Concurrent cisplatin and concomitant boost radiation therapy in the treatment of locally advanced squamous cell cancer of the head and neck

To determine the efficacy and toxicity of a treatment regimen that combined concomitant boost accelerated radiation therapy with cisplatin, in patients with locally advanced squamous cell cancer of the head and neck. Thirty-two patients with stage III to IV squamous cell cancer of the head and neck were enrolled in this study. They were treated with 70Gy radiotherapy including concomitant boost [CB] regimen [1.8Gy/d, weeks 1 through 6] then [1.6Gy second daily fraction, during weeks 1 through 6] then [1.6 Gy second daily fraction, during weeks 5 and 6 and two cycles of concurrent cisplatin 100mg/m[2] on days 1 and 22. Tumor and clinical status were assessed and also regimen's toxicities were graded. Thirty-two patients were evaluable for response and toxicity. Median follow-up was 28 months [range 4-38 months]. Primary sites were: Oral cavity 6, oropharynx 7, hypopharynx 12, and larynx 7. Sixty nine percent of patients had N[2]/N[3] disease, 81% had T[3]/T[4] disease. Twenty-four patients had a complete response 75%. Eight patients had persistent disease, progressive disease in 5 patients [15.6%] and stable disease in 3 patients [9.3%]. Local control was good among 24 patients obtained a complete response, 15 remained free of local recurrent disease, 9 patients have relapsed. Locoregional relapse free survival was 62.5% [15/24] at 2-years. However, considering the 8 patients with persistent disease, there were 17 patients [53.1%] failed at 2-years and locoregional failure-free survival was 46.8% [15/32]. Six of 32 patients [18.7%] developed distant metastases at 2-years and locoregional failure relapse and 4 patients as subsequent failure, and distant metastases failure free survival was 81.3% [26/32] at 2-years. No patients developed locoregional relapse, or distant metastases during the third year. The estimated overall survival was 65.5% at 2-years and 56.2% at 3-years. The rate of Grade 3 and 4 mucositis was observed in 65.6% of patients. Acute skin reaction was severe and protracted, grade 3 was observed in 40.6% of patients and the median duration of skin reaction was 5 weeks. Grade 3 and 4 anemia was observed in 15.6%, febrile neutropenia in 12.5%, and no grade 4 thrombocytopenia. Grade 3 acute dysphagia was observed in 50% of patients. Chronic dysphagia was observed in 12.5%, permanent xerostomia 9.3%, and trismus 6.2%. Concomitant boost [CB] radiotherapy with cisplatin is feasible and active approach for combining chemotherapy and radiation in the management of locally advanced head and neck cancer. It is associated with significant but acceptable toxicity profile. A continued focus on late effects, functional outcomes, and rehabilitation is important as locoregional approaches to the treatment of advanced head and neck squamous cell carcinoma

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

Weekly irinotecan in patients with progressive or rapidly recurrent colorectal cancer pretreated with fluorouracil-based chemotherapy

To prospectively evaluate efficacy and tolerability of weekly irinotecan [CPT-11] in patients with advanced colorectal carcinoma [CRC] that had recurred or progressed following fluorouracil [5-FU]-based therapy. Forty eight patients were enrolled in this study. They were treated with irrinotecan 125 mg/m[2] intravenously [IV] every week for 4 weeks, followed by a 2- week rest. All patients were accessible for toxicity and only 44 patients completed one full course of therapy and were accessable for response. Nine patients [20.5%] attained partial response [95% CI, 10% to 27%] and no cases achieved complete response. The median duration of response was 7 months [range4to 11.5 months]. The median survival time was 10 months [95% CI 8.2 to 13.1 months] and the 1-year survival rate was 43.8% [95% CI, 33% to 53%]. Median time to progression was 4.0 months [95% CI, 2.6 to 5.1 months]. Grade 3-4 diarrhea was observed in 17 patients [35.4%], grade 3-4 nausea and vomiting in 3 patients [6.3%] and 4 patients [8.3%] respectively. Grade 3-4 neutropenia was reported in 5 patients [31.3%]. Grade 3-4 febrile neutropenia or infection affected only 2 patients [4.2%]. Weekly schedule of irinotecan has demon strated significant activity against colorectal cancer that has progressed during or shortly after treatment with 5-FU-based chemotherapy. Diarrhea is the most frequent dose limiting toxicity but can be substantially reduced through appropriate interventional management

Combined chemoradiotherapy versus radiotherapy alone in patients with esophageal cancer

This study included 61 patients with locally unresectable esophageal cancer. Thirty-one patients received radiotherapy alone [RT group], the dose of radiotherapy ranged between 60-64 Gy/6-6.5 weeks, while the remaining 30 patients received radiotherapy in a dose ranged between 45-50 Gy/4.5-5 weeks plus chemotherapy [CT-RT group]. Chemotherapy [consisting of 5-fluorouracil, leucovorin and cisplatin] was given 2-3 cycles before radiotherapy and further 2-3 cycles were given after radiotherapy. The study concluded that combined modality therapy can improve the outcome in locally unresectable esophageal carcinoma with significantly better local rate, survival, progression-free survival rates and much reduction in the incidence and timing of treatment failures

Evaluation of different treatment modalities in dukes B and C rectal adenocarcinoma

A retrospective analysis of 291 eligible patients with carcinoma of rectum and rectosigmoid was undertaken. The patients were assigned to one of four treatment groups: Preoperative chemoradiotherapy [CRT], followed by postoperative chemotherapy [POCT], postoperative radiotherapy [PORT], postoperative chemotherapy [POCT] and postoperative CRT. The results showed that with a median follow up of 57.2 months, the 5-year overall survival was 47.8%, the 5-year DFS was 42.4%. The 5-year OS was 48.3% in the preoperative CRT group, 42.4% in PORT group, 34.3% for POCT group and 55% in the POCRT group. The 5-year DFS was 44.8%, 39.4%, 31.5% and 50% in the four treatment groups, respectively. Local failure [LF] occurred in 14.1% of the patients and distant metastasis [DM] was observed in 28.9%

Primary gastrointestinal non-Hodgkin's lymphoma; clinical features, management and prognosis of 56 patients

In this study, 56 patients with primary gastrointestinal tract [GIT] non-Hodgkin's lymphoma [41 males and 15 females, mean age 41.5 years] were retrospectively evaluated. Twenty-nine patients were treated with curative surgery and adjuvant chemotherapy and 19 patients were treated with non-curative surgery plus chemotherapy and 8 patients were treated with curative surgery alone. All patients were included in the response analysis and survival. Only 33 patients were included in the disease free survivals as they had a complete response after different treatment modalities. The study confirmed the prognostic value of stage of the disease, curative surgery plus adjuvant chemotherapy in patients with primary gastrointestinal tract non- Hodgkin's lymphoma [PGITL]

Activity and safety of navelbine and fractionated dose doxorubicin as first line therapy for advanced breast cancer

Very promising results have been obtained by vinorelbine-doxorubicin combination in the treatment of advanced breast cancer. However previous experience with schedules in which the doxorubicin dose was administered on day 1 alone were associated with a high level of cardiac toxicity. There is evidence that fractionating the dose of doxorubicin and administering it at weekly intervals may reduce the cardiac toxicity without substantially impairing the efficacy. To asses the efficacy and tolerability of vinorelbine and fractionated dose doxorubicin [the total dose was divided into two administrations on days 1 and 8] in patients with advanced breast cancer. Fifty-two patients with locally advanced or metastatic breast cancer who had received no prior chemotherapy except in an adjuvant setting were entered into the study. They were treated vinorelbine 25 mg/m[2] plus doxorubicin 25 mg/m[2] both administered in day 1 and 8 every three weeks. Objective responses were observed in 30 patients [71, 4%]. There were 7 [16.6%] complete responses [CR] and 23 [54.8%] partial responses [PR]. In addition 10 patients [23.8%] had stable disease [SD] and 2 [4.8%] progressed while on treatment. Twenty of 28 patients with visceral disease responded to treatment [71.4%]. The median duration of response was 11.5 months [range, 2 to > 24+] and the median overall survival was 21.5 months [range 2 to > 36+]. Hematological toxicity was predominantly related to neutropenia with Grade 3-4 reported in 18.1% of the cycles. Alopecia was reported in 66.7% of the patients. Grade 3 nausea/vomiting in 3.6% of the cycles. No clinically significant cases of cardiac dysfunction were seen. The fractionated schedule of vinorelbine and doxorubicin is associated with excellent tolerability [especially cardiac], coupled with high levels of activity comparable to those observed using the un-fractionated regimen