Clinical outcome of docetaxel in advanced or metastatic endometrial cancer

The aim of this study was to evaluate the efficacy, safety and toxicity of docetaxel as first-line chemotherapy or in previously treated patients [one regimen] with recurrent or metastatic endometrial cancer. Prospective phase II study in patients referred to the Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Egypt. Fifty patients with advanced or metastatic endometrial cancer were enrolled to receive docetaxel 70 mg/m2 administered intravenously on day 1 of a 3-week cycle. If patients responded well to docetaxel, additional cycles were administered until progressive disease or unacceptable toxicity occurred. Therapy response was evaluated every 6 weeks. Of 50 patients with a median age of 60 years [range, 40-70 years] who entered the study, 17 patients [34%] had received one prior chemotherapy regimen. All patients were evaluable for efficacy, yielding an overall response rate of 34% [95% confidence interval, 14.8%-55.6%]; complete response and partial response [PR] were 4% and 30%, respectively. Of 17 pretreated patients, 5 [29%] had a PR. The median duration of response was 2 months. The median time-to-progression was 4 months and the median survival time was 18 months. The predominant toxicity was grade 3-4 neutropenia, occurring in 92% of the patients, although febrile neutropenia arose in 10% of the patients. Edema was mild and infrequent. The study clearly demonstrated that docetaxel is active in the treatment of endometrial cancer. Toxicity was manageable and predominantly hematologic

randomized trial of brief treatment of early-stage Hodgkin lymphoma: is it effective?

Whether it is possible to reduce the intensity of treatment in early [stage I or II] Hodgkin lymphoma with a favorable prognosis remains unclear. Therefore, we conducted this random-ized trial, comparing two treatment groups consisting of a combination chemotherapy regimen of two different intensities followed by involved-field radiation therapy at two different dose levels. Prospective, randomized, in patients referred to the Department of Clinical Oncology and Nuclear Medicine. Ninety-eight patients with histologically proven early-stage Hodgkin lymphoma with a favorable prognosis were enrolled in this study between January 2008 and June 2010. They were randomly assigned in one of two treatment arms: arm I received four cycles of ABVD [Adriamycin, belomycin, vinblastine, dacarbazine]] followed by 30 Gy of involved-field radiation therapy; arm II received two cycles of ABVD followed by 20 Gy of involved-field radiation therapy. During the follow-up period, the 2-year relapse free survival rates were 96% and 95% in arm I and arm II, respectively [P=.8], while the 2-year overall survival rates were 98% and 95% in arm I and arm II, respectively [P=.16]. Acute toxicity affected 54% of patients treated with four cycles of ABVD, who had grade III or IV toxicity, as compared with 30% of those receiving two cycles [P<.02]. The rates of acute toxicity [grade III or IV] were also higher among patients treated with 30 Gy of involved-field radiation therapy than among those receiving 20 Gy [16% vs. 2.5%, P<.03]. In patients with early-stage Hodgkin lymphoma and a favorable prognosis, treatment with two cycles of ABVD followed by 20 Gy of involved-field radiation therapy was as effective as, and less toxic than, four cycles of ABVD followed by 30 Gy of involved-field radiation therapy

Squamous cell carcinoma metastatic to cervical lymph nodes from unknown primary origin: the impact of chemoradiotherapy / 癌症

The management of cervical lymph node metastases of squamous cell carcinoma from an unknown primary site is still a therapeutic challenge. We report here our experience in treating these patients with chemoradiotherapy as a curative approach. Data from 40 patients were reviewed. In total, 20 (50%) patients underwent excisional biopsy. All patients underwent radiotherapy, which was delivered to both sides of the neck and pharyngeal mucosa (extensive field), and concurrent chemotherapy consisting of weekly cisplatin at a dose of 40 mg/m(2). The clinical stage of the cervical nodes at presentation was N1 in 25%, N2 in 60%, and N3 in 15%. Most patients (75%) developed at least grade 3 mucositis. Eight patients (20%) had grade 3 xerostomia and 18 patients (45%) required esophageal dilation for stricture. The 5-year overall survival(OS) rate of all patients was 67.5%. The 5-year OS rates of patients with N1, N2, and N3 lesions were 100%, 67%, and 41%, respectively (P = 0.046). The 5-year progression-free survival rate was 62.5%. In multivariate analysis, only N stage significantly affected OS(P = 0.022). Emergence of the occult primary was very limited (1 patient only). Our results suggest that extensive irradiation of both sides of the neck and pharyngeal mucosa with concurrent chemotherapy results in a lower emergence of primary tumor. Because the survival of patients with unknown primary is comparable to that of patients with known primary, an attempt at cure should always be made.

Assessment of balance in osteoporotic postmenopausal women: effect of spinal proprioceptive extension program

To assess the balance in osteoporotic patients with kyphosis and the effect of intervention with a spinal proprioceptive extension exercise on the risk of fall in these patients. This study included 20 postmenopausal osteoporotic women with kyphosis and ten controls. Patients had to be physically active, and older than 60 years. Clinical assessment was performed by physical activity score fall efficacy scale and pain scale. Balance assessment was done by computerized dynamic posturography [CDP]. Each patient underwent a program of back extension exercise using one kg of weight suspended between T10 to L4 through fitted harness. Patients were instructed to use this harness two hours twice daily for 4 weeks. Then they were reassessed clinically and by CDP. There was a significantly decreased balance score in osteoporotic kyphotic women compared to controls. There was a significant inverse correlation between balance score and the fall efficacy scale [r=-0.53] and positive correlation between balance score and the physical activity score [r=0.55]. In clinical reassessment, patients showed a significant increase in the physical activity score [5.55 +/- 0.75] compared to pre-intervention values [4.4 +/- 0.68]. Also they had a significant decrease in the fall efficacy scale and pain scale compared to their baseline data. In balance reassessment, patients showed a significant increase in the balance score [75.5 +/- 8.50] compared to their baseline data [63.7 +/- 9.72] [p<0.001]] Osteoporotic postmenopausal women with kyphosis had significantly greater balance abnormalities which plays an important role in increasing their risk of falls. This study suggests that proprioceptive back extension exercise could reduce the risk of fall and improve the pain and physical activity in these patients

Conventional versus hyperfractionated radiotherapy in locally advanced head and neck cancer

Radiotherapy is often the primary treatment of locally advanced squamous cell carcinoma of the head and neck, but the optimal fractionation schedule has been controversial. The aim of this study was to examine whether, after preceeding induction chemotherapy, hyperfractionated radiotherapy [HFRT] is superior to conventional fractionated radiotherapy [CFRT]. Patients with locally advanced squamous cell carcinoma of the head and neck were treated with three cycles of cisplatin [100 mg/m[2] D1] and 5-fluorouracil [1000 mg/m[2] D1-4], repeated every 3 weeks. Then patients were randomized to receive either CFRT at 1.8-2 Gy/fraction /day, 5 day/week to 65-70 Gy/33- 35 fractions/7 weeks or HFRT at 1.2 Gy /fraction, twice daily with a 6-hours interfraction interval, 5 days/week to 76.8 Gy/64 fractions/7 weeks. All patients in both treatment arms received concomitant chemotherapy in the form of weekly bolus injection of cisplatin [20mg/m[2]]. Of the 60 patients entered, only 53 patients were evaluable for outcomes. The primary end points were local control and progression- free survival. Chemotherapy was well tolerated, the overall response rate after induction chemotherapy was 73.6%, including 13.2% complete response rate. After completion of radiotherapy, patients treated with HFRT had an overall response rate of 96.2% versus 77.8% in CFRT [P= 0.04] and complete response rate of 65.4% in HFRT versus 40.7% in CFRT [P=0.01]. After a median follow- up of 28 months, overall survival was 57.7% in HFRT versus 44.4% in CFRT [P= 0.07]. The 2-year progression-free survival was 44% in HFRT versus 23.8% in CFRT [P=0.03]. The 2- year locoregional control was significantly higher in HFRT [58.8%] than those with CFRT [36.4%] [P=0.02]. The incidence of local recurrence rate was 41.2% in HFRT versus 63.6% in CFRT [P=0.02]. However, the incidence of distance metastases was 7.7% in HFRT versus 11.1% in CFRT [P=0.4]. Patients treated with HFRT had significantly greater acute side effects compared to CFRT. However, there was no significant increase of late effects. After induction chemotherapy, hyperfractionated radiotherapy is more efficaceous than conventional fractionated radiotherapy in locally advanced squamous cell head and neck cancer. Acute but not late effects are increased, but it is tolerable and manageable