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%

Clinico - epidemiological pattern and survival in colorectal cancer: an inter institutional comparative study

Seventy-four patients with colorectal cancer were treated at King Abdul-Aziz Hospital and Oncology Center [KAAH], Jeddah, as well as 105 patients were treated at National Cancer Institute [NCI], Cairo. Surgery in the form of hemicolectomy or anterior resection was performed for patients with colon cancer and abdominoperineal resection [AP] or low anterior resection [LAR] for rectal cancer. Adjuvant 5-FU based chemotherapy was used for one year in addition to postoperative radiotherapy to patients at high risk of recurrence. The patients were followed up for a median of 27 and 29 months for KAAH and NCI patients, respectively. It was apparent that colorectal cancer occurred at a younger age among Egyptian population. There was a survival advantage for NCI patients, particularly females with early stage cancer rectum and particularly who have undergone low anterior resection. This subset of patients at KAAH had an exceptionally older age compared with their correspondings at NCI, a factor, which might compromise the choice of surgery for those patients. It was recommended that surgery should be optimized irrespective of age, gender or stage of the disease with a better utilization of the different diagnostic modalities as well as adjuvant therapies to achieve the highest control and survival for this disease

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

Intraoperative adjuvant chemotherapy with mitomycin-C during pterygium surgery: a propspective phase II study

This study aimed to evaluate the efficacy of topical intermediate dose concentration [0.3 mg/ml] of mitomycin-C intraoperatively for a longer exposure time [5 minutes]on the recurrence rate, toxicity and the recurrence free survival. Between January 2000 and March 2003, pterygium excision has been performed for 19 eyes in 19patients with bare sclera technique, their median age was 42 years with male to female ratio of 2.2:1. Immediately after pterygium excision, topical mitomycin-C [0.3 mg/ml] was applied for 5 minutes over the bare scleral bed. One patient suffered a recurrence of pterygium in the area of previous excision during a median follow up of 20.5 months [range 3-39 months]. Pyogenic granuloma was reported in one patient and no other serious side effects were reported. The recurrence of pterygium occurred 18 months after excision and the 3-year recurrence free survival rate was 85%. The study concluded that single topical application of mitomycin-C 0.3 mg/ml for 5 minutes is safe and effective method to control recurrence of pterygium with minimal side effects than that reported with higher drug concentration. Further randomized studies to compare this technique with other methods is warranted to validate its efficacy

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

Serum parathormone level as a predictor of sensitivity of preoperative Tc99M MIBI parathyroid scintigraphy in primary hyperparathyroidism

The diagnosis of primary hyperparathyroidism is made by the finding of elevated serum calcium [Ca] and intact parathormone [iPTH] levels. Tc99m MIBI scintigraphy represents the most suitable non invasive technique for preoperative localization of overfunctioning parathyroid tissue with a mean sensitivity of 91% and a range of 55-100%. The scan sensitivity was reported to decrease for small adenomas with lower serum Ca and iPTH levels. The aim of the current study was to verify the possibility of the use of serum level of iPTH as a predictor of sensitivity of preoperative Tc99m M1131 parathyroid scintigraphy in primary hyperparathyroidism and the feasibility to apply this for selection of patients who are going to get the utmost benefit from the scan according to iPTH serum level if we are going to take cost effectiveness into consideration. 98 patients with biochemically established primary hyperparathyroidism were enrolled retrospectively in the current study all were subjected to preoperative Tc99m MIBI parathyroid scintigraphy. All underwent surgery with histopathologically proven parathyroid pathology. The mean age of our patients was 56 years, with females representing 67%of study population. Eighty nine patients [90.8%] had parathyroid adenoma and the remaining 9 patients [9.2%] had parathyroid hyperplasia. The mean value of iPTH level for the whole group was 688pg/ ml; with a mean elevation above upper normal limit of 7.4 folds. The overall scan sensitivity was 59.2%. Seventeen patients were asymptomatic, they had significantly lower values of serum Ca and iPTH levels and scan sensitivity [29.4%] compared to the symptomatic group, the latter had scan sensitivity of 65.4%. According to degree of elevation of serum iPTH level, patients were divided into 4 main groups, group I with elevation less than 3 folds, group 2 [between 3 and 6 folds], group 3 [between 6 and 9 folds] and group 4 [more than 9 folds]. The mean value of serum iPTH level for patients" groups was I 17.6pg/ml, 374.7 pg/mI, 631.4 pg/mI and 1621.2 pg/mI with Tc99m MIBI scan sensitivity of 16.7%. 37.5%, 78,9% and 96.8% respectively. There is a statistically significant difference between all groups as regards both iPTH serum level and scan sensitivity. On addition of patients of group 1 and 2 together [48 patients with less than 6 folds elevation of iPTH level], the mean value of iPTH was 246pg/ml with scan sensitivity of 27%. These figures were significantly lower than those found for 50 patients of groups 3 and 4 together with iPTH serum level more than 6 folds [I 126pg/ml and 90% respectively]. It is concluded that asymptomatic patients with primary hyperparathyroidism had significantly lower levels of serum Ca and iPTH levels and lower Tc99m MIBI scan sensitivity compared to symptomatic group. Also we can conclude that serum iPTH level can be successfully employed to predict sensitivity of preoperative Tc99m MIBI scintigraphy. The degree of hormonal elevation is directly proportional to scan sensitivity with lowest value [16.7%] for less than 3 folds elevation, increasing to 37.5%, 78,9% and 96.8% for elevation from 3 to 6 folds, 6 to 9 folds and above 9 folds respectively. If we take cost effectiveness into consideration, it is advisable to perform Tc99m MIBI scan for patients with primary hyperparathyroidism in whom serum iPTH level is more than 6 folds elevation above upper normal limit, with scan sensitivity of 90% compared to 27% for those with lower hormonal level

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

Survival and prognostic factors in differentiated thyroid carcinoma-ongoing controversial Issue

Eighty-one patients with thyroid carcinoma have been treated at King Abdul Aziz Hospital and Oncology Center, Jeddah, KSA between 1992 and January 2000. They were referred postoperatively to Oncology Center for radioiodine ablation, hormone suppression +/- external irradiation. Their mean age was 39 years, with a peak in the 4th decade and follicular carcinoma patients were older than those with papillary carcinoma [median 42 Vs 35]. Females represented 76.6%, with female to male ratio 3.2:1. Diagnostic work up revealed that only 22.2% performed fine needle aspiration [FNA], 37% performed preoperative thyroid scan and 92.5% performed thyroid ultrasonography. Papillary carcinoma represented 84% Vs 12% for follicular carcinoma and the rest were medullary and anaplastic carcinoma. Survival analysis was performed for differentiated thyroid carcinoma patients only [78 patients]. Over a mean follow up of 42.6 months, the mean values for locoregional free survival was 35.4 months, distant metastases free survival was 38.1 months and overall survival was 38.5 months. Correlation of survival parameters with the different prognostic factors showed statistically insignificant difference for age variable [above and below 40 years], gender, tumour size [less or more than 4 cm diameter], presence or absence of cervical adenopathy, type of pathology and extent of surgical resection [lobectomy Vs. thyroidectomy in papillary carcinoma patients]. But there was a borderline statistical significance difference [p=0.07] for locoregional disease free survival for patients with or without capsular invasion. Also, there was a statistical significant difference [p=0.02] for distant metastases free survival and overall survival [p=0.02] for patients with or without vascular invasion. The estimated overall 5-year survival was 96.8% and it was 80% for patients with vascular invasion and 97.6% for paints without vascular invasion. The rate of local recurrence and distant metastases in correlation with the different risk factors showed only significance for capsular and vascular invasion. The prognostic impact of age, gender, cervical adenopathy, size of the nodule, pathological subtypes and extent of surgical resection needs a longer follow-up to clarify the exact significance of those factors; However, capsular and vascular invasion carried a worse prognosis on loco-regional, distant metastases and overall survival on short term follow-up, hence those patients should be treated aggressively. FNA should be one of the main diagnostic methods of malignancy, by which unnecessary surgery for benign conditions could be avoided. We have to expand our efforts to identify high-risk patients more accurately, thereby facilitating a more rational approach to treatment and till this time lobectomy for papillary carcinoma should be extremely restricted even for low risk patients to those in whom surgical morbidity is highly expected