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Pediatric non-Hodgkin's lymphoma (NHL) constitutes 16% of pediatric malignancies reported to the National Cancer Institute (NCI) in Cairo. Since July 1985, we have treated 39 previously untreated pediatric NHL cases younger than 16 years of age (mean, 7.6 years) with a new protocol consisting of alternating cycles: regimen A comprised cyclophosphamide, high-dose ara-C, Adriamycin and vincristine; regimen B consisted of ifosfamide, methotrexate and VP16, with intrathecal methotrexate. Diagnoses included 20 abdominal masses, 16 peripheral lymphadenopathies and 6 bony lesions. Histopathology according to the working formulation revealed 21 cases of small non-cleaved lymphoma, 6 lymphoblastic, 5 large-cell and 7 unclassified diffuse lymphomas. Responses were complete in 31 cases (82%) and partial in 4 cases (10%), and no response was obtained in 4 cases (8%). Overall survival was 82% in limited disease and 60% in extensive disease at 28+ months. This short-term ifosfamide-containing regimen proved its efficacy, with results matching those of other regimens used in the United States and Europe. [ABSTRACT FROM AUTHOR]

Ifosfamide was studied in advanced pancreatic tumor at the National Cancer Institute, Cairo. Over five years, 25 patients received a daily dose of 1.8 g ifosfamide for five days, courses reported every 21 days. Complete remission was achieved in 1 patient and partial remission in 14 patients, an overall result of 60%, average duration of response being 12+ months. Mesna was used for uroprotection. [ABSTRACT FROM AUTHOR]

Pediatric non-Hodgkin's lymphoma (NHL) constitutes 16 per cent of pediatric malignancies reported to the National Cancer Institute (NCI) in Cairo. The adopted treatment for these cases was, from 1982 to July 1985, a modified St Jude's regimen consisting of: vincristine, cyclophosphamide, adriamycin, prednisone and intrathecal methotrexate for the first 6 weeks for induction, followed by cranial irradiation for cranial prophylaxis. Patients in remission received maintenance therapy for 18 months. Of 32 patients complete remission (CR) was achieved in 24 patients (75 per cent); partial remission (PR) in one patient (3 per cent); five patients showed no response (15 per cent) while two patients died during the induction phase. At 60+ months follow-up, 60 per cent of cases are still alive, disease-free, and overall survival is 66 per cent. A new protocol was adopted in 1985, consisting of alternating cycles: A and B, for 4-8 cycles. Cycle A: cyclophosphamide, high dose ara-C, adriamycin, and vincristine. Cycle B: ifosfamide, methotrexate, VP 16, with intrathecal methotrexate. The response in 39 cases is: CR in 31 cases (82 per cent); PR in four cases (10 per cent); no response in three cases (8 per cent). At 60+ months, the disease-free survival is 60 per cent, and overall survival 80 per cent. This new protocol has the advantage of: short duration of therapy and so better patient compliance, no maintenance therapy or cranial irradiation with its sequelae in the future. Moreover, it has a better overall survival.

Seventy-one patients with T2 and T3 bladder cancer were randomized to receive either two courses of epirubicin 120 mg/m2 i.v. push every 21 days pre-operatively, and four additional courses post-operatively (group I = 34 patients), or radical surgery (group II = 37 patients). At a median follow-up of 24 months (range 22 months to 38 months) 25 patients from group I and 14 patients from group II are still alive and disease-free. The estimated two-year disease-free survival percentages were 73.5 and 37.9%, respectively (P = 0.05). After initial chemotherapy, resected specimens were subjected to histopathological study of chemotherapeutic effects. Necrosis was detected in 95% of cases with squamous cell carcinoma and in 57.3% of cases with transitional cell carcinoma. We conclude that the benefit which was obtained by pre-operative and post-operative chemotherapy with epirubicin is promising and may represent a significant improvement in the treatment of patients with carcinoma of the bilharzial bladder.

Thirty patients with locally advanced primary squamous cell carcinoma of the head and neck were treated with two courses of cis-platinum chemotherapy (50 mg/m2 every 3 weeks). Twenty-three of thirty patients had either partial remission, improvement, or stable disease. Chemotherapy was well tolerated. Follow-up of all patients was done in greater than 36 months. Seven of 23 patients remain in complete remission after chemotherapy plus surgery. Of these seven patients, four of seven were partial responders to chemotherapy, two of seven were improved, and one of seven had stable disease or chemotherapy. Preoperative adjuvant chemotherapy needs further evaluation in head and neck cancer.

The results of hexamethylmelamine therapy in 20 patients with advanced squamous cell head and neck cancer are reported. No patient had previously received chemotherapy. The dose of hexamethylmelamine was 8 mg/kg/day p.o. There was partial response in 3/20 (15%) patients. The duration of the response was 6-10 weeks. Twelve of 20 (12/20) patients had stable disease for a median of 8 weeks (range: 4-18 weeks). Hexamethylmelamine was well tolerated with the only significant toxicity being mild nausea and vomiting. This drug deserves further evaluation in the treatment of head and neck cancer.

The relatively short survival following chemotherapy in patients with metastatic carcinoma of the breast and the introduction of antiestrogens has led to renewed interest in the hormonal therapy of breast cancer. Pritchard et al. (Cancer Treat. Rep., 64: 787-796, 1980) have recently stated that response to the antiestrogen tamoxifen (TAM) strongly predicts a subsequent response to oophorectomy in premenopausal patients. The Southwest Oncology Group administered TAM to pre- and postmenopausal women with first recurrence of breast cancer. Following response and subsequent relapse, or after no response, patients underwent an oophorectomy while continuing on TAM. None of 14 premenopausal patients who responded to TAM had a response to oophorectomy plus TAM, while 5 of 22 had a remission with oophorectomy plus TAM after initially failing with TAM alone. The reverse was seen in postmenopausal women; 4 of 18 responders to TAM subsequently responded to oophorectomy plus TAM, but none of 18 TAM failures responded to oophorectomy plus TAM. These results suggest that in the premenopausal women the TAM dose may be insufficient to block all estrogen action and that oophorectomy, by removing the major source of estrogen, can result in a more effective antiestrogen action of TAM leading to a response. No explanation is readily available for the results in postmenopausal patients.

A study of the absorptive function of the small intestine in chidlhood malignant lymphomas was carried out at the Cancer Institute of Cairo University. The study comprised twenty-five children, with stage III or IV lymphoma. A complete lymphoma work-up was performed for each patient, comprising clinical, pathological, haematological, biochemical and roentgenological assessments. Evaluation of small intestinal function was done by means of mucosal biopsy, small bowel motor meal, xylose excretion test, and estimation of faecal fat excretion. These tests revealed evidence of malabsorption in 69% of the patients. The study provides a better understanding of childhood malignant lymphomas in Egypt, and shows that malabsorption may be more common in the disease than has been previously suspected.

A case-control study of breast cancer was conducted in Cairo, Egypt and in Kuwait. This is the first such report from Arabic countries and the most significant finding is the animal incidence rate of 7.67 per 100,000 in Kuwaiti women, which ranks amongst the lowest thus far reported in the world. Factors which contribute to this low rate are a short period of active menstruation, low family history, first childbirth at very early age and most likely significant dietary factors. More than 45% of Egyptian women give birth to a child before the age of 20, with 56.5% of controls and 42.3% of patients (p less than 0.01). Many patients already have extensive disease at time of diagnosis as a result of considerable delay. However, this delay did not result in a high incidence of inflammatory breast carcinoma, such as has been reported in Tunisia.

The SWOG carried out a Phase II evaluation of rubidazone in patients with advanced breast cancer. Good risk patients were given rubidazone 150 mg/m2 IV every three weeks. Poor risk patients were given a 25% dose reduction at the start of treatment. Rubidazone dose was increased or decreased depending on toxicity. One patient went into complete remission, four had partial remission and nine had stable disease. Forty-two patients showed increased disease on treatment. No cardiotoxicity was seen, but other common toxicities noted included mostly mild to moderate myelosuppression, nausea, vomiting and alopecia. This study failed to indicate significant antitumor activity of rubidazone in patients with advanced breast carcinoma.