The aim of this study was to evaluate the
effectiveness and possible toxicity of the combination of
temozolomide (TMZ) with whole-brain irradiation (WBI)
in the treatment of brain metastases from solid tumors.
Patients and Methods: 33 patients with brain metastases
were included in the study and treated with TMZ
60 mg/m2/day (days 1-16) concomitantly with WBI (36
Gy/12 fractions given in 16 days). One month after the
end of radiotherapy, 6 cycles of TMZ were administered
as adjuvant treatment (200 mg/m2/day for 5 consecutive
days every 28 days). Results: Responses were assessed
using computed tomography at the end of the 3rd and
6th cycle of chemotherapy. The objective response rate
was 54.5% and 57.6% after the 3rd and the 6th cycle, respectively.
The median overall survival was 12 months.
In patients with metastases from lung cancer the objective
response rate was 11/14 (78.6%) after both the 3rd
and the 6th cycle of treatment. The most common side
effects were anemia (24.2%), thrombocytopenia (18.2%),
as well as nausea and vomiting (18.2%). The high incidence
of hepatotoxicity (45.5%) might be related to concomitantly
administered antiepileptic drugs and not to
TMZ. Conclusion: WBI combined with TMZ as concomitant
and adjuvant treatment is effective in treating brain
metastases, with acceptable mild side effects.
Purpose: To study the cytoprotective impact of amifostine against acute radiation mucositis. Patients and Methods: A total of 117 cancer patients with carcinomas localized in pelvic organs, lung and head and neck were entered into this study. In a retrospective way, and in order to minimize the bias related to the investigator, 138 patients as historical controls were randomly selected from a database in our hospital. Acute radiation-induced gastrointestinal mucositis, esophagitis and stomatitis were assessed using the common toxicity criteria scale. The most severe grade recorded was evaluated as the final morbidity score for this patient. Mean toxicity score (MTS) was the mean value of recorded acute radiation toxicity. Mean interruption time (MIT) was the mean value of recorded interruption time due to radiation toxicity. Results: A significantly reduced severity of symptomatology related to oral, esophageal and rectal mucosa was noted in the amifostine group (group A) (p < 0.05, chi-square test). Furthermore, a significant reduction of MTS as well as MIT was observed in group A versus the historical controls (group B) (p < 0.05, Mann-Whitney U test). Conclusion: The administration of amifostine seems to protect patients against radiation-induced mucositis, but further investigation with randomized trials is needed.
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