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Kawaguchi T.,National Hospital Organization | Takada M.,Kinki University | Ando M.,Kyoto University | Okishio K.,National Hospital Organization | And 9 more authors.
European Journal of Cancer | Year: 2012

Aim: To evaluate the efficacy and feasibility of the consolidation therapy of the oral fluoropyrimidine agent S-1 after concurrent chemoradiotherapy for unresectable stage III non-small cell lung cancer (NSCLC). Methods: Eligible patients had unresectable stage III NSCLC with performance status of 0 or 1. Chemoradiotherapy at a total dose of 60 Gy consisted of cisplatin (80 mg/m 2) on days 1 and 29, vinorelbine (20 mg/m 2) on days 1, 8, 29 and 36. Sequential consolidation S-1 therapy was commenced at a dose of 80-120 mg twice daily on day 57 with two cycles of 4 weeks administration and 2 weeks withdrawal. Results: Of the 66 patients, 65 were evaluated. Chemoradiotherapy was completed in 57 (87.7%) patients, and S-1 consolidation therapy was administered in 45 (69.2%) and completed in 31 (47.6%). Grade 3 pneumonitis developed in three patients with one dying of it. The response rate was 61.5% (95% confidence interval [CI], 48.6-73.3%). The median progression-free survival was 10.2 (95% CI, 8.6-13.7) months and median survival time 21.8 (95% CI, 15.6-27.6) months. The 1- and 3-year survival rates were 73.9% and 34.0%, respectively. Conclusions: Chemoradiotherapy with cisplatin and vinorelbine followed by S-1 consolidation demonstrated a reasonable overall survival in patients with stage III NSCLC. However, less than half of the patients completed this regimen, and the additional effect of S-1 was marginal compared with historical control. We concluded that chemoradiotherapy alone is still the recommended standard treatment for patients. © 2011 Elsevier Ltd. All rights reserved.

Tobise K.,NHO Sapporo Minami National Hospital | Miyari M.,NHO Minami Yokohama National Hospital | Yamazaki Y.,Asahikawa Medical Center | Waga S.,NHO Aomori National Hospital | And 13 more authors.
IRYO - Japanese Journal of National Medical Services | Year: 2010

Under the counts of medical insurance fees in April 2006, our study showed the average income of 20, 079 yen per person per day in 2007, and 20, 233 yen in 2008 by tuberculosis medical care in National Hospital Organization. The average medical cost was 28,647 yen per person per day in 2007, and was 30, 399 yen in 2008, respectively. The expected break-even earnings from medical practice were 30, 227yen, 31,710 yen in 2007 and 2008, respectively. Even when we maintained about 30 inpatients (60% of operative sickbed rate) in one year, we recognized the deficit of 8,000-10,000 yen per person per day. The historical revision of medical insurance fees for the past several years is likely to consider a small increase in the future from the current 8,000 to 10,000 yen. So, in order to increase incomes, we should consider the income of public subsidy as well as medical insurance fees, and should change the medical care system from the unit of ward (mixed with the general ward) to the unit of beds with a negative pressure function. In addition, the tuberculosis treatment requires the hospital treatment with all departments instead of the treatment in tuberculosis sanatorium. It is the time that we should think about the field of these problems.

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