ABSTRACT
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
ABSTRACT
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
ABSTRACT
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.