Gan to kagaku ryoho. Cancer & chemotherapy
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This paper reviews the recent clinical trials of chemotherapy and combined modality therapy in small-cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). 1) A meta-analysis has shown that survival is prolonged when radiotherapy is used in combination with chemotherapy in the treatment of limited-stage SCLC. A randomized trial comparing early radiotherapy (RT) with late RT has reported the survival advantage in the early RT. Recent pilot trials employing accelerated hyperfractionated RT with concurrent cisplatin (CDDP) and etoposide have shown encouraging survival results. 2) The approach to increasing dose intensity has been attempted in the treatment of extensive-stage (ES) SCLC. ⋯ Results of pilot studies using this approach have shown the relatively high rate of complete response with an average of 36% and longer survival with a median of more than 10 months in ES-SCLC. 3) Combined modality treatment employing CDDP-containing chemotherapy or CDDP alone and radiotherapy have produced positive results in the treatment of locally advanced stage III A or III B NSCLC. In conclusion, despite the advances of treatment, the cure rate remains quite low in lung cancer. Further investigations are needed to improve the outcome with this disease.
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Hypercalcemia is one of the life-threatening paraneoplastic syndromes and urgent medical treatments are needed since malignant hypercalcemia progresses very rapidly. The intravenous administration of sufficient quantities of isotonic saline sometimes with loop diuretic agents is the first and fundamental step in the management of malignant hypercalcemia. As hormonal therapeutic agents for malignant hypercalcemia, calcitonin and/or glucocorticoid are the usual candidates. ⋯ These agents interact chemically with hydroxyapatite on the bone surface and prevent osteoclastic function and activity. According to the data of our own investigation, pamidronate, one of the relatively new generation of bisphosphonates, showed clearly hypocalemic effects for malignant hypercalcemia due to various kinds of malignancy by one intravenous administration (30-60 mg) without any adverse effect. In near future, the combination of calcitonin and bisphosphonates will also be the most effective medical management for malignant hypercalcemia in Japan.