PURPOSE: To evaluate the efficacy and toxicity of combination chemotherapy with low-dose paclitaxel and cisplatin in patients with advanced non-small cell lung cancer. MATERIALS AND METHODS: Chemotherapy-naive patients with unresectable, pathologically proven non-small cell lung cancer were eligible for inclusion in the study. Patients received paclitaxel (145 mg/m2 iv 3 hour D1) and cisplatin (60 mg/m2 iv D1) every 3 weeks. RESULTS: Forty-two patients were enrolled between February 2000 and February 2001. The median age was 53.5 years. Patients with adenocarcinoma numbered 29, squamous cell carcinoma 7, large cell carcinoma 3, and undifferentiated carcinoma 3. Seventeen patients had stage IIIB, 19 had stage IV disease and the remaining 6 displayed recurred disease after previous surgical resection. Four patients terminated treatment early because of hypersensitivity (1) and severe emesis (3). Of the 38 evaluable patients, 14 had PR and the response rate was 36.8%. Among partial responders, 6 patients received additional chest radiation. The median duration of response was 47.9 weeks and the median overall survival was 54.0 weeks. Of the total 176 courses, 14 were delayed, 22 required dose reduction, and grade 3~4 neutropenia occurred in 5.6% of courses. Only one episode of neutropenic fever developed and there were no treatment- related mortalities. Other toxicities were generally mild. CONCLUSION: The combination chemotherapy with low-dose paclitaxel and cisplatin was effective and tolerable in patients with advanced non-small cell lung cancer.
Adenocarcinoma ; Carcinoma ; Carcinoma, Large Cell ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Cisplatin* ; Drug Therapy ; Drug Therapy, Combination ; Fever ; Humans ; Hypersensitivity ; Mortality ; Neutropenia ; Paclitaxel* ; Thorax ; Vomiting

Based on the histopathologic findings of the lacrimal gland tumor, the lesion is classified as either epithelial or nonepithelial tumor. 22% of lacrimal gland lesions were primary epithelial neoplasm. 4%of epithelial tumor of lacrimal glands were primary malignant tumor. Squamous cell carcinoma arising from pleomorphic adenoma of lacrimal gland is a very rare(0.4%). Inspite of surgical intervention, postoperative radiation and chemotherapy, the mortality and recurrence rate of the carcinoma ex pleomorphic adenoma of lacrimal gland is very high. We report a case of squamous cell carcinoma ex pleomorphic adenoma of lacrimal gland, which was completely removed via lateral orbitotomy with bicoronal incision and had no major complication or recurrence.
Adenoma* ; Adenoma, Pleomorphic ; Carcinoma, Squamous Cell ; Drug Therapy ; Lacrimal Apparatus* ; Mortality ; Neoplasms, Glandular and Epithelial ; Recurrence

PURPOSE: In locally advanced head and neck cancer, radiation therapy is currently unsatisfactory because the end result is often limited regional disease control and survival. A clinical study was carried out to compare the effectiveness between the radiation therapy and the combined chemotherapy and radiation therapy. MATERIALS AND METHOD: Thirty-six patients with previously untreated, locally advanced squamous cell carcinoma of the head and neck were treated with radiotherapy alone and combined chemo-radiotherapy. Induction chemotherapy was administered 2~3 cycles, consisting of intravenous cisplatin (100 mg/m2 on day 1) and 5-fluorouracil (1000 mg/m2/day for 5 days as a continuous infusion) every 4 weeks followed by 7~8 weeks of radiation therapy for a total dose of 60~75 Gy. RESULTS: 1) Among 36 locally advanced head and neck cancer, 17 patients received radiation therapy alone and 19 patients received combined chemo-radiotherapy, respectively. 2) Response rate was 47% (complete response 29%, and partial response 18%) in radiation therapy group and 79% (complete response 37%, and partial response 42%) in combined chemo-radiotherapy group (p<0.05). 3) In median survival, radiation therapy group was 13 months and combined chemo- radiotherapy group was 15 months. Both groups were not significantly different (p>0.05). 4) Treatment related mortality was not noted, but the toxic effects were seen on the half cases of the both groups. Grade II toxicities were similar between the two arms. CONCLUSION: Combined chemotherapy and radiation therapy was more effective in local control but not superior in survival than radiation therapy alone. Continuous evaluation and identification of proper sequence for the therapeutic modality is supposed to prolong the survival of patients.
Arm ; Carcinoma, Squamous Cell ; Cisplatin ; Drug Therapy* ; Fluorouracil ; Head and Neck Neoplasms* ; Head* ; Humans ; Induction Chemotherapy ; Mortality ; Neck ; Radiotherapy

OBJECTIVE: To investigate the effect of neoadjuvant chemotherapy on cervical carcinoma and its association with clinical data. METHODS: A total of 97 patients with stage Ib2 approximately IIIa of cervical cancinoma were treated with neoadjuvant chemotherapy. The effect of chemotherapy, factors associated with outcome of chemotherapy, and histology were analyzed. RESULTS: Effective rate of chemotherapy was 86.6% which was associated with clinical stage and histology. Eight-four patients received radical hysterectomy. The histological grade of 17 patients was lowered, lymph nodes in 19 patients were positive, and 6 patients had parametrium invasion. One patient died within 1 year after the operation, and 5 patients recurred. CONCLUSION The effect of neoadjuvant chemotherapy for locally advanced cervical cancinoma is good. Surgery after chemotherapy can improve the prognosis and 5-year survival rate.
Adenocarcinoma ; drug therapy ; mortality ; surgery ; Adult ; Carcinoma, Squamous Cell ; drug therapy ; mortality ; surgery ; Female ; Humans ; Middle Aged ; Neoadjuvant Therapy ; methods ; Prognosis ; Survival Rate ; Uterine Cervical Neoplasms ; drug therapy ; mortality ; surgery

BACKGROUNDThe benefit of neoadjuvant chemotherapy in the management of head and neck squamous cell carcinomas (HNSCC) still remains controversial. The aim of this meta-analysis is to evaluate the role of the neoadjuvant chemotherapy with the cisplatin and fluororacil (PF) regimen in enhancing the overall survival of and decreasing locoregional relapse and distant metastasis in HNSCC patients.

METHODSMedline and manual searches were performed to identify all published randomized controlled trials (RCTs) investigating the efficacy of the neoadjuvant chemotherapy with the PF regimen. Outcomes assessed by meta-analysis included locoregional relapse, distant metastasis, and overall survival. The odds ratio was the principle measurement of effect, which was calculated as the treatment group (chemotherapy plus locoregional treatment) versus the control group (locoregional treatment alone) and was presented as a point estimate with 95% confidence intervals (CI).

RESULTSEight RCTs were adopted for analysis. The meta-analysis showed that the odds ratio for the locoregional relapse was 0.92 (0.70 - 1.22, 95% CI), which was not statistically significant. The odds ratios for distant metastasis and overall survival were 0.47 (0.33 - 0.68, 95% CI) and 1.28 (1.01 - 1.62, 95% CI) respectively, which were both statistically significant.

CONCLUSIONSNeoadjuvant chemotherapy with the PF regimen in HNSCC patients has no effect on locoregional relapse. However, it shows a small but significant benefit in reducing distant metastasis and improving the overall survival.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Squamous Cell ; drug therapy ; mortality ; Chemotherapy, Adjuvant ; Cisplatin ; administration & dosage ; Fluorouracil ; administration & dosage ; Head and Neck Neoplasms ; drug therapy ; mortality ; Humans ; Neoadjuvant Therapy ; Randomized Controlled Trials as Topic

BACKGROUND: Surgery has been considered the most effective and standard treatment modality in non-small cell lung cancer(NSCLC). However in stage IIIA lung cancer, the role of surgery is still controversial. To evaluate the role of surgery for stage IIIA NSCLC, we investigated the survival after surgery and the prognostic factors. MATERIAL AND METHOD: We evaluated 158 consecutive cases of stage IIIA NSCLC patients operated on between 1990 and 1996. There were 130 male patients and 28 female patients, and the mean age was 58.5 years. All patients except one underwent lung resection beyond lobectomy and extended mediastinal dissection. Postoperative adjuvant therapy were undertaken in 145(94.8%) patients. All patients(153) were followed and the mean follow-up period was 21.4months. RESULT: Twenty nine cases of the postoperative complications developed in 25 patients (15.8%). There were 5 operative mortality cases(3.2%) and the main cause of death was acute respiratory distress syndrome (ARDS). Local or distant recurrences developed in 84 patients(54.9%). The 5-year survival of 153 patients was 29.6% and the median survival time was 18.0 months. The 5-year survival of non N2 disease group(36.8%) was better than that of N2 disease group(26.6%)(p=0.35) and the 5-year survival of squamous cell carcinoma (38.1%) was better than that of adenocarcinoma(25.7%)(p=0.39) however there were no significant differences. Regarding the postoperative adjuvant therapy, in combined therapy group(84 patients), radiotherapy group(37 patients) and chemotherapy group(24 patients), the 5-year survival were 31.3%, 32.4%, and 14.6% respectively. There was no difference of survival between radiotherapy and combined therapy group(p=0.31), however the survival of the combined therapy group was better than the chemotherapy group(p=0.005). The survival of the complete resection group(31.9%) was better than the incomplete resection group(16.6%) however there was no significant difference(p=0.19). CONCLUSION: These observations indicate that the good 5-year survival(29.6%) in patients with stage IIIA NSCLC result from the agressive surgical treatment including extensive mediastinal nodes dissection.
Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Cause of Death ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Lung ; Lung Neoplasms ; Male ; Mortality ; Postoperative Complications ; Radiotherapy ; Recurrence ; Respiratory Distress Syndrome, Adult ; Small Cell Lung Carcinoma*

BACKGROUNDEsophageal cancer is the sixth most common cause of cancer-related death worldwide. Prior studies had demonstrated potential synergistic antitumor activity of gemcitabine in combination with cisplatin. Therefore, we studied the efficacy and tolerability of such combination for esophageal cancer.

METHODSBetween October 2003 and October 2006, thirty-eight patients with metastatic or recurrent advanced squamous cell carcinoma of the esophagus were enrolled. The median number of treatment cycles per patient was 4 (range 1 - 7). Gemcitabine was given at 1000 mg/m(2) over 30 minutes on days 1, 8 and cisplatin 40 mg/m2 was given on days 1, 2 in an every 21-day cycle.

RESULTSThe median follow-up for all 38 patients was 76 months (range 11 - 88 months). The overall response rate was 42.1% (95%CI, 25.5% - 56.5%). Median progression-free survival and median survival for all patients were 4.1 months (95%CI, 3.0 - 5.7 months) and 10 months (95%CI, 7 - 12 months), respectively. Patients with a response had significantly longer median survival compared with the patients without a response (11 months vs. 7.5 months, P = 0.0069). Overall survival at 1 year was 36.8%, at 2 years was 10.5%, and at 5 years was 5.3%. The most common grade 3 - 4 toxicity for all patients was leucopenia (44.7%).

CONCLUSIONSThis cisplatin-gemcitabine regimen was manageable and had significant efficacy in patients with esophageal squamous cell carcinoma. Patients with a response had improved survival time. Furthermore, a small number of the patients with metastatic esophageal cancer were still alive in 5 years with this regimen.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; Carcinoma, Squamous Cell ; drug therapy ; mortality ; Cisplatin ; therapeutic use ; Deoxycytidine ; analogs & derivatives ; therapeutic use ; Disease-Free Survival ; Esophageal Neoplasms ; drug therapy ; mortality ; Female ; Humans ; Male ; Middle Aged

OBJECTIVETo evaluate the effect of induction chemotherapy on the patients with moderate tongue squamous cell carcinoma and to investigate the factors that influence prognosis of these patients.

METHODSOne hundred and twenty two patients with moderate tongue squamous cell carcinoma (stage II-III, T2-3 N0/T1-3N1), treated from Jan. 1990 to Dec. 1999 were retrospectively reviewed. Among them, 69 and 53 patients were received operation alone and operation after induction chemotherapy respectively [cisplatin + 5-fluorouracil + bleomycin-A5 (PBF), 17 cases; bleomycin-A5, 36 cases]. Survival rate was estimated by Kaplan-Meier method. Multivariate analysis by the Cox proportional hazard model.

RESULTSThe mean follow-time of all patients were (79.9 +/- 49.8) (x +/- s) months (range: 7 to 177 months), and 45 patients died (including 5 lost to follow up) , 66 of 77 patients alive followed more than 5 years. The overall 3-year and 5-year survival rate were 79.4% and 69. 0% respectively. The overall 3-year and 5-year free-disease survival rate were 71.7% and 66. 3% respectively. The survival rate of 3-year and 5-year was 82.5% and 73.1% respectively for the group of operation alone; 82.4% and 70.1% respectively for the group of operation after induction chemotherapy with PBF, 72.2% and 61.1% respectively for the group of operation after induction chemotherapy with bleomycin-A5; and there were no significant difference between the above three groups (chi2 = 0.42, P = 0.8106). The locoregional recurrence rate were 30.4%, 41.2% and 38.9% for the operation alone group, operation after PBF induction chemotherapy group and operation after bleomycin-A5 induction chemotherapy group respectively. No significant benefit on decreasing locoregional recurrence (chi2 = 1.148, P = 0.563) or distant metastasis rate (chi2 = 2.305, P = 0.316) were found by induction chemotherapy by univariate analysis. Using multivariate analysis, risk factor that independently influence survival was the recurrence.

CONCLUSIONSRisk factors that independently influence survival of moderate tongue squamous cell carcinoma was the locoregional recurrence. No significant benefit on improving survival rate or decreasing locoregional recurrence or metastasis rate were found by induction chemotherapy, there was no difference between the two induction chemotherapy schemes on the survival rate or locoregional recurrence or metastasis rate of these patients.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; drug therapy ; mortality ; pathology ; Chemotherapy, Adjuvant ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Risk Factors ; Survival Rate ; Tongue Neoplasms ; drug therapy ; mortality ; pathology ; Young Adult

BACKGROUND: The treatment results of the advanced lung carcinoma is not satisfactory with the present therapeutic modalities: surgical resection, anti-cancer chemotherapy, and radiotherapy or combination therapy. To predict the prognosis of the non-small-cell lung carcinoma, TNM classification has been was as the basic categorization; however, it has been not satisfactory. It is necessary to consider the causes and the prognosis of the lung carcinoma from another points of view rather the conventional methods. We intended to find out the relationship between the major apoptotic factor, p53 gene and the prognosis of the patient with lung carcinoma. MATERIAL AND METHOD: Three hundreds and fifty-nine patients with lung carcinoma who underwent surgery were analysed. We observed p53 protein accumulated in the cellular nuclei. The p53 protein was detected by immuno-histo-chemical method. We collected information of the patient retrospectively. RESULT: p53 protein densities were observed in 40% in average as a whole. The protein density was 44 percent in man, 25 percent in woman, 49 percent in the squamous cell carcinoma, and 38 percent in the adenocarcinoma. There were significant correlations between the p53 protein density and the mortality in the squamous cell carcinoma (p=0.025), follow-up duration in TNM stage I group (p=0.010), and follow-up duration in the lobectomy patient group (p=0.043), and tumor cell differentiation (p=0.009). p53 protein densities were significantly different between the lobectomy and the pneumonectomy group (p=0.044). CONCLUSION: The authors found that p53 protein had some correlations with the prognosis of the lung cancer partially in some factors. We suggest the p53 protein density could be used as a marker of prognosis in the non-small-cell lung carcinoma.
Adenocarcinoma ; Apoptosis ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Cell Differentiation ; Classification ; Drug Therapy ; Female ; Follow-Up Studies ; Genes, p53 ; Humans ; Lung Neoplasms ; Lung* ; Mortality ; Pneumonectomy ; Prognosis ; Radiotherapy ; Retrospective Studies

Bafckground: Thr role and indication of surgery in the treatment of small cell lung cancer (SCLC) is currently limited and unsettled. MATERIAL AND METHOD: We analyzed the surgical results of 9 patients with SCLC at Yosei Medical Center from January 1990 to December 1996. There were 8 males and 1 female, and their mean age was 57.2 years (range; 35-76). Preoperatively SCLC was confirmed in 5, but the other 4 cases were diagnosed as undifferentiated squamous cell carcinoma. All patients underwent pulmoinary resection (lobectomy;5, lobectomy, segmentectomy and en-bloc resection of rib;1, bilobectomy; 2, pneumonectomy;1) and mediastinal lymph node dissection. RESULTS: There were no operative mortality with two complications (postoperative bleeding;1, arrhythmia;1). All cases were diagnosed as SCLC histologically and their TNM staging were confirmed as follows: T1N0M0;1, T2N0M0;4, T3N0M0;1, T3N1M0;1, T2N2M0; 1, T4N0M0;1. All patients had received postoperative chemotherapy, and radiotherapy was combined in 4 patients. During follow up period (range 1-63 months; mean 33.0months), there was only one metastasis to pelvic bone among 8 patients without lymph node metastasis, and all patients were alive. On the other hand, among 3 patients who had regional and/or mediastinal lymph node metastasis or T4 lesion, all patients had recurrences (local;2, brain;1), and 2 patients died. CONCLUSION: We suggest that the use of TNM staging is beneficial, and surgical resection should be recommended in the patients with early staged SCLC as an important treatment modality.
Carcinoma, Squamous Cell ; Drug Therapy ; Female ; Follow-Up Studies ; Hand ; Humans ; Lymph Node Excision ; Lymph Nodes ; Male ; Mastectomy, Segmental ; Mortality ; Neoplasm Metastasis ; Neoplasm Staging ; Pelvic Bones ; Radiotherapy ; Recurrence ; Small Cell Lung Carcinoma*