Preradiation chemotherapy versus radiotherapy in the treatment of adult meduloblastoma

To determine whether preradiotherapy [RT] chemotherapy would improve outcome for medulloblastoma when compared with RI alone. Chemotherapy comprised vincristine 1.5 mg/m2 days], 7 and 14, etaposide 100 mg/m2 days1.2. and 3 and carboplatin 500 mg/m2 days] and 2. Patients age ranged between 16 and 45 years inclusive were randomly assigned to receive 35 Gy craniospinal RT with a 19 Gyposteriorfossa boost, or chemotherapy followed by RT. Ls 0i5[i paienzs randomly assigned to treatment, 25 were treated with RT alone and the other 25 patients were treated with chemotherapy and Irradiation. There was a statistically significant difference in overall survival at 3 years between both arms 58% and 75% respectively. Acute toxicity was limited to alopecia, nausea and hematological toxicities. High grade nausea and vomiting was reported in 4 patients and neuropathy in two patient. Grade 3 or 4 [anemia, neutropenia and thrombocytopenia were recorded in group B, this is attributed to chemotherapy. Improved EFS and OS for chemotherapy group patients compared with RT alone were noticed. Chemotherapy was well tolerated. It is anticipated that this regimen could reduce atotaxicity and nephrotoxicity compared with cisplatin-containing schedule

comparative study of surgical approaches to cerebello-pontine angle tumours

The present study included 66 patients with cerebello-pontine angle [CPA] tumours. Retro sigmoid approach was done in 53 patients with CPA tumours, 29 retrospective cases and 24 pospective. Trans labyrinthine approach was done in 13 patients with CPA tumours, 8 retrospective cases and 5 prospective. Out of the 66 patients with CPA tumours ,40 cases were vestibular schwannomas, 14 were meningioma's, two arachnoid cysts, two epidermoid and eight patients with other tumours. In sub occipital retrosigmoid cases total resection were done in 71.42% and subtotal in 28.58%. Mortality occurred in 3 cases, facial nerve affection in 21.46%, hearing loss in 21.46% and CSF leakage in 7.14%. In trans labyrinthine cases total radicality occurred in 76.9% and subtotal in 25.1%. No mortality was recorded, hearing loss in all, CSF leakage in 7. 7%. Follow-up of patients for one year showed good preservation of facial nerve function in 76.9%·with trans labyrinthine resection as measured by House and Brackmann system. Facial nerve preservation occurred in all cases with small tumours, 50% of medium sized and55.5% of large tumours. With retro sigmoid resection of schwannomas facial nerve preservation was found in 85.71%.Complete hearing loss occurred in all patients with trans labyrinthine approach. Follow up of retro sigmoid surgery showed hearing preservation with good serviceable haring in 75% of moderate sized acoustic neuromas and hearing loss occurred in 21.46% in whole group of schwannoma. The present study demonstrated that with unserviceable hearing, the trans labyrinthine approach, whatever the size ·of the tumour, is the approach of choice. Young patients with good preoperative hearing are candidates for retro sigmoid surgery. If there is doubt concerning residual tumour the labyrinth should be sacrificed. With patients with tumours smaller than 1.5cm in diameter and in patients with good hearing and no extension in internal auditory canal, retro sigmoid approach is used. Tumours -size larger than 1.5 cm can be accessed by retro sigmoid or trans labyrinthine approaches

Impact of maintaining adequate haemoglobin level on the treatment outcome of stage III cervical carcinoma a prospective, nonrandomized study

It has been suggested that hemoglobin levels of 12-14 g/dL are optimal for tumor oxygenation, radiosensitivity, and prognosis. in this prospective study, we evaluated the effectiveness of epoetin-alpha to maintain hemoglobin levels at 12-14 g/dL during radiotherapy [RT] for patients with FIGO Stage III cervical carcinoma, and we examined the impact of erythropoetin on overall survival [OS], metastatic-free survival [MFS], and local control [LC]. Forty patients, who received RT between January 2002 and June 2004, were included in this prospective, nonrandomized study. Twenty patients received epoetin-alpha [150 lU/kg 3 times per week] during RT [Group A], and 20 patients did not receive epoetin-alpha [Group B]. Epoetin-alpha was started at hemoglobin levels < 13 g/dL and was stopped at hemoglobin levels >/= 14 g/dL. Hemoglobin was measured before RT and once weekly during RT. Both groups were balanced for age, performance status, histology, grading and hemoglobin level before RT. in 11 of 20 patients [55%]from Group A and in 13 out of 20 patients [65%]from Group B had Haemoglobin level < 12 mg/dl prior to radiotherapy. The median change in hemoglobin was + 0.4 g/dL per week in Group A and - 0.4 g/dL per week in Group B. Local Control [LC] was significantly better in Group A [66% vs. 38% at 1 year, respectively P=0.012], a trend was observed for Overall Survival [OS] [59% VS. 33%, respectively; P = 0.08] and Metastatic Free Survival [MFS] did not differ significantly [43% vs. 38%, respectively; P = 0.34]. No epoetin-alpha related toxicity was observed. Epoetin-alpha was effective in maintaining the hemoglobin levels at 12-14 g/dL during RT. The application of epoetin-alpha significantly improved LC, and a trend was observed for OS

Gemcitabine plus cisplatin in previously treated, relapsed breast cancer patients

Gemcitabine is an antimetabolite drug with proven antitumor activity and tolerability in metastatic breast cancer. In a total of nine studies, gemcitabine monotherapy has reached response rates of up to 37% in the first-line setting, 26% in the second-line setting, and 18% or better in the third-line setting. Gemcitabine is an excellent choice for combination therapy by its unique mechanism of action and favorable toxicity profile, thus limiting the risk of pretreatment-related drug resistance and overlapping toxicity and by its potential for synergistic interaction with some combination partners as indicated in preclinical studies. Numerous phase II clinical studies have combined gemcitabine with other active agents such as the taxanes, vinorelbine, vindesine, cisplatin, 5-fluorouracil, as well as anthracy dines across various regimens in conditions of p re treatment. Most of these two-drug combinations have consistently demonstrated higher efficacy than either single agent, particularly in pretreated patients. Even high efficacy has been obtained with triple-drug regimens including gemcitabine, anthracy dines [epirubicin or doxorubicin], and paditaxel; these regimens have development of effective combination treatment not only in first-line therapy, but also for intensively pretreated patients previously exposed to anthracy dines and/or yielded an overall response rates of 58-92% as first-line treatment. To evaluate the role of gemcitabine as a valuable alternative in the palliative treatment of metastatic breast cancer

Radiotherapy versus radiotherapy enhanced by vinorelbine in locally advanced non-small cell lung cancer

Experimental studies have shown that vinorelbine is a powerful radiosensitizer in vitro.In this study, 173 patients with inoperable non-small cell lung cancer, Stage III, were entered into arandomized trial comparing radiotherapy only [RT][45 Gy/15 fractions/3 weeks][arm A] versus RT and a dailylow dose of vinorelbine [4 mg/m2][arm B].An overall response rate of 58.9% was observed in arm A and%0.6%in arm B, respectively. Nodifferences in the pattern of relapse were noted between the two treatment groups. Median time to progression was10.6 months for arm A and 14.2 months for arm B. Median survivals were 10.3 months and 9.97 months,respectively. Toxicity was acceptable and no treatment-related death occurred in either treatment schedule. In thisstudy no significant advantage of the combined treatment over radiation therapy only was found.The encouraging, results achieved in some trials together with the intractability of the disease suggestthat further effects efforts should be made to optimize clinical trial protocols, perhaps by reviewing theradiobiological and pharmacological basis of the combined treatment.Non-small cell lung cancer, vinorelhine, Radiotherapy, Radiosensitizer

effect of nurses knowledge and beliefs on their practices while haning cytotoxix drugs

The handling of cytotoxic drugs [CDs] is currently considered to be an occupationally hazardous. Therefore, safety measures must be followed to protect health care personnel, especially nurses, who are always exposed to these drugs in the hospital setting. Of this study was to evaluate the effect of nurses' knowledge and beliefs concerning occupational exposure about their practice while handling CDs. The study was carried out at the Oncology Care Unit at the Main University Hospital of Alexandria University. The sample of this study consisted of all nurses [No=40] who are responsible for preparation and administration of CDs in Oncology Care Unit. Two tools were used to collect the necessary data. Tool I: A questionnaire to assess nurses' knowledge and beliefs was developed, in addition to a list of symptoms and reasons for not following preventive measures guidelines. Tool II: Consists of an observation checklist to assess nurses' practice of safety measure during preparation and administration of CDs. A gap was found between the nurses' knowledge and beliefs on one hand and their practice of safety measures during handling CDs on other. The study findings support the need to promote primary prevention by providing a safe environment for nurses by means of education, training with regards to safety measures, unit policy, written rules, and guidelines