Biomedical subjects
AT Turrisi
Publications and source records attributed to AT Turrisi.
Small Cell Lung Cancer: The Influence of Dose and Treatment Volume on Outcome.
The treatment of small cell lung cancer is clearly enhanced by the addition of radiation therapy. Survival increases modestly while local thoracic failure as first site of progression is reduced from approximately 60% when chemotherapy alone is used to 30% after combined modality therapy. The variables of radiation dose and treatment volume seem to be important in the successful management of this disease. Local chest control appears to increase as doses are escalated from low levels (25 Gy) to moderate levels (45 to 50 Gy(. With about one third of patients experiencing local chest progression, one can speculate that higher radiation doses might be of value. However, at this time there is no proof that increased dose or dose intensity bears out this promise. Indeed, increasing dose intensity of radiotherapy, eg, twice-daily treatment, increases esophagitis, perhaps reduces local failure, but has not improved overall survival. Using larger total doses or altered fraction schemes must still be considered to be under investigation. To increase dose in a safe manner, reduction in the volume covered by radiation portals will likely need to take place. Modern trials suggest that prophylactic treatment of the radiographically or clinically negative contralateral hilum and/or supraclavicular nodal regions may not be necessary for survival or local control. Importantly, reducing treatment volumes may permit increasing doses without exceding normal tissue tolerance. Also, reduced volumes pave the way for further clinical trials that improve radiation dose delivery by better target definition and more conformal therapy.
Radiotherapy in Limited Small Cell Lung Cancer: Fractionation and Timing of Modalities.
The use of thoracic radiotherapy is important to survival in the treatment of limited disease small-cell lung cancer. How to administer that therapy is the subject of continuing clinical trials and ongoing clinical debates. This article focuses on the issues of fractionation of the radiotherapy and describes the rationale for accelerated treatment and hyperfractionated treatment in small cell lung cancer. Theoretical and clinical concepts and recent trials are discussed. Altered fractionation schemes appear to increase acute responding reactions, but are associated with improved local control. The issue of fractionation and central nervous system tolerance is reviewed. Since the cornerstone therapy for this systematic disease is multiagent chemotherapy, strategies for integration of thoracic radiotherapy and systemic chemotherapy are reviewed. The concepts of sequential, alternating, and concurrent therapy are discussed in the context of clinical trials. The issue of integration in the course of treatment is also discussed. Early versus delayed radiation treatment may have different meanings for clinicians and investigators dealing with this disease. All of these issues are covered for the modern cisplatin-etoposide era.