ABSTRACT
Background: The primary goal of treatment in oncology is cure but efforts should be made to preserve quality of life. The gold standard for treatment of muscle-invasive bladder cancer is radical cystectomy. However, radical cystectomy cannot be performed without risk of complications and often the outcome for the patient is a mediocre quality of life as the patient has to live with an artificial bladder or ileal conduit. Even after radical cystectomy, 40–50% of patients will succumb to distant metastases within 5 years. As in the case of several other malignancies, increasing efforts have been made over the last few decades to adopt organ sparing treatment. Bladder-sparing monotherapies lead to disappointing results, local disease control may be maximized using a trimodal approach based on complete transurethral tumor resection of bladder (TURB), followed by concurrent chemoradiotherapy and cisplatin-based systemic chemotherapy. Objectives: The aim of our study is feasibility of concurrent cisplatin with radiation in bladder preservation in our hospital. Materials and Methods: Thirty-two previously untreated patients of histologically proven transitional cell carcinoma of urinary bladder received concurrent chemoradiation (60 Gy) with cisplatin. All patients received concurrent chemotherapy with cisplatin infusion in a dose of 20 mg/m2/day on consecutive 5 days from Day 1 to Day 5 in 1st and 5th week of radiotherapy. Detailed clinical examination along with cystoscopy, TURB along with biopsy, and computed tomography scan of abdomen pelvis were done before treatment and to assess response toxicity, and disease-free survival (DFS) during follow-up period. Results: Median follows up period was 36 months. Local disease control was seen in 71% patients. Five years DFS is 58%. Five years overall survival is 64%. Conclusions: Concurrent chemoradiation in carcinoma of urinary bladder is feasible in our hospital and results in good local control, survival with acceptable toxicity.
ABSTRACT
OBJECTIVE: To evaluate the efficacy and side effects of cispaltin and carboplatin each in combination with paclitaxel in recurrent epithelial ovarian cancer who had not taken paclitaxel-based chemotherapy. MATERIALS AND METHODS: Between January 1994 and October 1999, in department of obstetrics and gynecology, Asan medical Center, 42 recurrent ovarian cancer patients who had initial platinum-based chemotherapy except paclitaxel were treated with paclitaxel-based chemotherapy. One group was 14 patients treated with paclitaxel-cisplatin and the other group was 28 patients treated with paclitaxel-carboplatin. Disease free interval before recurrence was 6 months at least. Patients received paclitaxel 135mg/m2 followed by either cisplatin 75mg/m2 or carboplatin 300mg/m2. The schedule was repeated every 3 weeks for at least 6 cycle. Response was evaluated by physical examination, serial serum CA 125 measurement, chest PA before each cycle, and abdomino-pelvic CT scan every 3 cycles. RESULTS: As paclitaxel-cisplaitin group, with a median follow-up of 34.5 months (range, 9-60 months), 1 patient had complete response, 6 patients had partial response, 3 patients had stable disease and 4 patients had persistent disease, overall response rate was 50%, mean survival duration was 40 months. As paclitaxel-carboplatin group, with a median follow-up of 25.5 months (7-36 months), 4 patients had complete response, 11 patients had partial response, 6 patients had stable disease, and 7 patients had persistent disease, overall response rate was 53.4%, mean survival of 24 months. As grade of side effects in each group, we evaluated leukopenia, anemia, thrombocytopenia, nausea, vomiting, fever, neurological abnormality, and renal abnormality. The rate of grade 3 to 4 leukopenia was 11% in paclitaxel-cisplatin arm and 17% paclitaxel-arboplatin, in arm. CONCLUSION: These results demonstrate that the combined chemotherapy of paclitaxel followed by cisplatin or carboplatin is highly effective and safe in recurrent epithelial ovarian cancer who had taken no previous paclitaxel-based chemotherapy.