Squamous cell cancer of the esophagus is the most common cancer among black South African males, and 60% of patients present with localized inoperable disease. Combined chemoradiotherapy has been reported to be superior to radiotherapy alone for localized inoperable esophageal cancer in North American patients. A study was carried out to determine if this was also applicable to South African patients, who present with more advanced disease. From September 1991 through June 1995, 70 patients with locally advanced (T3N0-1M0) squamous cancer of the esophagus were prospectively randomized to receive radiotherapy alone or radiotherapy combined with cisplatin and 5-fluorouracil. There was no statistically significant survival difference between the two groups. The median survival was 144 days in the group receiving radiotherapy alone, and 170 days in the group receiving radiotherapy combined with chemotherapy (p = 0.42). The degree of weight loss before initiation of therapy had a significant effect on survival regardless of the treatment arm. Radiotherapy in combination with chemotherapy, as administered in this study for South African patients with locally advanced, inoperable squamous cancer of the esophagus, is no better than radiotherapy alone.
Forty-one patients with acute non-lymphoblastic leukemia were treated between March 1990 and November 1993 with mitoxantrone, cytarabine, etoposide and granulocyte-macrophage-colony-stimulating factor (GM-CSF) started on day 1. This was given as induction, consolidation and intensification treatment. A complete response was obtained in 26 of 41 (63%) patients. The median survival of the 25 evaluable patients in complete remission was 18 months. The median duration to neutropenia < 500/ul was 20 days during induction, 15 days during consolidation, 21 days during first intensification and 25 days during second intensification. Mitoxantrone, cytarabine and etoposide given with GM-CSF gave a complete response rate and median survival similar to other combination treatments but there was no definite evidence that the duration of neutropenia was reduced by the addition of GM-CSF from the start of treatment.
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