comparison of 5-HT3 receptor antagonist and metoclopramide in the patients receiving chemotherapeutic regimens including CMF, CAF and CHOP

Chemotherapy- induced nausea and vomiting [CINV] occur frequently causing problems with an unacceptably high incidence that significantly affect patients' daily functioning and health-related quality of life. The present study was aimed to compare acute CINV for granisetron as 5-HT3 receptor antagonist and metoclopramide in the patients receiving chemotherapeutic regimens including cyclophosphamide and adriamycin. An attempt is made to examine whether it is possible to successfully replace granisetron with metoclopramide in control of acute CINV. A total of 137 patients with breast cancer [78.8%] and lymphoma [17.5%] from two oncology departments in the first course of chemotherapy were enrolled. They received granisetron 3mg/IV and dexamethasone 8mg for the first referring and in the second referring metoclopramid 30mg/IV and dexamethasone 8mg/IV thirty minutes before chemotherapy and metoclopramide 20mg/IV during chemotherapy. The patients recorded the incidence of chemotherapy induced nausea and vomiting [CINV] and other side effects including headache, extra pyramidal manifestations and delayed nausea. Median age of studied patients was 49 +/- 15 year. The patients who received granisetron and dexamethasone had less acute nausea [during the first 24 hours after chemotherapy] than those who received metoclopramide. Also our study showed that controlled CINV episodes in patients who received CMF regimen were better than the regimen including adriamycin [CAF, CHOP] into both granisetron [p=0.06] and metoclopramid [p=0.04]. The most common adverse event related to these drugs was extra pyramidal manifestations for 16 and 10 patients who had received granisetron and metoclopramide respectively. While the number of the patients who had sever delayed CINV [2-7 days after chemotherapy] episodes with granisetron [7 cases] was lower than those who took metoclopramide drug [14 cases]. The number of patients who experienced extrapyramidal manifestations in metoclopramide group was lower than granisetron group. There were not any significant clinically serious adverse events in any patients undergoing chemotherapy due to cancer. Thus, the safety profiles of granisetron and metoclopramide were comparable in this study. The patients who were treated with cyclophosphamide, and adriamycin, the efficacy of dexamethasone and metoclopramide in controlling acute nausea and vomiting nearly equaled to those of granisetron. Thus the present study supports the use of metoclopramide due to its lower cost and nearly the same efficacy and safety compared to granisetron in CMF regimen

Prognostic significance of metastatic lymph node ratio in patients with gastric cancer: an evaluation in north-east of Iran

In this study we have evaluated the prognostic impact of Metastatic Lymph node Ratio [MLR] in gastric cancer patients whose have undergone curative surgical resection. A total of 121 patients with gastric adenocarcinoma undergoing curative surgical resection [R0] in our institutions between 2003 and 2010 have been included in this study. MLR has classified into 3 groups as follows: MLR0; 0, MLR1; >0-0.33 and MLR2; 0.34-1. We have used Kaplan-Meier method to calculate survival rates and log rank test to compare survival curves between groups. Cox proportional hazards model has utilized for multivariate analysis. The median age of patients was 65 [range; 32 to 89] with a male to female ratio of 91/30 [3.03]. 88 patients have undergone total gastrectomy [72.5%] and 33 subtotal gastrectomy [27.5%]. With a median total retrieved lymph node of 11 [range; 6 to 44], the MLR0 to MLR2 has calculated in 28[23.1%], 31[25.6%] and 62 [51.2%] patients respectively. MLR2 [>0.33] has significantly associated with higher Tumor stage [T1-T2: 18.7% vs. T3: 56.2%, p=0.002]. With a median follow up time of 12 months [range; 2-88], the 3-year survival in patients with MLR0, MLR1 and MLR2 was 75.1%, 54.8% and 9.5% respectively [p value<0.001]. Tumor location [p<0.01], tumor stage [p<0.01] and lymph node stage [p<0.001] were also significant predictor of survival. MLR has also significant correlated with survival in 91 patients with less than 15 obtained lymph nodes [p<0.001]. Cox-regression multivariate analysis has shown MLR as the most important and independent predictor of survival [p<0.001]. MLR with cutoff point of 0.33 could be used as an independent prognostic factor in gastric cancer patients whose have undergone curative surgical resection. This factor could effectively predict survival even in cases with insufficient [<15] retrieved lymph nodes

Treatment outcomes and prognostic factors in pediatric non-brainstem astrocytoma in north east of Iran

Central Nervous System [CNS] tumors have accounted for approximately one fourth of all pediatric malignancies. CNS tumors have been the most common solid malignancies among the children. In this study, we have evaluated survival and prognostic factors in children with non-brain stem astrocytoma. Children with non-brain stem astrocytoma, referring to radiation oncology centers of Ghaem and Omid hospitals of Mashhad, have included in this retrospective study, in years 2000-2010. Patients' demographic data, past medical history, clinical symptoms, extent of tumor resection and treatment modality have recorded. Disease-free survival and overall survival have measured using Kaplan-Meier method. We studied 87 patients with male to female ratio of 44/43 [1.02], and median age of 10 yrs [range: 2-15 yrs]. Tumor grade distribution was as follows: grade I: 20 [23%] subjects; grade II: 34 [39.1%] subjects; grade III: 20 [23%] subjects; and grade IV: 13 [14.9%] subjects. The median follow-up duration was 38 months [6 to 110], and 16 months [4 to 100] for patients with low- and high-grade tumors. The 2-year survival rates in grades I-IV were 100%, 84.7%, 60% and 10.8%, respectively. Tumor resection less than gross total and non-ambulation have associated with a significantly inferior survival in both groups multivariate analysis, with high- and low-grade tumors. For all the cases of the pediatric non-brainstem astrocytoma, tumor grade had dramatic influences on their survival. Performing gross total resection was crucial for achieving favorable outcomes in both low-grade and high-grade cases. Moreover, according to the results, having major motor deficits has associated with lower survival

Concurrent chemoradiotherapy without brachytherapy in locally advanced cervical cancer

Concurrent chemoradiotherapy [EBRT + cisplatin] plus intracavitary brachytherapy is the standard of care in patients with advanced cervical cancer. However, a number of patients could not undergone brachytherapy due to massive residual tumor or anatomical distortion. In this study, we have evaluated the treatment outcome in patients with locally advanced cervical cancer, undergone conventional EBRT plus cisplatin based chemotherapy. In this study, we have selected patients with locally advanced cervical carcinoma [stage: IIB to IIIB] undergone external beam radiotherapy and chemotherapy without brachytherapy at our institute between October of 2007 and October of 2009. The patients have received 50 Gy within 5 weeks to whole pelvic that has followed by a localized boost dose on tumor to 70 Gy concurrently with cisplatin 35 mg/m2 weekly. The treatment has related toxicities, and survival [overall and disease free] have evaluated. 30 cases with a median age of 55 [range; 40 to 73] have been studied. According to FIGO classification, the clinical stages were as follows: stage: IIB 23, IIIA 4, and IIIB 3 cases. Three months after treatment, 19 patients [63.3%] have achieved complete response. With a median follow up time of 18 months [range; 10-33 months], 8/23 cases [34.7%] with stage IIB and 2/7 [28.5%] among stage IIIA-IIIB remained disease free at the end of follow up. Data have shown a 2- year overall survival rate of 58.7% +/- 9% and 2- year disease free survival of 37.7% +/- 9% . Most toxicities were grade I and II. 2 [6.6%] grade III diarrhea and 4 [13.3%] grade III neutropenia have recorded. Although a considerable number of patients have achieved complete response using concurrent chemoradiotherapy without brachytherapy, the overall treatment outcomes especially for stage IIIA-IIIB were unsatisfactory. Using modern radiation therapy techniques with increased delivered boost dose could improve treatment results