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Biomedical subjects

R T Eagan

Publications and source records attributed to R T Eagan.

At least 37 records · Page 2Linked to original sources
PubMed1987

Pilot study of induction therapy with cyclophosphamide, doxorubicin, and cisplatin (CAP) and chest irradiation prior to thoracotomy in initially inoperable stage III M0 non-small cell lung cancer.

In an attempt to increase the resection rate of patients with non-small cell lung cancer, two cycles of cyclophosphamide, doxorubicin, and cisplatin chemotherapy and chest irradiation (3000 cGy in 10 fractions, split course) were administered to 42 initially inoperable (T3 or N2M0) patients. Three patients were subsequently determined to be ineligible, two because of small cell histology and one because of M1 disease. Among the 39 eligible patients, 20 (51%) had a regression following the combined-modality therapy. Seventeen of these patients plus two with stable disease had thoracotomy. Complete surgical resection was accomplished in 13 patients (33% of all eligible 39 patients; 68% of all 19 patients who had thoracotomy). There were no statistically significant survival differences between patients not having thoracotomy and those who had thoracotomy (or even those with complete tumor excision). The patients with chemotherapy, chest irradiation, and surgical resection had a low incidence of local in-chest failure (5%), but distant failure was still a major problem.

Aged↗
PubMed1986

Phase II study of the three-drug combination of mitomycin C, CCNU, and methotrexate (MCM) in advanced non-small cell lung cancer.

Ninety-two patients with advanced non-small cell lung cancer, 51 without prior chemotherapy exposure, were treated with the combination of mitomycin C, lomustine (CCNU), and methotrexate (MCM). Overall, the regression rate was 33%, the median regression duration 4.9 months, and the median survival 4.9 months. Patients with ECOG performance scores (PSs) of 0-1 had a statistically significant higher regression rate than did patients with ECOG PSs of 2-3 (43% versus 15%; p = 0.005) as did patients without prior chemotherapy (41% versus 22%; p = 0.05). Cell type and prior chemotherapy exposure did not affect regression duration, time to progression, nor survival. Subjective toxicity was quite acceptable. Cumulative myelosuppression was the most significant objective toxicity. MCM is a relatively effective combination chemotherapy regimen, even in patients with prior chemotherapy exposure (predominantly doxorubicin and cisplatin-based chemotherapy).

Adult↗
PubMed1986

Differing response rates and survival between squamous and non-squamous non-small cell lung cancer. Comparison of CAP versus MAP.

One hundred and thirty patients with advanced non-small cell lung cancer were treated in a randomized study with either CAP (cyclophosphamide, doxorubicin, and cisplatin) or MAP (mitomycin C, doxorubicin, and cisplatin). Among all patients, regardless of cell type, the regression rate was slightly higher for MAP (46%) than CAP (34%) but no differences were detected in time to progression and overall survival. However, differences were apparent by treatment when patients were divided into two groups: squamous cell (SQC) and non-squamous cell (non-SQC). MAP, compared to CAP, was associated with a significantly superior regression rate (60% vs. 33%), time to progression, and overall survival in SQC. On the other hand, CAP, compared to MAP, was associated with a significantly longer overall survival in non-SQC. This apparent difference among subtypes of non-small cell lung cancer in response to chemotherapy regimens differing only in one drug, if confirmed, will need to be kept in mind in designing future studies.

Adult↗
PubMed1985

Continuous five-drug versus alternating three-drug and two-drug chemotherapy after five-drug or three-drug induction in extensive small cell lung cancer.

Fifty-six patients with extensive small cell lung cancer were treated with vincristine, doxorubicin, cisplatin, etoposide, and cyclophosphamide in a prospective randomized trial using all five drugs together or as three-drug (cisplatin, etoposide, cyclophosphamide) and two-drug (doxorubicin, vincristine) combinations given sequentially, then alternatively. The five-drug combination was associated with a higher overall regression rate (p = 0.03), higher complete regression rate (p = 0.09), prolonged time to first progression (p = 0.03), more nervous system initial failures (p = 0.07), more anemia requiring transfusion (p = 0.04), but no prolongation of overall survival (median 332 days for five-drug, median 303 days for three-drug and two-drug). Until more and better chemotherapeutic agents become available, little or no advantage is likely to be gained for patients with small cell lung cancer given sequential, or alternating chemotherapy.

Adult↗
PubMed1984

Prognostic factors in patients with resected stage I non-small cell lung cancer. A report from the Lung Cancer Study Group.

The authors present prognostic information on recurrence and survival for resected Stage I lung cancer patients with squamous cell carcinoma, adenocarcinoma or large cell carcinoma. The data derive from 392 carefully staged patients and include results from the history and physical examination, preoperative laboratory tests, nature of the surgery, complications, initial pathologic findings following surgical resection, and final pathologic review. A simple multivariate model of recurrence, which is used to classify patients into low, intermediate, and high-risk groups, is based on tumor size and location (T1, T2), histologic type (squamous, nonsquamous/mixed) and nodal status (N0, N1). To model survival, the performance status and the presence of empyema, pneumonia, or wound infection were added to the previous factors. Not all factors associated with increased mortality are associated with increased risk of recurrence, and, in particular, postoperative empyema, pneumonia or wound infections carry an increased risk of death only. Serial measurements of performance status and leukocyte count have the potential for monitoring for increased risk of recurrence and death.

Adenocarcinoma↗
PubMed1984

Meningeal carcinomatosis in patients with primary breast or lung cancer.

We reviewed the records of 35 patients with meningeal carcinomatosis and primary lung or breast cancer in an effort to identify prognostic factors. No definite associations were found. The prognosis for these patients continues to be poor; the median duration of survival after the diagnosis of meningeal carcinomatosis was 43 days in our study group.

Adult↗
PubMed1984

Carcinosarcoma of the lung: Mayo Clinic experience and response to chemotherapy.

The clinical presentation, clinical course, and results of various treatment modalities of 17 patients with carcinosarcoma of the lung were reviewed. This group of patients was 0.2% of all Mayo Clinic patients with lung cancer who had been treated between 1971 and 1982. Most patients were men in the sixth decade of life who had a history of smoking. Ten of 17 neoplasms were located in the upper lobes. Noninvasive diagnostic tests had a low yield in detecting carcinosarcomas. Pulmonary resection with curative intent was performed in 15 of 17 patients; however, only 4 patients were alive at 6, 8, 28, and 39 months, respectively, postoperatively. The median survival was 1 year. Doxorubicin-based chemotherapeutic programs produced an objective response in two of four patients.

Adult↗
PubMed1984

Comparison of combination chemotherapy programs in advanced adenocarcinoma-large cell carcinoma of the lung: a North Central Cancer Treatment Group study.

One hundred and six patients with advanced adenocarcinoma and large cell carcinoma of the lung with no prior chemotherapy were entered in a prospectively randomized trial comparing cyclophosphamide, doxorubicin, and cisplatin versus methotrexate, doxorubicin, cyclophosphamide, and lomustine. The two regimens resulted in nearly identical regression probabilities (36% vs 34%), distributions of time to progression, and survival distributions. The major toxic effects from both regimens consisted primarily of myelosuppression and nausea and vomiting, with severe vomiting occurring more frequently in patients treated with cyclophosphamide, doxorubicin, and cisplatin (43% vs 19%).

Adenocarcinoma↗
PubMed1984

Pleural lavage after pulmonary resection for bronchogenic carcinoma.

A cytologic examination of pleural fluid was performed on a pleural lavage specimen collected at the completion of operation after pulmonary resection in 135 of 599 patients undergoing curative pulmonary resection for a non-small cell carcinoma of the lung between 1977 and 1982. The cytologic results of lavage was positive for malignant cells in 12 of the 135 patients (8.9%). The incidence of positive results was correlated with lymph node status (N2 greater than N1 greater than N0), cell type (adenocarcinoma greater than other non-small cell lung cancers), stage (III greater than II greater than I), and visceral pleural status (invaded greater than not invaded). No positive cytologic results were noted in 39 patients having a diagnostic excisional pulmonary biopsy prior to more definitive resection. The disease has recurred in nine of the 12 patients with positive cytologic results (only two in the ipsilateral pleural space), and eight have died. The prognostic role of pleural lavage cytology needs more study.

Adenocarcinoma↗
PubMed1983

The effect of CNS metastases on the survival of patients with small cell cancer of the lung.

The records of 227 patients with small cell lung cancer (SMCLC) treated between January 1974 and July 1978 in a series of randomized trials were reviewed to determine the influence of central nervous system (CNS) metastases on survival. Sixteen patients were excluded because of single agent chemotherapy (11), lack of CNS irradiation despite proven metastases (2), prior chemotherapy (2), and concomitant metastatic second primary (1). Of 211 evaluable patients, 100 presented with limited disease and 111 with extensive disease, 25 of whom had CNS metastases at presentation, 21 ("CNS-limited") as the only site of metastases. Treatment of limited patients consisted of chemotherapy and thoracic radiation, while chemotherapy alone was used for extensive patients. No prophylactic brain irradiation was used, but CNS radiation was given to almost all patients when CNS metastases developed. Median survivals were: limited, 13.8 months; CNS-limited, 15.1 months; and extensive 8.6 months (P less than 0.0001). There was no significant difference in the survival experience of limited and CNS-limited patients, although none of the CNS-limited patients experienced long-term remissions. Thirty-five of the limited patients and 21 of the extensive patients subsequently developed CNS metastases. Their median survivals following CNS metastases were 3.7 months and 1.6 months, respectively. In conclusion, CNS metastases as the sole site of metastatic disease at diagnosis of SMCLC is not necessarily a bad prognostic sign, while the subsequent development of CNS metastases may be.

Antineoplastic Agents↗
PubMed1983

Evaluation of prognostic factors in chemotherapy of recurrent brain tumors.

We have evaluated the prognostic significance of several easily obtainable and commonly used factors in patients with primary brain tumors (recurrent after irradiation) undergoing chemotherapy. Age, sex, tumor grade, on-study performance score, time from initial diagnosis to initial postirradiation progression, and prior chemotherapy or no were evaluated for affects on tumor response. None of the six factors significantly correlated with response to therapy. The above six factors plus response to chemotherapy were evaluated for their affects on time to progression and survival. Tumor regression following chemotherapy most strongly correlated with prolonged time to progression and survival. A good on-study performance score (not, or only minimally, symptomatic) significantly correlated with prolonged survival, but not with prolonged time to progression. Surprisingly, tumor grade did not significantly correlate with response, time to progression, or survival. Further study is required, but initial data analyses would suggest that essentially all patients with all grades of recurrent tumor could be used in chemotherapeutic trials with proper pretreatment stratification.

Adult↗
PubMed1983

Complications of treatment of small cell carcinoma of the lung.

Improvements in therapy for small cell carcinoma of the lung have been achieved with treatment regimens that result in significant toxicity. The workshop of the International Association for the Study of Lung Cancer focused on the following complications of chemotherapy and radiotherapy: leukopenia and resultant infections, esophagitis, pneumonitis and pulmonary fibrosis, cardiac toxicity, second malignancies, neurologic complications, and psychosocial effects. The data regarding the incidence and management of these complications are briefly reviewed, and recommendations for further studies are noted.

Aged↗
PubMed1983

Pharmacokinetics of mitomycin C in patients receiving the drug alone or in combination.

We have characterized plasma pharmacokinetics in 30 patients receiving mitomycin C (mitomycin) in doses ranging from 6 to 20 mg/m2 by iv bolus injection, either alone or in combination with other chemotherapeutic drugs. Plasma elimination of the drug was described by a two-compartment model in all but three cases, giving mean values for alpha-half-life of 8.2 mins, beta-half-life of 51.8 mins, and total body clearance of 332.9 ml/min/m2. The mean urinary excretion was 8.1% of the total dose administered. We did not detect alterations in pharmacologic parameters related to liver dysfunction, dose of mitomycin, and concomitant administration of other cytotoxic drugs.

Adult↗
PubMed1983

Preliminary communication--treatment of primary brain tumors recurrent after irradiation with aziridinylbenzoquinone (AZQ;NSC-182986).

Twenty-nine patients with primary brain tumors recurrent or progressive after cerebral irradiation were treated with AZQ. Twenty of the 29 patients had also failed prior chemotherapy. CT scan-documented tumor regressions were noted in 17.2% (5/29) and ranged from 15.0% (3/20) in patients with prior chemotherapy to 22.2 (2/9) in patients without prior chemotherapy. Myelosuppression was the only significant toxicity noted. AZQ is worthy of further studies in patients with primary brain tumors.

Adolescent↗
PubMed1983

Modern thirty-day operative mortality for surgical resections in lung cancer.

Modern postoperative mortality rates for resectional operations for lung cancer are not readily available. In recent publications estimating the risk factors for surgical resection, mortality rates of 10% to 15% for pneumonectomy and 5% to 7% for lobectomy are frequently quoted. In order to determine modern operative mortality rates (up to 30 days postoperatively), the Lung Cancer Study Group (LCSG) analyzed the surgical mortality rates of the various participating centers during the years 1979 to 1981. A total of 2,200 resections for lung cancer were available for analysis. Of the 2,220 resections performed, 1,058 were lobectomies, 569 were pneumonectomies, and 143 were lesser resections (segmental or wedge). Eighty-one postoperative deaths occurred from among the 2,220 resections (3.7%). The mortality rate for pneumonectomy was 6.2% and for lobectomy, 2.9%. Lesser resections carried a 1.4% mortality rate, not statistically different from lobectomy. In patients under the age of 60 years, the mortality rate was 1.3%, 60 to 69 years, 4.1%, and over 70 years, 7.1%, all significantly different (p less than 0.01). The postoperative mortality rate for patients 70 years or older was 7.1% (pneumonectomy 5.9% and lobectomy 7.3%). It is obvious that greater care was taken in selection among the older pneumonectomy patients. The striking similarity of postoperative mortality rates for resectional operations for lung cancer among the various centers of the LCSG and among the various institutions within these centers suggest that these data are a reasonably accurate analysis of modern surgical mortality rates in the treatment of lung cancer.

Aged↗