Lung Cancer.pdf

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Treatment of Patients with Advanced Non–Small Cell <strong>Lung</strong> <strong>Cancer</strong> 161 mended without reservation in these patients. In all cases, the risk of harm and the relatively small chance of benefit are clearly communicated to the patient. For patients with a PS score of 2, weekly regimens, such as singleagent vinorelbine on days 1 and 8 on a 3-week schedule or gemcitabine 1,000 mg/m 2 days 1 and 8 on a 3-week schedule, can be considered. These agents are relatively well tolerated, and there is the added benefit of increased ability to titrate the dose if side effects occur. Weekly regimens of carboplatin plus paclitaxel and taxotere are under investigation in a number of clinical trials and may offer similar advantages. Patients with a PS score of 3 are treated with supportive care and palliative local treatments—radiation therapy and, in some cases, palliative surgery. Rarely, patients with a PS score of 3 are treated with gentle chemotherapeutics as described above for patients with a PS score of 2 with the proviso that the patient is informed of the risks and the fact that benefit is not likely. Since older patients are more likely to have comorbid conditions and can have a less robust physical condition overall, monotherapy with gemcitabine or vinorelbine is often used (Table 9–1). Perrone and colleagues observed an increase in 1-year survival, improved quality of life, and minimal toxicity with the addition of vinorelbine 30 mg/m 2 days 1 and 8 on a 3-week cycle to BSC compared to BSC alone in patients with good PS who were 70 years of age or older (Perrone et al, 1998). Frasci and colleagues demonstrated improved survival when gemcitabine was added to vinorelbine (Frasci et al, 2000), but in a larger study done by Gridelli and colleagues (2001), this doublet was more toxic than vinorelbine alone, resulting in a significantly higher incidence of leukopenia and neutropenia; was more costly; and did not prolong survival as compared to vinorelbine or gemcitabine alone. Therefore, vinorelbine and gemcitabine are not administered in combination to elderly patients. Though older patients often have comorbid conditions, those with good PS may be able to tolerate regimens used for younger patients. This is an issue of substantial concern since 30% of patients with NSCLC are 70 years of age or older. Since few patients aged 70 years or older are treated in clinical trials, less information is available for these patients than for younger patients. Two of 3 recent retrospective studies showed no increase in risk or decrease in benefit with platinum-containing combinations in patients 70 years or older with good PS compared to patients younger than 70 years (Rosvold et al, 1999; Hensing et al, 2001). One study showed a trend towards greater morbidity (Kelly et al, 2001b). Thus, patients with good PS who are 70 years of age or older are often offered treatment with platinum-based regimens. However, since patients substantially older than 70 years were not studied separately, possibly because there were too few of these patients to treat them as a separate subset, use of platinum-containing regimens in these patients requires special caution, and these patients are often treated with single-agent vinorelbine or gemcitabine.
Table 9–1. Chemotherapy in Older Patients Study and No. of Median 1-Year Treatment Regimen Patients Response Rate Survival Time Survival Rate P for Survival Perrone (ELVIS) (1998) Vinorelbine best supportive care 80 20% 27 weeks 27% Best supportive care Frasci (2000) 81 — 21 weeks 5% .04 Vinorelbine 60 15% 18 weeks 13% Vinorelbine gemcitabine Gridelli (MILES) (2001) 60 22% 29 weeks 30%* .01 Vinorelbine 233 18.5% 37 weeks 41% Gemcitabine 233 17.3% 28 weeks 26% Vinorelbine gemcitabine 232 20% 32 weeks 31% * Projected. 162 R. Zinner
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Lung Cancer Frank V. Fossella, MD R
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Frank V. Fossella, MD Department of
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vi Foreword possible. Since the res
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x Contents Chapter 7 Surgical Treat
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xii Contributors Joe B. Putnam, Jr.
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2 J.B. Putnam, Jr., F.V. Fossella,
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26 F.V. Fossella common sites of lu
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28 F.V. Fossella history and physic
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30 F.V. Fossella Computed Tomograph
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32 F.V. Fossella Pulmonary Function
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34 F.V. Fossella The use of flexibl
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36 R.F. Munden and J.J. Erasmus hav
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38 R.F. Munden and J.J. Erasmus che
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40 R.F. Munden and J.J. Erasmus tha
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42 R.F. Munden and J.J. Erasmus (Gu
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44 R.F. Munden and J.J. Erasmus A B
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46 R.F. Munden and J.J. Erasmus in
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48 R.F. Munden and J.J. Erasmus Pat
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50 R.F. Munden and J.J. Erasmus D C
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52 R.F. Munden and J.J. Erasmus A B
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54 R.F. Munden and J.J. Erasmus Bol
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56 R.F. Munden and J.J. Erasmus Swe
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58 P. Tamboli and J.Y. Ro Chapter O
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60 P. Tamboli and J.Y. Ro Figure 4-
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62 P. Tamboli and J.Y. Ro Postopera
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64 P. Tamboli and J.Y. Ro Table 4-1
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66 P. Tamboli and J.Y. Ro Atypical
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68 P. Tamboli and J.Y. Ro Diffuse I
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70 P. Tamboli and J.Y. Ro noma. Cig
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72 P. Tamboli and J.Y. Ro Figure 4-
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74 P. Tamboli and J.Y. Ro alone. BA
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76 P. Tamboli and J.Y. Ro Other Mal
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78 P. Tamboli and J.Y. Ro Electron
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80 P. Tamboli and J.Y. Ro Niho S, Y
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82 Y. De Jesus and G.L. Walsh Chapt
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84 Y. De Jesus and G.L. Walsh Figur
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86 Y. De Jesus and G.L. Walsh guide
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88 Y. De Jesus and G.L. Walsh with
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Figure 5-2. Patient “pathway to r
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94 Y. De Jesus and G.L. Walsh Recov
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98 Y. De Jesus and G.L. Walsh KEY P
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100 Y. De Jesus and G.L. Walsh Jenn
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102 W.R. Smythe nation for these su
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104 W.R. Smythe patient reports of
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106 W.R. Smythe bar or limited lung
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108 W.R. Smythe hospitals for 149 p
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Page 127 and 128: 114 W.R. Smythe Future Directions F
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Page 131 and 132: 7 SURGICAL TREATMENT OF LOCALLY ADV
Page 133 and 134: 120 S.G. Swisher Treatment Options
Page 135 and 136: 122 S.G. Swisher Initial Assessment
Page 137 and 138: 124 S.G. Swisher Figure 7-1. Region
Page 139 and 140: 126 S.G. Swisher Table 7-2. (contin
Page 141 and 142: 128 S.G. Swisher upper paratracheal
Page 143 and 144: 130 S.G. Swisher is performed only
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Page 147 and 148: 134 S.G. Swisher Pancoast tumors th
Page 149 and 150: 136 S.G. Swisher A B Figure 7-2. Do
Page 151 and 152: 138 S.G. Swisher a combination of t
Page 153 and 154: 140 S.G. Swisher Dartevelle PG, Cha
Page 155 and 156: 8 NONSURGICAL TREATMENT OF EARLY-ST
Page 157 and 158: 144 R. Komaki morbid conditions pre
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Page 161 and 162: 148 R. Komaki Around 1998, by using
Page 163 and 164: 150 R. Komaki Table 8-5. Survival a
Page 165 and 166: 152 R. Komaki A total of 610 patien
Page 167 and 168: 154 R. Komaki tially obstructed air
Page 169 and 170: 156 R. Komaki report of Radiation T
Page 171 and 172: 9 TREATMENT OF PATIENTS WITH ADVANC
Page 173: 160 R. Zinner chemotherapy, in pati
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Page 205 and 206: Table 10-1. Complete Response Rates
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Page 211 and 212: 198 R. Komaki Figure 10-1. Survival
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Page 219 and 220: 206 R. Komaki Wagner H, Kim K, John
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Page 223 and 224: 210 G.R. Blumenschein, Jr. syndrome
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212 G.R. Blumenschein, Jr. toxicity
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214 G.R. Blumenschein, Jr. the year
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216 G.R. Blumenschein, Jr. is chara
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218 G.R. Blumenschein, Jr. new cyto
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12 PALLIATIVE CARE IN PATIENTS WITH
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222 J.B. Putnam, Jr. therapy. Patie
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224 J.B. Putnam, Jr. tion—includi
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226 J.B. Putnam, Jr. rates were 47%
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228 J.B. Putnam, Jr. Dyspnea The ma
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230 J.B. Putnam, Jr. Small-bore cat
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232 J.B. Putnam, Jr. A B Figure 12-
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234 J.B. Putnam, Jr. C D Figure 12-
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236 J.B. Putnam, Jr. B Figure 12-3.
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238 J.B. Putnam, Jr. KEY PRACTICE P
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240 J.B. Putnam, Jr. Rendina EA, De
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242 A.A. Vaporciyan, J.F. Kelly, an
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14 PREVENTION AND EARLY DETECTION O
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258 E.S. Kim and F.R. Khuri A secon
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260 E.S. Kim and F.R. Khuri Smoking
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262 E.S. Kim and F.R. Khuri Reversa
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264 E.S. Kim and F.R. Khuri yet to
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266 E.S. Kim and F.R. Khuri nation
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268 E.S. Kim and F.R. Khuri Methodo
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270 E.S. Kim and F.R. Khuri have be
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272 E.S. Kim and F.R. Khuri the tre
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274 E.S. Kim and F.R. Khuri changes
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276 E.S. Kim and F.R. Khuri KEY PRA
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278 E.S. Kim and F.R. Khuri Hong WK
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15 MOLECULAR EVENTS IN LUNG CANCER
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282 W.N. Hittelman, J.M. Kurie, and
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300 Index Anterior spinal column re
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302 Index Cardiac murmurs, 104 Card
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304 Index Diagnosis. See also under
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306 Index Growth. See Tumor growth
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308 Index Magnetic resonance (MR) i
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310 Index p16 gene, 285 p19 arf gen
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312 Index Pulmonary resection (cont
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314 Index Squamous metaplasia, 263-
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316 Index Vitamin A, 262 Vocal cord
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