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PubMed1991

Photodynamic therapy to treat tumors of the extrahepatic biliary ducts. A case report.

The poor survival rate of patients with extrahepatic bile duct tumors is well documented. Over the course of 4 years, we treated a white woman with diabetes diagnosed with histologically proven adenocarcinoma of the common bile duct with six injections of dihematoporphyrin ether followed by seven photodynamic therapy treatments to the biliary duct. As of July 1989, the patient was still alive, was not jaundiced, and had a Karnofsky performance status of 70. No changes occurred in any blood chemistry value from the time of injection to the time of photodynamic therapy. Of the transient elevations of some blood chemistry values and the white blood cell count, which occurred within 24 to 48 hours after photodynamic therapy, only those of alanine aminotransferase, aspartate aminotransferase, and amylase were significant.

Adenocarcinoma↗
PubMed1999

Survival after photodynamic therapy to non-pulmonary metastatic endobronchial tumors.

BACKGROUND: For the past 15 years we have used photodynamic therapy (PDT) to treat endobronchial tumors. Unfortunately patients who have non-primary lung cancer metastatic to bronchi and who have failed other treatment regimens may not be offered endobronchial tumor management. Thirteen patients with endobronchial tumors metastatic from non-pulmonary primaries were treated with PDT. We: 1) evaluated the effects of PDT on the tumor, the quality of life, and the length of survival; and 2) compared their survival after PDT to that of 27 patients with stage IV primary endobronchial tumors treated with PDT after they failed all other treatment regimens. MATERIALS AND METHODS: Photodynamic therapy was performed using 630-nm light delivered through cylinder diffusing tip quartz fibers passed through the biopsy channel of a flexible bronchoscope after intravenous injection of the photosensitizer dihematoporphyrin ether. One to two days after PDT bronchoscopy was repeated and necrotic tissue was mechanically removed and, if necessary, that site or other new sites were treated. Two days after this another bronchoscopy was performed and the necrotic tissue was mechanically removed. Bronchoscopy was repeated one month after PDT and periodically thereafter as needed to re-treat symptomatic residual tumor. The percent obstruction of the bronchus due to tumor was estimated before and at the end of each bronchoscopy. Clinical effects were evaluated using Wilcoxon signed rank tests for scaled parameters of dyspnea, cough, hemoptysis, and Karnofsky Performance Status (KPS) before and one month after PDT. All patients were followed until their death. RESULTS: The mean percent obstruction due to metastatic non-pulmonary tumors at 38 different endobronchial treated sites decreased from 85% to 13% at discharge after PDT. The 72% mean decrease of obstruction was statistically significant using the Wilcoxon signed rank test (P < .0001). There was a statistically significant improvement in the level of dyspnea (P = .012), hemoptysis (P = .028), cough (P = .027), and KPS (P = .020). Kaplan-Meier survival curves and Mann-Whitney U rank tests showed the median survival of stage IV primary tumor patients (4 months) vs. metastatic tumor patients (14 months) was statistically significant (P = .008). CONCLUSION: PDT of endobronchial metastatic tumors effectively decreased the amount of endobronchial obstruction, and improved the quality of life.

Aged↗
PubMed1996

A long-term assessment of adjuvant chemotherapy on outcome of patients with extracapsular spread of cervical metastases from squamous carcinoma of the head and neck.

BACKGROUND: Extracapsular spread (ECS) of cervical lymph node metastases of squamous cell carcinoma from head and neck sites portend poor prognosis. Therefore, a program of combined surgery, postoperative irradiation therapy, and adjuvant methotrexate and 5-fluorouracil (5-FU) was initiated in 1982 for such patients. METHOD: All patients operated on between June 1982 and December 1992 by the full-time faculty of the Department of Otolaryngology at the University of Pittsburgh School of Medicine were eligible and reported in this trial. All patients had negative surgical margins of excision of the primary carcinoma, and histologic evidence of cervical metastases with ECS. Postoperative irradiation included 50-60 cGy for 5 to 6 weeks followed by methotrexate and 5-FU administered on an outpatient basis on days 1 and 8 every 21 days. All patients were followed for 30 or more months for evidence of recurrent disease. RESULT: A total of 371 patients met eligibility criteria. Of this group, 53 (14%) were treated with surgery only, 187 (50%) received surgery and postoperative irradiation, and 131 (35%) received surgery, irradiation therapy, and chemotherapy. The primary site, extent of nodal involvement, and stage of the three patient groups were similar. However, performance status (Karnofsky) was best in the patients who received chemoradiation (average 90) when compared with those who received surgery and irradiation (average 80) or surgery only (average 70). Absolute disease free survival rate (30 months) was 9.5% in patients treated with surgery only, 34% in patients treated with surgery plus irradiation, and 53% in patients treated with surgery, irradiation, and chemotherapy. When adjusted for patients who died of intercurrent disease with less than 30 months follow-up, survival rates became 17%, 40%, and 58%, respectively. These differences are highly significant (P < 0.001). CONCLUSION: Results of this study suggest that postoperative chemoradiation may improve survival in patients with ECS of cervical metastases. Compliance with the chemoradiation was suboptimal and suggests that improved strategy must be developed.

Aged↗
PubMed1996

Prognostic significance of Ki-67 labeling indices obtained using MIB-1 monoclonal antibody in patients with supratentorial astrocytomas.

BACKGROUND: Identification of the prognosis of patients with gliomas is important for selecting and evaluating the effectiveness of treatment. The aim of this study was to evaluate the Ki-67 labeling index (LI) using the newly generated MIB-1 monoclonal antibody (MoAb) as a prognostic indicator for patients with astrocytomas. METHODS: Ki-67 immunohistochemistry was performed on paraffin sections to estimate the growth potential of 72 supratentorial astrocytomas using the MIB-1 MoAb after hydrated autoclaving treatment. Multivariate analysis using the Cox proportional hazard stepwise model was used to evaluate the influence of Ki-67 LI, as well as other prognostic factors, on the duration of survival of patients with supratentorial astrocytomas. RESULTS: The mean Ki-67 LI was 3.8% (+/- 2.7%; standard deviation [SD]) in Grade 2 gliomas (n = 19), 18.4% (+/- 9.7% SD) in Grade 3 gliomas (n = 25), and 31.6% (+/- 12.9% SD) in Grade 4 gliomas (n = 28). Multivariate survival analysis showed that histologic grade, Ki-67 LI, and Karnofsky performance status (KPS) score before and after treatment were independent, statistically significant prognostic factors for patients with all grades of astrocytomas. In high grade lesions, Ki-67 LI, tumor location (superficial vs. deep), and KPS score after treatment were significant prognostic variables, whereas histologic grade did not meet the significance level for entry into the stepwise model. CONCLUSIONS: These results indicate that the Ki-67 LI obtained using MIB-1 MoAb is an important and practical tool for estimating biologic behavior of gliomas, as well as for predicting survival.

Adolescent↗
PubMed1996

A randomized trial to assess the efficacy of surgery in addition to radiotherapy in patients with a single cerebral metastasis.

BACKGROUND: Cerebral metastasis is a common oncologic problem that occurs in 15-30% of cancer patients; approximately half such metastases are single. Previous retrospective studies and two randomized trials reported that the addition of surgical extirpation prior to radiation therapy increased survival, neurologic function, and quality of life compared with radiation alone in patients with a single brain metastasis. METHODS: A randomized controlled trial was conducted in which patients with a single brain metastasis were allocated to undergo radiation alone or surgery plus radiation. Radiation consisted of 3000 centigray to the whole brain in 10 fractions. RESULTS: Forty-three patients received radiation alone and 41 patients surgery plus radiation. All but two of the study patients died. No difference in survival was detected between the groups; the median survival for the radiation group was 6.3 months (95% confidence interval, 3-11.4) compared with 5.6 months for the surgery plus radiation group (95% confidence interval, 3.9-7.2) (P = 0.24). Most patients died within the first year (69.8% in the radiation arm vs. 87.8% in the surgery plus radiation arm). There were no significant differences in the 30-day mortality, morbidity, or causes of death. Extracranial metastases was an important predictor of mortality (relative risk, 2.3). The mean proportion of days that the Karnofsky performance status was > or = 70% did not differ between the 2 groups. CONCLUSIONS: This trial failed to demonstrate that the addition of surgery to radiation therapy improved outcome of patients with a single brain metastasis. Thus, the efficacy of surgery plus radiation compared with radiation alone needs to be addressed by further clinical trials and/or a meta-analysis.

Brain Neoplasms↗
PubMed1997

Increased survival associated with radiolabeled Lym-1 therapy for non-Hodgkin's lymphoma and chronic lymphocytic leukemia.

BACKGROUND: Because most patients with advanced non-Hodgkin's lymphoma (NHL) and chronic lymphocytic leukemia (CLL) respond to radioimmunotherapy (RIT), the study was designed to evaluate the relationship between response and survival in patients treated with radiolabeled Lym-1. METHODS: Fifty-seven patients with NHL (52) or CLL (5) were treated with radiolabeled Lym-1 antibody between 1985 and 1994. Influence of response to treatment on survival was examined directly and was also adjusted for other factors previously found to be significant predictors of survival. A multivariate model that was based on baseline Karnofsky performance status (KPS) and serum lactic dehydrogenase (LDH) predicted response and survival and was used to define risk groups. Proportional-hazards, Kaplan-Meier, and Landmark models were used to evaluate parameters for their ability to predict outcome. RESULTS: By using a proportional-hazards model with response as a time-dependent variable, overall response (P < 0.001) and complete response (P = 0.006) were predictive of increased survival in univariate analyses. Overall response continued to be significant (P = 0.02) in multivariate analyses, even when risk groups that also predicted survival were included. Median survival of responders was 84 weeks, whereas that of nonresponders was 22 weeks when the Landmark method, based on response status at 16 weeks from start of therapy, was used to generate survival curves. CONCLUSIONS: Response to treatment with radiolabeled Lym-1 was associated with increased survival, even when adjusted for baseline clinical parameters that also predicted for survival. The results provide the first unbiased evidence for survival effects of RIT in patients.

Adult↗
PubMed1998

Carboplatin, etoposide, and accelerated hyperfractionated radiotherapy for elderly patients with limited small cell lung carcinoma: a phase II study.

BACKGROUND: It is not clear how well elderly patients with limited small cell lung carcinoma tolerate intensive chemotherapy, and they have often been treated with palliative intent. As an alternative strategy, the authors designed and employed a short term combination regimen consisting of carboplatin and etoposide with accelerated hyperfractionated radiotherapy. METHODS: Seventy-five patients ages > or = 70 years with a Karnofsky performance status of > or = 60 and no other major medical problems, were enrolled in this study and 72 were evaluable. The protocol consisted of intravenous carboplatin (400 mg/m2) given on Days 1 and 29, oral etoposide (50 mg/m2) given on Days 1-21 and 29-49, and accelerated hyperfractionated radiation at a dose of 1.5 gray (Gy) administered twice daily (total dose, 45 Gy) starting on Day 1. RESULTS: The median follow-up period was 61 months. The response rate was 75%, and complete response was observed in 57% of the patients. The median survival time was 15 months, and the 2- and 5-year survival rates were 32% and 13%, respectively. Acute Grade 3 leukopenia, thrombocytopenia, and esophagitis were observed in 8.3%, 11%, and 2.8% of the patients, respectively. Only one patient experienced Grade 4 acute toxicity (thrombocytopenia). No late toxicity of Grade 3 or higher was observed. CONCLUSIONS: This combined treatment program was tolerable and produced promising long term results. Elderly patients should not universally be treated with palliative intent. Further studies exploring a potentially more effective regimen are warranted.

Administration, Oral↗
PubMed1999

The evaluation and treatment of patients receiving radiation therapy for carcinoma of the esophagus: results of the 1992-1994 Patterns of Care Study.

BACKGROUND: For the first time, a Patterns of Care Study (PCS) was conducted in 1992-1994 to determine the national practice standards in evaluating and treating patients with esophageal carcinoma and to determine the degree to which clinical trials have been incorporated into national practice. METHODS: A national survey of 61 institutions using 2-stage cluster sampling was conducted, and specific information was collected on 400 patients with squamous cell carcinoma or adenocarcinoma of the thoracic esophagus who received radiation therapy (RT) as part of definitive or adjuvant management of their disease. Patients were staged according to a modified 1983 American Joint Committee on Cancer staging system. Chi-square tests for significant differences between academic and nonacademic institutions for a particular variable were performed. RESULTS: The median age of patients was 66.7 years (range, 26-89 years); 76.5% were male and 23.5% were female. Karnofsky performance status was > or = 80 for 88.3% of patients. Squamous cell carcinoma was diagnosed in 61.5% and adenocarcinoma in 36.8%. Fifteen percent were Clinical Stage (CS) I, 39.5% CS II, and 29.5% CS III. Evaluative procedures included endoscopy (>93%), computed tomography (CT) of the chest (86%), CT of the abdomen (75%), esophagography (68.5%), and endoscopic ultrasound (3.5%). Endoscopic ultrasound and CT of the chest were performed significantly more frequently at academic than nonacademic facilities (6.1% vs. 1.0% and 91.9% vs. 81.3%, respectively). Three-quarters of all patients received chemotherapy and RT and 62.5% received concurrent chemotherapy and RT as part of their treatment. Treatments included chemotherapy plus RT (54.0%), RT alone (20.3%), preoperative chemotherapy + RT (13.3%), postoperative chemotherapy + RT (7.7%), postoperative RT (3.5%), and preoperative RT (1.2%). The chemotherapeutic agents most frequently used were 5-fluorouracil (84%), cisplatin (64%), and mitomycin (9%); academic instututions used cisplatin significantly more often and mitomycin significantly less often than nonacademic institutions. Brachytherapy was used in 8.5% of cases. The median total dose of external beam radiation was 50.4 gray and the median dose per fraction was 1.8 gray. CONCLUSIONS: This study establishes the national benchmarks for the evaluation and treatment of patients with esophageal carcinoma at radiation facilities in the U.S. It also indicates that the majority of patients given RT as a component of treatment for esophageal carcinoma receive chemoradiation rather than RT alone, as supported by clinical trials. Although some differences in the evaluation of esophageal carcinoma were noted between academic and nonacademic facilities, there was no difference in the frequency of use of chemoradiation versus RT by facility type.

Adenocarcinoma↗
PubMed1999

Double blind randomized trial of sucralfate vs placebo during radical radiotherapy for head and neck cancers.

BACKGROUND: This study sought to determine whether sucralfate prophylaxis during a course of high dose radiation therapy (RT) for head and neck cancer decreases acute side effects. METHODS: Patients receiving curative intent RT for advanced head and neck cancers participated in a single institution double-blind randomized trial comparing sucralfate to placebo. Patients were stratified according to fractionation, use of concurrent chemotherapy, Karnofsky performance status (KPS), age, and pretreatment presence of a feeding gastrostomy. Patients were prospectively evaluated during weekly treatment checks, and analyzed with regard to time (measured in terms of dose) until development of the following: weight loss, mucositis, pain, nutritional intake, and need for a treatment break. After completion of RT, time until healing was similarly compared. RESULTS: Fifty-two patients received sucralfate and 50 received placebo. The mean (+/-SD) prescribed dose was 69 +/- 7 Gy. Sixty-nine patients received BID fractionation and 27 received concurrent chemotherapy. No difference was detected in any outcome measure in the direct comparison between the two groups. On multivariate analysis, weight loss >5% or >10% occurred more frequently in patients receiving chemotherapy (p < 0.01 and p = 0.05, respectively). Grade 3 mucositis was more common in patients receiving chemotherapy (p = 0.05) or BID fractionation (p = 0.04) or having a poor KPS (p = 0.02). Interval to healing was not associated with any of the pretreatment- or treatment-related factors. Sucralfate did not result in any additional toxicity. CONCLUSIONS: Prophylactic treatment with sucralfate during high-dose head and neck RT did not decrease acute treatment side effects. Other modalities should be investigated.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Spanish version of the Rotterdam Symptom Check List: cross-cultural adaptation and preliminary validity in a sample of terminal cancer patients.

We report on the process of adaptation into Spanish of the Rotterdam Symptom Check List (RSCL). The original version was translated and back-translated by professional bilingual translators. A quantitative rating method was used to select the items to include in the final Spanish version. Validity (discriminant and construction) and reliability were test in 118 terminal cancer patients. In addition to the RSCL the Nottingham Health Profile (NHP) and the Karnofsky Performance Status (KPS) were used. The RSCL showed different ratings on all scales according to the functional level of the patients. The scales were moderately to highly correlated with the NHP (from 0.48 to 0.71). Internal consistency, measured by Cronbach's alpha coefficient ranged from 0.74 (physical) to 0.90 (activity). Twenty-four hours test-retest intraclass correlation coefficient ranged from 0.71 to 0.88. The results of this study suggest that the Spanish version of the RSCL is conceptually equivalent to the original. More research is needed to assess the responsiveness of the version before using it in clinical trials.

Activities of Daily Living↗
PubMedDate not supplied

Development of a scale to measure psychosocial concerns of Mexican women with advanced cancer.

This descriptive study was undertaken to explore the perceptions and attitudes of 143 women (mean age+/-51) with advanced cancer. Outcome measures were the Perceptions and Attitudes Scale (PAS), a 65-item instrument validated as part of the study, and the Karnofsky Performance Status Scale. Internal consistency (Cronbach alpha) and factor analytic techniques (principal component and orthogonal rotation) were performed. The scale has an internal consistency of 0. 79. Factor analysis revealed six factors which explained 39.6% of the variance (1) loneliness; (2) family and social sphere; (3) limitations and dependence conditions; (4) perceptions about their lives; 5) perceptions about their health and pain; and (6) perceptions of pain and anguish. These results point out the necessity of a multivariate approach to women with advanced cancer.

Adaptation, Psychological↗
PubMed1997

Analysis of prognostic factors for patients with single brain metastasis treated with stereotactic radiosurgery.

To evaluate and define treatment prognostic factors and selection criteria for patients with solitary brain metastasis treated with stereotactic radiosurgery. Between March 1990 and January 1995, 48 patients with solitary brain metastasis were treated with stereotactic radiosurgery at our tertiary care institution. Eleven patients were treated for progression or relapse of intracranial disease after whole-brain external beam radiotherapy or surgical resection. Patients were eligible for radiosurgery if they had a (1) Karnofsky Performance Status (KPS) of at least 70, (2) a solitary, radiographically distinct lesion < 4 cm in diameter, (3) lesion at least 1 cm from the optic chiasm, and (4) a reasonably well-controlled primary tumor. The factors subjected to univariate and multivariate analysis for local control and survival correlations were age, histology, control of systemic disease, surgical debulking, whole-brain irradiation, dose delivered, lesion volume, location (supratentorial vs. infratentorial), and new versus recurrent metastasis. Sex and initial KPS were also analyzed for survival. Local control was achieved in 39 (81%) patients. The only prognostic factor in the univariate analysis that significantly correlated with local control was new versus recurrent lesion (P = .009). Initial KPS of at least 80 and age < 65 years were significant with regard to survival in the univariate and multivariate analyses. Median survival after radiosurgery was 8 months. This study corroborates the usefulness of stereotactic radiosurgery for patients with a small solitary metastatic brain lesion. In our series, as well as in others, several characteristics (young age, optimal KPS, newly diagnosed metastasis, controlled or absent systemic disease) provide clues as to which patients will most benefit. Studies, including randomized trials, are needed to clarify patient and tumour characteristics that predict which patients will benefit from stereotactic radiosurgery.

Aged↗
PubMed1987

Interferon in renal cell carcinoma. The UCLA experience.

Three sequential studies of alpha interferon were performed in a total of 84 evaluable patients with metastatic renal cell carcinoma. In Study I, conducted from 1981 to 1982, 43 patients received human leukocyte alpha interferon (IFN alpha) 3 X 10(6) U/day, 5 days per week for 12 weeks. In Study II, performed in 1983, vinblastine (0.1 mg/kg/week) was added to the same IFN alpha regimen in 22 subjects. Study III, held from 1984 to 1985, evaluated the effects of escalating doses of interferon alfa-2a (from 3 to 36 X 10(6) U/day) administered 5 days per week to 19 patients. Overall, complete (CR) and partial responses (PR) totaled 17% (14%, 14%, and 26% in Studies I-III, respectively). Median survival of all patients was 49 weeks. Median survival appeared to be superior in the third study, likely because of the patient mix (skewed toward a Karnofsky performance status of 10, disease-free interval longer than 1 year, and disease confined to the lung). Those prognostic factors were also found to correlate with improved median survival in the total group of 84 patients. Likewise, response to therapy was linked to prolonged survival; patients with CR, PR, or minimal responses had a median survival of 72 weeks. In all the favorable subgroups, responders had better outcomes than nonresponders, but it was not clear whether response to therapy merely selected out patients with better initial prognoses or actually led to improved survival.

Adult↗
PubMed1987

The prognostic importance of myelosuppression in the response to chemotherapy and survival in advanced ovarian carcinoma.

Fifty-three patients treated between 1974 and 1981 were analyzed to establish the relationship between myelosuppression, tumor response, and survival in the treatment of advanced ovarian carcinoma, Stage III-IV, with melphalan alone or a melphalan-doxorubicin combination. The total response rate was 34% and the 5-year survival rate was 24.5%. Responders had significantly higher performance status and hemoglobin values at the start of chemotherapy. During chemotherapy the mean nadir values of leukocytes and thrombocytes were identical for responders and nonresponders and the degree of myelosuppression measured in this way did not predict the probability of tumor response or survival. The bone marrow of nonresponders seemed to be more active, judging from a tendency towards higher leukocyte and thrombocyte cell counts before the individual chemotherapy courses than in responders. Dose reduction and interval prolongation seemed to worsen the prognosis with regard to tumor response and long-term survival. Combination chemotherapy with melphalan-doxorubicin was superior to single drug therapy with melphalan with regard to bone marrow toxicity, tumor response rate and survival. The most important single prognostic factor at the start of chemotherapy was the performance status (Karnofsky's index). Myelosuppression per se did not improve the prognosis with regard to tumor response or survival in this series.

Adult↗
PubMed1988

Maintenance chlorambucil after CVP in the management of advanced stage, low-grade histologic type non-Hodgkin's lymphoma. A randomized prospective study with an assessment of prognostic factors.

One hundred sixty-two patients with Stages III and IV non-Hodgkin's lymphoma of low-grade histologic type were treated with combination chemotherapy using cyclophosphamide, vincristine, and prednisolone (CVP) followed by radiotherapy to sites of previous bulk disease. The patients were randomized to receive either follow-up alone or "maintenance" chemotherapy with 2 years of intermittent chlorambucil. A complete remission was obtained in 56% of patients and the median survival was 64 months (median follow-up, 74 months). Multivariate analysis revealed stage (P less than 0.0001) and Karnofsky performance status (P = 0.021) to predict complete response (CR) and the achievement of a CR (P less than 0.0001), female sex (P = 0.008), the absence of bulk disease (P = 0.038) and low serum alkaline phosphatase (P = 0.002) to predict prolonged survival. The median relapse-free survival (RFS) of the complete responders was 41 months. A prolonged RFS was predicted by low stage (P = 0.014), low serum lactic dehydrogenase (LDH) (P = 0.045) levels, and by the administration of maintenance chlorambucil (P = 0.045). A prolonged survival of the complete responders was predicted by a low number of nodal sites of involvement with lymphoma at presentation (P = 0.022) and lack of liver involvement (P = 0.011). The administration of oral maintenance therapy with chlorambucil for a full 2 years was only possible in 38% of patients, mainly because of progression of disease and the induction of thrombocytopaenia, but despite this it prolonged the median RFS by 38 months and its use could be considered when future studies are being designed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Photodynamic therapy of endobronchial malignancies.

Forty-nine tumor sites in 31 consecutive patients with tracheobronchial malignant neoplasms were treated with photodynamic therapy (PDT). After sensitization with the intravenous hematoporphyrin derivative (HpD) or its more purified form of dihematoporphyrin ether (DHE), 630 nm of light from a tunable sensitizer argon light system was delivered to the tumor site through the biopsy channel of a flexible bronchoscope. All patients had received, refused, or were ineligible for conventional surgery, ionizing radiation therapy, or chemotherapy. Before or at 1 month after each treatment, tumor response was evaluated according to the following categories: (1) complete response (CR) (no visible abnormality, and negative biopsy specimen and cytology); (2) partial response (PR) (degree of obstruction or size of tumor reduced more than 50%); (3) some response (SR) (degree of obstruction or size of tumor reduced 20% to 50%); and (4) progression (PROG) (degree of obstruction or size of tumor reduced by less than 20%). Results were as follows: (1) 37% of the tumors treated achieved CR; (2) 55% achieved PR; (3) 4% achieved SR; and (4) 4% were categorized as PROG. Complete follow-up was achieved in all patients. Clinical effect was evaluated 1 month after treatment by comparing the Karnofsky performance status (KPS), dyspnea level, oxygen requirement, and presence of symptoms. Sixty-eight percent had clinical improvement in at least one variable and 48% in two or more variables. The results of this study suggest that PDT can play a useful role in the treatment of endobronchial malignancies.

Airway Obstruction↗
PubMed1989

Prognostic variables in patients with hepatic metastases from colorectal cancer. Importance of medical assessment of liver involvement.

Variation in response rates to chemotherapy and survival in patients with hepatic metastases from colorectal carcinoma may be due to patient selection factors. The prognostic importance of 13 factors were analyzed in 112 patients with only hepatic metastases, who were eligible for hepatic artery infusional chemotherapy. When individually analyzed, six factors were found to significantly (less than 0.001) affect survival: the percentage of tumor involvement of the liver, assessed medically or surgically; initial serum albumin and lactic dehydrogenase; initial Karnofsky performance status; and weight loss. Patients with less than or equal to 30% liver involvement had a median survival of 24 months versus 10 months if they had greater than 30% involvement. There was a highly significant agreement between medical and surgical assessment of liver involvement (P = 0.0001). When the variables affecting survival were studied together by multivariable analyses, the most important factor was the medical assessment of liver involvement accomplished by evaluation of radionuclide liver scan and CTT scans. The next two most important factors in the model were the ability of the patient to obtain a tumor response and the presence or absence of weight loss. Only one factor helped predict response to chemotherapy, the type of perfusion seen on a 99Technetium-macroaggregated albumin (MAA) arterial flow scan. Forty-five percent of patients with good perfusion had a partial response while 13% of patients with poor perfusion had a tumor response (P = 0.006). We recommend that future studies, dealing with patients who have hepatic metastases from colorectal carcinoma and are eligible for hepatic arterial infusion, document and stratify for the following factors: the percentage of liver involvement, the presence or absence of weight loss, and the type of perfusion seen on MAA scans.

Adenocarcinoma↗
PubMed1989

Supportive care versus supportive care and combination chemotherapy in metastatic non-small cell lung cancer. Does chemotherapy make a difference?

Current chemotherapy treatment of metastatic non-small cell lung cancer has demonstrated some objective responses, but is still largely palliative. This report reviews the results of a randomized trial in patients with advanced metastatic non-small cell lung cancer which compared treatment with supportive care (treatment with palliative radiation, psychosocial support, analgesics, nutritional support) to supportive care plus combination chemotherapy with cisplatin and vinblastine. Although the patients receiving combination chemotherapy had a slightly longer median survival (20.43 weeks versus 13.57 weeks), it was not statistically significant (P = 0.09). In addition, the patients receiving chemotherapy experienced serious toxicity, and showed no significant benefit in terms of quality of life as measured by Karnofsky performance status score. The authors conclude that contemporary combination chemotherapy provides only modest survival benefit to patients with advanced metastatic non-small cell lung cancer and should not be considered standard therapy. Future investigations of chemotherapy in patients with unresectable non-small cell lung cancer should continue to utilize control arms which provide high-quality supportive care.

Aged↗