High versus standard dose prophylactic cranial irradiation for patients with limited sm allcell lung cancer incomplete remission

Small cell lung cancer [SCLC] accounts for approximately 20% of all patients with lung cancer. Limited-disease [LD] is considered potentially curable. The role of prophylactic cranial irradiation [PCI] in those patients who achieved a complete cure [CR] to induction therapy remains uncertain. Eligible patients were randomized to receive either high dose PCI [20 patients received 2.4 Gy once daily in 10 fractions for a total dose of 24 Gy] or a standard dose PCI [25 patients were treated with 2 Gy once daily in 18 fractions for a total dose of 36 Gy, while there was another group [15 patents] who refused PCI. Results: The results confirmed the observable reduction of brain metastases with the high dose PCI compared to the standard dose PCI and also for those who did not receive PCI [16%, 35%, and 53% respectively]. Also this result confirmed the loss of significant survival advantage between those who receive PI and those who did not. No evidence of consistent difference regarding neurological and cognitive impairment between patients given or not PCI

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

COPP/ABV chemotherapy followed by radiotherapy for patients with hodgkin's disease

The aim of this trial was to evaluate efficacy and toxicity of COPP/ABV combined with reduced radiotherapy in patients with stage I-III Hodgkin's disease [HD]. Forty-three patients were prospectively treated with 4 cycles [stage I and II patients] or six cycles [stage III patients] of COPP/ABV [cyclophosphamide, vincristine, procarbazine, prednisone/adriamycin, bleomycin, vinblastine] followed by radiotherapy; 25 Gy to areas of initial involvement. In sites of bulky disease >/= 5 cm, the radiotherapy dose was raised to 40 Gy. The complete remission [CR] rate was 83.7%. The 5-year progression free survival [PFS] was 64% and the 5-year overall survival [OS] was 77%. Prognostic factors that could significantly affect the CR rate and the PFS were age [< vs >/= 40 years], stage of disease [I and II vs III] and the presence of bulky disease >/= 5 cm. Treatment was well tolerated with acceptable early and late toxicity. It is concluded that COPP/ABV combined with reduced radiotherapy for patients with stage I-III HD is a safe and effective approach. Further research is needed with treatment strategies being tailored according to prognostic factors