Concomitant radiotherapy and paclitaxel as a radiosensitizer in locally advanced cancer cervix

This study aimed to evaluate the effect of concomitant radiotherapy with weekly paclitaxel as radiosensitizer in locally advanced cervical cancer on response rate, progression free survival and overall survival. In addition to evaluate the pattern of toxicity with this treatment regimen.Between June 2001 and December 2002, seventeen women with histopathologically proven squamous cell carcinoma of the uterine cervix, stages IIB, III and IVA were recruited in this study. Patients were treated with whole pelvis external beam radiotherapy 45 GY with 1.8 Gy/fraction administered five days a week concurrent with paclitaxel 50 ing/m2 administered in weekly basis. This was followed one to two weeks later with single intracavitary Cs137 insertion aiming at 30 Gy to point A and then parametrial boost [5-6 Gy] according to disease extension. Response to treatment, toxicity profile, 18-month disease free and overall survival were estimated. The median age of the patients was 56 years. The majority of patients had FIG0 stage IIIB [52.9%]. The most common histological grade was grade II [58.8%]]. The median tumor size was 5.4 cm [range 3-11 cm]. Bilateral parametrial involvement was encountered in 47% of patients. All patients had a fair performance with ECOG /<2. In general, toxicity was mild, none of the patients developed G IV toxicities. All patients completed their planned radiotherapy dose. Gaping during external radiotherapy occurred in only one patient [5.9%] for one week due to GIII diarrhea. On the other hand, chemotherapy was interrupted after the 3rd cycle for only one injection [D22] in two patients; one patient due to GIII diarrhea and the other due to GIII neutropenia. The overall response to the regimen was 94.1% with 64.7% complete response [CR]. The median progression free survival [PFS] was 12 months; however the median overall survival [OAS] was not reached. The 18 month overall survival was 76.3%, while the 18 month progression free survival was 71%

Assessment of response of locally advanced breast carcinoma to docetaxel and epirubicin neoadjuvant combination regimen: a prospective phase II study

This study aimed to evaluate the efficacy and toxicity of neoadjuvant chemotherapy [NCT] with docetaxel/epirubicin combination in patients with locally advanced breast carcinoma. In addition, to stratify the pathological response to chemotherapy according to a proposed grading system of response. Between July 2000 till December 2002, 24 patients with locally advanced breast carcinoma were recruited and completed their treatment with neoadjuvant chemotherapy, followed by surgery, adjuvant chemotherapy and radiotherapy +/- tamoxifen; following a proposed regimen. Clinical and pathological results of neoadjuvant chemotherapy were evaluated. The patients' median age was 50 years, 54.2% were postmenopausal and all patients had stage III disease with minimum T3 tumour. Clinically positive axilla was detected in 70.8% of patients and 91.7% had infiltrating duct carcinoma. Patients were treated with 4 cycles of NCT formed of epirubicin 90 mg/m2/i.v plus docetaxel 75 mg/m2, one-hour infusion on day one, repeated every 3 weeks upon full marrow recovery. The post treatment clinical assessment revealed that 6 patients [25%] showed clinical complete response, 70.8% achieved clinical partial response [overall response rate 95.8%] with significant reduction of the tumour and axillary nodes dimension. Twenty-two patients underwent surgical interference [10 conservative resection and 12 modified radical mastectomy]. Pathological assessment of the specimen showed that the objective pathological response of breast lesion was 59.1% with 18.2% pathological complete response [Grade 5]. Similarly pathological complete response of axillary involved lymph nodes [Grade D] was achieved in 50% of patients. The clinical and pathological responses were significantly higher for patients with negative hormone receptors. Grade 3 and 4 neutropenia were the major side effect encountered in 79.2% of patients during NCT phase. Patients were followed up for a median of 15 months, the median disease free survival [DFS] was 15 months and the median overall survival [OAS] was not reached. The estimated 2-year DFS was 70% and 2-year OAS was 84%. It was concluded that this regimen of NCT proved to be efficient for treatment of locally advanced breast cancer in terms of clinical, pathological responses as well as the rate of conservative surgery that could be achieved. The pathologic grading of response may be useful for selection criteria of the subset of patients that could benefit from maximizing adjuvant chemotherapy. Future trials should incorporate growth factor support in the treatment regimen to avoid undue toxicity

Concomitant chemoradiotherapy followed by adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma

In this study, 31 patients with stages III and IV non-metastatic nasopharyngeal carcinoma were treated with concomitant chemoradiotherapy in the form of 70 Gy to the primary tumor and the involved neck nodes and 50 Gy to non-involved neck nodes with cisplatinum 100 mg/m2/day 1, 22 and 43 of irradiation. This treatment was followed by 3 cycles of adjuvant chemotherapy in the form of cisplatinum 80 mg/m2/day 1-4/by 24 hours continuous infusion and the cycle to be repeated every 3-4 weeks. All patients were evaluated at the end of concomitant phase and adjuvant phase clinically and radiologically. Follow up was maintained for a median of 32 months. The response to treatment, toxicity profile, pattern of failure, 3-year disease free and overall survival rates were estimated. The current regimen resulted in an improved 3-year disease free survival [DFS] and overall survival [OAS] similar to other studies concerned with the same topic. However, there were high incidences of grade III and IV mucositis, neutropenia and weight loss in this group. Full nutritional support, proper oral hygiene and dental care with the possible use of radio and chemo-protectors as well as growth factor support might be indicated to increase the treatment compliance which ultimately lead to an improved long-term disease free and overall survival

Phase II multicenter study of irinotecan and 5-fluorouracil/leucovorin as a front line therapy in advanced colorectal carcinoma

This multicenter phase II study was designed to assess the efficacy and tolerability of the combination of irinotecan with bolus 5-FU and calcium leucovorin [LV] as a front line therapy for advanced colorectal cancer [CRC]. Patients with histologically proven advanced CRC and at least one measurable lesion, with age range 18-75 years, with a performance status of <2, normal baseline biochemical values and no prior chemotherapy [apart from adjuvant] were selected. The treatment regimen was formed of weekly CPT-11 [125 mg/m2] i.v. infusion, 5-FU [500 mg/m2] bolus i.v. and LV [20 mg/m2] i.v. for four weeks [two weeks, followed by two weeks rest, this constitute one cycle]. Treatment continued till either complete remission or disease progression or failure