Weekly gemcitabine and cisplatin concurrent with pelvic irradiation for primary therapy of cervical cancer: report of the first seven cases in Thai women

Purpose The aim of this study was to evaluate the compliance, response, and side effects of weekly gemcitabine (125 mg/m²) given concomitantly with standard weekly cisplatin (40 mg/m²) and pelvic radiotherapy for primary treatment of cervical cancer stage IB2–IVA in the first seven Thai cases. Materials and methods Weekly gemcitabine at a dose of 125 mg/m² was given concomitantly with cisplatin at 40 mg/m² for six cycles with concurrent radiotherapy in primary therapy of stage IB2–IVA cervical cancer. Radiation consisted of 5000 cGy in 25 daily fractions combined with brachytherapy to take point A to about 8600 cGy. Results Using weekly gemcitabine at a dose of 125 mg/m² with cisplatin at a dose of 40 mg/m², five of seven patients demonstrated a dose-limiting toxicity (DLT). DLTs consisted of nephrotoxicity in three cases and bone marrow suppression in two cases. Only one of seven patients could go through six cycles. All 5 living patients had a clinically complete response. Conclusions Weekly gemcitabine at a dose of 125 mg/m² with cisplatin at a dose of 40 mg/m² given concurrently with primary pelvic radiotherapy resulted in an excellent response but unacceptable toxicities for Thai women. The trial protocol was changed by reducing the cisplatin dosage to 20 mg/m².     

Comparision of Different Radiotherapy Planning Techniques for Breast Cancer after Breast Conserving Surgery

Objectives:To compare different radiotherapy planning techniques for breast cancer after breast conserving surgery.Materials and methods: Eighteen patients with breast cancer who underwent breast conserving surgery were selected.For each patient four different whole breast irradiation techniques including Tan, fIMRT, iIMRT and VMAT werecompared to the conventional tangential technique (Tan). Results: Mean maximum point dose (Dmax) for Tan, fIMRT,iIMRT and VMAT were 110.17% (±1.87), 105.89% (±1.13), 106.47% (±0.92) and 106.99% (±1.16) (p<0.001). Meanminimum point dose (Dmin) from Tan was 84.02% (±3.68) which was significantly higher than those from fIMRT,iIMRT and VMAT which were 76.57% (±11.4), 67.69 %( ±19.20) and 80.69% (±7.06) (p<0.001). Only the meanV95 of fIMRT was significantly less than Tan (p=0.01). Mean percentage of volume receiving ≥ 20 Gy (V20Gy) andmean doses of the ipsilateral lung were 17.09% and 953.05 cGy, 16.60% and 879.20 cGy, 14.79% and 772.26 cGy,15.32% and 984.34 cGy for Tan, fIMRT, iIMRT and VMAT. Only iIMRT had a significantly lower mean V20Gy andthe mean dose to ipsilateral lung in comparison with Tan. Significantly, high mean doses to the contralateral breast(498.07 cGy, p<0.001) were observed in VMAT. Conclusion: The conventional tangential technique provides adequatedose coverage but resulted in high dose-volumes. The iIMRT and fIMRT had significantly smaller high dose-volumesand better conformity. VMAT demonstrated excellent dose homogeneity and conformity but an increased low-dosevolume outside the target should be of concern.     

Maximum Diameter of Intracranial Metastatic Lesions as a Prognostic Factor in Patients Following Whole Brain Radiotherapy

Purpose: To evaluate whetehr maximum diameter of intracranial metastatic lesions may be a prognostic factor in intracranial metastatic patients receiving whole brain radiotherapy. Materials and Methods: The records of 114 cases who between January 2005 and December 2007 were retrospectively reviewed. There were 85 who met the inclusion criteria. Results: In these 85, the oneyear overall survival rate was 16.5% and the median survival time was 125 days. Median survival in relation to recursive partitioning analysis (RPA) classes I, II and III were 216, 133 and 85 days. Logrank tests of initial prognostic factors were significant for RPA classifications, Karnofsky Performance Status(KPS), maximum diameters of intracranial metastatic lesions and presence of necrotic centers. The median survivals with a maximum diameter of the largest intracranial metastatic lesion     

Survival Analysis of Glioblastoma Multiforme

Introduction: To evaluate the survival of Glioblastoma Multiforme (GBM). Material and Methods: Patients witha pathological diagnosis of Glioblastoma Multiforme (GBM) between 1 January 1994 and 30 November 2013, wereretrospectively reviewed. Inclusion criteria: 1) GBM patients with confirmed pathology, 2) GBM patients were treatedby multimodality therapy. Exclusion criteria: 1) GBM patients with unconfirmed pathology, 2) GBM patients with spinalinvolvement, 3) GBM patients with incomplete data records. Seventy-seven patients were treated by multimodalitytherapy such as surgery plus post-operative radiotherapy (PORT), post-operative Temozolomide (TMZ) concurrent withradiotherapy (CCRT), post-operative CCRT with adjuvant TMZ. The overall survival was calculated by the Kaplan-Meiermethod and the log-rank test was used to compare the survival curves. A p-value of ≤ 0.05 was considered to bestatistically significant. Results: Seventy-seven patients with a median age of 53 years (range 4-76 years) showeda median survival time (MST) of 12 months. In subgroup analyses, the PORT patients revealed a MST of 11 monthsand 2 year overall survival (OS) rates were 17.2%, the patients with post-operative CCRT with or without adjuvantTMZ revealed a MST of 23 months and 2 year OS rates were 38.2%. The MST of patients by Recursive PartitioningAnalysis (RPA), classifications III, IV, V, VI were 26.8 months, 14.2 months, 9.9 months, and 4.0 months, (p <0.001).Conclusions: The MST of the patients who had post-operative CCRT with or without adjuvant TMZ was better thanthe PORT group. The RPA classification can be used to predict survival. Multimodality therapy demonstrated the mosteffective treatment outcome. Temozolomide might be beneficial for GBM patients in order to increase survival time.