Colo-rectal cancer in a random sample of the Egyptian population: a different disease entity

Colo-rectal cancer [CRC] is not uncommon in Egypt. This study was conducted to identify the pattern, outcome and prognostic factors of CRC. Patients with CRC retrospectively collected from the year 1997 to 2002. Data were collected from the registry of Alexandria Surgical and Oncology departments. Presentation, analysis and correlation of the data was performed. Five percent was the level of significance. 363 cases [185M: 178F] were collected. The Mean age was 46.05+14.33 years [range: 15-96 years]. Forty percent of patients were <40 years. The peak age incidence was in the 4[th] and 5[th] decades of life. Adenomas were present in only 5.5%. The mean duration of symptoms was 32.6 +/- 20.03 weeks. Duke's stages B2 and C were the commonest stages [32.5% and 39.7%]. Mucoid adenocarcinoma developed in 29.5% of cases. Within a mean duration of follow-up of 41.81 +/- 16.66 months [range: 13-72 months], local recurrence [LR] developed in 39.9% of cases [mean duration: 20.12 +/- 9.09 months]. Systemic recurrence [SR] developed in 40.2% [mean duration: 19.28 +/- 8.92 months]. Disease Free Survival [DFS] was 22.38 +/- 19.19 months. Overall Survival [OS] was 32.38 +/- 17.32 months. Multivariate analysis using logistic regression model and Cox survival model revealed that Duke's stage and radical surgical resection were significant independent predictive variables for LR, SR, DFS and OS. Histopathological type was a significant predictive variable for SR and OS, while adjuvant chemotherapy was a significant predictor SR. CRC in Egypt carry different epidemiological, pathological and prognostic parameters compared to the West. Its main prognostic factors are extent of surgery and Duke's stage. It has no identifiable risk group except its peak incidence was in the middle age and absence of precursor lesions. A further larger multicenteric study is recommended to identify risk factors for CRC

phase II trial using altered fractionation irradiation with concomitant chemotherapy in the management of patients with muscle invasive bladder cancer [MIBC]

To identify the place of conservative treatment in patients [pts] with MIBC using concomitant cisplatin [C] and gemcitabine [G] with bifractionated split course radiotherapy. Eligible pts with stages T2-T4a, No Mo were entered in this study. Treatment began with transurethral resection [TUR] with complete macroscopic debulking followed by induction chemoradiation. The treatment regimen consisted of C 15 mg/m[2] and G 200 mg/m[2] on days 1-3 and 15-17 [one cycle of 6 days induction chemotherapy] .On days 1, 3, 15, and 17, radiation was given immediately following chemotherapy using twice-daily 2 Gy per fraction to the whole pelvis for a total dose of 16 Gy delivered in 8 fractions over 17 days. Patients with a complete response [CR] via cystoscopy after the induction cycle received another chemoradiation cycle as consolidation. Patients who did not achieve CR underwent cystectomy. Both groups received outpatient adjuvant chemotherapy: G 1g/m[2] on days 1, 8, and 15 plus C 70 mg/m[2] on day 1 every 28 days for 4-6 cycles. From July 2001 to January 2003, 36 pts were enrolled. All pts were evaluable for efficacy and toxicity. Twenty pts [55.5%] achieved CR after induction therapy and received consolidation chemoradiation. Of the pts who still had detectable tumor, 9 pts [25.0%] underwent radical cystectomy and 7 [19.4%] refused cystectomy and received the same chemoradiation. 6/16 died of progressive disease. The median follow-up is 22 months. The 2-year overall survival is 80%, and the 2-year probability of surviving with an intact bladder is 69.4%. Grade 3/4 thrombocytopenia was observed in 8 pts [22.2%], non hematologic toxicities in the form of grade 3 radiation cystitis in 3 pts [8.3%] and proctatitis in 4 pts [11.1%].This trial comprising of local TUR plus concurrent C/G, and hypofractionated radiation has been associated with acceptable hematologic toxicity. Both the complete response rate to induction therapy and the 2-year survival rate with an intact bladder are encouraging. Longer follow-up is needed to assess efficacy

Physical profile and clinical results of concurrent chemoradiotherapy or radiotherapy alone in the treatment of uterine cervix carcinoma using different dose rate brachytherapy

To evaluate physical profile, application techniques and clinical results of conventional external beam radiotherapy [EBRT] with different dose intracavitary brachytherapy [ICRT]. The role of concurrent cisplatin-based chemo-radiotherapy and HDR interstitial brachytherapy technique was also assessed. A total of 108 patients were prospectively studied, distributed into three treatment groups. Treatment was initiated with EBRT in all treatment groups. Groups I and II patients were divided into 2 subgroups [IA, IB], [IIA, IIB]. Both subgroups were treated by a conventional EBRT schedule, and concurrent cisplatin in group II. This was followed by ICRT either low dose rate [LDR] in subgroups IA, IIA or high dose rate [HDR] ICRT in subgroups IB, IIB. Group III patients received concurrent chemoradiotherapy followed by intertistial HDR brachytherapy. The mean age was 48 year. Vaginal bleeding was the most frequent symptom [84%, 80%, and 89% in groups I, II, and III respectively]. Exocervical lesions were the commonest presentation in groups I and II [70%]. Squamous cell carcinoma was dominant in all therapeutic groups. The clinical results showed complete response [CR] in 78% [group I] and 84% in group II, while in group III, only 61% achieved CR. Notably the associated early and late reactions were reported in group III more than the other two groups. Forty-two month actuarial pelvic/locoregional control rates were achieved in 66%, 77%, and 39% in groups I, II and III respectively [p=0.05]. The utilization of HDR ICRT compared to LDR produced a dramatically improved ability for dose distribution and optimization, not to mention patient convenience. The addition of cisplatinum with conventional EBRT and ICRT [LDR and/or HDR] demonstrated a clear positive impact on initial treatment results and subsequent progression-free and overall survival, with minimal differences in treatment related morbidities compared to radiotherapy alone. The utilization of interstitial rather than ICRT techniques, for patients with generally poor pelvic anatomy, producing more improved dose distribution/optimization, resulted in comparable actuarial 3.5-year cumulative overall survival rate

Dexamethasone, ifosfamide, cisolatin and etoposide with involved field radiotherapy in relapsed or refractory non hodgkin s lymphoma

To evaluate the tolerance and efficacy of dexamethasone, ifosfamide, cisplatin, and etoposide [DICE] combination chemotherapy regimen, as salvage the rapy for relapsed or refractory patients with intermediate and high-grade Non-Hodgkin's lymphoma [NHL]. It is a prospective trial that included forty-patients with refractory or relapsed NHL. All patients had a histological confirmation of intermediate or high-grade NHL and received DICE regimen. Toxicities were recorded according to the WHO scoring. Radiotherapy was given as involved-field [36 Gy in 20 fractions, 180 cGy per fraction] and began three weeks after the last cycle of chemotherapy. Patients were evaluated for response rate [RR], time to treatment failure [TTF], overall survival [OS] and prognostic factors that affect these variables. The overall response rate to treatment was 26.7%, and 35.5% achieved partial response. By adding involved field radiotherapy to chemotherapy, CR increased to 37.8%, and the overall response rate was 60%. Significant factors that affect response rate were stage at relapse, p=0.0001, IPI p=0.002], and disease status [p=0.03]. Time to treatment failure was significantly affected by IPI [p=0.04]. The median time to treatment failure was 8 months while the median OS was 12.5 months. Grade 3 and 4 neutropenia were observed in 31%, nausea and vomiting in 15.6%. Most of the chemotherapy toxicities were mild or moderate and manageable. DICE regimen is an effective salvage chemotherapy for patients with intermediate and high grade NHL. Most of the chemotherapy toxicities were mild or moderate and manageable. Neutropenia was the main dose-limiting toxicity

Quality of life and efficacy of vinorelbine and fluorouracil versus fluorouracil, adriamycin and cyclophosphamide chemotherapy in advanced breast cancer

To assess the effect of vinorelbine and 5-fluorouracil [NF] in comparison to 5-fluorouracil, adriamycin and cyclophosphamide [FAC] chemotherapy regimen on the treatment outcome and their impact on the quality of life in patients with advanced breast cancer [ABC]. The prognostic significance of the quality of life on survival was also studied. It is a phase Ill study that included 104 women with ABC who were randomly assigned to receive either FAC [Group I] or NF regimen [Group II]. Patients were evaluated for response rate [RR], time to tumor progression [TTP], overall survival [OS] and toxicities. The quality of life was assessed using Spitzer's quality of life index [QLI]. Patients who received FAC achieved significantly higher overall RR, compared to those who received NF regimen [69.2% versus 50.0%, p=0.04]. A significantly higher median TTP was achieved in patients who received FAC compared to those received NF [11.4 and 6.1 months] respectively with p=0.03. A higher median OS was observed in group I patients compared to group II 19.0 versus 16.4 months, however, the difference in OS was not statistically significant [p=0.4]. The quality of life index [QLI] was proved to be an independent factor affecting TTP in group I [p=0.001] and in group II as well [p=0.01] As regards OS, QLI has no significant prognostic influence in either groups. Since improvement in TTP is a major goal where treatment is mainly palliative, our impression is that FAC is still one of the standard anthracycline-containing regimens in ABC. Vinorelbine, 5-fluorouracil can be used as second-line or as first-line regimen in cases where anthracyclines are not appropriate. Quality of life can be used as a predictor for progression-free survival

Combined modality [chemotherapy and radiotherapy] versus radiotherapy alone in the management of locally advanced head and neck cancer

Generally radiotherapy alone or combined with surgery for locally advanced head and neck epidermoid carcinoma yields poor results. This study was designed to assess the therapeutic efficiency of combined modality treatment [neoadjuvant chemotherapy and radiotherapy] versus radiotherapy alone in the management of locally advanced head and neck cancer and to evaluate its impact on the progression free and overall survival. Three cycles of cisplatin [100 mg/m[2]] day I and 5-fluorouracil [1 gm/m[2]] days 1-3 repeated every 21 days were given for 30 untreated patients followed by radiation therapy. This arm [group I] was compared with radiation therapy alone In another 30 patients [group II]. These patients had stages III and IV disease with performance of 70=70% and with a minimum followed up of 18 months. In group I neoadjuvant chemotherapy induced complete response [CR] in seven patients [23.3%] and partial response [PR] in 19 patients [63.3%]. After the addition of radiation therapy, CR increased to 56.7%. In the radiotherapy alone group. CR and PR were 40% and 43.3% respectively The difference between both arms as regards the overall response was not statistically significant [p=0.704]. The chemotherapy schedule was tolerable but it increased the acute radiation reactions to the extent that eight patients could not tolerate the boost radiation dose. The progression free survival [PFS] of responders in the combined treatment arm was 52% compared with 44% in radiation alone ann. The median time to progression was 8.2 months versus 7.3 months in both arms respectively. The overall survival [OS] was higher in the combined treatment arm but not statistically significant [p>0.05]. Neoadjuvant chemotherapy could improve the response rate and OS with acceptable local and systemic toxicity. Accrual of large number of patients and longer follow up period is needed to emphasis the advantageous effect of neoadjuvant chemotherapy