Outcome of ablation of thyroid remnants with l00mCi [3.7GBq] iodine-131 in patients with thyroid cancer

Aim of the study: to determine the efficacy of a 100mCi dose for ablation of thyroid remnants; the influence of pre-therapy scanning; correlation between cervical uptake and efficacy; and the necessity of diagnostic scan for the patients with low serum Tg in the follow-up after remnant ablation

Patients and Methods: a retrospective study was conducted on 98 patients with differentiated thyroid cancer without metastases who received an ablative dose of 100mCi [3.7GBq] of iodine- 131 after total thyroidectomy

Results: six months to one year after ablation, 81/98 patients [82.6%] had a negative scan. Diagnostic scanning with 5mCi [185MBq] performed 72h or 3 months before ablation did not interfere with treatment success compared to patients not submitted to pre-therapy scanning. Pre-ablation cervical uptake values <2 %wer e associated with a higher ablation efficacy [92.8%], from 2 to 5% showed 79% success and values >5%, 57.1 % [p<0.05]. There were no significant differences between the responsive and non responsive groups in terms of age, sex, histological type or size of the primary tumor. 10.5% of the patients with low stimulated Tg [<2ng/ml] presented discrete thyroid bed uptake on follow-up diagnostic scan [<0.5%] without definitive residual disease and 79.4% had negative uptake on scan. The patients with Tg >2ng/ml presented thyroid bed [46] or ectopic [216] uptake on followup diagnostic scan

Conclusion: an ablative dose of 100mCi shows a high rate of efficacy, especially when cervical uptake is <2%, no difference was noted between patients assessed by scan within 72h or 3 months before treatment and those not scanned; follow-up diagnostic scan can be avoided in low risk patients with stimulated Tg <2ng/ml

therapeutic outcome of multimodality approach in management of locally advanced, stage III and IVa invasive thymoma

Background: surgery is the treatment of choice for malignant thymoma whenever a complete resection can be accomplished. For locally advanced [LA] and unresectable stage III and IVa thymoma, the therapeutic outcome has been poor

Purpose: to assess tumor response, respectability, event-free survival and, overall survival of multimodality approach in therapy of LA stage III and IVa malignant invasive thymoma

Patients and Methods: fourteen patients [7 males and 7 females] with histologically confirmed invasive thymoma were treated. The median age was 48 years [range: 24-64 years]. Six patients [42.9%] were in clinical stage III disease and, 8 patients [57.1%] had stage IVa disease. The most common histological type was lymphoepithelial [57.1%]. The treatment protocol consisted of 3 courses of induction cisplatin-based chemotherapy [PAC with corticostreoids: cisplatin: 50 mg/m[2] IV DI, doxorubicin: 50 mg/m[2] IV DI, cyclophosphamide: 50 mg/m2 IV DI and, prednisolone: 60 mg/m[2] PO D1-5], then surgery followed by postoperative radiotherapy and completion consolidation chemotherapy; another 3 courses of PAC plus corticosteroids

Results: fourteen patients were enrolled and assessed for response. After induction chemotherapy, complete response encountered in four patients [28.6%], partial response in 7 patients [50%], stable disease in 1 patient [7.1%] and progressive disease in 2 patients [14.3%]. Ten patients [71.4%] performed surgical resection: total resection in 8 patients [57.1%] and, subtotal in 2 patients [14.3%]. 1 refused surgery, 1 patient died with stable disease [7.1%], and 2 patients [lied with progressive disease [14.3%]. At the end of the study and after a median follow-up of 18 months. 11 patients were alive [78.6 %] and 9 patients are event-free [64.3%]. The 3-year calculated actuarial overall and event-free survival of studied patients was 71.3% and 57.1% respectively

Conclusion: Combined treatment approach in management of LA and unresectable invasive thymema is encouraging and demonstrated high objective overall response rates with increased respectability rate and, improvement of overall survival. Preoperative induction chemotherapy followed by surgical resection, postoperative radiotherapy and consolidation chemotherapy may become the standard treatment of LA and unresectable invasive thymoma

Triplet chemotherapeutic regimen in advanced or metastatic non-small cell lung cancer

Non-small-cell lung cancer [NSCLC] is the leading cause of cancer-related death. Chemotherapy is a reasonable standard treatment for well-selected patients with advanced, inoperable, or metastatic NSCLC. In a significant proportion of patients systemic treatment results in symptom control, maintenance of quality of life and some prolongation of survival when compared with best supportive care alone. The combination of Vinca alkaloid and cisplatin represents a standard option for the initial therapy of patients with advanced NSCLC. A number of new anticancer agents have also been tested and approved for the treatment of advanced NSCLC. More recently, triplet agent chemotherapy has entered clinical practice in treatment of advanced cases of NSCLC

Patients and Methods: 28 evaluable patients of NSCLC with stage III-B or IV were enrolled in this phase III comparative randomized study. One group [A] received [cisplatin 120 mg/m[2] D1, 22] and [etoposide 120 mg/m[2] D1-3 and recycle every 21 days]. The second group [B] received [gemcitabine 800 mg/m[2] D1, 8] then [oxaliplatin 80 mg/m[2] D1] and [VP16 120 mg/m[2] D1-3] and recycle every 21 days. Evaluation of response, toxicity and survival was performed

Results: Age ranged from [36-75] years with a median age of 61 years. The main side effects were nephrotoxicity, neurotoxicity and gastrointestinal tract toxicity in group [A], while hematological toxicity, orthostatic hypotension and neurotoxicity in group [B]. Febrile neutropenia occurred in 37.5% in arm [B] compared to 8.3% in arm [A]. Partial response was higher in triplet agent chemotherapy group. It occurred in 25% and 50% of cases < 60 years in group A and B, while disease progression occurred in [25%] and [18.8%] in group A and B respectively. Partial response occurred in 25% and 43.8% of cases of ECOG [0-1] in group A and B, compared to 8.3% and 12.5% of cases of ECOG -2 in both groups respectively. Improvement of dyspnea, hemoptysis, metastatic bony pains and quality of life was higher in group [B] than group [A]. Median time to disease progression was 5.3 and 7.3 months in group A and B, one-year survival was 33.3% and 56.3% in group A and B respectively

Conclusions: Even though hematological, neurotoxicities and orthostatic hypotension were higher in triplet drug regimen [gemcitabine, oxaliplatin, etoposide], but criteria of subjective improvement and objective response rate were in favor of triplet agent chemotherapy. In our study, replacing cisplatin by oxaliplatin with addition of gemcitabine and etposide increases the efficacy and response in advanced and metastatic NSCLC cases. But it does not seem to have statistically significant effect on survival; so selection of cases that may benefit from the triplet drug regimen is an important issue, especially because it is expensive and toxic regimen. It is better to be given to metastatic or advanced cases with age