Results of paclitaxel (day 1 and 8) and carboplatin given on every three weeks in advanced (stage III-IV) non-small cell lung cancer

BACKGROUND: Both paclitaxel (P) and carboplatin (C) have significant activity in non-small cell lung cancer (NSCLC). The weekly administration of P is active, dose intense, and has a favorable toxicity profile. We retrospectively reviewed the data of 51 consecutive patients receiving C and day 1 and 8 P chemotherapy (CT) regimen in advanced stage NSCLC to evaluate the efficacy and toxicity. METHODS: Patients treated in our institutions having pathologically proven NSCLC, no CNS metastases, adequate organ function and performance status (PS) ECOG 0–2 were given P 112.5 mg/m(2 )intravenously (IV) over 1 hour on day 1 and 8, followed by C AUC 5 IV over 1 hour, repeated in every three weeks. PC was given for maximum of 6 cycles. RESULTS: Median age was 58 (age range 39–77) and 41 patients (80%) were male. PS was 0/1/2 in 29/17/5 patients and stage was IIIA/IIIB/IV in 3/14/34 patients respectively. The median number of cycles administered was 3 (1–6). Seven patients (14%) did not complete the first 3 cycles either due to death, progression, grade 3 hypersensitivity reactions to P or lost to follow up. Best evaluable response was partial response (PR) in 45% and stable disease (SD) in 18%. Twelve patients (24%) received local RT. Thirteen patients (25%) received 2nd line CT at progression. At a median follow-up of 7 months (range, 1–20), 25 (49%) patients died and 35 patients (69%) progressed. Median overall survival (OS) was 11 ± 2 months (95% CI; 6 to 16), 1-year OS ratio was 44%. Median time to progression (TTP) was 6 ± 1 months (95% CI; 4 to 8), 1-year progression free survival (PFS) ratio was 20%. We observed following grade 3 toxicities: asthenia (10%), neuropathy (4%), anorexia (4%), anemia (4%), hypersensitivity to P (2%), nausea/vomiting (2%), diarrhea (2%) and neutropenia (2%). Two patients (4%) died of febrile neutropenia. Doses of CT were reduced or delayed in 12 patients (24%). CONCLUSIONS: P on day 1 and 8 and C every three weeks is practical and fairly well tolerated outpatient regimen. This regimen seems to be comparably active to regimens given once in every three weeks

Determining of metastatic lymph node ratio in patients who underwent D2 dissection for gastric cancer

The purpose of this study was to determine outcome of the ratio of metastatic lymph nodes to the total number of dissected lymph nodes (MLR) in patients with gastric cancer. We retrospectively analyzed 111 patients who underwent D-2 lymph node dissection. The prognostic factors including UICC/AJCC TNM classification and MLR were evaluated by univariate and multivariate analysis. The MLR was significantly higher in patients with a larger tumor, lymphatic vessel invasion, blood vessel invasion and perineural invasion, and advanced stage. Moreover, the MLR was significantly associated with the depth of invasion and the number of lymph node metastasis. The univariate analysis revealed for overall survival (OS) that stage of disease, lymphatic vessel invasion, blood vessel invasion, perineural invasion, lymph node metastasis (UICC/AJCC pN stage) and MLR were relevant prognostic indicators. Furthermore, both UICC/AJCC pN stage and MLR were detected as prognostic factor by multivariate analysis, as was perineural invasion. Our results indicated that MLR and UICC/AJCC pN staging system were important prognostic factors for OS of patients with D-2 lymph node dissection in gastric cancer in a multivariate analysis. MLR may be useful for evaluating the status of lymph node metastasis in gastric cancer

AKUT MYOKARD İNFARKTÜSÜNDE AKUT FAZ REAKTANLARINDAKİ DEĞİŞİM VE TROMBOLİTİK TEDAVİNİN BU DEĞİŞİME ETKİSİ

AKUT MYOKARD İNFARKTÜSÜNDE AKUT FAZ REAKTANLARINDAKİ DEĞİŞİM VE TROMBOLİTİK TEDAVİNİN BU DEĞİŞİME ETKİSİSerdar Fenercioğlu1, Mahmut Gümüş1, İbrahim Erbay1, Haluk Sargın1, Mehmet Sargın1, Mehmet Aliustaoğlu1, Taflan Salepçi1, Ali Yayla1Dr.Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi Dahiliye KliniğiMyokard infarktüsü, myokardın mutlak veya relatif ağır perfüzyon yetersizliği sonucu gelişen bölgesel nekrozudur. Yaptığımız çalışmada akut myokard infarktüsü seyrinde görülen, akut koroner olaylardan sorumlu faktörler olduğuna dair bulguların sürekli arttığı, inflamasyonun akut faz reaktanlarından olan C-reaktif protein (CRP), eritrosit sedimentasyon hızı (ESH) ve lökosit düzeylerinin trombolitik tedavi ile değişkenliği araştırılmıştır. Hastanemiz Koroner Yoğun Bakım Ünitesi'nde Ocak 2000-Aralık 2000 tarihleri arasında myokard infarktüsü nedeni ile trombolitik tedavi uygulanan 40 hasta ve AMİ tanısı alan fakat endikasyonu olmaması nedeni ile trombolitik tedavi uygulanmayan diğer 40 hasta çalışmaya alındı. Hastaların yatışlarının ilk saatinde kan şekeri, üre, kreatinin, ürik asit, kolesterol, trigliserid, yüksek dansiteli lipoprotein, karaciğer fonksiyon testleri, total protein, albumin, globulin, sodyum, potasyum, eritrosit sedimentasyon hızı, Anti-Streptolizin O (ASO), CRP, hemogram ölçümleri için kan örnekleri alındı. Ayrıca hastaların periferik yaymaları hazırlanıp boyanarak lökosit formülü yapıldı. Çalışmaya alınan hastaların 9'u (%11.3) kadın, 71 'i (%88.7) erkek idi. Yaş ortalamaları 54.4 ± 10.5 (28-70) yıl bulundu. Albumin, eritrosit sedimentasyon hızı, CRP, lökosit sayısı, hematokrit, platelet, polimorf nüveli lökosit (PNL), lenfosit, monosit ve eozinofil düzeylerindeki 1. ve 7. günler arasında değişim istatistiksel olarak anlamlı bulunurken, ASO düzeylerindeki değişimde ise istatistiksel olarak anlamlı fark saptanmamıştır. ESH, ASO, CRP, lökosit sayısı, hematokrit, platelet, PNL, lenfosit, monosit ve eozinofil düzeylerindeki değişimler trombolitik tedavi uygulanan ve uygulanmayan gruplar arasında değerlendirildiğinde ESH, ASO, hematokrit, platelet, PNL ve lenfosit düzeyleri açısından gruplar arasındaki fark istatistiksel olarak anlamlı bulunmuştur. CRP, lökosit, monosit ve eozinofil düzeyleri açısından ise istatistiksel olarak anlamlı fark saptanmamıştır. AMİ'nin l., 3. ve 7. günlerinde bakılan CRP düzeylerinin 3. günde en yüksek olduğu ve bu artışın akut koroner olaylardaki inflamasyonla ilişkili bulunduğu görülmektedir. Çalışmamızda incelenen diğer bir akut faz reaktanı olan albüminin 1. ve 7. günlerdeki değerlerine bakılmış, anlamlı bir düşme olduğu görülmüştür. Çalışmamızda 1., 3. ve 7. günlerde bakılan eritrosit sedimentasyon hızında belirgin bir artış saptanmış, trombolitik tedavi uygulanan hastalarda eritrosit sedimentasyon hızı, uygulanmayanlara göre anlamlı olarak daha düşük bulunmuştur. Reperfüzyonun bir göstergesi olarak CRP ile trombolitik tedavi etkinliği arasında çalışmamızda anlamlı bir ilişki kurulamamıştır.Anahtar Kelimeler:&nbsp;AKUT FAZ REAKTANLART, TROMBOLİTİK TEDAVİ, AKUT MYOKARD İNFARKTÜSÜTHE VARIABILITY OF ACUTE PHASE REACTANS IN ACUTE MYOCARDIAL INFARCTION AND EFFICACY OF THROMBOLYTIC TREATMENT TO THESE VARIABILITYSerdar Fenercioğlu1, Mahmut Gümüş1, İbrahim Erbay1, Haluk Sargın1, Mehmet Sargın1, Mehmet Aliustaoğlu1, Taflan Salepçi1, Ali Yayla1Dr.Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi Dahiliye KliniğiMyocardial infarction (MI) is a regional necrosis of heart and caused by absolute or relative perfusion insuffiensy. The variability of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leukocyte levels which were acute phase reactants of inflammation, were seen in AMI and have data that showed their responsibilities from acute coronary syndrome, were investigated with thrombolytic treatment in our study. Fourty patients who were put on thrombolytic treatment because of AMI and other 40 patients who were also diagnosed as AMI but were not thought to have an indication for thrombolytic treatment, were included into the study. They were hospitalized in intensive coronary care unit of our hospital between January-December 2000. Blood samples for blood glucose, urea, creatinine, uric acid, cholesterol, tryglyceride, high density lipoprotein, liver function enzymes, total protein, albumin, globulin, sodium, potassium, ESR, anti-streptolysin O (ASO), CRP, hemogram were obtained in the first hour after hospitalization of the patients. Nine (%11.4) of patients were female and 71 (%88.7) were male. Mean age was 54.4(10.5 years. Statistically significant difference was found between the first and 7th day levels of albumin, ESR, CRP, leukocyte, monocyte and eosinophyl counts; but not for ASO levels. When we compared the results by separating the patients into two groups as who have had thrombolytic treatment or not, there was a statistically significant differences between the groups according to ESR, ASO, hematocrite, platelet, PNL and lymphocyte levels. There was no difference between groups according to the CRP, leukocyte, monocyte and eosinophyl levels. CRP was highest at 3rd day when we analysed the results of the first, third and 7lh day of AMI and that increase was seen in relation with inflammation in acute coronary syndrome. Other acute phase reactant albumin levels were also evaluated and a statistically significant decrease was found between the first and 7lh day. In our study, a significant increase was detected in ESR and ESR was significantly lower in patients who were used thrombolytic treatment than the others. There was no correlation between efficacy of thrombolytic treatment and CRP as an indicator of reperfusion.Keywords:&nbsp;ACUTE PHASE REACTANTS, THROMBOLYTIC TREATMENT, ACUTE MYOCARDIAL INFARCTION</p

ANTIEMETIC EFFICACY OF DIAZEPAM IN THE PROPHYLAXIS OF ACUTE AND DELAYED EMESIS INDUCED BY CISPLATIN BASED CHEMOTHERAPY TREATED WITH STANDARD ANTI EMETICS

This study was conducted to evaluate the efficacy of diazepam in managing acute and delayed emesis induced by cisplatin-based chemotherapy. A total of 92 cancer patients who were receiving 60-75 mg/m(2) cisplatin based chemotherapy were treated with granisetron 3 mg/IV plus dexamethasone 16 mg/IV on the first day of the chemotherapy Forty three of these patients also treated with diazepam 5 mg/PO 10-12 and 1 hours before the chemotherapy and 42 of these patients did not received any diazepam prophylaxis. Categorical scales were utilised to document the incidence of vomiting, nausea and loss of appetite. Among the 85 evaluable patients there was no statistically significant difference between the treatment arms in terms of acute and delayed emesis. But more patients achieved acute complete control of vomiting (79% vs 64%) and defined their quality of life as very good and good (70% vs 52%) in the diazepam arm. The protection obtained at the first day significantly influenced the protection during the subsequent days irrespective of the treatment arms. Diazepam does not increase the efficacy of antiemetic treatment but the increase in the patients well being and complete control acute vomiting suggest that it could be added to the standard antiemetic protocols

Metastatic renal hemangiopericytoma: A rare case report

The hemangiopericytoma (HPC) of the kidney is extremely rare perivascular neoplasm. There are no specific radiological or clinical findings that can aid in preoperative diagnosis. In the world literature, only 41 cases of renal HPC have been previously documented. We report on a 56-year old woman with renal HPC of the right kidney who had lung metastasis at the time of diagnosis. The right radical nephrectomy was performed and the combination chemotherapy was given, postoperatively. After 3 cycles of chemotherapy, disease was stable, but progression was seen at the end of 6 courses of chemotherapy. The patient died due to progression of disease ten months later after the diagnosis. We suggested that for patients present with renal mass, renal HPC as well as the other renal tumors should be considered in the differential diagnosis