Toxicity and feasibility analysis for cisplatin-based concomitant chemoradiotherapy in locally advanced nasopharyngeal carcinoma

PURPOSE

To assess the side effects of cisplatin-based concurrent chemoradiotherapy (CRT) for locally advanced nasopharyngeal carcinoma (NPC).

PATIENTS AND METHODS

From 2001 through 2007, 34 (27 males; 7 females) patients received a median of 70 Gy curative radiotherapy (RT) with conventional fractionation. Twenty-one (62%) patients received induction chemotherapy (CT): 8 of them received 2 courses of cisplatin (75 mg/m(2), day 1) and 5-fluorouracil (5-FU) (750 mg/m(2), days 1-5) every 3 weeks and 13 patients received 3 courses of cisplatin (75 mg/m(2), day 1) and docetaxel (75 mg/m(2), day 1) every 3 weeks. Concomitant cisplatin was administered either 40 mg/m(2) weekly (n=8) or 75-80 mg/m(2) every 3 weeks (n=26) during RT. Median Karnofsky performance status (KPS) prior to RT was 80 (range 70-90). Patient, disease and treatment-related factors were analysed in relation to termination of concurrent CT.

RESULTS

Concurrent CT was administered to 13 (38.2%) patients without cisplatin termination, whereas 10 (29.4%) patients received 2 cycles of the 3-weekly schedule. Grade 3 oral mucositis (47.1%), grade 2-3 weight loss (44.2%) and grade 2 fatigue (44.1%) were the most frequently dose-limiting side effects during concurrent therapy. The rate of receiving cisplatin cycles as planned was 85% for patients with KPS >80, whilst it was 15% only for patients with KPS < or = 80 (p=0.006). None of the patients suffering of grade 2 fatigue could complete all cycles compared to 68% of patients with < grade 2 fatigue who completed all cycles (p <0.001). The severity of mucositis was significantly related to initial haemoglobin level (p=0.02) and weight loss during RT (p=0.04). Median follow-up was 20 months (range 5-65). Three-year locoregional relapse free (LRRFS), disease free (DFS) and overall survival (OS) rates were 79.3%, 68.8% and 79.2%, respectively.

CONCLUSION

Concurrent administration of CT during RT reveals better outcome but requires careful consideration for toxicity. Initial performance status prior to CRT might be a predictor for unplanned CT stopping due to side effects.

Self-radioiodination of iodogen

Iodogen (1,3,4,6-tetrachloro-3alpha,6alpha-diphenylglucoluril) is commonly used for the radioiodination of proteins as an oxidative agent. The oxidative character of iodogen is not clear, but the two carbonyl groups in its structure probably have an essential role in its oxidizing character. In this study, the self-radioiodination of iodogen has been examined. It was observed that about 10-20% of the initial iodine radioactivity was consumed for the self-radioiodination of iodogen itself. On the other hand, the radioiodinated iodogen removed by ethyl alcohol from the iodogen-coated tubes showed clearly that no thyroid uptake was observed and that it was rapidly cleared out from the whole body of a rabbit administered with the radioiodinated iodogen by injection via the ear vein.

A study of the nutrient foramina of lower limb long bones

In this study a total of 269 adult lower limb long bones were examined to determine the number and location of the nutrient foramina in the shafts of bones. The mean of foraminal index was 48.82 for femur, 33.17 for tibia, and 47.82 for fibula. The number of foramina noted were: two on the linea aspera in the middle third of the femur, one on the posterior surface of the upper third of the tibia, and one on the posterior surface of the middle third of the fibula.