Long term results of conservative management in T1 and T2 breast cancer among 170 cases

This retrospective study included 170 patients with histologically proven early breast carcinoma [T1 and T2 /<4 cm]. All patients underwent a conservative surgical resection of the primary tumor and axillary dissection. Postoperative radiation therapy was given as whole breast irradiation to a total dose of 50 Gy over 5 weeks in 25 fractions, followed by a boost 16 Gy over 1 and 1/2 weeks in 8 fractions to the tumor bed. Among the whole group, only 122 patients received adjuvant chemotherapy. At the end of the study with a median follow up period of 60 months, treatment failure was documented in 70 patients. Isolated local recurrence was detected in 26 patients and regional recurrence was reported in only 4 patients. Distant dissemination was recorded in 40 patients. Univariate analysis revealed that age group, menopausal status and adjuvant chemotherapy were significant factors influencing the relapse rate [0.006, 0.006 and 0.032, respectively]. The overall actuarial 5- and 10-year survival rates for the whole group were 80% and 60%, respectively. The overall actuarial 5 and 10-year survivals for patients developing local recurrence were significantly higher than the survival of patients who developed regional or distant relapse denoting a successful salvage treatment. While, the 5- and 10-year distant metastasis free survival rates of the whole group were 64.5% and 49.2%, respectively. Cox regression multivariate analysis showed that the relapse site, adjuvant chemotherapy, age group and number of involved axillary lymph nodes were independent prognostic factors that significantly influenced the over survival. On the other hand, the relapse site and age group were the significant factors that affected the distant metastasis free survival

Carboplatin and weekly paclitaxel in locally advanced [stage IIIB] and metastatic non-small-cell cancer [NSCLC]: a phase II pilot study

A phase II pilot study was conducted to determine the response, toxicity and survival rates of lung cancer patients treated with the combination carboplatin and weekly paclitaxel in stage IIIB and IV non-small-cell lung cancer [NSCLC]. A total of 19 cases were included in the current study. Paclitaxel was administered in a dose of 70 mg/m2 over 1 hour infusion weekly for 3 weeks, followed by 1 week of rest for each 4-week cycle for a total of four cycles. Carboplatin was administered in a dose of [area under the curve] AUC 6 day 1 each cycle following the paclitaxel. Assessment of treatment outcome was carried out following. An overall response rate was achieved in 36.8% of the cases [7/19], all of them were partial remissions and none of the patients achieved complete remission. Seven [36.8%] patients showed stationary disease and the remaining 5 [26.4%] patients showed disease progression. Treatment related toxicities encountered were mainly mild to moderate. Grade 3-4 neutropenia was reported in 3 [18.8%] patients, grade 3 anemia and thrombocytopenia were reported in two [10.5%] patients each. Neutropenic fever was encountered only in one [5.3%] patient. Grade 3 peripheral neuropathy and arthralgia/myalgia was reported in three [15.8%] patients. In general, treatment was well tolerated. Overall median survival was 10 months and 1-year overall survival was 42.5%. The median and 1-year progression free survival results were 8 months and 6.7%, respectively. Cox regression multivariate analysis of various prognostic factors revealed that response to treatment and presence of pleural effusion were significant and independent predictors of overall survival. The combination of carboplatin and weekly paclitaxel is an active and well tolerated regimen. The role of weekly paclitaxel in NSCLC should he better defined in future randomized studies

Primary radiation therapy in adults with localized aggressive NHLs

This retrospective study included adult patients with early stage [I and II] aggressive Non-Hodgkin's lymphoma treated with radiotherapy alone. Out of 50 evaluable cases, the complete remission [CR] rate was 88%. At a median follow up period of 60 months, the actuarial five-year overall and relapse free survival were 62.8% and 60.6%, respectively. Relapse rate was 18.2% and none of the relapses were encountered within the primary radiation portals and all relapses occurred with 30 months. Salvage rate with combination chemotherapy was 42.9% among relapsing cases. In an attempt to identify the various prognostic factors that influence survival; it was found that poor performance status, elevated serum level of LDH and osseous presentation were of statistical significance. Although the survival was low in clinically stage II cases [45%] compared with clinically stage I cases [71%], the difference was not statistically significant. Other factors such as age, pathologic subtype, tumor bulk, constitutional symptoms and radiation doses [within the range 35-40 Gy] did not affect survival significantly. This suggested that patients with low risk stage I disease could be successfully treated with radiotherapy alone. On the other hand, patients with high risk stage I and those with stage II disease are possibly better treated initially with chemotherapy