Tehran University Medical Journal

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Esophageal cancer is one of the most common malignancies in our country. Patients often seek medical advice in advanced and inoperable stages or with cervical esophageal cancer, in which operation is accompanied by sever morbidity. In this conditions many of them cannot tolerate chemo-radiation, or refuse it. Therefore radiotherapy is applied as a single modality in palliation of many patients with esophageal cancer. One of the palliative radio therapeutic methods is application of 5000 CGY in 20 fractions (Long Course) but considering the great number of our patients and limited capacity of radiotherapy centers, as well as emphasis of literature on palliation with 4000 CGY in 13 fractions (short course), we decided to compare these two methods (which are both used in our departments). In this retrospective analytic study, the files of 283 patients with esophageal cancer referred to cancer institute of Imam Khomeini Hospital from 1989-1999 were studied. Patients were between 27-97 years old (mean age=58.3) and most of them were male (53.7 percent). The mean length of lesion was 8.5 cm. The most common site of lesion was middle third at esophagus (48.1 percent) and the most common pathology was squamous cell carcinoma (99.6 percent). Fifty-four percent of patients were hot tea drinkers habitually. From the mentioned variables, only length of lesion had significant relationship with overall survival (P=0.04). Thirty-eight of 283 patients were excluded from analytic study because of incomplete follow-up. The number of patients had been treated by long course (5000 CGY in 20 fractions) was 137 and the remainder (108 patients) by short course (4000 CGY in 13 fractions). No significant difference was seen statistically between these two groups in overall and dysphagia-free survival (Kaplan-Meyer test). Also total dosage of spinal cord is lower in the short course. Thus regarding to less required time in short course and comparable palliation and survival between two methods, the short course policy is more preferable in esophageal cancer patients.

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Background: The standard treatment for high-grade astrocytoma (grades 3 and 4) is surgery followed by radiotherapy (post-op RT). Adjuvant chemotherapy increases disease-free survival (DFS) and overall survival (OS). There are several drugs used for this purpose, each of which have shown benefits and shortcomings. The superiority of combination therapies such as PVC (procarbazine, CCNU and vincristine) over single agents such as BCNU (carmustine) and CCNU (lumostin) has not been definitively established. Single agent CCNU could be a very convenient treatment, as it only involves oral prescription every six weeks. Thus, in this study, we compare CCNU alone with PCV to establish any potential superiority with regard to DFS and OS.
Methods: From 2003-2006, patients with high-grade astrocytoma who had undergone surgery and radiotherapy in the Cancer Institute of Imam Khomeini Hospital, Tehran, Iran, were randomized to CCNU alone or PCV. Chemotherapy was repeated every six weeks for six cycles. Six weeks after the end of sixth cycle, a CT scan was performed. New neurologic signs and symptoms or increases in the previous signs and symptoms and/or new masses in imaging and/or growth of the residual tumor (> 25%) and/or enhancement of any inactive mass from the previous imaging was considered a recurrence. DFS was considered to be the duration from the end of RT to the date of recurrence or last follow-up. OS was taken as the duration from the end of RT to date of death or last follow-up.
Results: After informed consent, of the 70 patients included in this study, 38 were treated with PCV and 32 were treated with CCNU. The mean age was 44 years, ranging from 16 to 78 years, and 51 of the patients were male. Nineteen patients had grade 3 anaplastic astrocytoma and 51 patients had grade 4 glioblastoma multiforme. There were no significant differences with regard to patient age, gender and pathology between the CCNU and PCV groups. DFS and OS were 26 and 27 months, respectively, in the CCNU group and 29 and 34 months, respectively, in the PCV group. By log-rank test, the difference between CCNU and PCV was not statistically significant with regard to the length of DFS and OS.
Conclusion: Although no significant differences were found, a trend toward better survival could be seen in patients treated with PCV. Further studies with more patients and longer follow-up are needed to definitively resolve this issue.