OBJECTIVETo evaluate the efficacy and drug-related toxicity of combined gemcitabine, cisplatin, and prednisone for the treatment of patients with relapsed or refractory aggressive non-Hodgkin's lymphoma (NHL).

METHODSFifteen patients with histologically confirmed relapsed or refractory aggressive NHL were included in this study. Gemcitabine was given on D1, 8 of a three to four weeks schedule at a dose of 1000 mg/m(2) intravenously over 30 minutes for no less than three cycles, and cisplatin was given on D1-3 at a dose of 25 mg/m(2). Prednisone was taken orally on D1-5 at a dose of 60 mg/m(2).

RESULTSOf 15 patients, 11 patients (73.3%) showed responses: 5 patients (33.3%) giving complete response and 6 patients (40.0%) partial response. Four patients' symptoms disappeared, and 1 in 6 patients was alleviated of type B symptoms. Drug-related toxic effects of chemotherapy were mild gastrointestinal reactions in most patients and severe bone marrow depression in very few patients.

CONCLUSIONThe present combination of gemcitabine, cisplatin, prednisone possesses moderate short-term efficacy, acceptable toxicity, and alleviation of suffering related to the disease. This protocol is worthy to be warranted as salvage for relapsed or refractory aggressive NHL.

Adolescent ; Adult ; Aged ; Antimetabolites, Antineoplastic ; administration & dosage ; adverse effects ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Cisplatin ; administration & dosage ; Deoxycytidine ; administration & dosage ; adverse effects ; analogs & derivatives ; Female ; Humans ; Lymphoma, Non-Hodgkin ; drug therapy ; Male ; Middle Aged ; Prednisone ; administration & dosage ; Salvage Therapy ; Secondary Prevention

BACKGROUNDIt is uncertain that the effect of multimodality treatment with operation on survival for locally advanced non-small cell lung cancer (NSCLC). The aim of this study is to evaluate the effect of multimodality treatment with or without operation on survival for locally advanced NSCLC.

METHODSFrom May 1992 to May 1999, 114 patients with locally advanced NSCLC were divided into two arms. Arm A (n=56): 39 cases were at stage IIIA, and 17 at stage IIIB; Median KPS was 80 (range from 70 to 90 ); Multimodality treatment program included operation, chemotherapy, radiotherapy and traditional Chinese herb medicine. Of them, lobectomy plus mediastinal systematic lymph node dissection or lymph node sampling accounted for 49 cases, sleeve lobectomy plus mediastinal lymph node dissection for 5 cases, and pneumonectomy for 2 cases. Preoperative or adjuvant chemotherapy regimens included MVP (mitomycin C, vindesine, cisplatin), NP (vinorelbine, cisplatin), TC (paclitaxel, carboplatin), GP (gemcitabine, cisplatin), which were repeated every 4 weeks for 4-6 cycles. Total dose of radiotherapy for lesions in the lung or mediastinal field was 5000-6000cGy. Arm B (n=58): 23 cases were at stage IIIA, and 35 at stage IIIB; Median KPS was 70 (range from 60 to 90); Treatment program was the same approximately as arm A except for no operation.

RESULTSArm A: (1) Metastatic locations in follow-up, in turn, showed as: lymph node, pleural-lung, bone, brain, liver, pericardium, skin and adrenal; (2) Median survival was 27 months, and 1-, 2- and 5-year survival rate was 82.1%, 60.7% and 25.0% respectively. Arm B: (1) Metastatic locations in follow-up, in turn, showed as: lymph node, pleural-lung, bone, brain, liver, pericardium, skin, adrenal, pancreatic and esophageal metastasis; (2) Median survival was 13 months, and 1-, 2- and 5-year survival rate was 53.4%, 31.0% and 1.7% respectively. Median survival duration of Arm A was significantly superior to Arm B (P=0.0001). There were significant differences in 1-, 2- and 5-year survival rate between the two groups (Chi-Square=9.4, P < 0.01; Chi-Square=8.9, P < 0.01;Chi-Square=11.5, P < 0.01).

CONCLUSIONSCompared with non-operative multimodality treatment, operative multimodality treatment including lobectomy or pneumonectomy with mediastinal lymph node dissection can remarkably improve the survival in patients with locally advanced NSCLC.