CMF with or without medical castration in pre-menopausal women with node positive breast cancer

The prognosis of breast cancer in young women is generally considered to be unfavorable. Thus adjuvant therapy post surgical intervention is essential in many patients especially those with high risk [e.g large tumors or positive nodes]. However the presence of steroid hormone receptors in the primary tumors of young ladies may represent a suitable target for therapy in this group of patients. In the current study 100 premenopausal women with positive axillary lymph nodes and have estrogen and/or progestrone receptor positive tumors were randomized after local therapy of the breast cancer into two groups; Group I received adjuvant chemotherapy CMF for a total of six cycles then medical castration with LHRH agonist for two years and Group II received the same chemotherapy as in group I for six cycles. Adjuvant radiotherapy was given in the majority of patients in both treatment groups. After median follow up of six years, there was no statistical significance difference between both groups as regard the disease free or overall survival P=0.537 and 0.526 respectively. The toxicity reported in both groups was quite mild with only increase in the rate of hot flashes in the medical castration group. This study confirm the safety and tolerability of addition of medical castration to adjuvant chemotherapy which can be easily accepted by young women because of its reversible action, however it didn't answer many important questions about the optimum duration of ovarian suppression and the need for combined hormonal therapy like addition of tamoxifen to ovarian castration and sequence of different therapy

Concomitant chemotherapy and radiotherary in locally advanced cervical cancer

Radiotherapy has been the standard therapy for locally advanced cervical cancer for decades. Neoadjuvant chemotherapy had failed to improve survival in these patients. Concomitant combination of chemotherapy and radiotherapy is promising in improving survival in many clinical trials with risk of increasing radiation reactions. We report a study comparing the combination of weekly cisplatin concomitant with irradiation versus irradiation alone in the same dose and technique. Sixty patients with cervical cancer [stage JIB-I VA] were randomized into two arms; either weekly cisplatin 40 mg/m2 plus radiotherapy [group A] or radiotherapy 45 Gy whole pelvis followed by intracavitary irradiation [to raise the dose to point A to 80 Gy] then parametrial irradiation with central shield for another 15 Gy [group B]. There was a significant difference in response to treatment in both arms [90% Vs. 69% respectively F<0.05]. Also, there was a statistically superior progression free and overall survival in the concomitant group [P<0.043 and p<0.0336]. The toxicity reported was generally limited in both groups and of lower grade despite being significantly higher in patients who received combination treatment. We conclude that combined modality is feasible and could be well tolerated in our patients population

Dexamethasone, ifosfamide, cisolatin and etoposide with involved field radiotherapy in relapsed or refractory non hodgkin s lymphoma

To evaluate the tolerance and efficacy of dexamethasone, ifosfamide, cisplatin, and etoposide [DICE] combination chemotherapy regimen, as salvage the rapy for relapsed or refractory patients with intermediate and high-grade Non-Hodgkin's lymphoma [NHL]. It is a prospective trial that included forty-patients with refractory or relapsed NHL. All patients had a histological confirmation of intermediate or high-grade NHL and received DICE regimen. Toxicities were recorded according to the WHO scoring. Radiotherapy was given as involved-field [36 Gy in 20 fractions, 180 cGy per fraction] and began three weeks after the last cycle of chemotherapy. Patients were evaluated for response rate [RR], time to treatment failure [TTF], overall survival [OS] and prognostic factors that affect these variables. The overall response rate to treatment was 26.7%, and 35.5% achieved partial response. By adding involved field radiotherapy to chemotherapy, CR increased to 37.8%, and the overall response rate was 60%. Significant factors that affect response rate were stage at relapse, p=0.0001, IPI p=0.002], and disease status [p=0.03]. Time to treatment failure was significantly affected by IPI [p=0.04]. The median time to treatment failure was 8 months while the median OS was 12.5 months. Grade 3 and 4 neutropenia were observed in 31%, nausea and vomiting in 15.6%. Most of the chemotherapy toxicities were mild or moderate and manageable. DICE regimen is an effective salvage chemotherapy for patients with intermediate and high grade NHL. Most of the chemotherapy toxicities were mild or moderate and manageable. Neutropenia was the main dose-limiting toxicity

Quality of life and efficacy of vinorelbine and fluorouracil versus fluorouracil, adriamycin and cyclophosphamide chemotherapy in advanced breast cancer

To assess the effect of vinorelbine and 5-fluorouracil [NF] in comparison to 5-fluorouracil, adriamycin and cyclophosphamide [FAC] chemotherapy regimen on the treatment outcome and their impact on the quality of life in patients with advanced breast cancer [ABC]. The prognostic significance of the quality of life on survival was also studied. It is a phase Ill study that included 104 women with ABC who were randomly assigned to receive either FAC [Group I] or NF regimen [Group II]. Patients were evaluated for response rate [RR], time to tumor progression [TTP], overall survival [OS] and toxicities. The quality of life was assessed using Spitzer's quality of life index [QLI]. Patients who received FAC achieved significantly higher overall RR, compared to those who received NF regimen [69.2% versus 50.0%, p=0.04]. A significantly higher median TTP was achieved in patients who received FAC compared to those received NF [11.4 and 6.1 months] respectively with p=0.03. A higher median OS was observed in group I patients compared to group II 19.0 versus 16.4 months, however, the difference in OS was not statistically significant [p=0.4]. The quality of life index [QLI] was proved to be an independent factor affecting TTP in group I [p=0.001] and in group II as well [p=0.01] As regards OS, QLI has no significant prognostic influence in either groups. Since improvement in TTP is a major goal where treatment is mainly palliative, our impression is that FAC is still one of the standard anthracycline-containing regimens in ABC. Vinorelbine, 5-fluorouracil can be used as second-line or as first-line regimen in cases where anthracyclines are not appropriate. Quality of life can be used as a predictor for progression-free survival

Prognostic factors in patients with unresectable liver metastases from colorectal cancer

To determine the prognostic factors in patients with unresectable liver metastases from colorectal cancer. The medical records of 112 patients with unresectable liver metastasis from colorectal cancer were reviewed. The series included 39 patients who were treated with fluorouracil and 73 patients were treated with fluorourail and folinic acid [leucovorin]. Univaraite and multivariate analyses of the prognostic factors were done using the Cox proportional hazard model. Survival curves were plotted using the Kaplan-Meier method. The actuarial overall survival [OS] for the whole series was 64.2% at one year and 29.5% at two years, while the progression-free survival [PFS] was 47.2% at one year and dropped to 12.5% at two years. Several significant factors were identified by univariate analysis. These factors were; age, performance status, surgical resection of the primary tumour, extent of liver metastases [distribution, number and size of the largest liver deposit], CEA level, liver enzymes, total bilirubin, prothrombin time, extrahepatic disease, time to diagnosis of liver metastases, and response to chemotherapy. The modulation of fluorouracil by folinic acid markedly increased the overall response rate [RR], 34.2% versus 17.9% for fluorouracil alone [p=0.291], but with no significant impact on survival, 32.2% versus 25.0% two year OS, respectively. In multivariate analysis five independent determinants of OS were identified. Factors that had an adverse effect on survival were in the following order: size of the largest metastatic liver deposit equal to or more than 5 cm [Hazard ratio [HR]= 3,31, p=0.0001], time to diagnosis less than 24 months [HR-2.75, p-0.001], poor performance status [MR-2.60, p=0.01] and elevated bilirubin level [MR-1.7, p=0.05]. Surgical resection of the primary tumour was associated with improved survival [HR=0.34, p=0.01]. Our data elucidated the prognostic value of the size of liver metastases, time to diagnosis, performance status, serum bilirubin and surgical resection of the primary. The addition of folinic acid to fluorouracil markedly improved the response but with only a trend towards better survival

Anepidemiological study of cancer larynx in Alexandria

The purpose of this work is to study the pattern of cancer larynx in Alexandria and to investigate some factors associated with its occurrence. All cases of cancer larynx admitted to Alexandria major hospitals [Main University Hospital and Gamal Abdel-Nassr Health Insurance Hospital] during 1994 were included in the study. For each case a control matched for age and sex was chosen from patients admitted to the same hospital for causes unrelated to cancer larynx. A questionnaire was completed by interview with the patient or his/her companion to collect the data concerning basic epidemiologic data, medical history, habits and exposures. Majority of cases occurred among males [84%]. The peak of occurrence was observed in elderly persons [65-74 years]. Supraglottic cancer larynx constituted 84% of all cases in men and 78% in women. The risk of cancer larynx was 12 times higher among smokers [OR = 12.27], 8 times among those who drink alcohol [OR = 8.75], 4 times in those with history of voice strain [OR = 4.28] and 2.5 times in those with low and very low social standards [OR = 2.55]. Exposure to wood dust increased the risk of cancer larynx 5 times. After controlling confounders by using multivariate logistic regression low social class, smoking, exposure to wood dust and voice strain remained significant risk factors [OR = 2.09, 10.6, 3.8 and 2.4, respectively], but the effect of alcohol intake was deleted. No exposure for irradiation of neck for thyroid, oil, leather, textile materials or precancerous lesions was found among cases or controls. In conclusion, cancer larynx is disease of old age and low social class. Smoking, alcohol intake, wood dust and voice strain increase the risk of occurrence of cancer larynx