Margaret Telfer

Results of a phase II concurrent chemoradiotherapy study using three‐dimensional conformal radiotherapy with cisplatin and oral etoposide in stage III nonsmall‐cell lung cancer

This phase II study was designed to utilize conformal radiation therapy with cisplatin and oral etoposide in patients with stage III or locally recurrent non-small-cell lung cancer to determine tolerance and toxicity of therapy. From April 1992-February 1996, 18 patients with pathologically confirmed stage IIIA, IIIB, or locally recurrent non-small-cell lung cancer (NSCLC) were entered on study. Metastatic workup included a CT scan of the thorax and upper abdomen as well as a bone scan. Chemotherapy consisted of IV cisplatin (100 mg/m2) with IV etoposide (25 mg/m2) on day 1; oral etoposide was given (50 mg/m2) days 2-14. Using three-dimensional planning, 40-45 Gy were delivered to the clinical target volume, followed by a boost to the gross tumor volume for a total of 70 Gy. Patients with recurrent disease received 40-50 Gy in total. Eighteen patients were enrolled: 16 patients were treated with curative intent and were evaluable for outcome. Two patients were treated for locally recurrent NSCLC and were not included in the outcome analysis. Stages included IIIA (44%) and stage IIIB (54%). Forty-four percent had T3/4 tumors, and 69% had N2/3 disease. Overall survival at 1 year was 64%, while 2-year overall survival was 50%. Distant metastasis-free survival at 1 year was 67%, and at 2 years 60%. The 1-year chest progression-free survival was 57%, and at 2 years 50%. Sixty-three percent required hospitalization for dehydration or neutropenia. Fifty-six percent developed leukopenia (<1,000 cells/microl) sometime during the therapy. We conclude that concurrent cisplatin and oral etoposide with conformal radiation therapy provide encouraging results in stage III lung cancer. The major toxicities of this therapy included leukopenia, thrombocytopenia, and mucosal esophagitis. Local progression of disease continues to be a problem with the current doses given. Future studies should evaluate dose escalation of radiation therapy with limited volumes, utilizing conformal radiation and chemotherapy to improve local control and potentially impact upon distant metastases.

Immunologic Status of Patients in Remission from Hodgkin’s Disease and Disseminated Malignancies

ABSTRACT: The immunologic phenotypes of peripheral blood lymphocytes of 20 patients cured of Hodgkins disease (Group I) and of 20 patients cured of diverse, disseminated malignancies (Group II) were compared. Eleven patients in Group I had an increase in circulating B lymphocytes, and 6 patients in Group II had a decrease in this lymphocyte subset (0.0005 < p <0.0125). The T4/T8 lymphocyte ratio was less than 1.0 in eight patients in Group I and in no patients in Group II (p <0.001). These statistically significant differences between the two groups were unrelated to type or duration of therapy, and thus suggest basic biologic differences between the immune status of cured Hodgkins disease patients and cured patients with other malignancies.

Pulmonary function in hemophiliac patients treated with commercial factor VIII concentrates

Pulmonary function was tested before and after the administration of a commercial preparation of factor VIII concentrate in 20 patients with hemophilia A. The material was infused through the filter provided by the manufacturer, which is supposed to remove particles larger than 170 mu. Baseline information showed that patients who smoke had a lower pulmonary diffusing capacity for carbon monoxide than nonsmokers (22.9 +/- 4.2 ml/minute/mm Hg, p less than 0.01). The administration of factor VIII was not associated with clinical abnormalities. There was a small reduction in carbon monoxide diffusing capacity (27 +/- 5.8 to 26.2 +/- 5.9 ml/minute/mm Hg, p = 0.03), which was no longer significant after carbon monoxide diffusing capacity was corrected for lung volume (5.66 +/- 1.32 to 5.54 +/- 1.34, p greater than 0.06). This study does not support the need for 40 mu filtration of factor VIII concentrate.

Frequency distribution of hepatitis C infection among patients with B-cell non-Hodgkin lymphoma in underserved minority population.

e18536 Background: The role of hepatitis C Virus (HCV) infection in the pathogenesis of non-Hodgkin lymphoma is not well clarified. Several studies show a variation (0% to 37%) in the prevalence of HCV infection in B-cell Non-Hodgkin Lymphoma (B-NHL) by geographical location. Mucosal-associated lymphoid tissue lymphoma (MALT) and diffuse large B-cell lymphoma (DLBCL) were reported to have the highest prevalence of HCV infection in subtype specific analysis of B-NHL in previous studies. METHODS We retrospectively studied 112 patients with histological diagnosis of B-NHL confirmed by flow cytometry and immunohistochemistry, consecutively seen from 2002 to 2007.Their clinical features and outcomes were evaluated. RESULTS Histopatholgy in patients with HCV was as follows: 12(67%) DLBCL, 3(16%) marginal zone lymphoma (MZL), 3(16%) Burkitt lymphoma (BL). 14(78%) patients had Stage III or IV disease, 11 (60%) had an IPI of ≥3, and 4(22%) had disease relapse. Regarding AA patients with HCV and B-NHL, the median age at diagnosis was 50 years, 6(60%) were males and 4 (40%) females. 8(80%) patients had DLBCL, 1(10%) had BL, and 1(10%) had MZL. 9 out of 10 had aggressive disease (DLBCL and BL). CONCLUSIONS The prevalence of HCV infection in patients with B-NHL we presente is higher than previously reported in some U.S. STUDIES 83% of patients with B-NHL / HCV infection, and 90% of AA with B-NHL/HCV, had aggressive disease, which is significantly higher than previously reported. This linkage should be further studied, and its relationship to other healthcare disparities in underserved populations should be evaluated. Of 112 patients, 18 (16%) were HCV positive, 17 (15%) were HIV positive and 6(5%) were hepatitis B (HBV) positive. Among HCV positive patients, the median age at diagnosis was 48 years; 12 (67%) were males and 6 (33%) females. 10 (55%) were African American (AA), 4 (22%) Caucasian, 3 (16%) Hispanic and 1 (5%) was Asian. 1 (5%) patient had coinfection with HBV and 2 (11%) had coinfection with HIV. [Table: see text] [Table: see text].

Stroger Hospital of Cook County (CCH) AIDS malignancy project: The CHAMP study—A 13-year, single institution retrospective study of cancers in patients infected with HIV.

1551 Background: CCH is the largest health provider for HIV patients in Chicago and has one of the largest HIV outpatient clinics in the United States, the Ruth M. Rothstein CORE Center (CC). Per year, over 5000 HIV + individuals are treated at the CC with over 500 HIV-infected individuals treated at CCH. Most studies of non-AIDS defining (NADC) and AIDS defining cancers (ADC) cover wide areas. Insights into the prevalence, type of cancer, and characteristics of HIV + cancer patients found in the inner city and underserved populations have been under represented in the literature. To this end, we examined all of the malignancies presenting to either the CC or CCH for the past 13 years. METHODS We identified via CCH, CC, and pharmacy databases all HIV infected patients with a cancer ICD9 codes from 1998-2010. HIV characteristics, cancer type, and patient demographics were confirmed by chart review. One-way Anova was used to show statistical significant between the prevalence among the different sub populations. RESULTS After initial screening, 404 cancers were confirmed, representing 21 malignancies. 56% were ADC, with 104 (25%) non-hodgkins lymphoma (NHL), 111(28%) Kaposi sarcoma, and 11(2.7%) cases of cervical cancer. Of the 104 NHL, the most common were DLBCL 61%, Burkitts (BL) 21%, and primary CNS lymphoma 7.6%. The most frequent NADC was anal cancer (n=30) and Hodgkin lymphoma (n=29). 70% of all cancers were stage III or above. HIV + patients at the CC were 71% African American (AA) and 19% Hispanic (Hsp) (compared to 26% and 23% in the Chicago population, respectively). In our study, AA represents 64% of all HIV cancers with Hsp and Caucasians 17% each. Though Caucasians with HIV and cancer in our cohort have the highest prevalence of cancer, 1.06%, vs. 0.69% AA vs. 0.60 Hsp (P< 0.001). The Male:Female ratio of all HIV malignancies in our cohort are 5.1:1. CONCLUSIONS Our data show a race disparity isolated to AA compared to the general population, and a male predominance. Although the Caucasian-HIV population is the smallest, they have the highest cancer prevalence.