Randomized study of concurrent carboplatin, paclitaxel, and radiotherapy with or without prior induction chemotherapy in patients with locally advanced non-small cell lung cancer

Multiple concepts of combined modality therapy for locally advanced inoperable non-small cell lung cancer have been investigated. These include induction chemotherapy, concomitant chemo-radiotherapy, and radiation only. To date, combined modality therapy specially the use of concomitant chemo-radiotherapy has led to promising results and was shown to be superior to radiotherapy alone in phase II studies. However the optimum chemo-therapeutic regimen to be used as well as the benefit of induction chemotherapy before concomitant chemo-radiotherapy are yet to be determined. Based on these observations, we investigated the use of paclitaxel and carboplatin concomitantly with radiotherapy and the benefit of prior two cycles induction chemotherapy. In this trial 60 patients with locally advanced inoperable non small cell lung cancer, good performance status and minimal weight loss have been randomized into 3 groups each of 20 patients. Group A received induction 2 cycles paclitaxel [175 mg/m2] and carboplatin [AUC 6] on day 1 and 28th followed by concomitant paclitaxel [45 mg/m2] and carboplatin [AUC 2] weekly with radiotherapy. Group B received concomitant carboplatin, paclitaxel [same doses as in group A] and radiotherapy with no prior induction chemotherapy. Group C received only radiotherapy to a total dose of 60 Gy in conventional fractionation. A total of 60 patients were enrolled in this study between 1998 and 2000. Pretreatment characteristics, including age, gender, performance status, histological features and stage were comparable in each group. The incidence of oesophagitis was significantly higher in group A and B than in group C [p>0.023]. Hematological toxicities was also significantly higher in group A and B than in group C [p=0.003]. The response rate was significantly higher in group A and B than in group C [75%, 79%, and 40% respectively] [p=0.02]. The time to in-field progression was significantly higher in group B as compared to group A [48% vs. 32% failure in 2 years respectively] [p>0.001]. The median 2 year survival was significantly higher in group A and B than in group C [p=0.039] but no statistical difference was seen between group A and B. Combined chemo-radiotherapy resulted in better response and survival as compared to conventional radiotherapy in the treatment of locally advanced non-small cell lung cancer Early initiation of radiation with concomitant chemotherapy resulted in prolonged time to infield progression. On the other hand, two cycles of induction chemotherapy did not show any significant difference regarding the response or survival. Weekly paclitaxel and carboplatin plus radiotherapy is a well tolerated regimen for outpatients with encouraging results

Electron beam therapy shielding material and clinical applications

The relative percent dose reduction of different electron energies [5, 9 and 13 Mev] were measured using Mevatron 74 Linear accelerator and different shielding materials [lead, aluminium, copper and stainless steel]. A step wedge of each was used during this wrk, the steps thickness ranged between 2 mm and 20 mm. It was found that 95% attenuation for energies [5, 9 and 13 Mev] were obtained by 2, 4 and 6 mm thickness of lead respectively compared to the attenuation obtained by other materials of the same tickness

Histopathological study and treatment results in management of pleural mesothelioma

Nineteen patients with malignant pleural mesothelioma seen at the Alexandria University Hospitals between 1987 and 1991 were the material of this study. The tumours were classified as epithelial, sarcomatous or of mixed type, also four samples from pleural effusion were subjected to routine cytological examination as well as electron microscopic studies. Most of the patients presented with locally advanced disease, the overall response to irradiation and chemotherapy was 55.3% with complete response rate of 33.3%. The response to treatment was correlated to some prognostic factors. The duration of response ranged between three and fifteen months and the median survival for responders was twenty months