, surgery, or external radiotherapy for a previous lung cancer., Treatment Protocol: Treatment was based on an escalating dose protocol. Patients received three to five fractions of 7 Gy prescribed at 10 mm from the center of the applicator, once a week., Results: Nineteen patients were included in this trial. The first two patients received three fractions of 7 Gy, the four next patients received four fractions, and the 13 remaining patients were treated with five fractions of 7 Gy. Two months after the end of the procedure, tumors in 15 of 18 evaluable patients (83%) were locally controlled with negative results of biopsies. At 1 year, local control was still obtained in 12 of 16 evaluable patients (75%). With a mean follow-up of 28-months, 1-year and 2-year actuarial survival rates were 78% and 58%, respectively, with a 28-month median survival. One patient with local control died from hemoptysis 12 months after treatment. Two patients suffered from severe necrosis of the bronchial wall; one of them died from hemoptysis., Conclusions: HDR brachytherapy is an effective treatment for small endobronchial tumors. Late toxicity on the bronchial wall is still too high and was attributed mainly to contact between the catheter and the bronchial mucosa. Exclusive HDR brachytherapy should be restricted to carefully selected patients for whom there is no alternative curative treatment. New bronchial applicators and a lower dose per fraction may reduce the incidence and attenuate the severity of late complications.

Radiation is often necessary after pneumonectomy, either immediately or due to local cancer recurrence. High radiation doses represent a challenge due to the limited tolerance of the lung and the necessity of preserving and protecting the remaining lung parenchyma. The use of CT scan based-treatment planning allows delivery of high radiation doses. To evaluate the radiation tolerance of the lung after high radiation dose, we compared pulmonary function tests performed before surgery and after radiation therapy. Ten male patients (mean age, 56 years old; age range, 45-73) were irradiated after pneumonectomy for lung cancer. All patients had a CT scan-based treatment planning. The mean radiation dose was 56 Gy (45-66 Gy) delivered with a linear accelerator and multiple complex fields. Two or more sets of pulmonary function tests were available (before surgery and 2 to 6 months after radiation). No patient developed clinical radiation pneumonitis and most of the patients had a minimal paramediastinal fibrosis at CT scan. Postirradiation pulmonary lung tests were compared to the theoretical values of the estimated defect observed after pneumonectomy. No significant decrease in forced expiratory volume in 1 s/inspiratory vital capacity (FEV1/IVC) was observed in ten evaluable patients; the observed values were comparable to those expected after pneumonectomy without irradiation (FEV1/IVC: 61 to 100%), showing that irradiation did not alter pulmonary function. Computerized tomography-based treatment planning and the use of complex beam positioning allowed optimal lung parenchymal preservation. Through this procedure, high doses of radiation can be delivered to the mediastinum and bed tumor. Comparison of pulmonary function tests performed before surgery and after radiation showed no alteration of lung function, even after high doses. Optimal tools required for the evaluation of radiation on lung parenchyma are still to be defined.

The accidental embolization of peripheral venous catheter fragments seems to be a rare event. Removal of the catheter embolus is usually recommended, because of the high morbidity and mortality rates from sepsis, perforation, thrombosis and arrhythmias. We report a case, in which the diagnosis was made 17 years after the embolization by the means of a systematic chest X-ray. The use of spiral CT scan with computerized post-processing 3D reconstruction confirmed the diagnosis. Because of good tolerance during this very long term, a not-to-treat decision was taken.

Pleurisies due to the syndrome of ovarian hyperstimulation typically accompany ascites and in their most severe form are associated with haemoconcentration, hypovolaemia and thromboembolic phenomena. It is not unusual in this context for pleural effusions to be isolated. They may occur during treatment for sterility by inducing ovulation, they are exudates and predominantly right sided. The pathophysiology is not clear and results in vascular hyperpermeability. Currently, no treatment aimed at the aetiology has proven its own efficacy. Spontaneous regression of the effusion is the rule but in severe forms, where the prognosis is uncertain, correction of hypovolaemia is a priority.

Unlabelled: Between February 1992 and May 1993, 22 patients older than 75 years, with non small cell lung cancer, were treated with carboplatin and oral etoposide. There were 18 men and four women with a median age of 79 years. Fourteen patients had an epidermoid carcinoma: four had an adenocarcinoma and four had an undifferentiated carcinoma. Carboplatin was administered intravenously on day 1 at a dose of 300 mg/m2; oral etoposide was administered at a dose of 600 mg/m2 (two capsules daily) for 9, 10, 11, or 12 days according to body surface. Courses were repeated every 28 days for a total of three courses., Toxicity: 15 patients (68%) had received previous chemotherapy. Myelosuppression was the main problem with one grade IV and five grade III hematologic toxicities. We observed one mild neurologic toxicity., Results: 19 patients were evaluable for response. We observed one complete response (5%), five disease stabilizations (26%) and 13 disease progressions. Median survival was 5 months. These results led to discontinue this study.

Mastocytosis (MS) may be exclusively cutaneous or, more rarely, systemic. MS may be indolent (benign), aggressive, leukaemic or associated with a myeloproliferative disorder. The clinical expression of MS may be secondary to the direct consequences of the development of mastocytes in tissue or correspond to the paroxysmal features related to the liberation of vasoactive and spasmogenic mediators by activated mastocytes. Dyspnoeic episodes are classical but the physiopathological mechanism is poorly documented. True asthma or bronchopulmonary mastocytosis seems rare. The authors report evidence of non-specific bronchial hyper-reactivity (HRB) to Carbachol in a patient effected with benign cutaneous mastocytosis with secondary elevation of the total serum IGE. Factors determining the HIB are discussed and appear primarily linked to the mastocytosis.

Radiation-induced cancer is a rare complication of radiotherapy. The diagnosis relies on chronological, topographical and histological data distinguishing the lesion from tumoural relapse. We report the case of a second cancer, meeting the criteria of radiation-induced malignancy, and attempt to define the frequency, clinical situations and risk man. In addition to gentic mechanisms, other factors appear to play a role in the genesis of radiation-induced cancer.

The authors report the case of a patient aged 27 suffering from a clear cell adenocarcinoma of the vagina which was related to her mother taking Diethylstilboestrol or Distilbene (DES) during her pregnancy. This young woman presented with pulmonary metastases for which several trials of chemotherapy ended in failure. The case raises several problems amongst which are epidemiologies of cancers induced by Diethylstilboestrol (DES), their prognosis as well as the therapeutic strategies at the time of diagnosis and the recurrences which occur as metastases.