TUR followed by systemic chemotherapy then local radiation therapy with adjunct cisplatinum in locally advanced bladder cancer- a preliminary report

Between February, 1989 and September, 1991, 15 patients with proved diagnosis muscle-invading transitional cell carcinoma of the urinary bladder were enrolled in a treatment protocol in Jeddah Cancer Center consisting of: maximal transurethral tumour resection followed by 4 cycles of systemic chemotherapy using M-VAC regimen then combined full dose external-beam irradiation and two extracisplatinum doses. Only 14 patients completed the previous protocol. All evaluable patients showed a complete clinical response at the end of the planned combined approach [with a response rate of 100 percent] which has been successfully maintained for a median follow-up period of 15 months [range from 6 to 31 months]. Toxicity was acceptable and manageable. This preliminary report suggests that the combined multi-modality therapy is highly effective in locally advanced bladder cancer. Longer follow-up is still required to conclude whether this approach can become an alternative to radical cystectomy in such cases

Dipyridamole thallium scintigraphy

Intravenous dipyridamole scintigraphy was performed in 100 cases with suspected or diagnostic coronary heart disease who were unable to exercise. Side effects were few of no clinical significance and disappeared following IV theophylline. Positive thallium scintigraphy was found in 55 cases, 31 had transient uptake defect, 17 had persistent defects and a combined uptake defects were present in 7 cases. The frequency of dipyridamole induced ST segment changes as well as the scintigraphic uptake defects were high in patients with history of typical anginal pain compared to those with atypical chest pain [p < 0.05, p < 0.05, respectively]. Persistent uptake defects diagnostic of myocardial infarction were found in 10 out of 14 patients [70%] in whom the diagnosis of myocardial infarction was inconclusive by history or electrocardiographic changes. Transient ischemic uptake defects were detected in 2 of 6 cases of recent MI [33%] and in 2 out of 9 cases of old MI [22%] denoting residual associated myocardial ischemia. Our study concluded that dipyridamole thallium scintigraphy imaging is a practically safe procedure. Its few side effects are reversible by IV theophylline. It provides a great diagnostic and prognostic value in patients with coronary artery unable to exercise and may thus serve as a useful alternative diagnostic modality to physical exercise

Radiotherapy of high grade cerebral gliomas: Results and prognostic factors

A retrospective survey of the records of forty-six patients with histologically verified high grade cerebral gliomas [14 grade III and 32 grade IV]; who were referred for treatment to Jeddah Cancer Center between November '86 and ecember '89 inclusive was carried out. They were 34 males and 12 females with a mean age of 43.87 [ +/- 17.08 years for the whole group. A significant beneft was obtained by postoperative radiotherapy. The mean survival time was 18.25 [ +/- 27.94] weeks without irradiation versus 76.1 [ +/- 33.33] weeks irradiation [P< 0.01]; extent of surgical resection [118.5 +/- 46.52 weeks for gross total excision vs 79 /- 49.34 weeks for subtotal excision [P< 0.05] and 75 +/- 38.81 weeks for biopsy only [P< 0.05]; total radiation dose to the tumour bed [109.29 +/- 37.02 weeks for a total dose > 60 Gy vs 41.9 +/- 35.4 weeks for a dose < 30 Gy [P< 0.01] and 77.13 +/- 30.59 weeks for a dose < 60 Gy [P< 0.01]; postoperative performance status [118.35 +/- 38.44] weeks for a scale of < 100 vs 72.3 +/- 41.1 weeks for a rate of < 80 [P< 0.01] and 50.12 +/- 29.65 for an index of < 60 [P< 0.01] as well as age at presentation [101.11 +/- 47.41 weeks for an age < 40 years vs 67.1 +/- 41.03 weeks for an age > 40 years [P< 0.01]. The mean survival time for the whole group was 81.13 +/- 46.46 weeks. By multivariate analysis, the most powerful factors affecting survival in order of importance were found to be total radiation dose, performance status, extent of surgery and tumour grade. In the design of prospective randomized studies, it would be better to stratify patients according to these prognostic variables

Treatment of advanced breast cancer in postmenopausal women with aminoglutethimide

Aminoglutethimide was used for treatment of 45 postmenopausal patients with disseminated breast cancer. All of them showed progressive disease following prior response to tamoxifen treatment. Eighteen patients received also systemic chemotherapy [CMF regimen] before tamoxifen. The results revealed complete response 2%, partial response 37%, stable disease 15%, and progressive disease 46%. The median duration of objective response was 10 months, and of stable disease 5 months. Previous chemotherapy did not influence the response to aminoglutethimide. The commonest side effects were lethargy and skin rash. The results indicated that aminoglutethimide is an effective, moderately did not influence the commonest side effects were lethargy and skin rash. The results indicated that aminoglutethimide is an effective, moderately well-tolerated, second- line hormonal therapy in postmenopausal patients with advanced breast cancer