Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Despite advances in the modalities used to treat non-small cell lung cancer (NSCLC), the frequency of locoregional and distant relapses necessitates further enhancement of the therapeutic program. Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) has demonstrated clinical efficacy against NSCLC and in vitro studies support its role as a radiation potentiator at concentrations achievable in vivo. Thus, a phase I study of weekly paclitaxel and daily concurrent thoracic radiation was conducted in patients with advanced NSCLC to determine (1) the maximum tolerated dose of paclitaxel administered on an outpatient basis for 6 consecutive weeks with daily radiation and (2) the toxicities of the paclitaxel/radiation combination. Paclitaxel was administered as a 3-hour infusion, repeated weekly for 6 weeks with the usual premedication regimen for hypersensitivity prophylaxis. The starting dose of paclitaxel was 10 mg/m2/wk, which was increased by 10 mg/m2 in successive cohorts of three new patients, as tolerated. Radiation therapy was delivered as 40 Gy in 20 fractions to the original volume with a boost of 20 Gy in 10 fractions to the primary tumor. Doses were escalated from 10 to 70 mg/m2/wk. Of the 23 patients evaluable for response, one had stage II NSCLC, four had stage IIIA, 17 had stage IIIB, and one had stage IV. Severe esophagitis (grade 4) occurred in two of the three patients treated at 70 mg/m2 and was dose limiting. One patient discontinued therapy due to hypersensitivity, two developed grade 3 neutropenia, and one developed radiation pneumonitis. With a median follow-up of 7 months, 15 of the 23 patients remain alive. Four had a complete response and 13 had a partial response, for an overall response rate of 74% (95% confidence interval, 52% to 90%). The schedule of weekly paclitaxel and daily thoracic radiation appears active in NSCLC and can be delivered safely in the outpatient setting. The principal dose-limiting toxicity is esophagitis, and the maximum tolerated dose of paclitaxel for this schedule is 60 mg/m2/wk. A phase II trial of weekly paclitaxel 60 mg/m2 and radiation has been initiated in patients with NSCLC.
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PMID:Combined-modality therapy for advanced non-small cell lung cancer: paclitaxel and thoracic irradiation. 864 69

Two hundred-thirty patients were operated on for peripheral lung cancer TIN0M0 in 1960-1990. Pheumonectory was performed in 3 cases, lobectomy-123, segmentectomy-40, wedge-like resection-57 and removal of tumor-in 7 cases. Limited resection in 20 patients was not followed by radiation therapy, Radiation treatment was given to 15 patients preoperatively, 53-postoperatively and 16 patients-pre-and postoperatively, Five-year survival after combined treatment was recorded in 70.5%, while without this treatment-68.7%. Local recurrences following limited intervention were usually detected 3-5 years later, regional and distant metastases developing within the first 24 months. A reverse correlation was established between extent of surgery and local recurrence incidence. Reoperation such as lobectomy or pneumonectomy is feasible in cases of timely diagnosis. The highest 5-year survival rates were registered for segmentectomies carried out in combination with postoperative radiotherapy (77.2%). Prognosis proved best in cases of adenocarcinoma and tumor arising in the cicatrix. Paliative surgery appeared preferable for primary tumor 1.5 cm in diameter and less. Even in small-size malignancy, removal of tumor is not radical enough, Wedge-like resection is admissible in small-size subpleural lesions only. Preoperative radiotherapy results proved inferior to those of other procedures of combined treatment. Pronounced radiation-induced pneumonitis involving re-hospitalization for symptomatic treatment occurred in 7 (5.5%) cases of lobectomy combined with radiotherapy and in 2 (1.9%) cases of limited resection.
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PMID:[Early peripheral cancer of the lung: long-term results of combined therapy using sparing resection techniques]. 881 40

Previously untreated patients with stages IIIA or IIIB non-small cell lung cancer entered this phase II study to evaluate the activity and toxicity of combined paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) and carboplatin and concurrent radiation. Patients received paclitaxel 50 mg/m2/wk as a 1-hour infusion and carboplatin area under the concentration-time curve of 2/wk for 7 weeks with radiation to the primary tumor and regional lymph nodes (44 Gy) followed by a boost to the tumor (22 Gy). In addition, patients received two additional cycles of paclitaxel 200 mg/m2 and carboplatin (area under the concentration-time curve of 6) 3 weeks apart. From March 1995 to February 1996, 23 patients entered the study and their overall response rate (complete plus partial responses) was 82%. The major toxicity was esophagitis. Nine patients (45%) had experienced grades 3 or 4 esophagitis by the end of the 7-week concurrent phase. Seven of the nine patients recovered from the esophagitis within 2 weeks and received the additional two cycles of paclitaxel 200 mg/m2 and carboplatin (area under the concentration-time curve of 6). Only one patient (4%) had grade 4 pneumonitis; this patient also recovered within 2 weeks and received the final two doses of combined chemotherapy. Therapy with paclitaxel, carboplatin, and concurrent radiation is a promising treatment for patients with locally advanced non-small cell lung cancer; it has a high response rate and acceptable toxicity.
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PMID:Paclitaxel plus carboplatin and concurrent radiation therapy for patients with locally advanced non-small cell lung cancer. 900 37

Many studies have been performed to determine some prognostic factors for malignant head and neck tumors. Defining the clinical and biological features would enable one to predict the progression of the disease and plan treatment. The aim of the present study has been to identify what host and neoplasm characteristics provide prognostic indication of possible recurrences. A group of 380 patients with squamous cell carcinoma of the head and neck was studied. The neoplasm was located in the following sites: 257 larynx-hypopharynx, 69 oropharynx, 54 oral cavity. At the present time 309 of these subjects are still alive and disease free while 71 have had recurrences. Analyses were performed on various variables regarding the patient, neoplasm and histology. Multivariante analysis of these prognostic factors was performed using the PLR-BMDP program. The time of recurrence in the primary tumor site and at the lymph node level was evaluated using the Kaplan-Meier method. Of the 28 variables analyzed 16 had no effect on the probability of recurrence. Two variables reduced the risk of recurrence: age over 61 years (p < 0.05) and primarily intra and peritumoral lymphocyte infiltration (p = 0.06). Of the data regarding the patient, age lower than 61 years and presence of associated internal pathologies (i.e. bronchial pneumonia and hepatitis) appeared to significantly facilitate the appearance of recurrence. The characteristics of the neoplasm which appear to effect recurrences are: tumor site (hypopharynx), presence of lymph node metastases, morphological elements of tissue spread (vascular invasion, plasmocyte infiltration), capsular breakdown, positive margins and post-operative infection. In conclusion, it can be asserted that technical development of multifactorial analysis has made it possible to identify important prognostic factors and quantify their impact on the evolution of a neoplasm.
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PMID:[Identification of clinical, biological and prognostic factors in recurring squamous cell carcinoma of the head and neck]. 948 48

We retrospectively reviewed the records of 11 thymoma patients to clarify the role of hemithoracic irradiation and chemotherapy for patients with thoracic dissemination at the initial presentation. Radiotherapy was administered postoperatively in all but two patients who were not candidates for surgical treatment. Radiotherapy doses ranged from 10 to 17 Gy for the entire hemithorax of the disseminated site and from 30 to 55 Gy to the primary tumor bed. Chemotherapy of various protocols was also employed preceding radiotherapy in seven cases. Cumulative 5- and 10-year survival rates were 80% and 64%, respectively. Regrowth-free 5- and 10-year survival rates were 55% and 37%, respectively. Six of the 11 patients were free from regrowth at a median follow-up interval of 60 months. The role of chemotherapy remained unclear. Acute or late sequelae were modest and acceptable. In conclusion, entire hemithoracic irradiation is justified as postoperative or definitive radiotherapy treatment for disseminated thymoma unless there is a risk of radiation pneumonitis. Further evaluation should be conducted.
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PMID:The role of low-dose hemithoracic radiotherapy for thoracic dissemination of thymoma. 949 91

To evaluate the efficacy of postmastectomy radiation therapy (PMRT) for prophylaxis against locoregional recurrence in high-risk breast cancer patients, and the rate of complication associated with such treatment, we retrospectively reviewed 79 breast cancers in 78 patients, who were given therapy (PMRT) between April 1990 and March 1995. Radiation doses were 46-50 Gy in 2-Gy fractions. High-risk factors included primary tumor (> or = 5 cm) in 19 (24.1%) patients, positive axillary lymph nodes (> or = 4) in 56 (70.9%) patients, positive or close (< or = 2 mm) surgical margins in 14 (17.7%) patients, and central or inner quadrant tumor with positive axillary nodes and lymphovascular invasion in seven (8.9%) patients. Adjuvant chemotherapy was also given to 69 of 78 (88.5%), patients and hormonal therapy to 41 of 78 (53.7%) patients. The median follow-up time was 25 months (range, 7-66 months) after mastectomy. Our study revealed that locoregional failure as the first site of failure occurred in only one of 78 (1.3%) patients. Relapse-free survival at 3 years was 67.7% [95% confidence interval (CI), 52.0-81.3], and overall survival was 76.9% (95% CI, 63.3-90.6). The incidence of radiological evidence of lung fibrosis increased significantly in patients whose internal mammary chain was included in the radiation field. The occurrence of lung fibrosis can be reduced by changing radiation treatment technique and keeping central lung distance (CLD) of tangential field to < or = 2.8 cm in tangential field technique or < or = 1.4 cm in tangential with a separate internal mammary field technique. We concluded that the risk of locoregional recurrence in high-risk breast cancer patients can be much reduced by PMRT. With careful selection of radiation treatment fields, radiotherapy technique, and limitation of CLD to < or = 2.8 cm in tangential technique or < or = 1.4 cm in separate technique, the risk of symptomatic radiation pneumonitis is minimal. PMRT should be recommended for breast cancer patients who are at high risk for locoregional recurrence.
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PMID:The benefit and risk of postmastectomy radiation therapy in patients with high-risk breast cancer. 949 49

We conducted a feasibility study of continuous etoposide infusion, which was expected to suppress DNA repair after radiation, combined with radiation in patients with advanced non-small cell lung cancer (NSCLC). Between July 1995 and January 1997, 10 patients with NSCLC were registered. Thirty-six mg/m2/day etoposide was infused continuously for a mean of 19 days (range 14-26). Patients tolerated a mean total dose of accelerated hyperfractionated thoracic radiotherapy (1.5 Gy twice per day) of 52.6 Gy (range 33-60). The primary tumors of 7 patients showed partial responses and distant metastasis progression occurred before primary tumor progression in all 7 responders. The hematological adverse effects of chemoradiotherapy were grade 3 or 4 leukopenia in all 10 patients, grade 3 anemia developed in 3, and 2 had grade 3 thrombocytopenia. Six patients contracted infections and one of them died of pneumonia. The major non-hematological adverse effect was esophagitis, which was grade 3 in 3 patients, one of whom died of renal dysfunction. The serum etoposide concentrations were 1.6-2.0 microgram/ml, except in one patient, who had liver dysfunction due to B-type hepatitis. DNA repair gene XRCC1 mRNA expression in peripheral blood mononuclear cells was analyzed, using the reverse transcriptase-polymerase chain reaction, in 8 patients and was suppressed during etoposide infusion in 2. No relationship was observed between serum etoposide concentration and XRCC1 expression and clinical outcome. In conclusion, continuous etoposide infusion combined with thoracic radiation induces severe toxicity and should be given only after careful consideration.
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PMID:A feasibility study of continuous etoposide infusion combined with thoracic radiation for non-small cell lung cancer. 1002 87

To clarify whether or not the lymphatic routes that have long been generally accepted are indeed correct, we retrospectively examined the clinical records of patients with solitary lymph node metastasis from gastric carcinoma. From 735 patients gastrectomized with lymph node dissection (more than D1), 51 (7%) were histologically proven to have only one lymph node involved. In 44 of these 51 patients, the involved nodes were all in the perigastric region (N1). There were also 7 patients with a jumping metastasis to the N2-N3 nodes. Three of them were found along the left gastric artery (#7 according to Japanese classification) and the other 4 were found along either the common hepatic artery (#8) or the proper hepatic artery (#12). The depth of invasion was submucosal in 2, proper-muscular in 2, subserosal in 1, and serosa-exposed in 2, and the conclusive stage was II in 2, IIIa in 3, and IIIb in 2. However, 1 of these patients died of liver cirrhosis and 2 died of pneumonia, while the other 4 were still alive at the time of this report more than 5 years after surgery. These results suggest that not every sentinel node is located in the perigastric region near the primary tumor and that, if the preoperative examination indicates submucosal invasion, then a systematic regional lymph node dissection should therefore be carried out.
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PMID:Lymphatic routes of the stomach demonstrated by gastric carcinomas with solitary lymph node metastasis. 1048 41

A 45-year-old woman with no history of cancer presented with a radiological and clinical diagnosis of metastatic tumor in the lungs. On the basis of the findings, the patient underwent an extensive investigation attempting to locate a primary tumor. After an unsuccessful workup, the patient was referred for biopsy, which showed findings of bronchiolitis obliterans organizing pneumonia (BOOP). This case illustrates that the clinical, roentgenographic, and CT findings of BOOP are nonspecific and in some cases can be confused with those of metastatic tumor in the lungs.
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PMID:Bronchiolitis obliterans organizing pneumonia mimicking multiple pulmonary metastases. 1065 40

Askin tumors are highly malignant small-round-cell tumors of the thoracopulmonary region, which occur rarely. Therefore, we report on our experiences with eight patients (5 male, 3 females), who were treated in our department between 11'94 and 10'97 (age: 9-40 years, mean age: 20.5 years). All Askin tumors were diagnosed by histological and immunohistochemical examinations as well as molecular genetic proof of characteristic translocations. In all patients, the tumor arose from the chest wall, infiltrating adjacent ribs and parts of the lung. At the time of first diagnosis, five patients did not reveal any metastases. One patient suffered from intrapulmonary metastases and two patients from an infiltration of the diaphragm and of adjacent vertebral bodies. Treatment consisted of a pre- and postoperative (radio-) chemotherapy according to the EVAIA protocol and a radical tumor resection in all patients. The postoperative course was uneventful in seven patients, one patient suffered from pneumonia after multiple wedge resections for intrapulmonary metastases. Four patients, in whom primary tumor resection was complete, are alive 14, 20, 35 and 84 months after first diagnosis - only one patient had to undergo a second operation for a local relapse 17 months after first diagnosis. The other 4 patients, who suffered from a very extensive primary tumor, expired 13, 17, 18 and 39 months after the diagnosis was made. Our data demonstrate that Askin tumors require an aggressive multimodality treatment consisting of pre- and postoperative chemotherapy, radical surgical resection and postoperative irradiation, which may be performed preoperatively in selected cases, too.
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PMID:Diagnosis, treatment and outcome of patients with Askin-tumors. 1110 Jul 69


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