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ABSTRACT: To evaluate the efficacy, survival and toxicity in patients with brain metastases from non-small cell lung cancer (NSCLC), treated with concurrent systemic chemotherapy and whole brain radiation therapy (WBRT) or sequential systemic chemotherapy/WBRT.
A total of 60 NSCLC patients with brain metastases were divided into two groups in this prospective clinical study: concurrent systemic chemotherapy and WBRT group (concurrent group) and sequential systemic chemotherapy/WBRT group (sequential group).
Of 59 assessable patients, the overall response rate was 22.0%, and the brain response rate was 35.6%; the median progression-free survival time was 3.0 months, and the overall 1- and 2-year survival rates were 55% and 24.4%, respectively, with a median survival time of 16.0 months. The overall response rate was 20.0% in the concurrent group and 24.1% in sequential group (P > 0.05). The brain response rates of 43.3% in concurrent group and 27.6% in sequential group were also not significantly different (P > 0.05). The median progression-free survival time for the patients in the concurrent group was 3.0 months versus 4.0 months in the sequential group, and the median survival time was 16.0 months versus 13.0 months (all P > 0.05). The 1- and 2-year survival rates were 58.5% and 37.2% versus 52.9% and 18.9%, respectively, with a significant difference in the 2-year survival rate between the two groups (P = 0.011). In the sequential group, leukopenia was more frequent during chemotherapy than that in the concurrent group (P = 0.029).
Concurrent systemic chemotherapy and WBRT is effective with tolerable adverse events in treating brain metastasis from NSCLC with an encouraging survival, and deserves further large sample and randomized multicenter clinical trials.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 01/2011; 33(1):58-62.
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ABSTRACT: Some clinical predictors can be used to evaluate the efficacy of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) therapy for non-small cell lung cancer (NSCLC), including female, East-Asian, non-smoker, adenocarcinoma, skin rash, etc. The aim of this study is to explore the prognosis of advanced NSCLC patients treated with gefitinib for more than 6 months.
Eighty advanced NSCLC patients treated with gefitinib for more than 6 months were collected from January, 2005 to March, 2010. The association of their clinical characteristics with median progression-free survival time (PFS) was analysed.
Significantly longer median PFS were found in patients with > 70 years old, earlier clinical stage (IIIb), non-bone metastasis (27 months vs 12 months; 32 months vs 12 months; 16 months vs 10 months, P < 0.05). There was no significant difference in median PFS between ECOG performance status 0-1 group and 2-4 group, between more than 4 cycles of chemotherapy and 1-4 cycles, between PFS of chemotherapy > 6 months group and ≤6 months group, however, ECOG 0-1 group and more than 4 cycles of chemotherapy or PFS of chemotherapy > 6 months group seemed to have longer median PFS (15 months vs 10 months; 16 months vs 12 months; 14 months vs 12 months). Compared with no skin rash and grade 0-I rash group, the patients with rash or grade ≥II rash had longer median PFS (16 months vs 13 months, P=0.171; 19 months vs 11 months, P=0.085). The median PFS was not related with sex, smoking index, pathological types, metastatic sites except bone, treatment strategy, etc (P > 0.05).
For gefitinib treatment, longer median PFS is likely to be obtained in patients with > 70 years old, earlier clinical stage (IIIb), non-bone metastasis.
Zhongguo fei ai za zhi = Chinese journal of lung cancer 11/2010; 13(11):1050-5.
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ABSTRACT: To evaluate the effect and side effects of CD34+ originated dendritic cells (DCs) infusion to treat malignant effusions.
Twenty-three patients with 26 malignant effusions received chemotherapy and granulocyte colony-stimulating factor (G-CSF) or G-CSF alone to mobilize peripheral blood hematopoietic stem cells. CD34+ stem cells were induced to differentiate into DCs by cytokines interleukin 4 (IL-4), granulocyte-macrophage colony stimulating factor (GM-CSF), and tumor necrosis factor-alpha (TNF-alpha). After being cultured for 10 to 14 days to stimulate proliferation and grow mature, DCs were refused into the body cavity by drainage tube weekly for 3 weeks.
The response rate was 54% (14/26) and the benefit rate 81%. The median duration of response was 20 weeks (range:4-45 weeks). Karnofsky performance score (KPS) was improved in 15 patients. The response rate was 50% for the naive patients and 57% for the refractory patients. There were no severe side-effects.
This pilot study demonstrates that DCs derived in vitro can exist viably after intropleural injection and can mediate biologic activity to malignant effusions. DCs immunotherapy is promising to treat malignant effusions with good tolerance.
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 11/2008; 40(5):486-8.
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ABSTRACT: It is well known that more than 40% patients were initially diagnosed with advanced non-small cell lung cancer (NSCLC) with intrapulmonary or/and distant metastasis. However, up to now, the reports about effects of different metastatic sites on survival were limited. The aim of this study is to investigate the clinicopathologic and survival difference by retrospective analysis among sole intrapulmonary metastasis, sole extrathoracic distant metastasis and simultaneous metastasis of lung and other extrathoracic organs for the patients with advanced NSCLC, and to analyze the prognosis-related factors of NSCLC with intrapulmonary metastasis.
Of the 425 patients with stage IV NSCLC diagnosed by pathology and through staging evaluation and treated at Beijing Cancer Hospital with long follow-up during Oct. 1995 to Dec. 2003, 81 cases had sole intrapulmonary metastasis, 98 cases had sole extrathoracic distant metastasis and 68 cases presented simultaneous lung metastasis and extrathoracic spread. Kaplan-Meier survival curve was performed to estimate the survival of patients with different metastasis, Log-Rank test was used to compare their survival difference, and univariate analysis was used to find prognostic related factors.
Median survival time (MST) and 1-, 2-, 3-year survival rate (SR) for patients with sole intrapulmonary metastasis were 13 months (95% CI: 11-15), 57%, 21%, 7%, respectively; MST was 22 months (95% CI: 18-26) for patients with N1 and/or N2 and 10 months (95%CI: 7-13) for patients with N3 (P=0.001). Among the patients with ipsilateral, contralateral and bilateral intrapulmonary metastasis, difference of MST and 1-, 2-, 3-year SR had no statistical significance (P > 0.05); Survival of patients with sole intrapulmonary metastasis was not significantly different from that of patients with sole brain or bone metastasis (P > 0.05), but was longer than that of patients with simultaneous lung and extrathoracic spread (P=0.021). One way analysis of variance showed that no significant association were found among age, pathologic subtype, differentiation degree or response of first-line chemotherapy and survival of the patients with sole intrapulmonary metastasis (P > 0.05), but sex and invasive status of lymph node (N1/N2 vs N3) were found to influence the survival of the patients (P= 0.018, P=0.001). Further stratified analysis by age showed that invasion of lymph node was independent prognostic factor (P=0.002); whereas for the patients with simultaneous metastasis of lung and distant organs, metastatic numbers (2 vs ≥3) of organ were independent prognostic factor (P=0.013).
No statistical difference is found among survival of NSCLC patients with sole intrapulmonary metastasis and with sole brain, bone metastasis. Invasive status of lymph node and metastatic number of organ are important prognostic factors for patients with sole intrapulmonary metastasis and simultaneous metastasis of lung and extrathoracic organs, respectively.
Zhongguo fei ai za zhi = Chinese journal of lung cancer 12/2006; 9(6):530-5.
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ABSTRACT: Now the treatment of non-small cell lung cancer (NSCLC) patients with brain metastasis is not a standard program. The aim of this study is to summarize the factors related to survival of patients with brain metastases from NSCLC.
A total of 111 NSCLC patients with brain metastases (from September 1995-May 2004) were defined as symptomatic group (37 patients) and asymptomatic group (74 patients) according to central nervous system (CNS) symptoms. The patients in the symptomatic group were given whole brain radiation therapy (WBRT, DT 30-40Gy/20f) first, and then received cisplatin-based chemotherapy. The patients in the asymptomatic group were given cisplatin-based chemotherapy first, and then received WBRT. During the treatment, 49 patients received chemotherapy of BCNU or VM-26 irregularly.
The median survival time was 11 months. The 1-and 2-year survival rate was 40.79% and 13.26% respectively. The survival time was not significantly different between the symptomatic group and asymptomatic group. Median chemotherapy of asymptomatic group was 3 cycles (1-6 cycles) before WBRT. Those patients who received 3 or 4 cycles of chemotherapy before WBRT had better survival (P= 0.0188 , P=0.0035). The treatment of BCNU or VM-26 was a benefit factor for survival (P=0.0219) in asymptomatic group. The hematologic toxicity of grade III or IV was not significantly different between the two groups (P > 0.05). The number of brain metastasis (P=0.000), extracranial metastasis (P=0.022) and WHO performance status (P=0.001) were independent prognostic factors.
The patients with asymptomatic brain metastases receive 3-4 cycles of chemotherapy before WBRT may be reasonable. During the therapy, the patients with administration of BCNU or VM-26 may have survival benefit.
Zhongguo fei ai za zhi = Chinese journal of lung cancer 12/2006; 9(6):540-3.
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ABSTRACT: To study the expression of targeting protein for Xklp2 (TPX2) and its significance in squamous cell carcinoma (SCC) of the lung.
Two SCC cell lines and 4 immortalized bronchial epithelial cell lines (as a precancerous model) were examined by Western blot for TPX2 expression. Reverse transcription-polymerase chain reaction analysis for TPX2 was also performed using tumor tissues from 21 patients with SCC of the lung. The expression of TPX2 was studied by immunohistochemistry (using tissue microarray) on paraffin-embedded sections of pulmonary SCC and corresponding precancerous lesions from a group of 319 patients.
TPX2 was variably expressed in all the cell lines studied. Compared with matched controls using normal lung tissue, high level of TPX2 mRNA was detected in 16 of the 21 SCC tumor tissue samples analyzed. Immunohistochemical study showed that TPX2 was mainly present in tumor tissues but not in normal controls. The expression of TPX2 correlated with tumor grade, stage and nodal status. As for precancerous lesions, the level of TPX2 was also increased, in accordance with the degree of dysplasia.
Expression of TPX2 may play a role in carcinogenesis of bronchial epithelium and tumor progression of pulmonary SCC. It may also represent a potential biomarker for surveillance of SCC of lung.
Zhonghua bing li xue za zhi Chinese journal of pathology 10/2006; 35(9):540-4.
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ABSTRACT: To investigate the efficacy, time to progression, survival time and toxicity of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor Gefitinib (Iressa), a target therapy agent, in the treatment of advanced non-small cell lung cancer (NSCLC), and to analyze the factors affecting the efficacy and patients' survival.
From Nov. 2003 to May 2005, 91 patients with advanced NSCLC who failed from previous first-line chemotherapy were treated by gefitinib in this trial with a median chemotherapy cycle of six. Sixty-eight of these 91 patients (74.7%) had received a second-line chemotherapy. Seventy-six (83.5%) of the 91 patients had stage IV disease, and 42 (46.2%) had developed metastases at least two sites. Gefitinib was administered orally at a dose of 250 mg daily until disease progressed or severe toxicity developed. Clinical data were analyzed using chi-square test, Log-lank test, Cox regression and Kaplan-Meier survival analysis in SPSS 11.5.
(1) Overall response rate was 20.9% (19/91) and the disease control rate (response and stable disease) was 63.7% (58/91). Patients'symptoms were improved in 72.7% (40/55), and ECOG score was improved or remained stable in 71.4% (65/91). The disease control rate of those who had adenocarcinoma, or received second-line chemotherapy or developed skin toxicity was significantly better than the other patients (P value = 0.04, 0.02, 0.00, respectively). (2) Median time to progress (TIP) was 5.0 months (95% CI 3.26-6.74). (3) Median following-up duration was 7.5 months (1-18. 5 months), and 1-year survival rate was 56.4%. Of the 56 patients (61.5%) who were still alive when following-up ended, 29 (51.8%) had stable disease, 20 had survived more than one year (12-18. 5 months). Non-smoker, stable diseases, skin toxicities, and controlled metastatic diseases during the treatment of gefitinib were the favorable factors affecting the survival (P value = 0.00, 0.00, 0.00, 0.01, respectively). (4) The main toxicity of gefitinib was grade I or II skin toxicity.
Gefitinib, a target therapy agent which may be an alternative, is effective and tolerable in the treatment for advanced NSCLC patients who have failed in the first-line or even second-line chemotherapy. It can remarkablely improve the disease control rate and disease-related symptoms, and also prolong survival in the responders.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 07/2006; 28(6):474-7.
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ABSTRACT: Bone metastasis is very common in lung cancer patients. Metastasis to spine can lead to paralysis and fracture, deteriorate the quality of patient's life. The objective of this study is to investigate the diagnostic values of bone scanning (NBS), MRI, CT and X-ray examination to discover bone meastasis of lung cancer, and the therapy of bone metastasis and the prognostic factors.
About 561 consecutive NSCLC cases were analyzed with NBS and compared with other radiological examinations (MRI, CT and X-ray).
Out of the 455 positive patients by NBS, 300 cases were confirmed to be with bone metastases by dynamic follow-up, MRI, CT and X-ray, and 5 cases were false negative.The sensitivity and specificity of NBS was 98.36% and 39.45% respectively. The accuracy of NBS was 71.48%. Among the 305 patients with bone metastases, 23 patients had no records, 138 patients had bone pain, the incidence of asymptomatic bone metastasis was 47.21%. Multivariables analysis showed that asymptomatic bone metastasis, flat bone metastases, therapy with disodium pamidronate were significantly good prognostic factors, respectively (P < 0.05).
A whole body NBS examination is preferred for the staging of NSCLC. NBS is necessary for patients with NSCLC. In order to exclude the possible false positive or false negative diagnosis by NBS, CT or MRI could be selected according to the sites of lesions.
Zhongguo fei ai za zhi = Chinese journal of lung cancer 01/2006; 9(4):357-61.
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ABSTRACT: Clinical trails showed that thymosin alpha1 offers protection from toxicities (nausea, vomiting, fatigue) of chemotherapy. This study was designed to investigate the protection of thymosin alpha1 to nervous system.
Twenty-two patients with advanced lung cancer, or advanced breast cancer were treated with vinorelbine (25 mg/m(2), d(1), d(8)) combined with cisplatin (80 mg/m(2), d(1)), or gemcitabine (1.25 g/m(2), d(1), d(8)) combined with cisplatin (80 mg/m(2), d(1)),or paclitaxel (80 mg/m(2), d(1), d(8), d(15)) combined with carboplatin (AUC=6 d(1)),or paclitaxel (80 mg/m(2), d(1), d(8), d(15)) combined with epirubicin (80 mg/m(2), d(1)). They all experienced grade 2 to 4 of neurotoxicities according to common toxicity criteria of National Cancer Institute after chemotherapy. The same chemotherapy regimens were combined with thymosin alpha1 (1.6 mg/d for 4 days before chemotherapy, and 1.6 mg twice weekly for 1-3 weeks after chemotherapy began) in the next cycle. Clinical neurologic evaluation was performed at baseline every week.
In 10 patients (45.4%), neurotoxicities reduced from grade 2-4 before chemotherapy to less than grade 2 after chemotherapy.
Thymosin alpha1 may prevent patients from chemotherapy-induced neurotoxicities.
Ai zheng = Aizheng = Chinese journal of cancer 11/2004; 23(11 Suppl):1428-30.
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Jin Gu,
Aiwen Wu,
Jiyou Li,
Xiaopeng Zhang, Jian Fang,
Ming Li,
Yunfeng Yao,
Yang Ke,
Jiang Gu,
Mingzhe Chen,
Weicheng You
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ABSTRACT: The differential diagnosis of severe acute respiratory syndrome (SARS) in patients with cancer can be challenging. Although diagnostic criteria for SARS have been issued by the World Health Organization (WHO), simple adoption of the established criteria may lead to overdiagnosis in patients with cancer or to an increase in the risk of spreading SARS within cancer hospitals.
The authors report their experience with the exclusion and quarantine of patients with cancer during the peak of the SARS epidemic in Beijing, China. The patients included 4 males and 7 females with a median age of 66 years (range, 39-73 years).
All 11 patients met the WHO diagnostic criteria for probable SARS. Among those 11 patients with probable SARS, only 1 had confirmed SARS; for the other 10 patients, the possibility of SARS infection was ruled out.
Special attention must be paid to patients with cancer who have symptoms similar to those seen in SARS. Although the WHO diagnostic criteria for SARS should be widely accepted, they are not definite or practical in certain populations.
Cancer 05/2004; 100(7):1374-8. · 4.77 Impact Factor
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ABSTRACT: To investigate the prognostic factors of 355 patients with advanced non-small cell lung cancer for researching an individual treatment module.
From March 1988 to October 2000, after diagnosed by histology or cytology and staged by staging examinations, 355 novel advanced NSCLC patients (stage III, 134; stage IV, 221) were enrolled, who were given at least 2-cycle chemotherapy. Response rate and survival were observed and prognostic factors were analysed.
Out of 355 patients, 101 got partial response and 147 had stable disease. Response rate was 28.45%, and tumor control rate was 69.86%. Median survival duration was 16 months. The 1-, 2-, 3- and 5-year survival rates were 58.41%, 29.35%, 14.60% and 8.60%, respectively. In the patients with stage IV, median survival duration was 14 months, and 1-, 2-, 3- and 5-year survival rates were 54.62%, 25.59%, 12.70% and 6.73%, respectively. COX multiple variable analysis showed that improved/stable ECOG score (P=0.044 0) and chemotherapy (after second line failure) combined with γ-IFN (P=0.039 0) had prognostic significance.
Improvement of quality of life is quite important in the treatment of advanced NSCLC. Combination with γ-IFN or TAM and radiotherapy of primary tumor may be helpful to improve the survival of patients with stage IV.
Zhongguo fei ai za zhi = Chinese journal of lung cancer 12/2002; 5(6):416-9.
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ABSTRACT: To judge clinical and prognostic values of serum CEA, NSE, CYFRA211, CA125 and CA199 levels in patients with advanced non-small cell lung cancer ( NSCLC) .
Ninety-five untreated but confirmed by histology or cytology patients with advanced NSCLC were studied. The serum levels of CEA, NSE, CYFRA211, CA125 and CA199 were detected before and after treatment by cisplatin-based regimens.
The positive rate was 53. 7%, 70. 5%, 62. 2%, 54. 1% and 31. 6% for CEA, NSE, CYFRA211, CA125, CA199 respectively, before treatment. The significant decreases of the markers were observed in 39 partial response patients ( P= 0. 030, 0. 000, 0. 009, 0. 002, 0. 034 respectively) . The overall 1- and 2-year survival rate were 52. 7%( 50/ 95) and 14. 7%( 14/ 95) respectively. Cox proportional hazard multivariate analysis showed that the prognosis of advanced NSCLC patients was related to response rate of first cycle, staging, performance status and serum CYFAR211 level before treatment, but not to histology and serum levels of CEA, NSE, CA125 and CA199 before treatment.
The decrease in CEA, NSE, CYFRA211, CA125, and CA199 levels could be used to evaluate the chemotherapeutic response. TNM stage and performance status and CYFRA211 before treatment can be used as prognostic parameters in patients with advanced NSCLC.
Zhongguo fei ai za zhi = Chinese journal of lung cancer 10/2001; 4(5):357-9.
