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Background: Rechallenge of a platinum-based chemotherapy is the most common approach for a recurrent platinumsensitive epithelial carcinoma ovary. However, this carries a substantial risk of cumulative neurotoxicity. Objectives: In the present study, we tried to compare the efficacy and toxicities of gemcitabine pegylated liposomal doxorubicin combination regimen to rechallenge of paclitaxel-carboplatin in this setting. Materials and Methods: A total of 30 patients were included in the study. The patients were randomized into two groups each containing 15 patients. The study group received injection gemcitabine at the dose of 1 g/m2 injection intravenously on day 1 and day 8 and liposomal doxorubicin 30 mg/m2 on day 1 in a 3 weekly cycle up to a total of six cycles in absence of disease progression or unacceptable toxicities. The control group patients were treated with injection paclitaxel at a dose of 175 mg/m2 I/V infusion and injection carboplatin at a dose considering area under the curve 6 in a 3 weekly for six cycles. Results: In the study arm, out of 14 patients, 4 (28.57%) patients had complete response, 6 (42.85%) had partial response, 3 (21.42%) had stable disease, and 1 (7.14%) showed disease progression. In the control arm, 6 (40%) patients out of 15 showed complete response, and 4 (26.66%) partial response. Disease progression was noted in 1 (6.66%) patient. There was less incidence of neurotoxicity compared to the control arm. Conclusion: Chemotherapy with a combination of gemcitabine and pegylated liposomal doxorubicin shows equivalent efficacy in platinum-sensitive recurrent ovarian cancer when compared to rechallenge of platinum-based chemotherapy. The regimen has an acceptable toxicity profile with lesser incidence of neuropathy than rechallenge of paclitaxel-carboplatin combination.
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Background: The first-line treatment for locally advanced squamous cell carcinoma of head-and-neck cancer is concurrent chemoradiation, which is the standard of care. Concurrent chemoradiation improved locoregional control but little impact on distance metastases. Induction chemotherapy (IC) can reduce local disease and distance metastases. Objectives: The purpose of our study is to compare the outcome of disease and toxicity between IC followed by concurrent chemo-radiation and only concurrent chemoradiation in patients of locally advanced unresectable head-and-neck cancer. Materials and Methods: A total of 37 patients were included in IC followed by concurrent chemoradiotherapy group. IC was administered with injection paclitaxel, injection carboplatin, and injection 5-fluorouracil for three cycles. Thirty-six patients were included in Arm B, concurrent chemoradiation group. The total dose of radiation was given in both the Arms 66 Gy in 33 fractions, five fractions per week for 6.3 weeks with concurrent chemotherapy injection cisplatin 40 mg/m2 weekly. Results: Grade 4 skin reaction was 2 (7%) in Arm A and 1 (3.3%) in Arm B. Grade 3 febrile neutropenia was 1 (3.4%) in Arm A and no Grade 3 febrile neutropenia was seen in Arm B. Grade 3 thrombocytopenia was 1 (3.4%) in Arm A and 2 (6.6%) in Arm B. Complete response of disease after 6 months of completion of treatment was 19 (65.5%) in Arm A and 18 (60%) in Arm B. Conclusion: Our study showed no significant difference in disease response regarding locoregional disease control between two groups but distance recurrence can be reduced with IC with manageable toxicity.
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Background: External beam radiotherapy with concurrent chemotherapy has become the mainstay of treatment for locally advanced head and neck cancers. Objective: The objective of this study was to compare paclitaxel to cisplatin as an agent for concurrent chemoradiation in locally advanced squamous cell carcinoma of head neck region in terms of toxicities and response to treatment. Materials and Methods: Biopsy-proven Stage III and Stage IVA head and neck squamous cell cancer patients were included in the study. The study arm patients received concurrent dose of paclitaxel 20 mg/m2 I/V 1 h infusion 4 h before radiation, repeated weekly for 6 cycles. Patients in the control arm received concurrent dose of cisplatin 30 mg/m2 I/V 1 h infusion 4 h before radiation, repeated weekly for 6 cycles. Patients of both arms received a total dose of 66 Gy external beam radiation, 200 cGy/day, 5 fractions in a week in 6.5 weeks treated on a Theratron 780E Cobalt-60 teletherapy unit. Results: Acute Grades III and IV renal toxicity and nausea were reported significantly more number of cases in cisplatin arm in comparison to paclitaxel arm. There was no statistically significant difference observed in the groups in terms of treatment response and failure pattern (χ2 = 3.63, df = 1, level of significance 0.05). On follow-up, up to 6 months, 51.85% of cases are disease free in the control arm and 50.66% of cases in the study arm. Conclusion: Low-dose weekly paclitaxel concurrent with external beam radiation therapy given in conventional fractionation is comparable to concurrent cisplatin in locally advanced head and neck squamous cell carcinoma in terms of efficacy. There is lower incidence of severe renal toxicity and vomiting with concurrent paclitaxel than with cisplatin.
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Background: Lung cancer is the most common cancer diagnosed worldwide. Tobacco smoking is the most important environmental factor associated with the development of lung cancer. However, a large number of patients with lung cancer have no history of smoking frequently among female patients. There are no enough data in Eastern India regarding epidemiological study of lung cancer. Objectives: The aim of our study was to evaluate the prevalence and pattern of lung cancer in our institution (NRS Medical College and Hospital). Materials and Methods: Our study was a retrospective analysis of prospectively collected data for newly diagnosed adult patients. All patients were registered only after lung cancer diagnosis was confirmed by histopathological and/or cytological examination. The following information was collected from the database such as age, sex, smoking status and histological type, disease location, and stage. Results: A number of male patients were 786 (82%) and a number of female patients were 172 (18%). 692 (72.2%) patients had a history of smoking and 266 (27.8%) patients had no history of smoking in their life. Among the non-smoker patients, female patients were 147 (55.3%) and male patients were 119 (44.7%). 80% of patients came from rural areas and 20% of patients came from urban areas. In our study; histologically, the adenocarcinoma was 398 (41.6%) found most prevalent which is followed by squamous cell carcinoma 365 (38.1%). Conclusion: Adenocarcinoma lung with the right upper lobe involvement was prevalent in our study and non-smoker female patients were predominant. The major etiological factor was smoking. Awareness in the society is needed about cancerous effect of tobacco smoking for reducing the incidence of lung cancer.
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Background: The worldwide epidemiology of lung cancer is ever changing, and non-squamous non-small-cell lung cancer (NSCLC) in never-smoking women has been gradually increasing. In Indian population, adenocarcinoma lung was more common in never smoker persons. Approximately 70–80% of lung cancer cases are NSCLC. Most of NSCLC patients present with advanced disease or brain metastasis. The prognosis of patients with advanced NSCLC is generally considered poor, with a median survival of 9–11 months and a 2-year survival around 20–30%. There are no enough data in Eastern India regarding disease response, treatment-related toxicity, overall survival, and progression-free survival in advanced adenocarcinoma lung treated with chemotherapy and radiotherapy. Objectives: The objectives of this study were to compare disease response, toxicity, overall survival, and progression-free survival in advanced adenocarcinoma lung treated as first line with pemetrexed/carboplatin versus paclitaxel/carboplatin. Materials and Methods: A total of 123 patients were placed in Group A and another 117 in Group B (stage III disease). Group A patients were treated with pemetrexed 500 mg/m2 and carboplatin area under the concentration (AUC) 6 every 3 week. Group B patients were treated with carboplatin at dose AUC 6 and paclitaxel 200 mg/m2 administered 3 weekly. Dose of radiation was planned 60 Gy in 30# for 6 weeks in conventional fractionation schedule 3 weeks after completion of chemotherapy. Results: Hematological toxicities were Grade 3 anemia 27 (22%) in Group A and 29 (24.8%) Group B, Grade 3 neutropenia 34 (27.6%) in Group A and 33 (28.2%) in Group B, and Grade 4 neutropenia 5 (4%) in Group A and 4 (3.4%) in Group B. Grade 3 sensory neuropathy was seen in Group B 17 (14.5%). There was no Grade 3 or Grade 4 sensory neuropathy in Group A. Grade 3 fatigue was seen in Group B 19 (16.2%). Grade 3 diarrhea was seen 9 (7.3%) in Group A and 8 (6.8%) in Group B. Overall response rate was 63 (51.2%) in Group A and 43 (36.8%) in Group B. The complete response of disease was 19 (15.4%) in Group A and 6 (5.1%) in Group B. The partial response was 44 (34.6%) in Group A and 37 (31.6%) in Group B. Stable disease was 41 (33.3%) in Group A and 51 (43.6%) in Group B. The progressive disease was 19 (15.4%) in Group A and 23 (19.6%) in Group B. Median overall survival was 14.6 months in Group A and 14.4 months in Group B. Conclusion: In our study, pemetrexed/carboplatin provides better efficacy and tolerance, a reduced need for supportive therapies, and more convenient administration than paclitaxel/carboplatin for the first-line treatment of patients with advanced adenocarcinoma lung.
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Background: Esophageal carcinoma is high prevalence in Asia, including India and most of the patients present in advanced and inoperable stage. Most of the patients have poor nutritional status and low performance status. These patients are unable to tolerate radical treatment. Prognosis of these patients is very poor. There are no enough data of prospective study in palliation of dysphagia of the patients with inoperable esophageal carcinoma with radiotherapy in Eastern India. Objectives: The main objective of our study was palliation of dysphagia of the patients with inoperable esophageal carcinoma with radiotherapy. Materials and Methods: The study was done with 43 patients with histopathologically proven squamous cell carcinoma and/or adenocarcinoma at thoracic esophagus, intraluminal brachytherapy feasible. Patients were received external beam radiotherapy palliative dose 30 Gy in 10 fractions for 2 weeks followed by intraluminal high-dose rate brachytherapy 6 Gy per fraction per week for 2 weeks. Results: In our study, the mean age of the patients was 58 years (age range 48 years–70 years). 1 month after completion of intraluminal brachytherapy, a number of patients with improvement of dysphagia were 34 (79%). The improvement of dysphagia was maintained 25 (73.5%) patients at 3-month completion of treatment and 14 (56%) patients at 6-month completion of treatment. The median duration of dysphagia relief was 5.2 months. Post-radiotherapy complications as chest pain were seen in 10 (23.2%) patients, esophageal strictures were developed in 7 (16.3%) patients, ulcerations were in 4 (9.3%) patients, and esophageal fistula was developed in 1 (2.3%) patient. Conclusion: The patients with advanced inoperable or metastatic esophageal carcinoma and poor performance status, palliative radiotherapy are effective modality of treatment for the improvement of dysphagia.