Concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: feasibility and efficacy in Malaysian patients

To determine the efficacy and tolerability of concurrent chemoradiotherapy [CCRT] for the treatment of Malaysian patients with locoregionally advanced nasopharyngeal carcinoma. from May 2004 to May 2006, 30 patients with 1997 American Joint Committee on Cancer and Internation Union Against Cancer stages III to IV [M0] were treated with radiotherapy [66 grays] using shrinkage field technique and concurrent cisplatin 30 mg/m[2] weekly during the course of radiotherapy. After a median follow-up of 18 months 40% of the patients developed tumor relapse. The 2 years progression free survival [PFS] for stages III and IV was 70% and 30% respectively, and it was significantly better for stage III [p=0.005, Hazards ratio 0.60, 95% CI, 0.40 to 0.92], while PFS was not statistically different for sex [p=0.2, Hazards ratio 1.04, 95% CI, 0.64 to 1.71] or different age groups [p=0.23, Hazards ratio 1.03, 95% CI, 0.68 to 1.67]. The compliance with CCRT was high, all patients completed the proposed treatment and only 20% and 17% developed grade 3-4 mucositis and skin reaction respectively. We conclude that CCRT is feasible but the outcome is unsatisfactory, higher doses of radiotherapy and combination concurrent chemotherapy is warranted

Chemotherapy with or without radiotherapy in limited stage aggressive non hodgkin's Lumphoma

To compare the efficacy, toxicity and clinical out come in patients with limited-stage aggressive nondgkin's lymphoma treated with eight cycles of chemotherapy alone or four to six cycles of chemotherapy plus involved field irradiation. One hundred patients with limited aggressive non-Hodgkin's lymphoma were randomly signed to either eight cycles of CHOP alone or four to six cycles of CHOP plus involved-field radiotherapy. The end point were response rate, toxic effects, disease-free survival d overall survival Patients treated with four to six cycles of CHOP is radiotherapy had significantly better disease-free survival in patients treated with CHOP alone. The five-year estimates disease-free survival for patients receiving CHOP plus radiotherapy and for patients receiving CHOP alone were,6% and 65.1%, respectively [p=0.041]. The five-year imates of overall survival for patients receiving CHOP plus radiotherapy and for patients receiving CHOP alone were%and 70%, respectively [p=0.160]. Complete response eswere experienced in 92% in patients treated with CHOP is radiotherapy and 86% in patients treated with CHOP me [p=0.338]. Relapse in original site of disease was significantly higher in patients treated with CHOP alone 9% vs 6.5% in patients treated with CHOP plus radiotherapy =0.007. However, there was no statistically significant difference in systemic relapse between patients treated with CHOP alone [13.9%] and patients treated with CHOP plus radiotherapy [15.2%] [p=0.866]. The adverse effects included a treatment-related deaths in patients treated with eight cycles of CHOP alone versus no treatment-related deaths in ients treated with CHOP plus radiotherapy [p=0.239]. Life threatening toxic effects: grade 3,4 neutropenia were recorded 20% in patients treated with CHOP plus radiotherapy versus% in patients treated with eight cycles of CHOP alone p=0.048, symptoms and signs of congestive heart failure rerecorded in two patients treated with eight cycles of IOP alone, but in no patients treated with CHOP plus iotherapy. For subgroups identified using the Miller modification of the International prognostic Index [IP1], the 5 year disease-free survival and overall survival were signifi-Itly influenced by the number of risk factors in both treat-pt groups [CHOP alone p=0.006, p=0.043 and CHOP plus btherapy p<0.001, p=0.0/3, respectively]. Pour to six cycles of CHOP followed by involved field-radiotherapy are superior to eight cycles of CHOP alone for the treatment of localized aggressive non-Hodgkin's lymphoma. Patients who attained complete response after CHOP plus radiotherapy had more prolonged disease-free survival and higher local control than in patients treated with CHOP alone. IPI risk group was found to be the only significant predictor of overall survival and disease-free survival in both treatment groups.

Gemcitabine-cisplatin versus methotrexate, vinblastine, doxorubicin and cisplatin in locally advanced or metastatic transitional cell carcinoma of the bladder

To compare the efficacy and toxicity of the combination of gemcitabine plus cisplatin [GC] and methotrexate, vinblastine, doxorubicin plus cisplatin [MVAC] in the treatment of patients with locally advanced or metastatic transitional cell carcinoma [TCC] of the bladder. Forty five patients with locally advanced or metastatic TCC of the bladder were r and omized to GC [gemcitabine 1000mg/m[2] days 1, 8 and 15; cisplatin 70mg/m[2] day 2] or st and ard MVAC [methotrexate 30mg/m[2] days 1, 15 and 22; vinblastine 3mg/m2 on days 2, 15 and 22; doxorubicin 30mg/m[2] on day 2; and cisplatin 70mg/m[2] on day 2]. The cycles were repeated every 28 days for a maximum of six cycles. Forty five patients were r and omized [GC, n=23; MVAC, n=22]. Overall response rates were similar on both. arms [GC, 47.8%; MVAC, 45.5%, p=0.934]. Overall survival and progression free-survival were similar on both arms [HR, 1.067; 95% CI, 0.595 to 1.915, p=0.828, and HR, 0.861; 95% Cl, 0.461 to 1.610, p=0.640, respectively]. Patients on the [GC arm received a median of six cycles compared with a median of 4 cycles for patients on the MVAC arm. Dose adjustments occurred in only 40% of the cycles with GC and in 64.7% with MVAC. Grades 3 and 4 anemia and thrombocytopenia were seen more often on GC arm than on MVAC arm [26% vs 18.1%, p=0.776 and 43.5% vs 22.7%, p=0.265 respectively]. However, the RBC and platelet transfusion rates were similar on both arms. More MVAC treated-patients compared with GC treated-patients had grade 3 and 4neutropenia [81.8% vs 60.8% respectively, p=0.043], neutropenic fever [18.2% vs 0% respectively p=0.049], neutropenic sepsis [13.6% vs 0% respectively, p=0.089], grade 3 and 4 mucositis [27.2% vs 0% respectively, p=0.027] and alopecia [54.5% vs 8.7% respectively, p=0.001]. More patients on GC had better results than MVAC patients as regard weight and performance status. Combination chemotherapy of gemcitabine plus cisplatin provides similar outcomes to that of st and ard MVAC in treatment of patients with locally advanced or metastatic TCC of the bladder with a better safety profile and tolerability