Impact of the revised FIGO/WHO system on the management of patients with gestational trophoblastic neoplasia.

OBJECTIVE: To study the effect of a change in disease scoring systems on the management of patients with gestational trophoblastic neoplasia (GTN) in our supra-regional treatment centre. METHODS: We reviewed disease characteristics and treatment outcomes in 632 GTN patients managed at our centre from 1973 to 2006. Two disease scoring systems were used sequentially, the Sheffield modification of the Charing Cross Scoring System (SCCSS) before 2000, and the revised FIGO/modified WHO system (FIGO 2000) thereafter. RESULTS: Using the SCCSS 573 (90.7%) patients were classified as low risk (LR) and 59 (9.3%) as high risk (HR). With FIGO 2000, 587 (92.9%) were LR and 45 (7.1%) HR. For LR patients, the complete response (CR) to first line single agent chemotherapy was 77% before 2000 and 61.6% from 2000 to 2006. For HR patients, the CR rates with first line chemotherapy were 79.5% and 75% respectively. The higher threshold for assigning a patient as HR using FIGO 2000 had an impact on the success of treatment; only 7/19 patients (37%) who were scored 6 by FIGO 2000, and thus treated as LR with methotrexate/folinic acid, achieved a CR. CONCLUSION: In our experience, the revised FIGO/modified WHO scoring system has down scored some patients who would have been considered as high risk with the previous scoring system. A trend to lower CR with first line chemotherapy and an increase in the need for second line chemotherapy was seen.

Epirubicin/vinorelbine adjuvant chemotherapy in young women with breast cancer is associated with preservation of menstrual function.

AIMS: To determine whether the epirubicin and vinorelbine regimen in the adjuvant (neoadjuvant) treatment of breast cancer has minimum adverse effects on menstrual function. PATIENTS AND METHODS: Thirty-six premenopausal women with a median age of 32 (25-47) years received epirubicin and vinorelbine. Twenty-eight received only epirubicin and vinorelbine without any other neo/adjuvant chemotherapy agents. Amenorrhoea was defined as absence of periods 6 months after the completion of chemotherapy. The medical records of all patients were reviewed retrospectively. RESULTS: Twenty-six patients were assessable for effects of epirubicin and vinorelbine on menstruation. All the 26 patients resumed menstruation within 6 months of completing epirubicin and vinorelbine treatment. Epirubicin and vinorelbine was well tolerated. After a median follow-up of 38.5 (11-78) months, six (21%) patients had developed disease relapse and three (11%) had died. The 6.5-year disease-free survival and overall survival probabilities were 77 and 86%, respectively. CONCLUSION: Adjuvant (neoadjuvant) epirubicin and vinorelbine is an effective and well-tolerated regimen that is associated with the retention of menstrual function.

Evaluation of some biochemical markers as prognostic factors in malignant lymphomas.

UNLABELLED: This study aimed to estimate the pre- and post-treatment serum levels of glycosaminoglycans (GAGs), soluble p55 tumor necrosis factor receptor (sp55TNF-R) and soluble L-selectin in order to evaluate their prognostic significance and their role in monitoring tumor growth and host-tumor response in malignant lymphomas. Also, the work aimed to investigate the relationship between these levels with B symptoms and disease stage. For this purpose, 43 newly diagnosed patients with malignant lymphoma (12 with Hodgkin's disease (HD) and 31 with Non-Hodgkin's lymphoma (NHL) were selected from Mansoura University Hospital. Among NHL patients, 7 were in stage I/II, 13 in stage III and 14 in stage IV. In addition, 10 NHL patients were presented with B symptoms while, 21 did not. 7 apparently healthy individuals were selected as a control reference group. RESULTS: 1-Pre-treatment levels of GAGs, sp55TNF-R and sL-selectin increased significantly in both HD and NHL before treatment as compared to control. Pre-treatment sp55TNF-R levels in both diseases and sL-selectin (only in HD patients) may have a significant value in predicting response to therapy, while GAGs level in both diseases and sL-selectin in NHL patients had a limited value in such prediction. 2- In contrast to sp55TNF-R and sL-selectin, post-treatment GAG levels are thought to be a good sign of remission in both HD and NHL. 3- Serum GAG levels increased significantly before treatment in stages III/IV NHL as compared to stage I/II, so serum GAGs at diagnosis could reflect tumor bulk and the disease activity. 4- Elevated serum sp55TNF-R before treatment was associated with the presence of B symptoms and such association lead to a worse prognosis. CONCLUSION: Pre-treatment sp55TNF-R levels in both HD & NHL and sL-selectin (only in HD patients) could be used as prognostic factor with respect to predicting treatment outcome. Serum GAGs at diagnosis could reflect tumor bulk and the disease activity.

High-dose chemotherapy and peripheral blood stem cell support in refractory gestational trophoblastic neoplasia.

We present retrospectively our experience in the use of high-dose chemotherapy and haematopoietic stem cell support (HSCS) for refractory gestational trophoblastic neoplasia (GTN) in the largest series so far reported. In all, 11 patients have been treated at three Trophoblast Centres between 1993 and 2004. The conditioning regimens comprised either Carbop-EC-T (carboplatin, etoposide, cyclophosphamide, paclitaxel and prednisolone) or CEM (carboplatin, etoposide and melphalan) or ICE (ifosfamide, carboplatin, etoposide). Two patients had complete human chorionic gonadotrophin responses, one for 4 and the other for 12 months. Three patients had partial tumour marker responses for 1-2 months. High-dose chemotherapy and HSCS for GTN is still unproven. Further studies are needed, perhaps in high-risk patients who fail their first salvage treatment.

VEDex (vincristine, epirubicin dexamethasone): an effective and well tolerated palliative chemotherapy regimen for non-Hodgkin's lymphoma.

An evaluation was carried out of the efficacy and toxicity of a novel weekly palliative chemotherapy regimen comprising vincristine, epirubicin and dexamethasone (VEDex) in 57 patients with non-Hodgkin's lymphoma (NHL) treated at this centre. The age range was 34-88 years and the median age was 67 years. Twenty-three patients (40%) had low grade disease and 4 patients (7%) had transformed NHL. Thirty patients (53%) had high grade NHL; 7 had relapsed after conventional chemotherapy and were not fit for high-dose chemotherapy, 7 were heavily pre-treated, 8 had received prior radiotherapy and 8 had not received any prior therapy. Responding patients received a total of 8 weeks of treatment, but treatment could be repeated at a later stage if required. The overall response rate was 66.6%; 11 patients (19.3%) achieved a complete response and 27 (47.3%) achieved a partial response. A further 11 patients (19.3%) had stable disease. Twenty-four patients (42.1%) reported complete resolution of symptoms and 21 (36.8%) had partial resolution of symptoms. The median survival from the onset of treatment was 6 months. Grade III neutropenia was seen in 9 patients (15.8%). Other toxicity included nausea and vomiting grade II (3.5%), grade III (1.8%) and alopecia grade III (1.8%). There were no treatment related deaths. We conclude that VEDex is an effective palliative treatment in patients with indolent or aggressive lymphoma with poor performance status or who have been heavily pre-treated. It is well tolerated in the elderly.