Endoscopic assisted transoral approach with palatal splitting for a giant retropharyngeal schwannoma: a challenging case

Retropharyngeal schwannoma is rare. To the best of our knowledge, only 18 cases have been published in the English literature. Complete surgical excision is the treatment of choice for schwannomas. Transoral approaches have been applied for smaller lesions, and external cervical approaches are preferred for larger and more complex lesions. In this report, we present a case of large retropharyngeal schwannoma that was excised using an endoscopic-assisted transoral approach with palatal splitting. Postoperative functional and oncologic outcomes were satisfactory with no reported intraoperative/postoperative complications.

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

Metastatic colorectal carcinoma [MCRC]: front line chemotherapy by 5 fluorouracil, leucovorin and irinotecan

To evaluate the objective tumour response rates, assess toxicity and impact on survival of treatment with 5 fluorouracil, leucovorin and irinotecan as front line chemotherapy in patients with metastatic colorectal carcinoma. Thirty one evaluable patients with metastatic colorectal carcinoma [MCRC] were subjected to chemotherapy regimen given as follows: day 1 inotecan [CPT[11]] 180 mg/m[2] as 90 minutes intravenous [IV] infusion followed by leucovorin [LV] 200 mg/m[2] as two hours IV infusion and then 5fluorouracil [5FU] 400 mg/m[2] as IV bolus over 10 minutes. followed by 5FU 600 mg/m[2] in a continuous. 22 hours infusion. On day 2, LV was given as 200 mg/m[2] as a 2 hours IV infusion. Chemotherapy regimen was recycled every 2 weeks. Initial assessment of response was done after 6 cycles [i.e. 12 weeks from start of chemotherapy]. The overall response rate of the whole group [complete response [CR]+partial response [PR]] was 32% [10-31 patients]. Thirty two percent [10/31 patients] achieved partial response. No complete responses were encountered. Forty eight percent [15/3 1 patients] showed stationary disease [SD] and 20% [6/31 patients] showed disease progression [DP]. As regards grade III and IV World Health Organization [WHO] toxicity grades [1], it was found that, 10% [3/31 patients] had nausea, 7% [2/31 patients] had vomiting, 10% [3/31 patients] had neutropenia. 13% [4/31 patients] had diarrhoea and 7% [2/31 patients] had stomatitis. After a median follow up of 15 months [range 6-30 months] it was found that, the progression free survival [PFS] was 9 months and one year survival rate was 58%. 5 fluorouracil, leucovorin and irinotecan combination is an effective chemo-therapeutic regimen in the management of metastatic colorectal carcinoma with tolerable toxicity

Advanced low grade non hodgkin's lymphoma [LGL]; treatment results using cyclophosphamide, fludarabine, and prednisone [CFP]

Fludarabine has been shown to be an effective agent in the treatment of low grade lymphoma; either used alone or in combination with other chemotherapeutic agents. It maintains its efficacy both for newly diagnosed cases as well as for patients with recurrent progressive low grade Non Hodgkin's Lymphoma [RPLGL]. This an open phase II study of CFP chemotherapy regimen conducted in patients with advanced LGL to explore the efficacy of this regimen and its toxicity profile. Between January 1998 and March 2000 41 patients aged 42-69 years [median 54] were enrolled to this multicenter study. All of the 37 evaluable patients, were allocated to receive 6 cycles of cyclophosphamide 300 mg/m[2] intravenously [IV.] day 1-3[DI-3], Fludarabine 25 mg/m[2] I.V.D 1-3 and prednisone 40 mg/m[2] PO, Dl-5. Chemotherapy cycles were repeated every 28 days for 6 cycles. Of the 37 evaluable patients. 20 patients [54%] had recurrent progressive disease [RPLQL], while 17 patients [46%] were newly diagnosed advanced LGL [stage; II bulky. III, and IV]. Clinical response to treatment was evaluated immediately after the completion of the chemotherapy schema, and defined according to categories; complete remission [CR], partial remission [PR]. The overall response rate for the whole group was 86% [32/37 patients]. Eleven patients [3 0%] achieved CR, and 21 patients [56%] achieved PR. Patients with newly diagnosed LGL had better

Prognostic significance of prostate specific antigen PSA in patients with non-metastasic carcinoma of the prostate

Prostatic carcinomas vary in their biologic potential. Serum prostate specific antigen, stage, tumor grade and Gleason's grade were studied in patients with non-metastatic carcinoma of prostate. Thirty-six patients with non-metastatic carcinoma of prostate were included in this study of stage A2, B or C. Their age range was 57 to 68 years median age of 62 years. All patients were treated by external beam radiation therapy. Serum prostate specific antigen was estimated before treatment and every two-four months post treatment. Thirty-one patients were evaluable for treatment results as five patients did not attend follow up after treatment. Twenty-nine patients had their prostate specific antigen lowered to a normal level after the radiation therapy treatment [<4 ng/ml]. Two patients had lowering of their serum PSA level but to values above 4 ng/ml. The disease free survival at two-years for the whole group was 64%. Pretreatment serum PSA, Gleason's grade and stage were statistically significant predictors of disease free survival

Radiation therapy and chemotherapy in the treatment of rectosigmoid carcinomas

Carcinomas of the rectum and sigmoid colon are the most common tumours of the gastrointestinal tract. The treatment results and prognostic factors of 63 patients with stage B-C carcinomas of the rectum and simoid colon were analyzed. Thirty-one patients [49%] had stage B disease. Thirty-two patients [51%] had stage C disease. All patients had surgical resection in the form of abdomino-perineal resction, anterior resection of rectal carcinoma, or simoid colon resection. This was followed by adjuvant treatment by external beam radiation therapy [dose of 4500-5040 cGy, at 180 cGy per fraction, five fraction a week] Using Six linear accelerator, adjuvant chemotherapy was given using fluorouracil and Leucovorin, for six months. The 3-year disease free survival for the whole group was 65%. Disease free survival rate at 3 years for stage B was 74% and for stage C, was 56%. The 56% local regional recurrence rate and distant metastasis rate at 3 years for the whole group was 35%. Distant metastases rate was 30%. No life threatening complications were recorded to this multidisciplinary treatment. The stage of the disease was the most important prognostic factor in predicting the survival

Changes of urinary bladder salvage preservation in muscle invading transitional cell carcinoma of urinary bladder by the use of neoadjuvant chemotherapy and radiation therapy

Based on the excellent results obtained with chemotherapy in patients with advanced transitional cell carcinoma of urinary bladder, neoadjuvant chemotherapy has been advancated t improve survival and in some cases to permit bladder conservation. Twenty nine patients with transitional cell carcinoma of urinary bladder were seen at EBGH, Jaddah Cancer, Jan 1991-1994. All patients had tumour of either T[2] or T[3] stage N[X]-N[2] MO. Patients were given 3 cycles of CMV chemotherapy with cisplatinum, methotroxate and vinblastine. Patients who attained complete are partial response were given radioation therapy. The clinical complete response rate after chemo-radiation therapy was 59% [17/29 patients]. The 2-year disease free survival rate for the complete respondent is 76% whereas for the complete responders goups a 25% 2-year survival is attained. Surgery by radical cystectomy was offered to non responders as well as to chemoradiation therapy failures. The 2-year disease free survival with preserved bladder is 41%. Complete responders after chemoradiation therapy stand a good change of disease control with bladder preservation. Radical cystectomy is the appropriate treatment if no complete response is attained after chemotherapy