Radical chemoradiotherapy in the treatment of young and elderly patients of muscle invading transitional cell carcinoma of the bladder

This study which was conducted from January 1995 to December 1999 included two groups of patients, the young group [n 19] <50 Y [Range 30-50Y and Median 43Y] and the old group [n 18] >50Y [Range 52-70Y and Median 62Y]. All patients had pathologically documented muscle invasive transitional cell carcinoma of the bladder and all had a Karnofsky performance status of >70. Treatment protocol included cytoreductive transurethral resection of the tumor, 2 cycles of MVAC chemotherapy [methotrexate, vinblastine, doxorubicin and cisplatin] and radiotherapy [45 grays [GY] on pelvic volume with concurrent cisplatin [20mg/m[2] on days 1-5]. Response was determined by cytoscopic examination with tumor site biopsy and urine cytology. If there was a complete response, radiotherapy continued to a total dose of 65GY, if there was no complete response, cystectomy was performed. Of the young group [n 19] 12 patients 63% had complete response, 5 [26%] had partial response and 2 [11%] had no response. In the old group [n 18], 9 patients [50%] had complete response, 6 [33%] had partial response and 3 [17%] had no response. A significant difference in response to treatment was detected between T2 and T3a and between Bilharzial and non Bilharzial groups of patients P [0.037] and P [0.002] respectively. Overall survival for the young group was 50%, 39%, 30% in the 2[nd], 3[rd] and 5[th] years of follow up respectively, while in the old group it was 45%, 35%, and 30% for the 2[nd], 3[rd], 5[th] years of follow up respectively. Severe toxicity was uncommon. The most frequent toxicities being emesis and cystitis in both groups. The difference between both groups regarding toxicity, tolerability and response to treatment was not statistically significant. This protocol of treatment can be used for both young and elderly patients of muscle invading transitional cell carcinoma of the bladder especially in low stage non Bilharzial cancer despite a few well tolerated short term complications

Evaluation of vinorelbine and doxorubicin as first line treatment for metastatic breast cancer in Suez Canal Area

Forty three patients with metastatic breast cancer, 25 premenopausal, 18 post menopausal who had received no prior chemotherapy except CMF [cyclophosphamide, methotrexate and 5-fluoromacil] as adjuvant treatment for their disease were included in this study. Navelbine was administered at 25 mg/m[2] by thirty minutes intravenous infusion on days I and 8 and doxorubicin at 50 mg/m[2] by slow IV infusion on day I with each course repeated at 3 weeks intervals. Patients were treated for a maximum 11 cycles. Objective overall response was seen in 30 patients. Complete response [CR] was seen in 9 patients [20%] and partial response [PR] in 21 patients [48%]. Overall response was seen in both visceral and non visceral metastases, 18 out of 20 patients [90%] and 12 out of 23 patients [52%] respectively. The response rate is not affected by the extent of the disease. The main dose limiting toxicity was neutropenia, it was seen with its grade 3, 4 in 35% of the patients. We have no cardiac toxicity in our patients. while the other non hematological toxicity [alopecia, vomiting, constipation, neuropathy] were mild, and tolerable. Navelbine/doxorubicin is an active combination which is generally tolerated and can he strongly recommended for the management of those patients requiring an aggressive approach to control widespread metastatic breast cancer

value of carcinoembryonic antigen [C.E.A.] determination in breast cancer

One thousand RIAS were done to measure plasma CEA using Hoffmann La Roch Kits. In 99% of 96 normal healthy individual and cases with benign breast masses. Plasma CEA level was within the normal range m = 0.64 ng/ml + 0.81, and for benign breast masses m = 0.54 ng/ml+1.06, p> 0.5. In 51.4 of 141 patients with cancer breast a value higher than normal was observed m = 4.04 ng/ml + 4.03, p< 0.01. In 27 cases with stage II the plasma CEA value is m = 2.3 ng/ml +2.59. In 36 cases with stage III the plasma CEA value is m= 5.48 ng/ml + 5.2, and when compared p< 0.01. In nine cases treated by radical radiotherapy, there was significant reduction in plasma CEA one month later, m =0.55 ng/ml + 0.77, p< 0.01. In 17 patients with metastatic breast carcinoma treated by combination chemotherapy, there is detectable reduction in CEA levels after eight courses, m = 5.08 ng/ml +2.86, p = 0.02. In 63 patients surgically resected there was an obvious drop m = 2.21 ng/ml + 2.88. CEA estimation is a good prognostic index and a pointer for treatment effectiveness in carcinoma of the breast