Masayuki Nishioka

CPT-11: a new derivative of camptothecin for the treatment of refractory or relapsed small-cell lung cancer.

PURPOSE To evaluate the activity of CPT-11, which is a new derivative of camptothecin, against refractory or relapsed small-cell lung cancer (SCLC). PATIENTS AND METHODS Sixteen patients with refractory or relapsed SCLC were entered onto a prospective, non-randomized, single-institution phase II trial. All 16 patients had been pretreated heavily with some form of cisplatin-based combination chemotherapy. Five patients had received previous chemotherapy with cisplatin, vincristine, doxorubicin, and etoposide (CODE) as an induction therapy. Six patients had been treated with concurrent cisplatin and etoposide plus chest x-ray. The median time off chemotherapy was 7.3 months (range, 1.9 to 15.1 months). Patients were treated with a CPT-11 starting dose of 100 mg/m2 body surface given as a 90-minute intravenous (IV) infusion every week with subsequent doses based on toxicity. Fifteen patients were assessable for toxicity, response, and survival. RESULTS Seven patients (47%; 95% confidence limits for an overall response rate, 21.4% to 71.9%) responded to CPT-11 with a median duration of response of 58 days. The major toxicities were myelosuppression (predominantly leukopenia), diarrhea, and pulmonary toxicity. CONCLUSION CPT-11 is an active agent against refractory or relapsed SCLC and deserves to be studied more closely as both a single agent and in combination with other drugs to treat patients with SCLC.

Weekly dose-intensive chemotherapy in patients with small-cell lung cancer : a pilot study

The study was aimed to evaluate the feasibility of dose-intensive chemotherapy given on a weekly basis for 12 weeks. Seventeen [7 with limited disease (LD) and 10 with extensive disease (ED)] previously untreated patients with small-cell lung cancer (SCLC) were treated with the cisplatin, vincristine, doxorubicin, and etoposide (CODE) regimen. Recombinant human granulocyte colony-stimulating factor (rhGCSF) was given to eight patients for the purpose of increasing the dose intensity. Overall response rate was 88%, with a 29% complete response. The median survival times were >20.5 months for LD patients and 8.1 months for ED patients. Overall actual dose intensity was 88% of planned protocol. The major toxicity was myelosuppression. Fifteen patients (88%) had grade 3 or 4 leukopenia. Other problems were weight loss and worsening of performance status during the treatment. RhG-CSF significantly reduced leukopenic nadirs and shortened the neutropenic period. Our preliminary results indicate that 12 cycles of the CODE regimen on a weekly schedule is effective for SCLC, but is also associated with significant toxicity.

Quality of portal verification images using GLP7 film

RATIONALE AND OBJECTIVES To improve portal verification radiographs, we tested the application of GLP7 film. METHODS The quality of the portal verification radiograph using the XV cassette-GLP7 film combination and the XL cassette-GLP7 film combination was investigated. The XV cassette-XV2 film combination and the SA cassette-GS screen-XTL film combination also were used for comparison. RESULTS The characteristic curves showed that the relative speeds were 0.32 and 0.47 for the XV-GLP7 and XL-GLP7 combinations and that the average gradients were 1.93, 2.14, and 1.32 for the XV-GLP7, XL-GLP7, and XV-XV2 combinations, respectively. In the experiment using Burgers phantom, the smallest visible volumes were 11.8, 11.3, 28.7, and 19.6 mm3 for the XV-GLP7, XL-GLP7, XV-XV2, and SA-GS-XTL combinations, respectively. In the lower dosage treatment in the clinic, there were no marked differences between the GLP7 film and XV2 film. However, in the higher dosage treatment, the GLP7 film had a better quality than did the XV2 film. CONCLUSION Portal verification radiographs using GLP7 film are of sufficient quality for clinical use.

Radiotherapy and Systemic Chemotherapy for Brain Metastasis in Small Cell Lung Cancer.

脳転移巣では血液脳関門が破壊されている可能性があることから小細胞肺癌脳転移症例に対し全身化学療法が試みられるようになった.従来から行われている放射線治療と化学療法の役割を明らかにする目的で, 小細胞肺癌脳転移症例の治療成績をretrospectiveに検討した.放射線治療, 化学療法の奏効率は55%, 31%であった.放射線治療単独, 化学療法単独および両者併用のMSTは1.6ヵ月, 4.0ヵ月, 6.1ヵ月で, 前2者と後者の間に有意差が見られた.脳転移による死亡は49%, 63%, 42%であった.化学療法の新鮮例, 再発例のうち初回化学療法CR例およびPR例のMSTは6.1ヵ月, 6.1ヵ月, 3.3ヵ月で, 前2者では脳転移の存在が化学療法のcontraindicationにはならないと考えられた.放射線治療は生存期間並びに死因を考慮すると化学療法に併用すべきであり, また奏効率が高く毒性は低いので対症療法としても有用と考えられた.

Cisplatin, Vindesine, and Concomitant Radiation Therapy for Unresectable Non-small Cell Lung Cancer.

切除不能の肺非小細胞癌17例に対して, シスプラチン (100mg/m2, day 1), ビンデシン (3mg/m2, daylandday8) と胸部放射線照射 (2Gy/day, day 2～15) の同時併用療法を行った.適格例は16例で, 腫瘍効果はPR12例, NC3例, PD1例, 奏効率は75%であった.骨髄抑制は強く, 食道炎も高頻度に発生したが一過性で, その他に重篤な合併症はみられなかった.本療法は許容範囲内の副作用で, 高い奏効率が示されたことから, III A, III B期の切除不能肺非小細胞癌に有効な治療法と考えられた.