Bladder cancer in Africa: update.

Carcinoma of the bladder is the most prevalent cancer in Egypt and in most African countries. At the National Cancer Institute (NCI), Cairo, it constitutes 30.3% of all cancers. The median age at diagnosis is 46 years, with a male preponderance of 5:1. Whether in Egypt or other African countries such as Sudan, Kenya, Uganda, Gold Coast, and Senegal, it is mostly of the squamous cell type, and arises in a background of schistosomiasis or bilharziasis. Tumors are usually advanced at the time of presentation. Bladder carcinogenesis is probably related to bacterial and human papilloma virus (HPV) infections, usually associated with bilharzial infestation. Management is mainly surgery, with 5-year survival rates after radical cystectomy increasing from 35% in the 1970s to 48% in the 1990s. The addition of adjuvant and neoadjuvant radiotherapy and chemotherapy to surgery since 1976 significantly improved both disease-free and overall survival rates. Molecular genetic studies concerning potential prognostic markers, tumorigenesis, and tumor progression in bilharzial bladder cancer are limited. However, a comprehensive detailed analysis of these factors is underway. Bilharzial bladder cancer is a preventable malignant disease. Primary prevention could be possible if the parasite is eliminated nationwide. Chemoprevention using retinoids or cyclooxygenase 2 (COX-2) inhibitors is a possible alternative. Semin Oncol 28:174-178.

A phase II study of epirubicin in breast cancer.

We evaluated the efficacy of epirubicin in a phase II trial in breast cancer, as well as its cardiac toxicity. The study was carried out on 40 female patients with advanced, metastatic, or recurrent breast cancer. The patients were grouped into two groups: group I received 30 mg/m2 epirubicin weekly, and group II 90 mg/m2 epirubicin every 3 weeks. Cardiac monitoring was by ECG, roentgenography, echocardiography and endomyocardial biopsies. Clinical results were 35.3% overall response in group I, and 50% overall response in group II. No untoward cardiac toxicities were encountered. We conclude that epirubicin is an effective agent in breast cancer with relatively little cardiac toxicity.

Pediatric non-Hodgkin's lymphoma abdominal presentations: a comparative study between two treatment regimens at the National Cancer Institute Cairo.

Abdominal presentations of pediatric NHL are rarely amenable to complete surgical resection. Chemotherapy is the hallmark of treatment for pediatric NHL. Treatment of various types of this disease including intra-abdominal NHL in children with various protocols have not exceeded 54 per cent two-year disease-free survival. We have attempted to study and compare the effects of two treatment regimen upon two groups of previously untreated children up to the age of 16 years who presented to the Pediatric Oncology Unit at the NCI. The first group included 18 children who presented between 1983 and 1985 and were treated by a modified St Jude regimen: while the second group of patients was comprised of 19 children who presented between 1985 and 1987 and were treated by a multi-national protocol: the MCP 842. The two groups will be compared with respect to various patient characteristics, response to therapy and their two-year disease-free survival as well as overall survival.

Cardiac morphologic and functional changes induced by epirubicin chemotherapy.

Cardiac toxicity was evaluated in 24 patients who received epirubicin as a single chemotherapeutic agent, in doses of either 30 mg/m2 every week (11 patients) or 90 mg/m2 every 3 weeks (13 patients). The total doses of epirubicin ranged from 180 mg/m2 to 918 mg/m2 (mean, 491 +/- 187). No patient had prior heart disease, hypertension, mediastinal irradiation, or chemotherapy with other anthracycline agents. None of the patients developed overt heart failure, significant arrhythmias, ECG alterations, or roentgenographic changes in heart size. There was no significant change in the mean value of echocardiographic percent fractional shortening before and after epirubicin therapy. Patients receiving epirubicin doses less than 450 mg/m2 had minimal hemodynamic disturbances; however, no cut-off point separating two significantly different subpopulations could be demonstrated. Endomyocardial biopsy was performed on all patients; 20 biopsies were evaluable. Histologic and ultrastructural changes were similar to those caused by other anthracycline agents. A strong correlation was demonstrated between total dose of epirubicin and pathologic change as quantified using the Billingham scale (r = .7, P = .0006). A cut-off point beyond which there was a probability of increased pathologic damage was statistically defined at 450 mg/m2 of epirubicin. Severe pathologic alterations and moderate hemodynamic changes were observed in only one patient, who received 918 mg/m2 of epirubicin. Patients who are expected to receive epirubicin in excess of 450 mg/m2 should be monitored for cardiac toxicity, and continuation of epirubicin therapy beyond 900 mg/m2 should be based on the results of monitoring.

Methyl CCNU and adriamycin for patients with metastatic sarcomas: a Southwest Oncology Group study.

This protocol study (SWOG-7431) combining adriamycin and methyl CCNU (MAD) for metastatic sarcomas was initially used on patients who were refractory to cytoxan, vincristine, and/or actinomycin-D. After the initial good results, the study was expanded to include any untreated patients with metastatic sarcoma. The initial starting dose of adriamycin was 60 mg/M2 on day 1 and 45 mg/M2 on day 22. Methyl CCNU was given once every six weeks at an initial dose of 150 mg/M2 orally. Fifty-five patients received therapy and 53 were evaluable for response. The complete remission rate was 9.4%. The partial remission rate was 35.9%, with a total complete and partial remission rate of 45.3%. The median survival time was ten months. When the combination of cytoxan, DIC, vincristine and adriamycin was used, the response rate was similar and the median survival time in eligible patients was 10 months. The methyl CCNU and adriamycin combination is more convenient for the patient because it necessitates fewer clinic visits and significantly fewer injections than other combinations. These data suggest that treatment with methyl CCNU, when combined with adriamycin, increases the response rate and survival time over adriamycin alone, but that the response is similar to that seen with the combination of cytoxan, DIC, vincristine, and adriamycin.

Clinical staging of malignant lymphoma in patients suspected to have hepato-splenic schistosomiasis.

Exploratory laparotomy, splenectomy and liver biopsy were carried out as a pre-treatment staging procedure in 32 cases of pathologically proved malignant lymphoma with clinically palpable spleen. The spleen was found to be negative for lymphoma in 17 cases, of which liver pathology showed bilharzial hepatic fibrosis in eight cases, nutritional cirrhosis in two cases and non-caseating granuloma in three cases. The liver was clinically positive in 13 cases. After laparotomy, three cases showed bilharzial pathology only. Bilharziasis has accounted for about one half of the false positive hepato-splenic involvement. These findings exemplify the usefulness of laparotomy as a staging procedure in regions endemic for hepato-splenomegaly.