Conventional versus hyperfractionated radiotherapy in locally advanced head and neck cancer

Radiotherapy is often the primary treatment of locally advanced squamous cell carcinoma of the head and neck, but the optimal fractionation schedule has been controversial. The aim of this study was to examine whether, after preceeding induction chemotherapy, hyperfractionated radiotherapy [HFRT] is superior to conventional fractionated radiotherapy [CFRT]. Patients with locally advanced squamous cell carcinoma of the head and neck were treated with three cycles of cisplatin [100 mg/m[2] D1] and 5-fluorouracil [1000 mg/m[2] D1-4], repeated every 3 weeks. Then patients were randomized to receive either CFRT at 1.8-2 Gy/fraction /day, 5 day/week to 65-70 Gy/33- 35 fractions/7 weeks or HFRT at 1.2 Gy /fraction, twice daily with a 6-hours interfraction interval, 5 days/week to 76.8 Gy/64 fractions/7 weeks. All patients in both treatment arms received concomitant chemotherapy in the form of weekly bolus injection of cisplatin [20mg/m[2]]. Of the 60 patients entered, only 53 patients were evaluable for outcomes. The primary end points were local control and progression- free survival. Chemotherapy was well tolerated, the overall response rate after induction chemotherapy was 73.6%, including 13.2% complete response rate. After completion of radiotherapy, patients treated with HFRT had an overall response rate of 96.2% versus 77.8% in CFRT [P= 0.04] and complete response rate of 65.4% in HFRT versus 40.7% in CFRT [P=0.01]. After a median follow- up of 28 months, overall survival was 57.7% in HFRT versus 44.4% in CFRT [P= 0.07]. The 2-year progression-free survival was 44% in HFRT versus 23.8% in CFRT [P=0.03]. The 2- year locoregional control was significantly higher in HFRT [58.8%] than those with CFRT [36.4%] [P=0.02]. The incidence of local recurrence rate was 41.2% in HFRT versus 63.6% in CFRT [P=0.02]. However, the incidence of distance metastases was 7.7% in HFRT versus 11.1% in CFRT [P=0.4]. Patients treated with HFRT had significantly greater acute side effects compared to CFRT. However, there was no significant increase of late effects. After induction chemotherapy, hyperfractionated radiotherapy is more efficaceous than conventional fractionated radiotherapy in locally advanced squamous cell head and neck cancer. Acute but not late effects are increased, but it is tolerable and manageable

Gemcitabine-cisplatin versus methotrexate, vinblastine, doxorubicin and cisplatin in locally advanced or metastatic transitional cell carcinoma of the bladder

To compare the efficacy and toxicity of the combination of gemcitabine plus cisplatin [GC] and methotrexate, vinblastine, doxorubicin plus cisplatin [MVAC] in the treatment of patients with locally advanced or metastatic transitional cell carcinoma [TCC] of the bladder. Forty five patients with locally advanced or metastatic TCC of the bladder were r and omized to GC [gemcitabine 1000mg/m[2] days 1, 8 and 15; cisplatin 70mg/m[2] day 2] or st and ard MVAC [methotrexate 30mg/m[2] days 1, 15 and 22; vinblastine 3mg/m2 on days 2, 15 and 22; doxorubicin 30mg/m[2] on day 2; and cisplatin 70mg/m[2] on day 2]. The cycles were repeated every 28 days for a maximum of six cycles. Forty five patients were r and omized [GC, n=23; MVAC, n=22]. Overall response rates were similar on both. arms [GC, 47.8%; MVAC, 45.5%, p=0.934]. Overall survival and progression free-survival were similar on both arms [HR, 1.067; 95% CI, 0.595 to 1.915, p=0.828, and HR, 0.861; 95% Cl, 0.461 to 1.610, p=0.640, respectively]. Patients on the [GC arm received a median of six cycles compared with a median of 4 cycles for patients on the MVAC arm. Dose adjustments occurred in only 40% of the cycles with GC and in 64.7% with MVAC. Grades 3 and 4 anemia and thrombocytopenia were seen more often on GC arm than on MVAC arm [26% vs 18.1%, p=0.776 and 43.5% vs 22.7%, p=0.265 respectively]. However, the RBC and platelet transfusion rates were similar on both arms. More MVAC treated-patients compared with GC treated-patients had grade 3 and 4neutropenia [81.8% vs 60.8% respectively, p=0.043], neutropenic fever [18.2% vs 0% respectively p=0.049], neutropenic sepsis [13.6% vs 0% respectively, p=0.089], grade 3 and 4 mucositis [27.2% vs 0% respectively, p=0.027] and alopecia [54.5% vs 8.7% respectively, p=0.001]. More patients on GC had better results than MVAC patients as regard weight and performance status. Combination chemotherapy of gemcitabine plus cisplatin provides similar outcomes to that of st and ard MVAC in treatment of patients with locally advanced or metastatic TCC of the bladder with a better safety profile and tolerability

role of [99m] Tc-MIBI SPET in predicting and monitoring the chemotherapeutic response in primary lung cancer

The aim of this study was to evaluate the role of technetium-99m methoxyisonitrile [MIBI] which is more available and cheaper than PET agents in monitoring the chemotherapeutic response in primary lung cancer. In this study, 37 patients with primary lung cancer underwent 99mTc-MIBI single photon emission tomography [SPET] before chemotherapy and after the 3rd cycle of chemotherapy. SPET images were recorded at 15 minutes [early] and at 3-4 hours [delayed] post- injection of the tracer. From the SPET images, early and delayed tumor/lung ratios [ER and DR] were obtained before and after chemotherapy. CT scan studies before and after chemotherapy were also performed for all patients. According to the changes in tumor size on CT scan taken two weeks after the 3rd cycle of the chemotherapy, patients were divided into two groups, responders [R[+]] and non- responders [R[-]]. The results suggested that 99mTc-MIBI might be used in routine practice not only to detect and evaluate active lesions, but also to predict and monitor the chemotherapeutic response in patients with primary lung cancer, especially when PET is not available

randomized trial of sequencing adjuvant chemotherapy and radiotherapy in lymph node positive premenopausal operable breast cancer

The objective of this study was to evaluate the value of the early initiation of either adjuvant chemotherapy or postoperative radiotherapy, considering the optimum and proper sequencing and gaping between both modalities. Between October 1998 and January 2000, 93 cases of premenopausal operable breast cancer with positive axillary lymph node were enrolled in this prospective study. Sixty-two patients underwent modified radical mastectomy and only thirty-one patients underwent conservative breast surgery. All patients received postoperative radiotherapy and adjuvant chemotherapy. They were classified according to the sequence of administration of chemotherapy and radiotherapy into three treatment groups. Group 1 was treated by early radiation therapy, group 2 was treated by sandwich technique, while group 3 was treated by delayed radiation therapy after the end of six cycles of chemotherapy. The sequence of the administration of chemotherapy and radiotherapy had an influence on the treatment failure and subsequently had an influence on the overall survival and disease-free survival rates. The extent of surgery was found to have an influence on the treatment failure and disease-free survival