Comparison of oral versus intravenous clodronate in patients with skeletal metastasis with respect to bone mineral density and pain score

Background: Clodronate is a bisphosphonate available both in oral as well as intravenous formulations. It is one of the effective drugs painful skeletal metastasis. The present study aimed at comparison of oral vs intravenous formulation with regard to improvement in bone mineral density and pain score among patients having skeletal metastasis

Methods: Two hundred patients having any cancer with skeletal metastasis were included in the study. They were given either oral Clodronate or intravenous Clodronate for six months and a comparison was made between them with regard to improvement in bone mineral density and pain score

Results: Out of 200 patients 135 were males and 65 females with a mean age of 54 years. Mean T score of patients on oral treatment before start of treatment was -2.42 that improved to -2.15 [p<0.005] after 6 months of therapy. Mean T-score of patients on intravenous therapy at baseline was -2.37 also improved to -2.11 [p<0.005] after 6 months of therapy. The two arms of treatment did not show statistically significant difference in pre- and posttreatment T scores. The mean pain score of the patients receiving oral Clodronate at the start of treatment was 7.33 that improved to 3.13 [p<0.005] while among patients on intravenous Clodronate it improved from 7.37 to 3.11 [p<0.005]. The comparative improvement in pain scores in the two arms was not significantly different [p=0.909]

Conclusion: Clodronate improves both T score on DEXAscan and pain score among patients with skeletal metastasis irrespective of the route of administration

Association between hypolipidemias and colorectal carcinoma

Objective: To study association of hypolipidemias and primary colorectal carcinoma in population of patients of colorectal carcinoma presenting to Combined Military Hospital [CMH] Rawalpindi

Study Design: Case control study

Place and Duration of Study: Oncology department, Combined Military Hospital [CMH], Rawalpindi. Material and Methods: Forty one treatment naive patients between ages of 18-75, with histologically confirmed primary colorectal carcinoma were selected and their serum lipid profile was measured after an overnight fast, from Armed Forces Institute of Pathology [AFIP]. These levels were compared with 41 controls, selected from healthier population, using an unpaired T test. Frequency and percentages were computed for variables; sex, age and stage at presentation

Results: Colorectal carcinoma had significant association with triglycerides [p=0.007], total cholesterol [p=0.014] and LDL [p=0.013]

Conclusion: There is an inverse relationship between serum total and LDL cholesterol, and colorectal carcinoma, implying that hypolipidemias may play a role in development of colorectal carcinoma

Efficacy of combination chemotherapy; gemcitabine and docetaxel, in patients with advanced urinary bladder carcinoma

To evaluate the efficacy of combination chemotherapy; gemcitabine and docetaxel, in terms of objective response, in advanced urothelial carcinoma of urinary bladder. Quasi-experimental study. Oncology Department of Combined Military Hospital Rawalpindi, from Oct 2012 to July 2013. Fifty one patients with histologically confirmed urothelialcarcionoma of the bladder were enrolled into this study. Patients were staged and their radiological features were documented before chemotherapy. Four cycles of gemcitabine and docetaxel; combination chemotherapy were administered to the patients. Response was evaluated after 4 courses. Patients with progressive disease were not given further chemotherapy. Patients who could not complete 4 courses were excluded from the study. Remaining patients were given 2 more courses of chemotherapy. Patients were followed up for a period of 1 year after being enrolled for the study to document median survival. Total 46 patients were included in the study out of which 2.2% patients had a complete response, 37% had a partial response, 28.3% patients had a stable disease while 32.6% patients had a progressive disease. The objective response rate was 39.2% while the median survival time was 42 weeks. The results of our study have shown that combination of gemcitabine and docetaxel in patients with advanced urothelial carcinoma of the urinary bladder, has a good therapeutic index and stands as a reasonable first Line option for such patients

Large B cell lymphoma-year by year

Non Hodgkin's Lymphoma [NHL] comprises a group of lymphoproliferative disorders the frequency of which continues to rise. Although many classification systems exist for identifying specific histological subtypes, NHL is generally divided into indolent [low-grade] and aggressive [intermediate- and high-grade] forms. Large B Cell Lymphoma [LBCL] is one of the commonest aggressive NHLs. The aim of this review is to provide a general overview of NHL, its clinically practicable cellular classification, epidemiology and in depth overview of the evolution of treatment of LBCL during the past 5 years. Current guidelines from National Cancer Institute [NCI], USA and National Institute on Clinical Excellence [NICE], UK are mentioned and recommendations according to our own set-up are suggested

Toxicity profile and objective response of paclitaxel in metastatic breast cancer

To evaluate the efficacy and toxicity of 1-hour weekly Paclitaxel in metastatic breast cancer along with evaluation of overall survival. A phase II interventional trial. Oncology Department, Combined Military Hospital, Rawalpindi, between August 2001 to July 2003. Thirtysix patients were enrolled in the study. All patients with histologically confirmed and bidimensionally measurable metastatic breast cancer who had received previously either chemotherapy or hormone therapy were included in the study. Paclitaxel was administered in 1-hour weekly infusion in a dose of 100 mg/m2 for 12 doses. All patients had received previous chemotherapy with either CAF or CMF. Twenty five patients had also received hormone therapy, 61% had two or more metastatic sites involved, and lung was the common site of involvement. Complete response was observed in 4 [11.1%] patients, partial response in 14 [38.8%] patients, with an overall response rate of 50.0%. Clinical benefit was 94.4% and median overall survival was 11 months. Treatment was well-tolerated with no grade 3 or 4 toxicity. Common side effects were arthralgias, myalgias and neutropenia. Treatment with 1-hour weekly infusion of Paclitaxel is a well-tolerated chemotherapy with a substantial degree of efficacy in patients with metastatic breast cancer