Phase II study of capecitabine and oxaliplatin given prior to and concurrently with preoperative pelvic radiotherapy in patients with locally advanced rectal cancer.

This multicentre phase II study evaluated the efficacy and safety of preoperative capecitabine plus oxaliplatin and radiotherapy (RT) in patients with locally advanced rectal cancer (T3/T4 rectal adenocarcinoma with or without nodal involvement). Treatment consisted of one cycle of XELOX (capecitabine 1000 mg m(-2) bid on days 1-14 and oxaliplatin 130 mg m(-2) on day 1), followed by RT (1.8 Gy fractions 5 days per week for 5 weeks) plus CAPOX (capecitabine 825 mg m(-2) bid on days 22-35 and 43-56, and oxaliplatin 50 mg m(-2) on days 22, 29, 43 and 50). Surgery was recommended 5 weeks after completion of chemoradiotherapy. The primary end point was pathological complete tumour response (pCR). Sixty patients were enrolled. In the intent-to-treat population, the pCR rate was 23% (95% CI: 13-36%). 58 patients underwent surgery; R0 resection was achieved in 57 (98%) patients, including all 5 patients with T4 tumours. Sphincter preservation was achieved in 49 (84%) patients. Tumour and/or nodal downstaging was observed in 39 (65%) patients. The most common grade 3/4 adverse events were diarrhoea (20%) and lymphocytopaenia (43%). Preoperative capecitabine, oxaliplatin and RT achieved encouraging rates of pCR, R0 resection, sphincter preservation and tumour downstaging in patients with locally advanced rectal cancer.

[Cost reduction in long-term nursing thanks to a memory clinic--results of a case control study]. / Kostenreduktion im Langzeitpflegebereich dank Memoryklinik--Resultate einer Fallkontrollstudie.

Between 1991 and 1995, 334 persons from the city of Zurich have been investigated at the gerontologic counselling facility of the memory clinic of the nursing home Entlisberg near Zurich. 49 (14.7%) of these persons suffered from a treatable disease (16 from depression, 13 from chronic intoxication, 20 from other treatable diseases), 10 from other disturbances (debility or postapoplectic state), and 275 from dementia. In 45% of the cases dementia was moderate, in 47% moderate to severe, and in 8% severe. In most cases dementia was of Alzheimer's type (60.7%), others were of multi-infarct type (17.5%), of mixed type (13.1%), or other types (8.7%). Until march 1996, 64 (19.4%) of these 334 on the average 74-year-old persons treated in the memory clinic have been admitted to a city nursing home. They have compared to a random sample, including 312 demented persons of similar ages and similar date of admittance to the same institutions. The proportion of demented persons cared before admittance by a spouse was about 28% in both groups. On an average, the mini mental state (Zurich variant) at admittance to a nursing home was 10.95 points in patients from the memory clinic, compared to 13.43 points in the control group. Thus, patients that have formerly been advised and trained entered the nursing home in a state of dementia more advanced by 2.48 points. Based on an average yearly demelioration by about 2.4 points, this means admittance to a nursing home is delayed by 376 days. Patients for whom admittance to a nursing home could be avoided completely by the treatment proposed by the counselling were not considered in this calculation.