Seminars in oncology
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Third-party payer reimbursement policies have undergone significant changes in recent years and will probably continue to do so as the nation's health care system is reformed. These changes will have important implications for oncologists, similar to those that have arisen as a result of Medicare's payment system changing from one of "reasonable charges" to a fixed-fee schedule. The likely growth of managed competition as part of health care reform may prove to be disadvantageous to the oncologist without laws or rules guaranteeing cancer patients the right to treatment by a specialist and to tertiary care. Other areas of importance that will probably be affected include reimbursement of patient care costs associated with clinical trials and of drug costs when the drug is used for off-label indications.
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Seminars in oncology · Jun 1994
Meta AnalysisThe treatment of non-small cell lung cancer: current perspectives and controversies, future directions.
The projected cure rate for patients who develop lung cancer in 1993 is only 13%. The majority of these patients have metastatic disease at the time of diagnosis, and are therefore ineligible for curative surgery. Among the minority of patients who undergo surgical therapy with curative intent, the majority experience relapse in metastatic sites. ⋯ Response rates in excess of 20% were reported for paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ), irinotecan (CPT-11), topotecan, and gemcitabine. Studies in the next few years will help to define the ultimate role of these agents. Further developments in understanding the biology (and molecular biology) of lung cancer are leading to preclinical studies of antigrowth factors and genetic therapy.
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Seminars in oncology · Jun 1994
ReviewCombined chemotherapy and radiation in locally advanced non-small cell lung cancer.
The majority of patients with locally advanced, unresectable, non-small cell lung cancer (NSCLC) treated with conventional radiation therapy develop distant metastases and succumb to the disease. Thus, NSCLC should be viewed as a systemic disease, and attempts to control micrometastatic disease with chemotherapy should have a greater impact on survival. This does not eliminate the role of radiation therapy, as locoregional control is equally important. ⋯ Preliminary results show that the combination is feasible and well tolerated; median survival rates compare favorably to those seen in the combined-modality arms of the randomized, sequential studies. Definitive conclusions based on the results of the reported studies are not possible, yet there seems to be a potential benefit to adding chemotherapy to radiation therapy. These trials need to be confirmed before they can be used to define a "standard of care" for patients with locally advanced, unresectable NSCLC.
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Seminars in oncology · Jun 1994
Induction chemotherapy with and without recombinant human granulocyte colony-stimulating factor support in locally advanced stage IIIA/B non-small cell lung cancer.
Patients with non-small cell lung cancer (NSCLC) in stage IIIA with more than minimal N2 involvement or in stage IIIB are considered unresectable. Response rates to chemotherapy for these patients are in the range of 40%. Reduction of tumor mass by induction chemotherapy may lead to resectability and to improved survival. ⋯ Median survival after response to chemotherapy and incomplete resection (11 patients) was 17 months, whereas median survival after response to chemotherapy and complete resection (18 patients) has not yet been reached. Only four patients in this group have died with a follow-up of 4 to 60 months. Of 20 patients receiving accelerated chemotherapy with r-metHuG-CSF support, World Health Organization grades 3 and 4 neutropenia occurred in five and eight patients, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)