Neoadjuvant chemotherapy and radiotherapy followed by surgery in selected patients with stage IIIB non-small-cell lung cancer: a multicentre phase II trial

BACKGROUND: Stage IIIB non-small-cell lung cancer (NSCLC) is usually thought to be unresectable, and is managed with chemotherapy with or without radiotherapy. However, selected patients might benefit from surgical resection after neoadjuvant chemotherapy and radiotherapy. The aim of this multicentre, phase II trial was to assess the efficacy and toxicity of a neoadjuvant chemotherapy and radiotherapy followed by surgery in patients with technically operable stage IIIB NSCLC. METHODS: Between September, 2001, and May, 2006, patients with pathologically proven and technically resectable stage IIIB NSCLC were sequentially treated with three cycles of neoadjuvant chemotherapy (cisplatin with docetaxel), immediately followed by accelerated concomitant boost radiotherapy (44 Gy in 22 fractions) and definitive surgery. The primary endpoint was event-free survival at 12 months. Efficacy analyses were done by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00030810. FINDINGS: 46 patients were enrolled, with a median age of 60 years (range 28-70). 13 (28%) patients had N3 disease, 36 (78%) had T4 disease. All patients received chemotherapy; 35 (76%) patients received radiotherapy. The main toxicities during chemotherapy were neutropenia (25 patients [54%] at grade 3 or 4) and febrile neutropenia (nine [20%]); the main toxicity after radiotherapy was oesophagitis (ten patients [29%]; nine grade 2, one grade 3). 35 patients (76%) underwent surgery, with pneumonectomy in 17 patients. A complete (R0) resection was achieved in 27 patients. Peri-operative complications occurred in 14 patients, including two deaths (30-day mortality 5.7%). Seven patients required a second surgical intervention. Pathological mediastinal downstaging was seen in 11 of the 28 patients who had lymph-node involvement at enrolment, a complete pathological response was seen in six patients. Event-free survival at 12 months was 54% (95% CI 39-67). After a median follow-up of 58 months, the median overall survival was 29 months (95% CI 16.1-NA), with survival at 1, 3, and 5 years of 67% (95% CI 52-79), 47% (32-61), and 40% (24-55). INTERPRETATION: A treatment strategy of neoadjuvant chemotherapy and radiotherapy followed by surgery is feasible in selected patients. Toxicity is considerable, but manageable. Survival compares favourably with historical results of combined treatment for less advanced stage IIIA disease. FUNDING: Swiss Group for Clinical Cancer Research (SAKK) and an unrestricted educational grant by Sanofi-Aventis (Switzerland).

Il razzismo della prosperità nell’Europa contemporanea - Riflessioni a margine del pensiero antirazzista di Walter Lorenz

Recent publishing on the migration phenomena in the communitarian and globalized Europe, puts in evidence a fundamental racism which is capable of making cultural processes grow and feed both chaos and social disorder. As a matter of fact we are approaching the ending debates on multicultural citizenship as well as on solidary integration and antiracism. Since the appearing of these phenomena, namely the huge post colonial migration in the nineteen-eighties, by which the colonized countries became almost “emigrant nurseries”, one could expect their stabilization. On the contrary, globalization and migration (twin subjects) everywhere still produce, at various levels, social disturbances together with some chauvinistic limitations as an ultimate kind of western prosperity defense. The peculiar European features of this new racism, less than ideological (superiority, homogeneity and civilizing mission), are confined to the concepts of patriotism, inequality and exclusion. In these terms one can understand why the new economic expansionism and the quest for new world markets makes European policies unstable, which remain undecided between conservatism, liberalism and extreme right. All this explains at least two things: the existing ambiguities of some European policies aiming to enhance particular forms of protectionism, and the difficulties in which the antiracist thought seems to be embedded. Indeed, according to what Walter Lorenz has already made clear, by using a well founded methodology, which prevents any fruitless protestations, it is impossible to contrast racism and nationalism. In such context, the educational field should try to use an operative epistemology. In other words the antiracist thought should dispose of competences and skills and, especially, personal and reflective capabilities. All this in order to avoid that which, in different historical scenes, permit the revival of the sense of moral opprobrium could not be identified with the political alibi to maintain privileges as well as advantages for the exclusive benefit of wealthy countries.

Walter Lorenz – Wegbegleiter und Orientierungspunkt in der interkulturellen Sozialen Arbeit

First meeting, common interests and ways together The European Centre for Social Welfare, Training and Research situated in Vienna, was our first meeting place. W. Lorenz was interested in the international comparison of the different concepts and perspectives of social welfare problems in the European countries and the different developments in the training of social professions in Europe. The challenge of intercultural, antiracist social work in the context of Erasmus-Intensive Seminars To organize an intensive seminar with the aim to train students and colleagues for intercultural and antiracist competence in social professions, we formed an European network of European universities and schools of s.w. in Vienna (VIENNET), with the support of ECCE (European Centre of Community Education) in Koblenz. “The group discovered that working on these issues in an international context raises issues of ‘difference’ with renewed acuteness”(cit. W. Lorenz). We learned to cope with a variety of differences: biographical, language, theoretical and institutional backgrounds and discourse traditions. A Venue for an Intensive Seminar In choosing a venue for an Intensive Seminar we were relatively free. We locked for a place, “one dream about”, to support in the best way our seminar aims, to promote a base built on knowledge, skills and values particularly in the area of inner/outer borders, disadvantage, ignorance, minorities, majorities, vulnerable groups, racism and xenophobia. In a small village in Burgenland (Austria), very close to the Hungarian border, we thought to have found it. Future Prospect Are we only representatives of our background institutions or did we act and exposed ourselves as persons with a very specific biography and training experience. Can we sustain this created network, as a network of experts and friends in the field of intercultural, antiracist social work? This question is still open.