Partial brain irradiation [PBI] or whole brain irradiation [WBI], the justified solution in the management of patients with malignant astrocytomas

Postoperative conventional radiotherapy [RT] improved survival for glioblastoma multiforme [GBM] and astrocytoma anaplasticum [AA], but local recurrences were still a reason of poor outcome. The optimum RT in GBM and AA patients has not been clearly defined by prospective randomized trials. Today, individually constructed partial brain irradiation [PBI] remains to be accepted model, but, however, controversies still exist with respect to its size. The main purpose of this study was to compare response and acute radiation toxicity in patients with malignant astrocytoma treated by PBl or whole brain irradiation [WBI]. Thirty-four patients with supratentorial malignant astrocytomas were enrolled in this study and treated between January 2003 and December 2004 in the Clinical Oncology Department, Faculty of Medicine, Alexandria University. Patients were randomized in two therapeutic groups according to the used treatment volume. In group I PBI covered the contrast-enhancing lesion with 2 cm added margins. The dose was 50 Gy/25 fractions over 5 weeks followed by boost dose of 15 Gy/5 fractions per week. Group II patients were treated by WBI to a dose of 40 Gy/20 fractions and a boost dose of 25 Gy in 12 fractions. Complete response was achieved in 35.3% and 11.8% of patients in group I and group II respectively. Improvement of KPS to 90-100% by 76.5% of group I and 41.2% of group II [p=0.0365]. Four patients had recurrence in both groups I and II with a median recurrence time of 6.8 and 4.5 months respectively. The median survival time was 9.95 months for group I and 9.54 for group II [p=0.761] and the one year overall survival of both groups I and II was 59% and 48% respectively. Although the limitation of the treatment volume does not prolong the duration of survival, its application is justified to decrease brain necrosis. Due to rescuing the normal brain tissue, PBI leads to a possibility for applying high radiation doses that could improve the local tumor control and more exact localization of the lesion contributes to more efficient treatment

study of pre and post chemoradiation 5-FU and gemcitabine for combined treatment of advanced unresected non metastatic pancreatic adenocarcinoma

To evaluate local effects and acute toxicities of involved field irradiation with concurrent gemcitabine [GEM], 5-flourouracil [5FU] for unresectable pancreatic carcinoma. Thirty patients with unresectable pancreatic carcinoma were treated between July 2002 and April 2004 with neoadjuvant combination chemotherapy 5FU [500 mg/m[2]] and GEM at 1000 mg/m[2] days 1, 8 and 15 [one cycle] followed by chemoradiotherapy [CCRT] using a combination of GEM 75mg/m[2] /week and bolus 5FU [500mg/m[2]] given concurrently days 1-3, at the beginning of each 20Gy of radiotherapy to a median radiation dose of 50.4 Gy in 1.8 Gy daily fractions to a standard pancreatic field. Eighteen males and 12 females were enrolled. Median age was 62.5 [range 47-74 years], ECOG PS 0/1 = 10/11 patients. As for the primary site, only five patients [16.7%] achieved a complete response at one year; however, seven additional patients attained >50% tumor reduction for an overall response rate of 40%. Grade 3 and 4 Leukopenia [33% and 6.7%], thrombocytopenia [40 and 16.7%], nausea/vomiting [20% and 0%]. Median survival time and survival at 1 year were 14 months and 62.5%, respectively, for the entire group. Involved-field irradiation with concurrent GEM/5FU was well tolerated without compromising locoregional effects. Further studies with other combinations of GEM and 5-FU are not compelling, and clinical trial resources should address other combinations and novel agents

comparative study of combination chemotherapy with docetaxel/cisplatin versus gemcitabine/cisplatin for locally advanced non-small cell lung cancer

Multiple concepts of combined modality therapy for locoregionally advanced inoperable non-small cell lung cancer [NSCLC] have been investigated. These include induction chemotherapy [CT], concomitant chemoradiotherapy [CRT], and intensified radiation therapy [RT] schedules. Concomitant chemoradiotherapy has led to promising results when combination chemotherapy regimens were used in the phase II setting. Induction chemotherapy followed by CRT has been proposed as one of the best treatment for locally advanced NSCLC, although both loco-regional and distant control of micrometastatic disease remains suboptimal. A comparative study was performed to investigate the efficacy of neoadjuvant combination chemotherapy using docetaxel [D] and cisplatin [C] versus gemcitabine [G] plus cisplatin [C] in patients with locally advanced NSCLC and the radiosensitization effects of both docetaxel and gemcitabine. From January 2003 to July 2004, 22 eligible patients were recruited, excluding those with malignant pleural effusion or vena cava syndrome and brain metastasis. Patients were treated as follows: A] Neoadjuvant chemotherapy: Chemotherapy-naive patients with stage III NSCLC were randomized to receive either D 90 mg/m[2] over one hour, followed by C 80 mg/m[2] on day 1 [Arm I] or G 1250 mg/m[2] on days land 8, C 80 mg/m[2] on day 1 [Arm II]. Treatment was repeated every three weeks for 3 cycles for both regimens. B] Concomitant chemoradiotherapy: Responsive and stable patients received CRT in the form of D 36 mg/m[2] over one hour, or G 300 mg/m[2] on days 1,8,22 and 29 of radiotherapy for both arms [at least 4 hours before RT] which was given in a total dose of 60 Gy/6 weeks, in daily fractions of 2 Gy for 5 days/week. The median age was 61 years [range 48-73], M/F = 18/4; ECOG PS 0-1, [7-15]; histology: Sq.C.C.=10, adenocarcinoma=5, large cell=4, undifferentiated=3; stage IIIAN2= 10[45.5%], IIIB=12[54.5%]. Myelosuppression was the predominant toxicity. WHO grade 3-4 anemia, granulocytopenia and thrombocytopenia were observed in 9.1%, 18.2%, 27.3% of patients in arm I and 9.1%, 18.1%, 45.5% in arm II respectively. Sensory neuropathy developed in 27.3% of arm I. After CT cycles the objective response rates [ORR] were 63.6% [2 CR and 5 PR] and 54.5% [one CR and 5 PR] in arms I and II respectively. After the addition of CRT, the ORRs were increased to 72.7% and 63.6% in both arms respectively. At a median follow-up of 12.4 months, the one-year survival was 75% and 65% in both arms. This study demonstrated that CT followed by CRT for responsive and stable patients was feasible and effective for both arms. Neither esophagitis nor pneumonitis was dose-limiting toxicities with these treatment regimens and no other dose-limiting toxicities were observed. Moreover, the good tolerability profile has clinical implications in terms of patient quality of life