Pattern of relapse and experience with first line treatment of metastatic and relapsed breast cancer in Oman

The objective of this study was to evaluate the pattern of relapse and the management experience of metastatic and relapsed breast cancer in Oman. Patients who presented to the Royal Hospital, Muscat, between January 1999 and September 2001 either with metastatic breast cancer at first presentation or who relapsed after initial adjuvant treatment were included. Treatment for relapsed patient was tailored according to the previous adjuvant treatment, disease free period, and pattern of metastatic disease. Patients who presented with metastatic disease at first presentation were treated with anthracycline based chemotherapy and/or hormonal therapy. Fortynine patients were studied. 48 [98%] females [of which 29 were pre-menopausal] and only one male patient [2%]. The mean age was 52.7 years [range 30-80 years]. Thirtyone patients [63%] had relapsed disease, and 18 patients [37%] presented with metastatic disease at first presentation. The most common sites- of metastatic disease were bone [45%], lung [31%], liver [18%], soft tissue [26%], and brain [4%]. Out of the 18 patients who presented with metastases, 13 [72%] had only one site involved and the others [28%] had between 2-4 involved sites. The mean disease-free period for patients who developed relapse was 32.2 months. The mean progression free survival [PFS] for treated relapsed patients [31 patients] was 10.4 months. Nineteen patients of 31 [61%] received chemotherapy, 12 had anthracyclines, and 7 received taxanes: the mean PFS for both groups was 8.3 months and 11.2 months respectively [p = 0.022] Twenty patients out of 31 received hormonal therapy, and 11 patients did not receive any hormonal therapy: the mean PFS were 14 months and 4 months respectively [p = 0.002]. The mean PFS for patients who presented with metastatic disease [18 patients] was 14.4 months, 12/18 [67%] patients received chemotherapy. The mean PFS for patients who presented with only one metastatic site was 15.5 months versus 11.5 months for patients who presented with more man one metastatic site. This study demonstrated that the majority of out patients still presented with advanced stage. Among the studied patients, the most common metastatic site was bones. Relapsed patients treated with taxanes had significantly longer PFS than those who were treated with anthracyclines. Patients who presented with only one metastatic site had longer PFS than patients who presented with more than one site. Better health education and increasing the awareness of breast cancer is needed

Early results of pre-irradiation cisplatin and etoposide in the treatment of childhood medulloblastoma

Fifteen children with a pathologically confirmed diagnosis of medulloblastoma were treated with three cycles of cisplatin 100 mg/m2 i.v. Dl and VP16 100 mg/m2 i.v. Dl-3 before standard craniospinal irradiation, then followed by another three cycles chemotherapy after irradiation. After the initial three cycles of cisplatin-VP16, there were three complete responders [CR], nine partial responders [PR], two patients with stationary disease [SD] and one patient had a progressive disease [PD]. After completing the craniospinal irradiation, there were eleven complete responses and four partial responses. At the end of six cycles, there were twelve CRs and three PRs. The progression free survival ranged between 4 and 22 months [mean 14.1 months]. The toxicity of treatment was minimal ranging from mild to moderate nausea for 2-4 days post chemotherapy. Grade 1 neutropenia was encountered in five patients [5 in 90 cycles]. No renal or ototoxicity were encountered during the study

Comparative study to evaluate the safety and efficacy of high dose tamoxifen and dexamethasone versus dexamethasone alone in the management of recurrent malignant gliomas

This study included 19 [15 males and 4 females] evaluable patients with recurrent malignant gliomas who failed treatment with external radiotherapy, they were randomly assigned into two arms [A and B] by a simple toss test. Arm A included ten patients [eight males and two females] treated with tamoxifen in an escalating dose to reach the target dose of 160 mg/day in the third week of treatment and dexamethasone in a dose of 12 mg/day. Arm B included nine patients [seven males and two females] treated with dexamethasone only in the same dose. In arm A, a clinical improvement was detected in three patients and radiological improvement was detected in one of them and two patients had a stable disease. The remaining five patients had a rapid progressive disease despite of treatment. In arm B, two patients had clinical improvement of a short duration and one patient had a stationary course and no radiological improvement was detected in any patients. The remaining six patients deteriorated rapidly. No major side effects were reported in both arms apart from one patient in arm A who developed deep venous thrombosis [DVT] and responded to medical treatment