Lung cancer : journal of the International Association for the Study of Lung Cancer
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In the last years, the main topoisomerase I inhibitors (TP1-I) (i.e. topotecan and irinotecan) have been used in combination chemotherapy in non-small cell lung cancer. Several drugs (also alternative to cisplatin) have been used in combination with TP1-I, but to date the higher remission rate obtained with combinations is not translated into a more prolonged survival in comparison with TP1-I given alone. ⋯ Furthermore, the best schedule for TP1-I has not been completely elucidated. Randomised studies are few (only two phase III trials) and only controlled studies will be able to clarify the best TP1-I combination regimen.
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Endobronchial ultrasound (EBUS) is a new diagnostic tool, which has expanded the view of the bronchoscopist beyond the confinements of the airways. It has great potential for diagnosis of mediastinal processes and staging of lung cancer. These will be discussed and illustrated. EBUS will become a superior tool for staging of lung cancer, and several comparative studies on EBUS as compared with standard techniques in order to assess its role in the staging procedure are just on their way or already completed.
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Docetaxel, an active agent for non-small cell lung cancer (NSCLC), has demonstrated activity as a radiosensitizer in numerous pre-clinical studies. We conducted a phase I trial to determine the maximum-tolerated dose (MTD) and dose-limiting toxicities (DLT) of weekly Docetaxel, Carboplatin with concurrent thoracic radiation therapy (TRT) in patients with unresectable stage III NSCLC. ⋯ This combination regimen has activity with manageable toxicity in patients with stage III NSCLC. A phase II study is planned to define activity.
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Among all cancer, lung cancer has the highest rate of mortality in the western world. The persisting grim lung cancer mortality figures argue powerfully for new approaches for controlling this disease such as chemoprevention that has been defined as the use of agents that inhibit or reverse lung carcinogenesis. Carcinogens from cigarette smoke are implicated in about 90% of male and 75-80% of female lung cancer deaths. ⋯ The fact that 85% of heavy smokers will not develop lung cancer points to a variation in individual susceptibility. It also suggests that modulation of susceptibility might be used as a preventive strategy. This review summarizes the outcomes of recent clinical chemoprevention trials and reveals that the chemoprevention approach in lung cancer is still experimental.
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The combination of low-dose chemotherapy and thoracic radiotherapy is one of the treatments proposed in an attempt to improve the prognosis of locally advanced non-small cell lung cancer. Chemotherapeutic drugs administered at subtoxic doses act by means of a radiosensitization mechanism. ⋯ However, the optimal dose and timing of such drugs when used concurrently to radiotherapy are unknown. This paper will review the results obtained using new chemotherapeutic drugs as radiosensitizers.