Concurrent chemoradiotherapy plus consolidation chemotherapy compared with concurrent chemoradiotherapy alone in unresectable stage III non-mall-cell lung cancer

To evaluate the addition of consolidation chemotherapy to concurrent Chemoradiotherapy in patients with locally advanced unresectable stage III non-small-cell lung cancer as regard efficacy and safety. Forty one patients were randomly assigned to either concomitant Chemoradiotherapy alone [arm 1, n = 19] or concomitant Chemoradiotherapy followed by consolidation chemotherapy [arm 2, n = 22]. In the concurrent arm, patients received weekly paclitaxel [45 mg/m[2]], carboplatin [100 mg/m[2]] and concomitant thoracic radiotherapy at a dose of 63 Gy in 34 fractions over 7 weeks. In the concurrent/consolidation arm, the same regimen was administered followed by two additional courses of paclitaxel [200 mg/m[2]] and carboplatin [300 mg/m[2]] every 3 weeks. Pre-treatment characteristics were well balanced between the two arms. Median survival was 13 months in the concurrent arm and 16.5 months in the concurrent/consolidation arm [p = 0.59]. One-, 2-, and 3- year survival rates were better in the concurrent/consolidation arm [63.6%, 36.4%, and 13.6% respectively] than in the concurrent arm [52.6%, 26.3%, and 10.5% respectively], p = 0.48. Grade 3/4 granulocytopenia occurred in 16% and 27% of patients on the concurrent and concurrent/consolidation arms respectively [p = 0.38]. The most common grade 3/4 non-hematological toxicity was esophagitis. It was more frequent in the consolidation arm than in the concurrent arm [32% v 21%], p = 0.43. Concurrent Chemoradiotherapy followed by consolidation chemotherapy represent the preferred regimen for the treatment of unresected stage III NSCLC. However, toxicity, particularly, non-hematological toxicity, remains a major obstacle

Mansoura randomized trial: Irinotecan/de gramont regimen versus de gramont regimen alone in chemotherapy naive matastic colorectal carcinoma

The mainstay of treatment for metastatic colorectal carcinoma is chemotherapy. The De Gramont regimen [high-dose leucovorin [LV] and fluorouracil [5-FU] bolus plus continuous infusion every 2 weeks] had been proved to be superior to the standard North Central Cancer Treatment Group/Mayo Clinic 5 day bolus 5-FU/LV regimen in the metastatic state. Irinotecan [CPT-11], a semi-synthetic derivative ofcamp-tothecin, has been shown to exert a cytotoxic action in colorectal carcinoma via the potent and specific inhibition of the nuclear enzyme DNA topoisomerase 1. Investigating the difference in response, toxicity, progression-free and overall survival between the de Gramont regimen alone and the irinotecan plus the de Gramont regimen in the management of cases of metastatic colorectal carcinoma in our locality 160 patients with metastatic colorectal carcinoma were referred mainly from the Gastro Enterology Center [GEC] to both the Clinical Oncology and Nuclear Medicine Department and the Oncology Center of Mansoura University and randomized to receive a 2-hour infusion of LV [200mg/m2/d] followed by a 5-FU bolus [400mg/m2/d] and 22-hour infusion [600mg/m2/d] for 2 consecutive days every 2 weeks, either alone [group A] or together with irinotecan [180mg/m2, 30min intravenous infusion] on day 1 [group B]. Median follow up period was 15 months. Patients allocated to the irinotecan/deGramont regimen had statistically better response rate and symptom amelioration [p=0.04]. Moreover, improvement of patients weight and performance status were statistically better in group B [p=0.03 and 0.02 respectively]. Concerning survival figures, group B had statistically better median progression free survival [8 versus 5 months respectively] and better median overall survival [17 versus 14 months respectively] [p=0.00 and 0.01 respectively]. As regard toxicity, both diarrhea and neutropenia of grade 3 and 4 were more encountered in group B [p=0.004 and 0.003 respectively. free survival were receiving irinotecan, good performance status and normal levels of both hemoglobin and white blood cell count at presentation. On the other hand, independent favorable prognostic factors affecting overall survival were good performance status receiving irinotecan, limited number of metastatic foci and normal levels of hemoglobin, white blood cell count and alkaline phosphatase at presentation. The benefit of adding irinotecan to the de Gramont regimen was reflected positively on all the end points as response, progression-free and overall survival. In addition, the toxicity is generally tolerable and manageable. It is clear that performance status, the number of metastatic foci, and the level of each of hemoglobin, white blood cell count and alkaline phosphatase at time of presentation had their prognostic effect on the course of metastatic colorectal carcinoma

Chemotherapy with or without radiotherapy in limited stage aggressive non hodgkin's Lumphoma

To compare the efficacy, toxicity and clinical out come in patients with limited-stage aggressive nondgkin's lymphoma treated with eight cycles of chemotherapy alone or four to six cycles of chemotherapy plus involved field irradiation. One hundred patients with limited aggressive non-Hodgkin's lymphoma were randomly signed to either eight cycles of CHOP alone or four to six cycles of CHOP plus involved-field radiotherapy. The end point were response rate, toxic effects, disease-free survival d overall survival Patients treated with four to six cycles of CHOP is radiotherapy had significantly better disease-free survival in patients treated with CHOP alone. The five-year estimates disease-free survival for patients receiving CHOP plus radiotherapy and for patients receiving CHOP alone were,6% and 65.1%, respectively [p=0.041]. The five-year imates of overall survival for patients receiving CHOP plus radiotherapy and for patients receiving CHOP alone were%and 70%, respectively [p=0.160]. Complete response eswere experienced in 92% in patients treated with CHOP is radiotherapy and 86% in patients treated with CHOP me [p=0.338]. Relapse in original site of disease was significantly higher in patients treated with CHOP alone 9% vs 6.5% in patients treated with CHOP plus radiotherapy =0.007. However, there was no statistically significant difference in systemic relapse between patients treated with CHOP alone [13.9%] and patients treated with CHOP plus radiotherapy [15.2%] [p=0.866]. The adverse effects included a treatment-related deaths in patients treated with eight cycles of CHOP alone versus no treatment-related deaths in ients treated with CHOP plus radiotherapy [p=0.239]. Life threatening toxic effects: grade 3,4 neutropenia were recorded 20% in patients treated with CHOP plus radiotherapy versus% in patients treated with eight cycles of CHOP alone p=0.048, symptoms and signs of congestive heart failure rerecorded in two patients treated with eight cycles of IOP alone, but in no patients treated with CHOP plus iotherapy. For subgroups identified using the Miller modification of the International prognostic Index [IP1], the 5 year disease-free survival and overall survival were signifi-Itly influenced by the number of risk factors in both treat-pt groups [CHOP alone p=0.006, p=0.043 and CHOP plus btherapy p<0.001, p=0.0/3, respectively]. Pour to six cycles of CHOP followed by involved field-radiotherapy are superior to eight cycles of CHOP alone for the treatment of localized aggressive non-Hodgkin's lymphoma. Patients who attained complete response after CHOP plus radiotherapy had more prolonged disease-free survival and higher local control than in patients treated with CHOP alone. IPI risk group was found to be the only significant predictor of overall survival and disease-free survival in both treatment groups.

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

Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin and cisplatin in locally advanced or metastatic bladder cancer

This trial was undertaken to compare gemcitabine plus cisplatin [GC] versus methotrexate, vinblastine, doxoruhicin and cisplatin [MVAC] in patients with locally advanced or metastatic transitional cell carcinoma [TCC] of the bladder. A total of 46 patients with locally advanced [n=21] or metastatic [n=25] TCC of the bladder and with no prior systemic chemotherapy were included in this study. They were randomized to GC [gemcitabine 1000 mg/m2 days 1, 8 and 15, cisplatin 70 mg/m2 day 2] or standard MVAC [methotrexate 30 mg/m2 on days 2, 15, 22, doxorubicin 30 mg/m2 on day 2 and cisplatin 70 mg/m2 on day 2]. The cycles were repeated every 28 days for a maximum of six cycles. It was found that gemcitabine/cisplatin combination is an active and safe treatment option in advanced and metastatic bladder cancer. It is a real alternative to MVAC with the same clinical benefits and significantly improving safety and tolerability