Treatment outcome of supratentorial high grade astrocytoma and glioblastoma multiform

The study was initiated to obtain epidemiologic data and information on anatomic distribution, clinical features and treatment results in patients with primary supratentorial anaplastic astrocytoma and glioblastoma multiform. Between January 2000 and January 2006, 113 primary high grade astrocytoma patients were eligible to evaluate clinical features. Radiotherapy was received by all patients whether gross total tumor excision had been carried out or not. External beam radiation therapy was delivered at 2Gy once daily to the intracranial lesion and surrounding oedema with 2-3cm safety margin all around with a dose of 4000cGy/20 fraction in4 weeks, followed immediately by a booster localized field to intracranial bed proper to a dose of 2000cGy/10 fraction in 2 weeks using [60]Co photons. A total of 58.4 patients had anaplastic astrocytoma and 41.6 of the cases, had glioblasloma multiform. The most common site of origin was the temproparietal region [31.8%]. Large tumors [>/= 5cm] accounted for the majority [75.2%]. Seventy one percent of primary high grade astrocytoma patients had a duration of symptoms of

Use of temozolomide in the management of high grade gliomas at relapse.

This study was done at NEMROCK and other private as well as official governmental oncology centers, where 30 patients with residual or relapsed high grade gliomas received temozolomide at a dose of 200 mg/m2/day for five successive days to be recycled on day 21 for a total of six courses. Drug administration was quite safe with accepted toxicity profiles. The response parameters, including partial response, stationary disease and progressive neoplastic process, were documented in 33%, 45% and 22%, respectively

Medullary thyroid carcinoma: a review of 19 cases

Ninteen patients with medullary thyroid carcinoma were referred for further management following surgery to NEMROCK during the period 1985 to 1989. Nine patients were males and 10 were females with male to female ratio of 1: 1.1. The mean age was 49 years with an age range of 28 - 75 years. Seventy four percent of all patients presented by a painless swelling in front of the neck. Two patients had associated endocrinopathies. Total thyroidectomy was performed for 11 patients, hemithyroidectomy for 5 patients and only biopsy for 3 patients with advanced disease. Post-operative irradiation was given for patients who had hemithyroidectomy or total thyroidectomy without neck dissection. In this study, post-operative irradiation given to patients subjected to less extensive surgery was found as effective as total thyroidectomy and neck dissection in controlling the locoregional disease [mean follow-up period 30 months] 67% versus 75%, respectively

Results of radiation treatment in 59 patients with ependymomas

Fifty-nine patients [56% adults and 44% children] suffering from ependymomas were treated by radiation therapy. Supratentorial involvement was the commonest in 47.5%, followed by infratentorial end spinal ependymomas in 37.3% and 15.2%, respectively. Low pathologic grade [1,2] was more evident in 45.8% and high grade was seen in 42.4% and 11.8% had no definite grading. Following radiation therapy, complete response was evident in 19 Patients, partial response in 21 patients and 19 patient had no response. At the end of three years, 12/19 patients with complete response still in remission, four patients had local recurrence and three patients had spinal metastasis. The three years survival rate was 52% in low grade ependymomas compared with 26% in high grades; while no definite correlation of survival rate to site or treatment adopted

comparative phase III study using epirubicin, cyclophosphamide, 5-fluorouracil [FEC] versus adriamycin, cyclophosphamide, 5-fluorouracil [FAC] in advanced breast cancer patients

From January 1987 to April 1990, 40 patients with advanced breast cancer who either had failed non-anthracycline treatment or had no prior chemotherapy were randomised according to treatment with either epirubicin or doxorubicin in a combination chemotherapy regimen with 5-flourouracil and cyclophosphamide [FEC or FAC]. Cyclophosphamide was given in a dose of 500mg/m2 on day 1, 5-flourouracil was given in a dose of 500mg/m2 on days 1 and 8. Doxorubicin was given in a dose of 50mg/m2 on day 1 [regimen A] while epirubicin was given in two doses; 50mg/m2 [regimen B] and 75mg/m2 [regimen C] also on day 1. Cycles were repeated every 3weeks until disease progression or to cumulative doses of 550mg/m2 for doxorubicin and at least 700mg/m2 for epirubicin. The study was a comparative prospective for the overall response rate; time to progression; toxicities and dose-dependence of epirubicin. All patients were comparable in age; menopausal state; performance status; histopathology; previous treatment; site of disease and disease-free interval. As for efficacy, there was no significant difference between doxorubicin and epirubicin given in equimolar conventional doses, where the overall response rate [CR+PR] was 57% for FAC and 50% for FEC-50. The mean time to progression was 41 weeks and 39 weeks, respectively. Although high dose epirubicin [ArmC] gives an overall response rate 75% with 53 weeks mean time to disease progression, yet statistically it has no significant difference when compared to FEC-50 [ArmB]. The mean survival time for the three arms was 77 weeks for FAC; 73 weeks for FEC-50 and 111 weeks for FEC-75. As for toxicity, given in equal doses, epirubicin was less toxic than doxorubicin. Although FEC-50 was better tolerated than FEC-75, yet there was no statistical significant difference between both regimens. In its different doses ,epirubicin was less cardiotoxic than doxorubicin. Two patients under FEC developed congestive heart failure [CHF] at cumulative doses 490mg/m2 and 600 mg/m2. Although some patients treated with epirubicin [Arms B and C] received a cumulative dose reaching 1000mg/m2, yet no one developed CHF. These results indicate that epirubicin given in equimolar dose to doxorubicin is equally effective and less toxic than its parent drug. Epirubicin in higher dose proved to be well tolerated by patients and could be given to a higher cumulative dose without increasing the hematological or cardiac toxicity and meanwhile could attain a higher efficacy in patients with advanced breast cancer