Search

Aim: Undifferentiated nasopharyngeal carcinoma (UNPC) is a chemosensitive tumour; a randomized study evaluating neoadjuvant chemotherapy with bleomycin/epidoxorubicin/cisplatin (BEC) in addition to conventional radiotherapy has resulted in a better disease-free survival in the chemotherapy arm. The bleomycin infusion in the BEC regimen has necessitated hospitalization for the infusion, and resulted in serious pulmonary toxicity. This study has aimed to omit the bleomycin, and test the efficacy and toxicity of cisplatin (C) and a higher dose of epidoxorubicin (EPI) in patients with locally advanced UNPC. Methods: Seventy-one patients with locally advanced UNPC were treated with three cycles of C 100 mg/m2 day 1, and EPI 100 mg/m2 day 1 every 3 weeks followed by conventional radiotherapy of 70 Gy. Results: Neoadjuvant chemotherapy was well tolerated. There was only 1-week delay in 14.3% of the patients and no dose modification. Grade III–IV neutropenia occurred in 18.9% of the cycles; none of the patients developed neutropenic fever. No patient progressed during chemotherapy, the complete response rate was 26.8% (95% CI=16.9–38.6) and the partial response rate was 59.1% (95% CI=46.8–70.7) for an objective response rate of 85.9% (95% CI=75.6–93.0) at the end of the three cycles of chemotherapy. After the completion of radiotherapy, the complete response rate increased to 81.7% (95% CI=70.7–89.9) and the objective response increased to 91.5% (95% CI=82.5–96.8). The median disease-free interval and the median survival have not been reached. The 5-year disease-free and overall survival rates are 53.0% (95% CI=43.7–62.0) and 57.2% (95% CI=48.3–65.2), respectively.Conclusion: Neoadjuvant C and EPI, easily administered in the outpatient setting, is an effective and well-tolerated regimen in the treatment of locally advanced UNPC. Onat, H. et al. (2002). Clinical Oncology 14, 449–454 Copyright 2002 The Royal College of Radiologists. Published by Elsevier Science Ltd. All rights reserved. [Copyright &y& Elsevier]

Purpose: To retrospectively analyse the disease-free survival (DFS) and overall survival (OS) according to the International Prognostic Index (IPI) risk groups in patients with aggressive non-Hodgkin's lymphoma (A-NHL) treated at the Institute of Oncology, Istanbul University between 1989-1998., Patients and Methods: The records of 201 patients with A-NHL and aged 15 years and over were retrospectively analysed. Features evaluated for potential prognostic importance for DFS and OS included sex, age, tumor stage, performance status (PS), "B" symptoms, bone marrow infiltration, number of extranodal disease sites, size of the largest tumor, histologic grade, erythrocyte sedimentation rate (ESR), and serum levels of lactate dehydrogenase (LDH), albumin and beta2-microglobulin. The International Working Formulation system and the Ann Arbor staging system were used for histologic and staging classifications, respectively. Kaplan-Meier, log-rank and Cox's methods were used for statistical analyses., Results: Sixty-six percent of the patients were classified in the low risk group; 23% in the low-intermediate risk group; 9% in the intermediate-high risk group; and 2% in the high risk group. The median follow-up was 25.9 months (range 1-150 months). Five-year DFS and OS were 41% and 47%, respectively, in all patients. According to IPI, based on the age, tumor stage, LDH level, PS, and extranodal involvement in the identified 4 risk groups of all patients and all ages, the 5-year DFS and OS rates were 66-51%, 49- 43%, 40-34%, and 0%, respectively. Patients in the lowintermediate and intermediate-high risk groups had a worse survival outcome than low risk patients (p=0.001)., Conclusion: The IPI can be used in the selection of appropriate therapeutic strategy for individual patients. IPI is the most acceptable prognostic system, but being not the ideal one, is still being under critical discussion.

Extragonadal germ cell tumors are rare neoplasms with histologic features comparable to those of gonadal origin. In this case report we present a 21-year-old female patient with an atypical localization of metastatic gestational choriocarcinoma. She was admitted to our hospital with recurrent epistaxis, abnormal vaginal bleeding, rectal bleeding, subcutaneous nodules on both thighs and forearms and left maxillary mass with intranasal cavity invasion. Laboratory analysis revealed significant elevation in serum beta-human chorionic gonodotropin (beta-HCG) level. Abdominal computerized tomography (CT) revealed left renal and retroperitoneal masses and thoracic CT displayed multiple bilateral lung metastases. Histopathological evaluation of the biopsy specimen obtained from the maxillary sinus showed choriocarcinoma. Based on WHO criteria she was classified as high-risk metastatic choriocarcinoma and treated with combination chemotherapy. We believe that in young women with recurrent epistaxis, gross abnormal vaginal and rectal bleeding and atypical maxillary sinus tumor with multiple lung metastases, choriocarcinoma should be included in the differential diagnosis and previous history of pregnancy or abortion should be obtained.

The taxanes are the most active new agents for squamous-cell carcinoma of the head and neck (SCCHN) since the discovery of cisplatin. Our aim was to define the therapeutic efficacy and toxicity of paclitaxel and cisplatin combination therapy in patients with recurrent SCCHN. Patients with locally recurrent or metastatic SCCHN were enrolled in the study. Patients were required to be chemotherapy-naive, and should have completed radiation therapy at least 6 weeks prior to enrollment. A World Health Organization (WHO) performance status of less than 3 was required. Paclitaxel (Taxol, Bristol Myers Squibb Company, Princeton, NJ) and cisplatin therapy (PC) consisted of prophylaxis with pheniramine 50 mg i.v., ranitidine 150 mg i.v. and dexamethasone 20 mg i.v. given prior to paclitaxel 175 mg/m2 as a 3-hour i.v. infusion, followed by cisplatin 75 mg/m2 as a 1-hour infusion with an additional 3000 cc of saline for hydration. This treatment was repeated every 3 weeks for a maximum of six cycles. Patients were evaluated for response after the third and sixth cycles, or at the time of clinical progression. Fifty patients were enrolled in the study. The overall response rate was 32% with a 10% complete response rate. Forty-eight patients were assessable for toxicity. A total of 221 cycles of chemotherapy was given and the most common toxicity was myelosuppression; 7.7% of cycles had grade III-IV neutropenia. Severe neuropathy, nephropathy, mucositis, and emesis were uncommon (<10 %). At a median follow-up period of 25 months, the median overall survival was 10 months and the 1-year progression-free and overall survival rates were 16.7% and 35.2%, respectively. We conclude that patients with recurrent SCCHN have a moderate response to combination chemotherapy with cisplatin and paclitaxel. Given this moderate response rate, it is unlikely that this combination (PC) might ultimately prove to be superior to standard treatment regimens in terms of significant survival advantage.