Evaluation of the efficacy of concurrent cisplatin and radiotherapy in locally advanced head and neck cancer

Thirty-six patients with locally advanced unresectable head and neck squamous cell carcinoma were included in this study. All patients received radiotherapy by cobalt60 machine. They received 70 Gy to the tumor area in 35 fractions for 7 weeks and 50 Gy to the uninvolved cervical and supraclavicular LN in 25 fractions for 5 weeks duration [cisplatin]. Concurrent cisplatin [CDDP] was infused in 3 hours and 1/2 hour before radiotherapy. The dose of CDDP was 20 mg/m2 from day 1 to 5, day 22 to 26 and day 43 to 47. The patients were evaluated for response at three weeks after the completion of irradiation and every month for six months, then every three months. The assessment of the response to treatment showed that the overall response was 75% [61% complete remission [CR] and 14% partial remission [PR]]. Six patients showed a stationary course and three patients showed disease progression. Acute toxicity was tolerable and no treatment interruption occurred. The most frequent toxicity was vomiting GI in 21 patients, stomatitis GII in 17 patients and dryness of the mouth GII in 23 patients. Finally, the results of concurrent radio- and chemotherapy were encouraging and a large number of patients and a long time follow up are needed to assess the improvement in survival

Value of chemotherapy prior to brachytherapyin bulky carcinoma of cervix initially treated by external beam radiotherapy

The use of chemotherapy between external beam radiotherapy [EBRT] and intracavitary brachytherapy [BT] in patients with bulky carcinomas of the uterine cervix which, regress poorly after initial [EBRT] has been evaluated in this study. The aim of chemotherapy was to limit tumor clonogen repopulation while awaiting further tumor regression in order to improve the [BT] dose distribution. Twenty patients with FIGO stage II A, II B, IIIB cervical carcinoma were give,: [EBRT] 4500-5000 Cgy by four fields technique to pelvis. Six patients responded well and were subjected to subsequent brachytherapy. While the response to EBRT were not satisfactory in 14 patients where the tumor volume extended beyond Point A so that the application of [BT] was not suitable. These 14 patients were subjected to 3 cycles of chemotherapy of cisplatin based regimen. After chemotherapy, 11 patients responded well and brachytherapy could be applicable. Only three patients with stage IIIB were still bulky even after chemotherapy. These results suggest that in stage II A, IIIB carcinoma of cervix which remain bulky after initial EBRT the use of integrated chemotherapy prior to intracavitary BT could reduce tumor bulk and make the application of subsequent brachytherapy optimum

Pral VP-16 and tamoxifen as a palliative treatment in patiens with advanced hepatocellular carcinoma

This is a prospective single arm study including 20 patients with hepatocellular carcinoma [HCC] aiming to evaluate the therapeutic efficacy of prolonged use of oral VP-16 plus tamoxifen [a potential multidrug resistant reversing agent] in patients with an advanced HCC. Eligibility criteria were unresectable objectively measurable tumors, adequate hemogram, renal functions and karnofsky PS of greater than or equal to 50%. The treatment protocol included VP-16 50 mg/m2/day orally and tamoxifen 40 mg/day, day 1-21 repeated every five weeks. Male to female ratio was 9: 1 with a median age of 46 years, the patients received an average of 3.1 [range 1-6 cycles] courses. GIII and IV leucopenia was developed in 25% and 10% of patients, while thrombocytopenia was developed in 5%, respectively. The dose was reduced in six patients. Hematologic toxicity was moderate and tolerable in the majority of patients and five patients achieved PR. The median survival of responders was eight months and three for the non-responders. The median Karnofsky PS of responders was improved from 70% to 80%. It was concluded that the use of oral VP-16 plus tamoxifen for 21 days had a modest activity and an acceptable toxicity in patients with an advanced HCC and it was useful as a palliative treatment in 25% of the patients