COVID-19 vaccination knowledge, attitudes, risk perception, and intention among health workers in a district in Manila, Philippines

Background@#Vaccination is an effective public health measure. Health workers, who are at risk of acquiring infectious diseases due to their occupation, are important targets of vaccination. However, previous studies have shown varying rates of vaccine uptake among health workers. @*Objective@#This study aimed to determine the knowledge, attitudes, risk perceptions, and intention towards COVID-19 and vaccination of Filipino health workers in the city of Manila, Philippines. @*Methodology@#The study employed a sequential mixed methods design. A self-administered questionnaire was used to collect data on the study variables. Descriptive statistics was used to analyze the level of COVID-related knowledge, attitude, risk perception, and intention to receive the COVID-19 vaccine. Logistic regression was performed to identify the factors that were associated with intention. @*Results@#Majority (89.4%) had a good knowledge of COVID-19 but had little to moderate knowledge of COVID-19 vaccines. Around half reported feeling unsure about the safety and efficacy of the vaccines while the remaining half expressed intent to get the vaccine. Logistic regression analysis showed that the odds of intention to get vaccinated were higher among those with positive perceived self-efficacy, behavioral intention, external cues to action, perceived vaccine efficacy, and good knowledge on COVID-19 infection prevention. @*Conclusion@#Health workers play a crucial role in the promotion of public health measures such as vaccination to control the spread of COVID-19. The study confirms the need for strengthening education and communication strategies focusing on the safety and efficacy of COVID-19 vaccines to prevent the spread of false information and promote vaccine uptake among health workers.

Association of knowledge and risk perceptions of Manila City school teachers with COVID-19 vaccine acceptance

Background and Objective@#In addressing vaccine acceptance, teachers may play a pivotal role as educators and models of behavior, as they serve as reliable sources of information. Thus, this study aimed to determine the association between knowledge and risk perception of teachers and their acceptance of the COVID-19 vaccine. @*Methodology@#This study utilized an analytic, cross-sectional design. Seven hundred and seven public secondary school teachers in Manila City, Philippines accomplished the online self-administered questionnaire. The study was guided by the Health Belief Model (HBM). Multiple logistic regression was used to determine the factors associated with acceptance of the COVID-19 vaccine. @*Results@#Respondents had a high knowledge on COVID-19 mode of transmission (95.2%), signs and symptoms (92.9%), diagnosis (57.6%), treatment (98.9%), and prevention (92.2%). They had a high risk perception (>69.2%) pertaining to four constructs (Perceived Susceptibility, Perceived Severity, Perceived Benefits, Cues to Action) of the HBM. Low risk perception of barriers was observed (66.1%). The majority (92.5%) are willing to accept the COVID-19 vaccine. Respondents who teach health-related subjects (94.4%) garnered more vaccine acceptors compared to teachers of non-health-related subjects (91.6%). After adjusting for sex, age, highest educational attainment, and subjects taught, Cues to Action remained to be associated with COVID- 19 vaccine acceptance. @*Conclusion@#Although high levels of knowledge and risk perceptions were observed, only Cues to Action had a significant association with COVID-19 vaccine acceptance. Hence, they need external cues, from physicians or the Food and Drug Administration, to accept the COVID-19 vaccine.

Detecting Local Clusters of Under-5 Malnutrition in the Province of Marinduque, Philippines Using Spatial Scan Statistic.

Underweight and overweight among under-5 children continue to persist in the island Province of Marinduque, Philippines. Local spatial cluster detection provides a spatial perspective in understanding this phenomenon, specifically in which areas the double burden of malnutrition occurs. Using data from a province-wide census conducted in 2014-2016, we aimed to identify spatial clusters of different forms of malnutrition in the province and determine its relative risk. Weight-for-age z score was used to categorize the malnourished children into severely underweight, moderately underweight, and overweight. We used the multinomial model of Kulldorff's elliptical spatial scan statistic, adjusting for age and socioeconomic status. Four significant clusters across municipalities of Boac, Buenavista, Gasan, and Torrijos were found to have high risk of overweight and underweight simultaneously, indicating existence of double burden of malnutrition within these communities. These clusters should be targeted with tailored plans to respond to malnutrition, at the same time maximizing the resources and benefits.

Assessment of the research capacity of the Centers for Health Development, Philippine Department of Health

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> In 2012, the Philippine Department of Health (DOH) established the Health Systems Research Management (HSRM). One of the HSRM components is increasing the research capacity of the Centers for Health Development (CHD) which is the regional office of the DOH.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the research capacity of CHDs and to describe research input, research process, and research output.</p><p style="text-align: justify;"><strong>METHODS:</strong> A descriptive cross-sectional study design was employed. The data were collected using self-administered questionnaire with the Regional Director as the CHD respondent. The research capacity level was determined using rating scale measurement. Based on the ratings, each CHD was assigned a score with the corresponding capacity level: excellent (85-100%); good (70-84%); fair (51-69%); poor (<50%).</p><p style="text-align: justify;"><strong>RESULTS:</strong> Fourteen (82%) of the 17 CHDs participated in the study. The institutional capacity level of the CHDs was poor in the areas of research management (43.0%) and in structure/ organization/ monitoring/ evaluation (30.0%), while it was fair in the area of resource mobilization (54.5%). Research input, research process, and research output were found to be lacking.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The capacity level of the CHDs in the various aspects of institutional research ranged from poor to fair. Specific areas under research input, research process, and research output that need improvement were identified which can be used as benchmark for capacity-building activities and as information-base against which the effectiveness of these activities in the CHDs can be evaluated.</p>

Correlates of health literacy among Filipinos aged 50-70 years old belonging to low-income families in a selected community

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> A number of studies worldwide have shown that health literacy is vital in the improvement of health status of individuals as well as in the effective implementation of health programs. In the Philippines, however, data regarding the level of health literacy among Filipino adults are yet to be gathered. This study then aimed to describe the health literacy level and to determine the correlates of health literacy among Filipino adults aged 50 to 70 years old belonging to the lower socioeconomic class in a selected community.</p><p style="text-align: justify;"><strong>METHODS:</strong> An analytical cross-sectional study was conducted, utilizing data from the study of Briones, M. et. al in 2015, among selected Filipino adults in a barangay in Pasig City.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Ninety-four percent of the study participants had problematic/inadequate health literacy level. The factors found to be statistically associated with having problematic / inadequate health literacy were having at most high school level education, and not being able to visit a medical doctor in the past 12 months. Nonetheless, being self-employed made an individual less likely to have a problematic/inadequate health literacy.</p><p style="text-align: justify;"><strong>CONCLUSIONS:</strong> There was a high proportion of individuals who had problematic/inadequate health literacy among 50 to 70 years old in the study area. Socio-economic characteristics such as educational attainment and healthcare access were shown to be associated with an individual's level of health literacy. Despite the extensive health information available to the public, the level of health literacy still remained to be poor. This indicates that there is a need to evaluate if said information are easily accessed, understood, appraised and applied by individuals to make sound health decisions.</p>

Factors associated with newborn screening compliance among mothers who gave birth in Quezon City lying-in clinics

BACKGROUND: Newborn screening (NBS) detects genetic and metabolic conditions that may be present in a newborn before clinical symptoms manifest. Early detection and treatment prevents catastrophic health outcomes. It was introduced into the public health delivery system with the enactment of the Newborn Screening Act of 2004. However, there still seems to be a trend of noncompliance.OBJECTIVE: The study sought to determine the prevalence of NBS compliance in Quezon City lying-in clinics (LICs) between 2010-2015 and the factors that are associated with compliance of mothers with NBS.METHODS: An analytic cross sectional study design was utilized. Records of 710 mothers who gave birth in Quezon City LICs were randomly selected. Multiple logistic regression was used to determine if the mothers' age, civil status, PhilHealth membership, gravidity, and parity were associated with NBS compliance.RESULTS: A 6-year prevalence of NBS compliance of 36.6% was found. PhilHealth members were more likely to comply with newborn screening (AOR=4.1; 95%CI: 2.9 - 6.0). Moreover, the odds of compliance among married mothers were higher than unmarried mothers (AOR=1.6; 95%CI: 1.1 - 2.3). Finally, primiparous mothers were more likely to comply than multiparous mothers (AOR=1.5; 95%CI: 1.0 - 2.1). Age and gravidity were not found to have statistical association with NBS compliance.CONCLUSION: The higher odds of compliance among PhilHealth members was expected since they can avail of NBS for free. Ninety-five percent of primiparous mothers included in the study were primigravid; they are more likely to go to prenatal checkups when NBS information is given, according to literature.

Association between leptospirosis-related knowledge and practices of male pedicab drivers in Manila

OBJECTIVE: The study aimed to determine whether or not an association exists between leptospirosis-related knowledge and the practices of pedicab drivers in Manila. METHODS: An analytic, cross-sectional study was done among 174 male pedicab drivers. Face-to-face interviews were conducted using an interview schedule containing 12 questions covering knowledge of transmission and prevention, and 8 questions covering preventive occupation-related practices against leptospirosis. Logistic regression was employed to examine association while controlling for the confounding effects of other variables. RESULTS: Forty-nine percent were found to have good knowledge on the transmission and prevention of leptospirosis while 21% had satisfactory preventive and health-seeking practice. After controlling for the confounding effect of pedicab ownership, the odds of having unsatisfactory practices among those with low knowledge were found to be 13 times higher than those with good knowledge. Education was found to be an effect measure modifier. CONCLUSION: The results suggest that a low level of education combined with poor leptospirosis-related knowledge has a magnified effect on practices. Increasing the knowledge of pedicab drivers especially those with a low level of education is necessary to improve their practices. Information dissemination on leptospirosis should be further intensified. Collaboration between health workers and organizations of pedicab drivers can be done to organize health information seminars.

Cadmium concentration in brown and polished rice from selected farms in Barangay Real, Calamba City and its potential non-cancer health risk in adult population

OBJECTIVES: This study was conducted to determine the cadmium (Cd) concentration in brown and polished rice collected from the 9 farms in Barangay Real, Calamba City. This study also assessed the non-cancer health risk to adults (?20 years old) of long-term consumption of rice with Cd using the non-cancer hazard quotient (NHQ). METHODS: Rice grains with hull were collected in November-December 2013. Both rice types were analyzed for Cd using a graphite furnace atomic absorption spectrophotometer (GFAAS). The NHQ was calculated by dividing the estimated daily intake of Cd via rice consumption by the oral reference dose (RfD) for Cd.RESULTS: Mean Cd concentrations in brown and polished rice collected from the 9 farms in Barangay Real ranged from 0.0062 to 0.0725 mg/kg and 0.0047 to 0.0778 mg/kg, respectively. The NHQ values of Cd in both rice types were less than 1.0 for adults (?20 years old). CONCLUSION: Cd concentrations in brown and polished rice from the 9 farms did not exceed the 0.4 mg/kg maximum allowable Cd concentration in rice set by FAO/WHO. Since the NHQ did not exceed 1.0, long-term exposure to Cd through consumption of brown and polished rice from these farms is unlikely to cause non-cancer health effects in adults (?20 years old). It is unlikely for adults to develop kidney diseases such as tubular proteinuria, decreased glomerular filtration rates, and itai-itai disease.

[Targeted therapies and radiation therapy in non-small cell lung cancer]. / Thérapies ciblées et radiothérapie dans les cancers bronchiques non à petites cellules.

Lung cancer is the leading cause of cancer-related death. Between 80-85% of lung cancers are non-small cell lung carcinomas. One third of the patients are diagnosed with locally advanced stage. In this condition, concomitant radio-chemotherapy is the standard treatment for patients with good performance status. Despite important improvements in the last years, non-small cell lung carcinoma prognosis remains poor, with high rates of both local recurrences and metastases. The heterogeneity of molecular characteristics of non-small cell lung carcinoma cells and a better knowledge of potential targets offer promising developments for new pharmacologic agents. Hereafter we will review the currently most studied pathways and the most promising ones for the treatment of locally advanced unresectable non-small cell lung carcinoma. Two of the most attractive pathways where new agents have been developed and assessed in combination with thoracic radiotherapy or radiochemotherapy are the EGFR pathway (either with the use of monoclonal antibodies or tyrosine kinase inhibitors) and the angiogenesis inhibition. The development of targeted agents could lead to individualized therapeutic combinations taking into account the intrinsic characteristics of tumor cells. Pharmacological modulation of tumour cells radiosensitivity by targeted therapies is only starting, but yet offers promising perspectives.

[Sentinel node biopsy in breast cancer]. / La technique du ganglion sentinelle dans le cancer du sein: quelques considérations récentes.

As compared to conventional axillary dissection, the sentinel node technique is accompanied by reduced morbidity and shorter hospital stay. Based on available data, the use of this technique does not seem to yield higher rates of axillary recurrence. A combination of both radioisotope detection and blue dye increases the identification rate, while also reducing false-negative rate. Surgical results are optimized when preoperative lymphoscintigraphy mapping is obtained in addition to peroperative probe detection. Considering the site of injection, the subareolar injection can be easy to apply even in case of non-palpable tumours, and gives higher count rates. However, the intraparenchymal, peritumoral, injection is necessary to evidence cases of extra-axillary drainage (internal mammary, infra- or supraclavicular) that is present in about 20% of patients. With the advent of hybrid cameras (SPECT-CT), the topography of these extra-axillary nodes can be given with high precision. Use of the sentinel node technique has been accompanied by an increase in the percent of patients with node involvement, due to an increased detection of micrometastases inferior or equal to 2 mm. Following an overview of basic principles, and of the main results with the sentinel node technique we focus the discussion on several points that are still open to debate, such as: 1) which group of patients can benefit from the sentinel node technique? 2) What is the optimal methodology? 3) What is the prognostic significance of micrometastases and of isolated tumour cells? 4) What attention should be given to extra-axillary drainage?

[Salvage radiotherapy for patients with PSA relapse after radical prostatectomy: comparisons among ASTRO and Phoenix biochemical failure definitions]. / Radiothérapie de rattrapage pour récidive biochimique après prostatectomie : comparaison entre les définitions de récidive biochimique de l'Astro et de Phoenix.

PURPOSE: Study about the efficacy of salvage radiotherapy (RT), in terms of biochemical disease free survival (bDFS), according to ASTRO and Phoenix (nadir+2) definitions, for persistent or rising PSA after radical prostatectomy. PATIENTS AND METHODS: Retrospective analysis of 59 patients who underwent RT between 1990 and 2003 for PSA recurrence after radical prostatectomy. Patients received a median of 66Gy to the prostate bed with 3D or 2D RT. The main end point was bDFS according to ASTRO and Phoenix (nadir+2) definitions. Different criterion sets were analysed to calculate bDFS and pretreatment factors that might predict biochemical relapse were sought for each. RESULTS: After a 38-month median follow-up, the 3-year bDFS rates were: 60 and 72% for ASTRO and Phoenix (nadir+2 ng/ml) definitions respectively. According to univariate analysis, pre-RT PSA> or =1 ng/ml and seminal vesicle involvement were associated with biochemical relapse. Multivariate analysis retained only pre-RT PSA> or =1 ng/ml as an independent predictor of biochemical relapse for the two definitions. CONCLUSION: Salvage RT is an effective treatment after radical prostatectomy according to ASTRO or Phoenix definitions. Only pre-RT PSA> or =1 ng/ml predicted relapse.

[Do locally advanced esophageal cancer still need surgery?]. / Faut-il encore opérer les cancers de l'oesophage localement évolués?

Results of surgery in locally advanced esophageal carcinomas (T3 and/or N1) are disappointing. Concomitant chemoradiotherapy (RTCT) gave equivalent survival results in many phase II studies. Two randomized trials (French and German) compared surgery or additional RTCT after a first phase of RTCT. Both drew the same conclusions, that is surgery did not improve overall survival but increased postoperative mortality. However, local control was found better in the surgical arms, and in some subgroups, esophagectomy improved disease-free survival suggesting that some patients may benefit from surgery. After preoperative RTCT, absence of residual disease in the surgical specimen (pathological complete response) occurs in 15 to 30%; these patients underwent a radical surgery without any benefit but with high risk of morbidity and mortality. Nevertheless, it is still difficult to select this sub-population: CT-scan or endoscopy with biopsies have a low sensitivity and specificity. 18-FDG-PET-scan, performed after or during the RTCT, is able to increase sensitivity, but only preliminary results with small populations are available. No biological factor of chemoradiosensitivity (p53, NfkappaB, p21...) could predict who will respond or not. Another approach is to reserve surgery only to patients with a demonstrated local failure (salvage surgery) but the feasibility of this technique is still debated. Finally, local relapses are frequent after RTCT and optimisation of the current schedules is mandatory to improve oncologic results. Unfortunately, increasing the radiation dose did not improve local control and showed more toxicities. New drugs as taxanes, oxaliplatine, or targeted therapies are tested in on-going phase III trial.

[Irradiation of lymph nodes areas in breast cancer]. / Irradiation des aires ganglionnaires dans le cancer du sein.

Postoperative radiotherapy after breast surgery increases overall survival by decreasing the local relapse rate. The main site of relapse is the breast or the chest wall. The value of irradiation of the nodal basins is still discussed. It must be emphasized that nodal areas were systematically irradiated in the postmastectomy randomized trials demonstrating a benefit in survival for adjuvant radiotherapy. Axillary relapses are infrequent in case of complete axillary dissection; complementary irradiation could be proposed if the axillary dissection is incomplete or if there is a massive pathologic involvement of the axilla. Its main complication is lymphoedema, which remains the most frequent sequellae of the treatment of breast cancer. Supraclavicular irradiation is logical in case of axillary involvement. Internal mammary nodes are involved in 20 to 40% of the patients, depending of the axillary involvement and location of the tumor inside the breast. Irradiation of the internal mammary basin is difficult: optimal dosimetry required a CT-based simulation. Its benefit remains to be proved. Internal mammary nodes irradiation probably increased cardiovascular mortality. Sophisticated techniques are needed to spare the heart from irradiation. Two large randomized trials (French group, European Organization for Research and Treatment of Cancer [EORTC]) are currently evaluating the possible benefit of internal mammary irradiation.

[Adjuvant chemotherapy followed by conformal chemoradiotherapy in gastric carcinoma]. / Chimiothérapie adjuvante suivie d'une chimioradiothérapie conformationnelle dans les cancers de l'estomac.

PURPOSE: Analysis of the feasibility and results of adjuvant chemotherapy followed by conformal chemoradiotherapy after surgery for gastric carcinoma. PATIENTS AND METHODS: Twenty-six patients (R0 or R1) were treated postoperatively by three cycles of 5-fluorouracil (5-FU) and cisplatin, followed by a concomitant association of LV5FU2 chemotherapy with a conformal radiotherapy of 45 Gy. RESULTS: The tumor was classified pT3-T4 in 77% of the patients and 92.5% had a nodal involvement (pN1: 54%; pN2: 31%). FEASIBILITY: (1) Adjuvant chemotherapy: nausea/vomiting grade II/III: 12 patients (48%); neutropenia grade III/IV: two patients; completed in all patients, except one. (2) Chemoradiotherapy: nausea/vomiting grade II/III: 10 patients; diarrhea grade II/3: two patients; oesophagitis grade II/III: two patients; myocardial infarction/pulmonary embolism: two patients. All patients except one received the planned dose of 45Gy. Radiotherapy was interrupted in six cases, with a median duration of 14 days. Survival: with a median follow-up of 30 months, 65% of the patients were alive without disease; median survival was 32 months. CONCLUSION: This postoperative schedule was judged feasible. It allowed the deliverance of a more intensified chemotherapy than the classical schedule. Its clinical benefit must be evaluated in a phase III trial.

[Conformal radiotherapy of prostate cancer]. / Radiothérapie conformationnelle du cancer de la prostate: technique et résultats.

A number of retrospective and prospective studies have demonstrated that radiotherapy of prostate cancer must be actually conformal. Three-dimensional (3D) treatment planning consists in an as accurate as possible definition of target-volume, usually by CT-scan, and design of radiation fields shaped to this target-volume. Several steps are required, each step being important for the overall quality of the treatment. Conformal radiotherapy is better tolerated than conventional irradiation, with significantly less rectal toxicity. It allows dose-escalation up to 80 Gy. It is now possible to go beyond this dose with intensity-modulated radiotherapy. The benefit of these high doses was demonstrated by some large retrospective studies and some prospective dose-escalation trials. Several randomized trials are in progress, preliminary results of two of them have been published, both showing an improvement in disease control with the higher doses. The advantage of higher doses is clearly evident for patients in the intermediate prognostic group, but is still discussed for patients with a low risk tumour or treated in combination with hormone therapy. Late proctitis is the main toxicity of these high doses. Some volume constraints have been defined during the last years and will allow a decrease of the rate of rectal toxicity. Because of these technological improvements, results of radiation therapy are now similar to those of surgery: no direct comparison with a randomized trial is available, but large comparative studies show that long-term disease control are identical with both techniques. Radiation therapy must be proposed to all patients with a prostate carcinoma as an alternative to surgery.

[Does primary chemotherapy really increase the rate of breast conserving treatments?]. / La chimiothérapie première permet-elle réellement d'augmenter le taux de conservation mammaire?

Initially, preoperative chemotherapy had three aims, to improve the overall survival by an early exposure to systemic therapy, to evaluate in vivo the efficacy of chemotherapy and to monitor post-operative treatment, and to increase the rate of breast-conserving treatments. Eight randomised trials have been published. The general consensus about the results of these trials is that neoadjuvant chemotherapy did not improve overall survival, in comparison with an adjuvant treatment. Clinical and especially pathological complete response rates were correlated with the outcome of the patients and could be considered as an independent prognostic factor. Primary chemotherapy is a powerful tool to study the predictive factors, especially biological factors, of chemosensitivity. However, the usefulness of this approach to adjust post-operative treatments remains to be demonstrated. Finally, primary chemotherapy slightly increased the rate of breast conserving treatments, but is accompanied by a small increase in the risk of local recurrence. To propose a conservative treatment to a woman initially not suitable for a lumpectomy needs clear information about this enhanced risk.

[Endobronchial brachytherapy: technique and indications]. / Curiethérapie endobronchique: technique et indications.

The endobronchial brachytherapy procedure involves the insertion of an afterloading catheter into bronchus in close proximity to an endoluminal lesion, and to perform limited irradiation sparing as much as possible normal health tissues. The catheter is inserted during a classical flexible bronchoscopy. Three types of indications have been discussed: (i) palliative treatment of lung carcinoma, with or without laser desobstruction: an improvement in respiratory symptoms was observed in 60 to 80% of the cases; (ii) curative treatment for localised endobronchial carcinomas, in previously irradiated patients, or in case of contraindication of surgery or external beam irradiation; local control rate range from 60 to 70% at 2 years; (iii) combination of external irradiation and brachytherapy in the first line treatment of lung cancers. Two randomised trials did not show any improvement in survival for this approach; however, they have included advanced diseases. In the opposite, this association seems very effective for early stage lung carcinomas. Two major complications were regularly reported, haemoptysis and radiation bronchitis. Predictive factors for these toxicities are actually better known: haemoptysis could be due to a progressive disease more often than to brachytherapy itself; technical factors (dose, volume, fractionation), however, could explain a number of radiation bronchitis, and their incidence could decrease in the future.

[Post-prostatectomy radiotherapy: for which patients and when?]. / Radiothérapie post-prostatectomie: pour quels patients et quand?

Biochemical relapse after radical prostatectomy is not exceptional, ranging from 10 to 40% in the literature. To prevent this biochemical failure, adjuvant radiotherapy was proposed to patients with a high risk of relapse. No phase III trial has actually validated this attitude. Best indications for adjuvant irradiation seem to be patients with an extensive extracapsular extension or multiple positive margins. Historical comparisons seems to confer, in these case, a benefit in biochemical control for adjuvant irradiation versus observation. Others authors prefer immediate post-operative irradiation, a delayed treatment, when biochemical relapse has occurred. This attitude has spared some patients irradiation useless. This salvage irradiation lowered the PSA level in 40 to 70% of the cases, but long-term efficiency is obtained only in the case of a low value of the PSA before irradiation. Delayed radiotherapy is, therefore, justified only if a close follow-up is performed, with repeated dosage of PSA. Whatever the case, it is important to differentiate between local and distant relapse: patients with positive nodes at the time of surgery are most likely at risk of distant relapse. It seems that patients with seminal vesicles involvement are also at high risk for distant relapse, but this must be confirmed.

[Chemotherapy with cisplatinum, carboplatin and 5FU-folinic acid, followed by concomitant chemo-radiotherapy in unresectable esophageal carcinomas]. / Chimiothérapie par une association de cisplatine, carboplatine et 5-fluoro-uracile-acide folinique, suivie de chimio-radiothérapie dans les cancers de l'oesophage inopérables.

UNLABELLED: The best chemotherapeutic regimen for advanced carcinoma of the esophagus remains to be determined. We have evaluated a combination of carboplatin, cisplatin and 5FU modulated by folinic acid. Patients. Twenty-seven patients (median age 57 yrs) with an unresectable carcinoma of the esophagus were included in this trial: 9 patients with a local relapse after surgery, 6 patients with a locally advanced (T4) tumor, and 12 patients with metastasis. Treatment schedule. Initial chemotherapy : carboplatine IV d1, AUC4; 5FU: bolus injection of 400 mg/m2 d1, followed by a continuous infusion of 600 mg/m2/24 h, d1 and d2; folinic acid (200 mg/m2) IV, before the 5FU bolus, d1 and d2; cisplatine 80 mg/m2, d3; on d15 and d16, 5FU and folinic acid were repeated with the same schedule. The second cycle began on d28. Concomitant chemo-radiotherapy with 5FU (1,000 mg/m2 d1 to d3), cisplatine (50 mg/m2 d1 and d2) and external irradiation (20 Gy in 10 fractions from d1 to d12) was then performed, for three cycles (until a total dose of 60 Gy). Results. TOXICITY: neutropenia grade 3-4 (32%), thrombopenia grade 3-4 (18%). More important, a lymphopenia (< 500/mm3) was noted in 12 patients (43%). Accordingly, 4 serious infectious complications were observed, with three toxic deaths. Objective response rate: 44% after initial chemotherapy; 75% after chemoradiotherapy, with 8 complete responses (38%). Median survival was 7.4 months, with a one- and two-year survival of 33% and 17,8%, respectively. Conclusion. This association of cisplatin, carboplatin, and 5FU did not offer a better response rate than the classical 5FU-cisplatinum association. But serious infectious complications occurred during the trial. We do not recommended further evaluation of this biplatinum therapy with 5FU in advanced esophageal carcinomas.

Impact on survival of surgery after concomitant chemoradiotherapy for locally advanced cancers of the esophagus.

BACKGROUND: To evaluate the results of chemoradiotherapy with or without surgery in locally-advanced esophageal carcinomas (T3 and/or nodal involvement). METHODS: One hundred twelve patients with locally-advanced carcinoma of the esophagus without histologically proven invasion of the tracheobronchial tree or distant visceral metastases were treated with concomitant chemoradiotherapy followed by re-evaluation; surgery was performed or chemoradiotherapy continued, based on tumor regression and the patient's general status. Chemoradiotherapy consisted of concomitant 5-fluorouracil (5FU)(1 g/m(2) day 1-3), cisplatinum (50 mg/m(2) day 1 and 2), and external beam irradiation up to a dose of 40 or 43.2 Gy. After a 4-week rest period, radical esophagectomy or a new cycle of chemoradiotherapy (up to a total dose of 65 Gy) was performed. RESULTS: A complete clinical response was obtained in 25.7% of the patients and a partial response in 45.9%. Fifty patients underwent surgery, but only 38 patients had an esophagectomy. Post-esophagectomy mortality was 5.3%. A complete histologic response rate of 23.7% was obtained. Two- and 5-year survival rates were, respectively, 41.5% and 28.6% for the whole population. According to multivariate analysis, prognostic factors for survival were Karnofsky index, esophagectomy, and response to chemoradiotherapy. Five-year survival for patients who experienced a partial response to radiation and chemotherapy was 49.1% for those who had surgery and 23.5% for those treated without surgery (p = 0.003). There was no obvious benefit for the small number of patients treated surgically after complete response to radiation and chemotherapy. Toxicity, essentially hematologic, was moderate. CONCLUSION: For locally-advanced esophageal carcinomas, esophagectomy, after concomitant chemoradiotherapy, could improve the survival rate, especially for patients who responded partially to the latter.