PubMed Health⌕ Search

Biomedical subjects

S L Stroup

Publications and source records attributed to S L Stroup.

12 recordsLinked to original sources
PubMed1997

Paclitaxel, carboplatin, and extended-schedule etoposide in the treatment of small-cell lung cancer: comparison of sequential phase II trials using different dose-intensities.

PURPOSE: In two sequential phase II studies, we evaluate the feasibility and efficacy of adding paclitaxel to a standard platinum/etoposide regimen in the first-line treatment of small-cell lung cancer. PATIENTS AND METHODS: One hundred seventeen patients with small-cell lung cancer were treated between June 1993 and July 1996. The first 38 patients received a lower-dose regimen: paclitaxel 135 mg/m2 by 1-hour infusion, carboplatin at an area under the concentration-time curve (AUC) of 5.0, and etoposide 50 mg alternating with 100 mg orally on days 1 to 10. When only mild myelosuppression was observed, doses of paclitaxel and carboplatin were increased in the subsequent 79 patients (paclitaxel 200 mg/m2 by 1-hour infusion and carboplatin at an AUC of 6.0). All patients received four courses of treatment, administered at 21-day intervals. Patients with limited-stage small-cell lung cancer also received thoracic radiation therapy (1.8 Gy/d; total dose, 45 Gy) administered concurrently with courses 3 and 4 of chemotherapy. RESULTS: Seventy-two of 79 patients (91%) who receive the higher-dose regimen had major responses. Thirty-two of 38 (84%) with extensive-stage disease responded (21% complete response rate); median survival was 10 months for this group. With limited-stage disease, the overall response rate was 98%, with 71% complete responses; the median survival time has not been reached at 16 months. Median survival in extensive-stage patients was longer in patients who received the higher-dose regimen (10 months) than in the previous group treated with lower doses (7 months; P = .008). The higher-dose regimen was well tolerated, with myelosuppression being the major toxicity. Compared with the lower-dose regimen, grade 3/4 neutropenia increased from 8% to 38% of courses, but the incidence of hospitalization for neutropenia and fever did not increase. Other nonhematologic toxicities were uncommon, and did not increase substantially with the higher-dose regimen. CONCLUSION: Paclitaxel can be added at full dose (200 mg/m2) to a carboplatin/etoposide combination while maintaining a tolerable toxicity profile. Median survival times in both extensive- and limited-stage patients compare favorably with other reported regimens. This regimen merits further investigation, and a randomized trial to compare this regimen with a standard carboplatin/etoposide combination is underway.

Aged↗
PubMed1996

Paclitaxel, carboplatin, and extended schedule etoposide in the treatment of small cell lung carcinoma.

BACKGROUND: Paclitaxel is an active agent in the initial treatment of patients with small cell lung carcinoma. The authors evaluated the toxicity and efficacy of paclitaxel (1-hour infusion) added to a standard combination regimen of carboplatin and etoposide in a Phase II trial for the treatment of patients with small cell lung carcinoma. METHODS: Thirty-eight patients with previously untreated small cell lung carcinoma were treated with a combination regimen including paclitaxel, 135 mg/m2 by 1-hour intravenous (i.v.) infusion, on Day 1; carboplatin at AUC 5, on Day 1; and oral etoposide, 100 mg alternated with 50 mg, on days 1-10. Prior to availability of reimbursement for oral etoposide, 13 patients received etoposide, 25 mg/m2 i.v. on Days 1-5 and 8-12. Treatment courses were repeated every 21 days for a total of 4 courses. Patients with limited stage disease received radiation therapy (4500 centrigray in 25 fractions) concurrently with the last 2 courses of chemotherapy. RESULTS: This combination chemotherapy regimen was easily tolerated. Eleven episodes of Grade 3 or 4 leukopenia occurred in 9 patients (8% of courses); Grade 3 and 4 thrombocytopenia and anemia were also infrequent. Fifteen patients were hospitalized for treatment of fever associated with leukopenia. Concurrent treatment with chemotherapy and radiation therapy was also tolerable, but was more toxic; 6 of 15 patients (40%) developed esophagitis (Grade 3 in 5 patients, Grade 4 in 1 patient), and 45% of all episodes of Grade 3/4 leukopenia occurred during concurrent therapy. Other nonhematologic toxicity was uncommon. Twenty-nine of 38 patients (76%) achieved a partial or complete response to treatment (limited stage, 14 of 15 patients, 93%; extensive stage, 15 of 23 patients, 65%). The complete response rate was 26% (limited stage disease, 40% versus extensive stage disease, 17%). Median actuarial overall survival was 7 months for patients with extensive stage disease, and 17 months for patients with limited stage disease. Prophylactic whole brain irradiation was not used, and seven patients developed brain metastases as their initial site of relapse. CONCLUSIONS: The combination of paclitaxel, administered by 1-hour infusion, carboplatin and extended schedule etoposide is feasible and well tolerated in the doses administered in this Phase II trail. This regimen was highly active with treatment results comparable to other standard regimens. Increased doses of both paclitaxel and carboplatin could probably be tolerated and are currently being evaluated. Precise definition of the role of paclitaxel in the treatment of small cell lung carcinoma awaits the results of randomized studies.

Adult↗
PubMed1996

Paclitaxel in combination chemotherapy with radiotherapy in patients with unresectable stage III non-small-cell lung cancer.

PURPOSE: The addition of combination chemotherapy to standard radiation therapy has improved treatment for locally unresectable non-small-cell lung cancer. In this phase II study, we evaluated the toxicity and efficacy of a novel chemotherapy regimen that included paclitaxel, cisplatin, and etoposide plus concurrent radiation therapy in this group of patients. PATIENTS AND METHODS: Thirty-three patients with previously untreated, unresectable stage III non-small-cell lung cancer (stage IIIA, 11 patients; stage IIIB, 22 patients) initially received two courses of chemotherapy, which included paclitaxel 135 mg/m2 by 1-hour infusion on day 1, cisplatin 60 mg/m/ intravenously (i.v.) on day 2, and etoposide 100 mg/m2 i.v. on days 1, 2 and 3. On week 6, radiation therapy (60 Gy in 30 fractions) was initiated in conjunction with two additional courses of chemotherapy: paclitaxel 135 mg/m2 i.v. by 1-hour infusion on day 1, cisplatin 5 mg/m2 i.v. on days 2- to 10, and etoposide 25 mg/m2 on days 1 to 10. RESULTS: This combined modality program was feasible and well tolerated by most patients. During the two courses of induction chemotherapy, grade 3 or 4 myelosuppression occurred in only six patients (18%). Esophagitis was common during combined modality therapy (grade 3, 10 patients; grade 4 five patients). Forty-two percent of patients had partial response after two courses of induction therapy, and 82% of patients had an objective response at completion of therapy. Twelve patients (36%) had a complete response. Nineteen patients remain progression-free at a median of 8 months; the median survival time has not been reached. CONCLUSION: This paclitaxel-containing combined modality therapy is feasible and highly active in patients with inoperable stage III lung cancer. Esophagitis is the most common severe toxicity with this program. Further studies with paclitaxel-containing combination regimens in patients with stage III non-small-cell lung cancer are indicated.

Adult↗
PubMed1995

Paclitaxel by 1-hour infusion in combination chemotherapy of stage III non-small cell lung cancer.

We report our preliminary phase II experience with paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) given as a I-hour infusion with cisplatin, etoposide, and concurrent radiotherapy to patients with unresectable stage IIIA or IIIB non-small cell lung cancer. Twenty-three patients have been started on therapy, with 15 thus far completing treatment. Eight of 15 patients have achieved complete or "near complete" responses, and five more patients have had partial responses. No patients experienced disease progression. The combined-modality regimen was well tolerated, with the exception of grade 3 or 4 esophagitis, which usually occurred during the last 2 weeks of radiation therapy (eight patients). It is hoped the results of these and other studies will help clarify the role of paclitaxel in multimodality therapy for lung cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1980

Testicular infiltrate in childhood acute lymphocytic leukemia. The need for biopsy in suspected relapse.

The testicle is a prime initial target for infiltration during relapse in male children with acute lymphocytic leukemia. Herein wer report our experience with management of this entity in 8 childre. It is stressed that a biopsy is essential to the diagnosis. The differential diagnosis is usually straightforward. One is admonished not to make presumptive diagnosis by palpation. Orchiectomy is unwarranted. The treatment of choice is testicular radiation with 2,000 rads in ten fractions in a twelve-day course plus reinsstitution of high-dose adjunctive chemotherapy in those children off chemotherapy, or reinduction therapy for children who relapse while still on chemotherapy. Prognosis of male children who undergo a bout of testicular infiltration is guarded.

Antineoplastic Agents↗
PubMed1979

Small cell lung cancer. Complete remission and improved survival.

Thirty-two patients with limited-stage small cell lung cancer were treated with combined supervoltage radiotherapy and a combination of cyclophosphamide, doxorubicin and vincristine chemotherapy. The goal of obtaining a complete remission, the necessary step which precedes improved survival, was successful in 26 of 27 of completely re-evaluated patients. Fiberoptic bronchoscopy was useful in substantiating complete remission status. Seventeen of the 32 patients remain alive from 8+ to 28+ months (median 16+ months). Ten patients are alive and relapse-free from 12+ to 28+ months (median 19+ months). Transient granulocytopenia (mean nadir 650 cells/mm3) during induction therapy and the associated risk of infection were the most serious toxicities encountered. This therapy produces complete remission on roentgenography and bronchoscopy, symtomatic improvement and improved survival in the majority of patients with limited-stage small cell lung cancer. A portion of these patients may have their disease eradicated.

Adult↗
PubMed1977

Surgical experience with Cushing's disease.

During the period 1952 to 1976 at Vanderbilt University Hospital 119 patients with pituitary-dependent hypercortisolism or Cushing's disease were studied. The less severe cases, which constitute a majority, were treated by pituitary irradiation with endocrinologic cure or improvement in two-thirds of the treated patients. Bilateral total adrenalectomy was reserved for the most severe cases and for failures of pituitary irradiation. In 29 patients with total bilateral adrenalectomy there was one postoperative death. Two of 28 survivors had incomplete relief of hypercortisolism and required additional therapy for its control. One patient with recent operation is improved and another with early improvement died suddenly at home three months after operation. The 24 other adrenalectomized patients, followed 6 months to 20 years, were considered endocrinologic cures of Cushing's disease. One patient in the group who had not received pituitary irradiation developed signs of expanding pituitary tumor after adrenalectomy (Nelson's syndrome) with satisfactory response to radiation therapy.

Adolescent↗
PubMedDate not supplied

Physical approach to depth dose distributions in a water phantom irradiated by a teleisotope photon beam.

The physical basis of deposition of radiation dose within a homogeneous phantom irradiated by a monoenergetic photon beam has been studied in terms of photon attenuation and energy-absorption properties of the phantom material. A semi-empirical model based on the Klein-Nishina formula for Compton scattering, and the ratio of multiply scattered to singly scattered photon fluences, has been developed for the scatter dose component within a realistic phantom to determine the central-axial percent depth dose (PDD) and off-central-axis ratios (OCR). Differences between the predicted and measured values of PDD and OCR for cobalt-60 and cesium-137 beams are less than 3% for fields of equivalent-square-side less than 20 cm, and less than 5% for larger fields. Beam profiles of all field sizes can be well simulated by this model and reasonable agreement has been found between the predicted and tabulated values of scatter functions and the backsetter factor for cobalt-60 beams. This formulation involves no variable parameters, and is valid for all values of the source-to-surface distance, field length and width, and field shape. However, the algorithm developed is not suitable for routine multiple-field treatment planning because it requires large computer memory size.

Cesium Radioisotopes↗
PubMedDate not supplied

Semi-empirical model for depth dose distributions of megavoltage x-ray beams.

The dose distribution due to absorption of photon energy fluence in a homogeneous water phantom irradiated by megavoltage x-ray beams has been analyzed with a semiempirical model. The method generalizes an analytical formalism for the scattering component of dose within a water phantom which was developed recently for monoenergetic photon beams. Contributions to dose via Compton interaction and pair creation form the essential structure of the secondary component formula. Both the central-axis percent depth dose and off-central-axis ratios can be determined for beams of different sizes, used at any value of source to surface distance. The input data include the values of linear attenuation and energy-absorption coefficients in water at energies between 10 keV and the equivalent energy of the beam. Predicted values of the central-axis percent depth dose and the off-central-axis ratios are compared with the measured data for 2, 4, 6, 8, 10, 14, 20, 35, 45, and 70 MVp x-ray beams. For the central-axis percent depth dose, agreement is within 3% for fields of sizes between 5 X 5 and 20 X 20 cm2, and 5% for larger fields, for beams of MVp up to 20. For higher energy beams, comparison was made only for the 10 X 10 cm2 fields and the discrepancies were within 3%. For the off-central-axis ratios, agreement between the predicted and measured values is within 5% over the umbra region but worsens in the penumbra region and geometrical shadow. This formalism requires large computer storage for generating data for all realistic beams irradiating normal-size phantoms.

Computers↗
PubMedDate not supplied

Evaluation of tissue-air ratios and tissue-maximum ratios with the photon energy-fluence absorption dose model.

Values of tissue-air ratio (TAR) and tissue-maximum ratio (TMR) have been calculated with the photon energy-fluence absorption dose model, at depths d greater than dn (depth of dose normalization) in a homogeneous water phantom, for Co-60 gamma-ray, and 4, 6, 10, 14, and 45 MVp x-ray beams of EQS (the side of the equivalent square) up to 20 cm. It has been found that by (i) slightly altering the formula for the depth modification factor so that it depends on the difference (d -- dn) rather than d alone; and (ii) permitting E, the effective energy of the beam, to vary with EQS for some x-ray beams, it is possible for the model to reproduce within 2.5% the measured data at depths d greater than dn, on TAR, TMR and PDD (the central axis percent depth dose), for any source to surface distance.

Computers↗