Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “RADIOTHERAPY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources
PubMed1995

Improving the acceptability of high-dose radiotherapy by reducing the duration of treatment: accelerated radiotherapy in high-grade glioma.

Radiotherapy, although clearly beneficial in patients with high-grade glioma, is largely palliative, and a protracted course of treatment may not be the most appropriate approach in the context of limited survival. We therefore assessed the feasibility, toxicity and survival results of a short accelerated radiotherapy regimen given twice daily over a period of 3 weeks. A total of 116 patients with high-grade glioma were treated with radiotherapy in a prospective study using an accelerated fractionation regimen. The total dose of 55 Gy was given in 32-36 fractions of 1.72-1.53 Gy, twice daily 5 days a week, with a minimum 6 h interval between fractions. Toxicity was assessed using Karnofsky performance status scale and in the later part of the study with the Barthel index. Survival data were compared with a control group treated with 60 Gy in 30 daily fractions in a previous MRC study, matched for known prognostic factors. The median survival of 116 patients treated with accelerated radiotherapy was 10 months. Survival comparison of accelerated patients with matched controls treated with conventional fractionation demonstrated a hazard ratio of 1.13 (95% confidence interval 0.85-1.51; P = 0.39). Early treatment toxicity was acceptable, with only seven patients developing transient decrease in performance status. The accelerated radiotherapy regimen was logistically feasible and acceptable to patients, carers and staff. Treatment time was reduced without apparent increase in early toxicity and there was no loss of survival benefit. The effectiveness and convenience of a short accelerated regimen makes this a suitable alternative to a 6 week course of radiotherapy in patients with high-grade glioma. However, a full randomised trial comparing conventional and accelerated radiotherapy may be required as proof of equivalence.

Actuarial Analysis↗
PubMed1999

Efficacy of an ondansetron orally disintegrating tablet: a novel oral formulation of this 5-HT(3) receptor antagonist in the treatment of fractionated radiotherapy-induced nausea and emesis. Emesis Study Group for the Ondansetron Orally Disintegrating Tablet in Radiotherapy Treatment.

A significant number of patients who are receiving radiotherapy experience the distressing side effects of emesis and nausea. Although prophylactic antiemetics are often given to patients who are receiving single-fraction, high-dose radiotherapy to the abdomen, a survey has revealed that antiemetic prophylaxis is not routinely offered to those receiving fractionated radiotherapy. Hence there is a need for an effective treatment of emesis for use in this group of patients. Ondansetron is an effective and well-tolerated antiemetic, which is used for the prevention of both chemotherapy and radiotherapy-induced emesis and nausea. This agent has been developed as a novel freeze-dried oral formulation. Ondansetron orally disintegrating tablets (ondODT) disperse rapidly when placed on the tongue. As the tablet does not need to be swallowed with water, it is a particularly useful formulation for patients who have difficulty with swallowing or who do not feel able to drink. This study was undertaken to investigate the efficacy of ondODT in the treatment of established emesis and nausea induced by radiotherapy. Two doses of ondODT, 8 mg and 16 mg, were compared with placebo in patients who developed emesis and/or moderate/severe nausea after receiving fractionated radiotherapy to sites located between the thorax and the pelvis. The study showed that ondODT was clinically superior to placebo in treating emesis and nausea successfully over a 12-hour period after taking the medication. There were no statistically significant differences between the two doses of ondODT. In the 2 hours after taking the study medication, patients who received ondODT (8 mg and 16 mg) had significantly fewer emetic episodes compared with those who received placebo. They also experienced significantly less nausea. In conclusion, ondODT 8 mg is effective in the treatment of radiotherapy-induced emesis and nausea and provides an effective alternative to the conventional ondansetron tablet.

Administration, Oral↗
PubMed1996

A randomized study of high-dose split course radiotherapy preceded by high-dose chemotherapy versus high-dose radiotherapy only in locally advanced non-small-cell lung cancer. An EORTC Lung Cancer Cooperative Group trial.

BACKGROUND: The treatment results of radiotherapy in stage III non-small-cell lung cancer are very poor. Several phase II studies showed that neoadjuvant chemotherapy followed by radiotherapy was feasible in this patient group and suggested that treatment outcome might improve. A randomized phase II study was performed addressing the response rate and morbidity of high-dose split course radiotherapy (RT) versus the same radiotherapy preceded by high-dose chemotherapy (CT) in patients with stage III non-small-cell lung cancer. PATIENTS AND METHODS: Seventy eligible patients were randomized in this study. CT consisted of cisplatin 100 mg/m2 days 1 and 22, and vindesine 3 mg/m2 on days 1, 8, 22 and 29. Radiotherapy started on day 43 in the combined arm and immediately in the RT-only arm. The primary tumour and the regional nodes were treated by 30 Gy/10 fractions/2 weeks and after the split by a second course of 25 Gy/10 fractions/2 weeks. In the combined arm a third CT cycle was planned during the split between RT courses. RESULTS: In the CT + RT arm 34 patients were evaluable for response and toxicity and 30 patients in the RT only arm. After completion of treatment 7 patients had a complete response (2 in the CT plus RT arm, 5 in the RT alone arm) and 26 patients a partial response (13 in the CT plus RT arm, 13 in the RT alone arm) for an overall response rate of 52% (95% CI 39%-65%). Acute toxicity was worse in the combined treatment arm with grade 4 leucocytopenia in 8 patients and thrombocytopenia grade 4 in one patient. Three patients had reversible renal toxicity grade 2. There was one toxic death in the RT plus CT arm. There was no enhancement of acute or late radiation pulmonary or oesophageal toxicity. Time to progressive disease (median 30 vs. 35 weeks) and overall survival time (median 12 months) were equal in both treatment arms. CONCLUSION: High-dose radiotherapy preceded by high-dose chemotherapy was more toxic than radiotherapy alone and did not result in this study in any benefit in terms of response rate, time to progressive disease and overall survival.

Adult↗
PubMed1998

A randomized study of radiotherapy alone versus radiotherapy plus 5-fluorouracil and platinum in patients with inoperable, locally advanced squamous cancer of the esophagus.

Squamous cell cancer of the esophagus is the most common cancer among black South African males, and 60% of patients present with localized inoperable disease. Combined chemoradiotherapy has been reported to be superior to radiotherapy alone for localized inoperable esophageal cancer in North American patients. A study was carried out to determine if this was also applicable to South African patients, who present with more advanced disease. From September 1991 through June 1995, 70 patients with locally advanced (T3N0-1M0) squamous cancer of the esophagus were prospectively randomized to receive radiotherapy alone or radiotherapy combined with cisplatin and 5-fluorouracil. There was no statistically significant survival difference between the two groups. The median survival was 144 days in the group receiving radiotherapy alone, and 170 days in the group receiving radiotherapy combined with chemotherapy (p = 0.42). The degree of weight loss before initiation of therapy had a significant effect on survival regardless of the treatment arm. Radiotherapy in combination with chemotherapy, as administered in this study for South African patients with locally advanced, inoperable squamous cancer of the esophagus, is no better than radiotherapy alone.

Adult↗
PubMed1999

Hypoxic radiosensitizers in radical radiotherapy for patients with bladder carcinoma: hyperbaric oxygen, misonidazole, and accelerated radiotherapy, carbogen, and nicotinamide.

BACKGROUND: In animal models carbogen (normobaric 95% oxygen, 5% carbon dioxide) provides significant enhancement of local tumor control with fractionated radiotherapy. This approach to radiosensitization has been evaluated in the treatment of patients with bladder carcinoma using radical radiotherapy. METHODS: Sixty-one patients with locally advanced bladder carcinoma were treated using a Phase II trial delivering radiotherapy to the bladder (50-55 Grays in 20 daily fractions over 4 weeks) with inhalation of carbogen alone in 30 patients and the addition of oral nicotinamide (80 mg/kg) prior to radiotherapy with carbogen in 31 patients. The results from these 61 patients were compared with those from two earlier attempts at hypoxic sensitization: the second Medical Research Council (MRC) hyperbaric oxygen trial in patients with bladder carcinoma and a Phase III trial of misonidazole with radiotherapy in patients with bladder carcinoma performed at Mount Vernon Hospital. RESULTS: Although there was no difference between the hyperbaric oxygen and misonidazole trials, when compared with the two earlier series there was a large, statistically significant difference in favor of those patients receiving carbogen with or without nicotinamide for local control (P = 0.00001), progression free survival (P = 0.001), and overall survival (P = 0.04). CONCLUSIONS: Although the advantage for the carbogen group may be explained in part by changes in radiotherapy practice over the period of the three studies the improvement in local control is sufficiently great to support the hypothesis that hypoxia is important in modifying the control of bladder carcinoma using radiation therapy. Further evaluation of accelerated radiotherapy, carbogen, and nicotinamide in patients with bladder carcinoma is needed in a Phase III trial.

Adult↗
PubMedDate not supplied

Comparative evaluation of hypofractionated radiotherapy and conventional fractionated radiotherapy in the management of carcinoma of the cervix in Ibadan, Nigeria.

Four hundred and eighty patients with histologically confirmed carcinoma of the uterine cervix were randomized into 2 groups to either receive hypofractionated radiotherapy (HF--230 patients--study group) or conventional fractionated radiotherapy (CFR--250 patients--control group) between December 1988 and November 1992 at the Radiotherapy Department, University College Hospital, Ibadan. The 5-year survival rate for HF patients in Stages I, II, III and IV were, respectively, 91.3%, 67.2%, 40.2% and 18.0% while for CFR patients in Stages I, II, III and IV were respectively, 92.8%, 69.2%, 42.5% and 19.6%. Though early radiation adverse effects were similar in CFR and HF patients, marked late adverse radiation effects were observed in HF patients than in CFR patients. Complete response rate and local tumour controls were found to be similar in the HF and CFR patients. This study revealed that with similar 5-year survival, complete response rate and local tumour control in HF and CFR patients while a significantly higher late radiation adverse effects were recorded in HF patients, conventional fractionated radiotherapy is the preferred form of radiation therapy in the management of carcinoma of the uterine cervix. Administration of hypofractionated radiotherapy for cervical cancer patients with the aim of maximizing the use of few available radiotherapy facilities, as currently obtained in some radiotherapy centres in Nigeria will result in high post treatment morbidity.

Adenocarcinoma↗
PubMed1990

Radiotherapy combined with low-dose cis-diammine dichloroplatinum (II) (CDDP) in inoperable nonmetastatic non-small cell lung cancer (NSCLC): a randomized three arm phase II study of the EORTC Lung Cancer and Radiotherapy Cooperative Groups.

UNLABELLED: A randomized Phase II study was carried out to assess the feasibility and tumor response of radiotherapy combined with low dose cis-diammine dichloroplatinum (II), (cDDP), in patients with inoperable non-small cell lung cancer (NSCLC). One hundred patients were treated with either radiotherapy alone (arm I), with radiotherapy plus cDDP given once a week (arm II), or daily (arm III). The endpoints were acute and late toxicity and tumor response. Esophagitis was observed more frequently in the cDDP arms, but was severe in only 4% of the patients. Nausea and vomiting were more frequent and more severe in patients treated with the combination therapy. In 37% they required medication or were intractable (WHO, grade 3-4). There were no deficits in renal function when hydration schemes were used. Lung fibrosis was similar in the three arms, with an average of 75% of which 50% was severe. Response (complete and partial remission) was observed in 21 out of 34 eligible patients in arm I, in 20 out of 30 patients in arm II, and 20 out of 30 patients in arm III. The 1- and 2-year survival data were 38% and 14% for radiotherapy alone, 49% and 17% for radiotherapy and cDDP given once a week, and 50% and 32% for radiotherapy combined with daily cDDP. IN CONCLUSION: a combination of concomitant cDDP and radiotherapy is tolerable. Based on these results, the study has been continued as a Phase III study with survival as most important end point.

Adenocarcinoma↗
PubMed1996

Radiotherapy vs. radiotherapy and razoxane in the treatment of soft tissue sarcomas: final results of a randomized study.

PURPOSE: The effect of the sensitizer razoxane on soft tissue sarcomas (STS) was prospectively evaluated in a randomized, controlled trial. The main purpose of the study was to determine the response rates and local control under the combined treatment compared to irradiation alone. METHODS AND MATERIALS: Between 1978 and 1988, 144 patients entered the study; 130 were evaluable for response, toxicity, or survival. The patients were randomized to receive radiotherapy alone or radiotherapy with razoxane. They were divided into postoperative cases and patients with gross disease (unresectable primaries, recurrent disease, or metastatic disease). The median radiation dose was 60 Gy postoperatively, and 56-58 Gy in patients with gross disease. The dose difference has palliative reasons. Razoxane was given orally at a daily dose of 150 mg/m2 during the time of the radiotherapy, starting 5 days before the first irradiation. In general, the groups were comparable as to their prognostic factors. There was some imbalance, however, in favor of the postoperative group reveiving radiotherapy alone. RESULTS: Between the patient groups treated postoperatively in an adjuvant form, there were no substantial differences in local control and survival. Among 82 patients with gross disease, the treatment with radiotherapy and razoxane led to an increased response rate compared to photon irradiation alone (74 vs. 49%). The local control rate was likewise improved (64 vs. 30%;p < 0.05). The acute toxicity was somewhat higher in the sensitizer arm, but there was no difference in the occurrence of late complications. CONCLUSIONS: Radiotherapy combined with razoxane seems to improve the local control in inoperable, residual, or recurrent STS compared to radiotherapy alone. The combined treatment is a fairly well tolerated procedure at low costs. It can be recommended for inoperable primary STS or gross disease after incomplete resection, conditions which are still associated with limited local control and a grave prognosis.

Adolescent↗
PubMed2000

Clinically staged T3N0M0 laryngeal cancer: how is it best treated? Definitive radiotherapy with salvage surgery v/s combined surgery and radiotherapy.

Controversy surrounds the optimum treatment of T3N0 cancer larynx. Curative radiotherapy with salvage surgery in reserve is an accepted methodology as is also a combined protocol of surgery and radiotherapy. A retrospective analysis of the survival results of 119 cases of clinically staged T3N0 cancer larynx treated over a 14-year period at a single centre with either of the above two modalities has been undertaken. The selection of the treatment modality for an individual patient was decided jointly by the patient and the clinicians at a combined cancer clinic. The combined surgery plus radiotherapy treatment group was comprised of a relatively greater number of transglottic tumours while the curative radiotherapy group had a higher proportion of glottic tumours. Actuarial four-year disease-free survival rates were significantly better with combined treatment (79.3 per cent) than with radical radiotherapy and surgical salvage (65.3 per cent)--p value = 0.024. In the radical radiotherapy group, failure was almost always at the primary site and the probability of surviving with an intact larynx was approximately half of the total survival. As per this study, a policy of radical radiotherapy (with salvage surgery for failure) for unselected clinically staged T3N0 cancer larynx, does not provide for comparable cure rates or for satisfactory laryngeal preservation.

Combined Modality Therapy↗
PubMed2002

[Non-randomized clinical study comparing chemotherapy plus radiotherapy with radiotherapy alone in neoadjuvant therapy for oral cancer].

Neoadjuvant therapy plays an important role for organ preservation and survival rate in the treatment of oral cancer. We clinically compared the effect of neoadjuvant radiotherapy and chemoradiotherapy in patients with oral cancer. We retrospectively examined 47 patients diagnosed with oral squamous cell carcinoma who underwent neoadjuvant therapy followed by curative surgery in the oral and maxillofacial surgery department of Ehime University Hospital. We divided them into two groups: radiotherapy alone (24 cases) and chemoradiotherapy (23 cases). The patients in the radiotherapy group underwent irradiation of 32.6 +/- 5.0 Gy (mean +/- SD). The patients in the chemoradiotherapy group received a low-dose fraction of cisplatin (8 mg/mm2/day, 5 days a week; total dose: 139.4 +/- 67.1 mg) and 5-fluorouracil (300 mg/mm2/day, 5 days a week; total dose: 5,900 +/- 1,839.8 mg) combined with simultaneous irradiation of 31.0 +/- 3.2 Gy. None of the 24 patients had a complete response to radiotherapy alone and 12 (50%) had a partial response. Six (26%) of the 23 patients had a complete response to chemoradiotherapy and 12 (52%) had a partial response. The primary control rate (82.6%) to chemoradiotherapy was higher than that (67.5%) to radiotherapy alone although no significant difference was found. The 5-year survival rate was 64.3% in the radiotherapy group and 62.8% in the chemoradiotherapy group. The findings of the present study suggest that while the combination of radiation and cisplatin/5-fluorouracil in neoadjuvant therapy for oral cancer may not bring a significant benefit to improve survival rate, the primary local control rate is improved in comparison with radiotherapy alone.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

Results of radiotherapy and combined radiotherapy and chemotherapy of inoperable lung cancer.

In this study there is presented a comparative analysis of immediate results after radiotherapy and combined treatment (radio- and chemotherapy) in 174 patients with highly differentiated inoperable lung cancer. The data were provided by participants of a joint investigation in some CMEA member countries (Hungary, USSR, Czechoslovakia) during the period of 1976 to 1980. In the randomized study radiotherapy (a total dose of 60 Gy) was applied in 98 patients, radiotherapy with chemotherapy (methotrexate and 5-fluorouracil) was applied in 76 patients. The comparative analysis showed that the employment of complementary chemotherapy tend to improve the immediate therapeutic effects. In the case of highly differentiated planocellular carcinoma a pronounced positive effect was seen in 48.6% of patients as compared to the 31.2% of those treated with radiotherapy alone. Nevertheless, with respect to survival rate prolongation, these differences are not manifested in favor of the combined method of treatment. After a conservative treatment (radiotherapy and radiotherapy in combination with chemotherapy) of patients with differentiated types of inoperable lung cancer there was a one-year survival rate of 55.7%, 17.27% of the patients survived for 2 years, and 8.55% for 3 years. In radiotherapy applied alone as in the combined method as well, a direct dependence of survival rate prolongation on immediate therapeutical effects was detected. For more than 1 year survived 49 patients (73.1%) out of 67 exhibiting pronounced immediate effects, and for 3 years survived 8 patients out of 9.

Adult↗
PubMed2000

Postoperative radiotherapy for non-small cell lung cancer.

BACKGROUND: The role of postoperative radiotherapy in the treatment of patients with completely resected non-small cell lung cancer was not clear. A systematic review and quantitative meta-analysis was therfore undertaken to evaluate the available evidence from randomised trials. OBJECTIVES: To evaluate the effect of post-operative radiotherapy (PORT) on survival and recurrence in patients with completely resected non-small cell lung cancer. To investigate whether or not pre-defined patient sub-groups benefit more or less from PORT. SEARCH STRATEGY: MEDLINE and CANCERLIT searches were supplemented by information from trial registers and by hand searching relevant meeting proceedings and by discussion with relevant trialists and organisations. SELECTION CRITERIA: Both published and unpublished trials were eligible for inclusion provided the patients had undergone a complete resection; had been randomised between radiotherapy and no immediate further treatment; that the method of randomisation precluded prior knowledge of the treatment to be assigned; and that recruitment was between 1965 and 1995. DATA COLLECTION AND ANALYSIS: A quantitative meta-analysis using updated information from individual patients from all available randomised trials was carried out. Data from all patients randomised in all eligible trials were sought directly from those responsible. Updated information on survival, recurrence and date of last follow up were obtained, as were details of treatment allocated, date of randomisation, age, sex, histological cell type, stage and performance status. To avoid potential bias, information was requested for all randomised patients including those who had been excluded from the investigators' original analyses. All analyses were done on intention to treat on the endpoints of survival and recurrence-free survival. Subgroup analyses by age, sex, histological cell type, tumour stage and performance status were also done. MAIN RESULTS: 2128 patients from 9 trials were included (median follow-up of 3.9 years). The results show a significant adverse effect of PORT on survival with a hazard ratio of 1.21 or 21% relative increase in the risk of death. This is equivalent to an absolute detriment of 7% at 2 years (95% confidence interval 3 to 11%) reducing overall survival from 55% to 48%. Exploratory subgroup analyses suggested that this detrimental effect was most pronounced for patients with stage I/II, N0-N1 disease, whereas for stage III, N2 patients there was no clear evidence of an adverse effect. REVIEWER'S CONCLUSIONS: PORT is detrimental to patients with early stage completely resected non-small cell lung cancer and should not be used in the routine treatment of such patients. The role of PORT in the treatment of N2 tumours is not clear and may justify further research.

Carcinoma, Non-Small-Cell Lung↗
PubMedDate not supplied

Radiotherapy of liver malignancies. From whole liver irradiation to stereotactic hypofractionated radiotherapy.

AIMS AND BACKGROUND: Until recently radiotherapy of hepatic malignancies has played a limited role due to the well-known limited radiotolerance of the liver. The aim of this paper is to review the available data on the risk of radiation-induced liver disease (RILD) and to define the modern role of radiotherapy in the management of patients with metastatic or primary liver malignancies. METHODS: The advent of three-dimensional conformal treatment planning with dose-volume histogram analysis has made the study of partial liver irradiation possible. Limited portions of the liver may withstand high doses of radiation with minimal risk of RILD. Patients with solitary unresectable liver tumors may be treated with high-dose radiotherapy with curative intent. Recently, the feasibility of stereotactically guided treatment techniques with a single fraction or few treatment sessions has been explored in numerous institutions. RESULTS: The radiation tolerance of the whole liver found by several investigations is in the order of approximately 30 Gy, which seriously restricts its clinical application. The role of whole liver irradiation therefore appears of limited benefit in the palliation of patients with multiple liver metastases. The use of three-dimensional conformal techniques has made partial liver irradiation possible to doses in the 70-80 Gy range with conventional fractionation. At least two published series have reported improved local control and survival rates with dose escalation with three-dimensional conformal radiotherapy in patients with unresectable liver metastases. Similar outcomes have been recently reported with single dose (or hypofractionated) stereotactic radiotherapy both in metastatic and primary hepatic malignancies with minimal morbidity. Accurate target delineation and treatment reproducibility are the key to the success of this novel treatment approach, and specific treatment planning techniques and patient setup procedures must be developed to implement it. CONCLUSIONS: Stereotactic high-dose radiotherapy is technically feasible for the treatment of inoperable liver malignancies, with the potential of high local control and low morbidity. Definitive evidence on the clinical advantages of this technique over other more established treatments can only be gathered from well-designed clinical studies.

Dose Fractionation, Radiation↗
PubMed2000

ARCON: accelerated radiotherapy with carbogen and nicotinamide in head and neck squamous cell carcinomas. The experience of the Co-operative group of radiotherapy of the european organization for research and treatment of cancer (EORTC).

BACKGROUND: Since there is increasing evidence that both acute (perfusion-limited) and chronic (diffusion-limited) hypoxia, and tumor repopulation may prejudice the outcome of radiotherapy, the combination of carbogen (95% oxygen-5% carbon dioxide) and nicotinamide with accelerated radiotherapy (ARCON) should reduce the impact of these factors of radioresistance. AIM: This clinical study was aimed at determining the feasibility, as well as the qualitative and quantitative toxic effects of a therapeutic approach based on ARCON, and assessing the tumor response rates that can be achieved with this regime in patients with locally advanced tumors of the head and neck. METHODS: A phase I/II study conducted between 1993 and 1996 by the Co-operative Group of Radiotherapy of the EORTC included three consecutive steps: accelerated fractionation (AF) combined with carbogen (11 analyzable patients), AF combined with the daily administration of nicotinamide (n=10), and AF with both carbogen and nicotinamide (n=17). Radiotherapy was based on an accelerated regime (72 Gy in 5.5 weeks). Nicotinamide was delivered 90 min before the first irradiation session, at a daily dose of 6 g. Carbogen breathing started 5 min before irradiation and lasted throughout the entire radiotherapy sessions. RESULTS: No significant difference in loco-regional toxicity was found among the three study steps, when carbogen and nicotinamide, either alone or in combination, were combined with AF. The feasibility of the ARCON protocol, as proposed in the present EORTC study, appears to be significantly impaired when nicotinamide is added, at a daily dose of 6 g, to AF and carbogen, in an unselected group of patients. More than 20% of patients experienced grade 2 or 3 emesis. It also demonstrates, in unselected groups of patients, no significant difference in tumor response and local control when carbogen and nicotinamide, either alone or in combination, are added to accelerated radiotherapy. The percentages of objective response at 2 months were 81, 70 and 87%, respectively. CONCLUSION: Future ARCON trials should target selected head and neck tumor localizations and stages, and a lower nicotinamide dose is needed to reduce severe upper gastro-intestinal toxicity.

Adult↗
PubMed2001

Combined chemo- and radiotherapy vs. radiotherapy alone in the treatment of primary, nonresectable adenocarcinoma of the rectum.

PURPOSE: In a randomized study in primarily inextirpable rectal cancer, conventional radiotherapy to reduce the tumor mass was compared with combined chemotherapy and radiotherapy. METHODS AND MATERIALS: The combined treatment (CRT) was given every other week, four times, during a 7-week period. The drugs used were methotrexate, 5-fluorouracil in bolus injection followed by continuous infusion and leucovorin rescue. Radiotherapy (RT) was given simultaneously with five 2-Gy fractions in 3 days to a dose of 10 Gy to a total dose in the four courses of 40 Gy. This regimen was compared with radiotherapy in 2-Gy fractions to a total dose of 46 Gy in the radiotherapy group. Surgery was performed 3-4 weeks after finished treatment. Seventy patients were included between November 1988 and August 1996; 36 patients were allocated to RT and 34 to CRT. RESULTS: Twenty-five (74%) of the patients in the CRT group underwent a locally radical resection with 20 (59%) patients without any known metastases. The corresponding figures in the RT group were 23 (64%) and 18 (50%), respectively. Among the patients who underwent any tumor resection, 5/29 (17%) in the CRT group and 12/27 (44%, p = 0.05) in the RT group have had a local recurrence. After a locally radical resection, the corresponding figures are 4% and 35% (p = 0.02), respectively. Local disease-free survival was significantly superior in the CRT group (66% at 5 years) compared with the RT group (38%, p = 0.03 log-rank test). Five-year survival was 29% (9 patients) in the CRT group and 18% (6 patients) in the RT group, a nonsignificant difference (p = 0.3). Five patients in the RT group did not complete planned treatment, mainly due to the appearance of metastatic disease. In this group toxicity was usually of Grade 0-1. In the experimental group, the toxicity usually was Grade 2 or higher, and 6 patients did not manage to fulfill the planned treatment due to toxicity. CONCLUSION: In this study, with fewer included patients than intended, resectability rates were high in both groups. The addition of chemotherapy to radiotherapy significantly improved local control rates, but no statistically significant difference was found in survival between the groups. The acute toxicity after CRT was higher than after RT alone, but manageable.

Adenocarcinoma↗
PubMed2002

Results of radiotherapy with, or without, salvage surgery versus combined surgery and radiotherapy in advanced carcinoma of the hypopharynx.

There is considerable controversy surrounding the optimum treatment of advanced hypopharyngeal cancers. Curative radiotherapy with surgical salvage in reserve is an accepted protocol as is also a combined treatment of surgery and radiotherapy. The present study is a retrospective analysis of the survival results of 195 cases treated in a single centre. The combined surgery and radiotherapy group comprised a greater number of pyriform fossa and post-cricoid tumours whereas, the curative radiotherapy group had a higher proportion of posterior pharyngeal wall tumours. Actuarial two-year disease-free survival rates were significantly better with combined treatment when results of stage III and IV lesions (164 patients) of all sites are taken together, as compared to those obtained with curative radiotherapy without salvage (p = 0.000) or radiotherapy with surgical salvage for residual/recurrent tumours (p = 0.0021).

Adult↗
PubMed1996

[Value of the association of partial surgery and postoperative radiotherapy in the management of tumors of the hypopharynx. A study of 141 T1-T2 cases of hypopharyngeal cancer treated by partial surgery, radical surgery or radiotherapy alone].

A retrospective study of 142 T1-T2 hypopharyngeal cancers treated from 1977 to 1988 was carried out. Forty-seven patients were treated by local conservative surgery, curage and postoperative radiotherapy of the remaining pharyngolarynx and cervical node areas (group 1), 48 by radical surgery and postoperative radiotherapy (group 2) and 47 by radiotherapy alone (group 3). There were more T1 tumors in group 1 (64%), than in group 2 (33%), and group 3 (40%). Sixty two percent of the patients of group 1 had clinical nodes, 56% of group 2 and 49% of group 3. There were 70% N+ and 30% N+ with extracapsular invasion (N+ RC+) in group 1, 81% N+ and 35% N+ RC+ in group 2. A histologically non-satisfactory resection was observed in 21% of patients of group 1 and 6% in group 2. Patients more than seventy years old comprised 11% in group 1, 15% in group 2 and 26% in group 3. Indications for radiotherapy alone was for 75% an impossibility for surgery (surgical contraindications or refusal by the patients). Overall survival was 34% at 5 years and 18% at 10 years. Five-year survival for groups 1, 2 and 3 were 48%, 33.5% and 22%. Deaths by cancer evolution was as frequent in group 2 as in group 3 (43%) but deaths by metastatic evolutions were twice as frequent in group 2 and deaths by local regional evolution twice as frequent in group 1 (2%). Treatment of group 1 was recommended because of the good survival at 5 years, 48%, and the good voice conservation, 100% (despite non-satisfactory resections and N+ RC+). At present, some of these conservative surgeries would be replaced by radiotherapy alone in case of complete response after initial chemotherapy, which would be an advantage for cases with an indication for radical surgery, but not necessarily so for cases with an indication for partial surgery, taking into account the good results that we have achieved with an association of partial surgery and radiotherapy.

Actuarial Analysis↗
PubMed2000

Reduction of late complications after irregularly shaped four-field whole pelvic radiotherapy using computed tomographic simulation compared with parallel-opposed whole pelvic radiotherapy.

BACKGROUND: Tumor control and late complication rates of irregularly shaped four-field whole pelvic radiotherapy using CT simulation were compared with those of whole pelvic radiotherapy using parallel-opposed fields in a non-randomized study. METHODS: From 1986 to 1996, 74 patients who underwent surgery for clinical stage I, II or III squamous or adenosquamous cell carcinoma of the uterine cervix were treated with postoperative radiotherapy consisting of 50 Gy in 25 fractions in 6 weeks. Thirty-four patients were treated with an irregularly shaped four-field technique following computed tomography (CT) simulation using beam's eye view and three-dimensional treatment planning and lead blocks. Forty patients received the conventional two-field technique, with CT simulation in 13 patients and X-ray simulation in 27 patients. There was no significant difference in patients' characteristics between the two groups. RESULTS: There was no statistical difference in survival, relapse-free survival or pelvic control rate between the two-field and irregularly shaped four-field groups with a mean follow-up period of 60 months. The actual 5-year pelvic control rate was 94% for the two-field technique and 100% for the irregularly shaped four-field technique. The incidence of grade II-III bowel complications in the irregularly shaped technique group (2.9%, 1/34) was significantly lower than that in the two-field technique group (17.5%, 7/40) (p < 0.05). The actual 5-year complication rates of grade II leg edema were 28.6 and 3.1% for the two-field technique and irregularly shaped four-field technique groups, respectively (p = 0.0123). CONCLUSIONS: Irregularly shaped four-field post-operative pelvic radiotherapy using CT simulation appears to be as effective as parallel-opposed whole pelvic radiotherapy with a lower incidence of bowel complication and chronic leg edema.

Adult↗