Background: The combination of etoposide plus cisplatin (EP) is considered to be standard therapy for small-cell lung cancer (SCLC). To determine whether drug intensification improves survival of ...patients with extensive SCLC, we compared this treatment with a four-drug regimen containing EP plus cyclophosphamide and 4′-epidoxorubicin (PCDE). Methods: In a phase III clinical trial organized by the French Federation of Cancer Institutes, patients were randomly assigned to receive either EP (n = 109; etoposide at a dose of 100 mg/m2 on days 1–3 plus cisplatin at 100 mg/m2 on day 2) or PCDE (n = 117; etoposide and cisplatin given as in EP plus cyclophosphamide at 400 mg/m2 on days 1–3 and 4′-epidoxorubicin at 40 mg/m2 on day 1) every 4 weeks. Both groups received a total of six cycles. Survival differences were analyzed by Wilcoxon and log-rank tests. Associations of treatment group and putative prognostic variables with survival were tested in the Cox proportional hazards model. Quality of life was assessed from the responses to the European Organization for Research and Treatment of Cancer quality-of-life questionnaire (C30, health status and lung cancer module 13). All statistical tests were two-sided. Results: Patients in the PCDE arm had a statistically significant higher frequency of combined complete plus partial responses compared with those in the EP arm (21% plus 55% versus 13% plus 48%, respectively; P = .02 for difference in combined objective responses). Patients in the PCDE arm survived longer than those in the EP arm (1-year survival rate: 40% and 29%, respectively; median survival: 10.5 and 9.3 months, respectively; log-rank P = .0067). In the Cox model, the relative risk of death for patients in the PCDE arm compared with those in the EP arm was 0.70 (95% confidence interval = 0.51 to 0.95); the disease also progressed more slowly in patients in the PCDE arm. Hematologic toxicity was higher in the PCDE arm (22% with documented infections compared with 8% in the EP arm; P = .0038), and the toxicity-related death rate was 9% in the PCDE arm versus 5.5% in the EP arm (P = .22). The global health status showed similar improvement in both arms during treatment. Conclusion: Compared with the EP regimen, the PCDE regimen yielded higher response rates and better survival rates in patients with extensive SCLC without affecting the quality of life of the patients during chemotherapy.
To evaluate respiratory risk in dairy farmers, the present authors conducted a longitudinal study in the Doubs region of France. From a cohort constituted in 1986 (T1), 157 (62.8%) dairy farmers and ...159 (63.6%) controls were re-evaluated in 1998 (T3). The study protocol comprised a medical and occupational questionnaire, spirometric tests at both evaluations, and noninvasive measure of blood oxygen saturation with pulse oximetry (S(p,O(2))) at T3. In 1998, the prevalence of chronic bronchitis was higher in dairy farmers. In cross-sectional analyses, all respiratory function parameters and S(p,O(2)) were significantly lower in dairy farmers. In a multiple linear regression model, farming, age, male sex and smoking were significantly and negatively correlated with S(p,O(2)). However, the mean annual decline in respiratory function parameters did not differ significantly between groups. After adjustment of covariables, accelerated decline in vital capacity and forced expiratory volume in one second was associated with age, smoking and male sex. Decline in vital capacity was accelerated in dairy farmers working in traditional farms and those currently foddering. The current study demonstrates that dairy farming is associated with an increased risk of lung disorders and a decrease in blood oxygen saturation and suggests that respiratory function impairment is correlated with cumulated exposure to organic dusts.
Based on the studies published during the last 20 years, the surgery and chemotherapy combination has become a standard for patients with a stage II-IIIA operable non-small cell lung cancer. The ...survival advantage is better documented for adjuvant chemotherapy than for neo-adjuvant chemotherapy. However, there are advantages for the preoperative delivery of chemotherapy, which should not be neglected. The results of ongoing studies should help to define the respective indications of pre- and post-operative chemotherapy in the future. The recently updated "Standards, Options, and Recommandations", published on behalf on the Fédération Nationale des Centres de Lutte Contre le Cancer, define the current practice of perioperative chemotherapy according to the evidence-based medicine.
The combination of chemotherapy and surgery is a standard of care for non-small cell lung cancer, as shown by the recently published "Standards, Options et Recommandations" (SOR) by the Fédération ...des Centres de Lutte contre le Cancer. This document was approved by the INCa, the SPLF, the Ligue contre le Cancer, the IFCT. However, the respective position of chemotherapy and surgery remains debated. Most trials of preoperative chemotherapy were closed when the positive studies of adjuvant chemotherapy were published. Therefore, the trials of preoperative chemotherapy lack strength to conclude on the validity of the concept. Confirmation will come from meta-analyses. Two meta-analyses based on published data have been yet published, and are positive.
Aims: To compare respiratory status in dairy farmers with that of non-farming controls. Methods: Longitudinal study in the Doubs (France). From a cohort constituted in 1994 (T1), 215 (81.1%) dairy ...farmers and 110 (73.8%) controls were reevaluated in 1999 (T2). The protocol comprised a medical and occupational questionnaire, spirometric tests at both evaluations, allergological tests at T1, and a non-invasive measure of blood oxygen saturation (Spo2) at T2. Results: In 1999 analyses, the prevalence of chronic bronchitis was higher (p = 0.013), and FEV1/VC (p < 0.025) and Spo2 (−0.7%, p < 0.01) lower in dairy farmers than in controls. In a multiple linear regression model, farming, age, and smoking were significantly and inversely correlated with Spo2. In the whole population, the mean annual decline in FEV1 and FEV1/VC was −13.4 ml and −0.30%, respectively. Farming was associated with an accelerated decline in FEV1/VC (p < 0.025) after adjustment for covariates. No relation between allergy and respiratory function changes was observed, except for FEF25–75. Conclusions: This prospective study shows that dairy farming is associated with an excess of chronic bronchitis, with a moderate degree of bronchial obstruction and a mild decrease in Spo2.
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