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At least 19 recordsLinked to original sources
PubMed2001

[Non-small-cell bronchial carcinoma with pathological N2 involvement: adjuvant radiotherapy versus adjuvant chemo-radiotherapy].

Fifty-eight patients, 28 of them included in a German multicenter study, were treated either with radiotherapy (5 x 2 Gy/50 Gy) or combined radio-chemotherapy (cisplatin 75 mg/m2 d1 in cases with pneumonectomy etoposide 120 mg/m2 d1-3) and Ifosfamid 1.5 mg/m2 d1-4, 3 cycles) following surgery in pN2-NSCLC. Metastatic disease or local failure was seen in 24 patients (43%), in the majority with distant metastasis (n = 21), in 4 patients combined local and distant failure. Time to progression (TTP) was 27 to 1172 days, median 244 days. Median survival of the whole group was 873 days (= 29 months), the 3-year survival 49%. Comparing the two groups there was an advantage (not significant) in favor of the combined treated group with a median survival of 1449 days versus 765 days (p = 0.22).

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

Early cervical cancer treated with definitive or adjuvant radiotherapy: improved survival with adjuvant radiotherapy attributable to patient selection.

The optimum management of patients with early cervical cancer (Federation Internationale de Gynécologie Stages IB and IIA) remains controversial. We reviewed our radiotherapy practise and compared patients with early stage cervical cancer who had surgery and adjuvant radiotherapy (ART) to those that had definitive radiotherapy (DRT). One hundred and twenty-seven patients were identified, 81 of these underwent ART and 46 underwent DRT. Patients who underwent DRT were significantly older and of poorer performance status than those who underwent ART. The 5-year relapse-free survival in the ART and DRT groups were 79 and 72%, respectively (P = 0.70). The corresponding 5-year overall survival figures were 86 and 58% (P = 0.006). The difference was due to increased deaths from other causes in the DRT arm, 37 versus 7% (P = 0.0007.) The poorer overall survival of DRT patients was due to patient selection.

Adult↗
PubMedDate not supplied

High-grade gliomas: results in patients treated with adjuvant radiotherapy alone and with adjuvant radio-chemotherapy.

BACKGROUND: Despite advances in the surgical, radiotherapeutic and chemotherapeutic fields, the outcome for patients with high-grade gliomas remains poor. Our experience of patients treated with and without chemotherapy is reported. MATERIALS AND METHODS: From April 1999 to July 2003, 30 patients with high-grade gliomas were treated: 13 received adjuvant radiotherapy (RT) alone whereas 17 received temozolomide 75 mg/m2/d during the irradiation time and 200 mg/m2 daily per 5 consecutive days, every 28 days for three to six cycles, starting 4 weeks after the end of radiotherapy. RESULTS: The median follow-up was 12.5 months. The median overall survival (OS) was 15 months. In patients treated with RT plus chemotherapy, no statistical difference was observed between those who had undergone partial surgical resection and those with total resection (p=0.5128). In patients with glioblastoma multiforme (GBM) treated with combined radiochemotherapy, the median OS was 18 months, while it was 7 months (p=0.0204) in those treated without chemotherapy. Multivariate analysis (Cox model) evidenced statistical differences for performance status (p =0.002) and for the type of adjuvant therapy (p=0.006). CONCLUSION: Radio-chemotherapy plus adjuvant temozolomide seemed to offer the best results in patients not submitted to debulking surgery. The performance status remained the most important prognostic factor. Tolerance to the combined regimen was very good.

Adult↗
PubMed1999

A limited role for adjuvant radiotherapy after the Wertheim/Okabayashi radical hysterectomy for cervical cancer confined to the cervix.

BACKGROUND: The indications for radiotherapy after radical hysterectomy for early stage cervical cancer are changing. In the past only tumor outside the cervix was considered an indication for radiotherapy. Today adjuvant radiotherapy is also considered for an "intermediate-risk" group with tumor confined to the cervix but poor prognostic primary tumor parameters such as large tumor diameter, vascular space invasion, and deep stromal penetration. OBJECTIVE: The aims of this study were to determine the risk of isolated pelvic recurrences in an intermediate-risk group (GOG Study No. 92) and to analyze whether this group will theoretically benefit from adjuvant pelvic radiotherapy. PATIENTS AND METHODS: A retrospective analysis was performed on 271 patients with early cervical cancer treated by a radical hysterectomy in a uniform fashion in one institute. Radiotherapy was administered only when tumor was found outside the cervix. Tumor diameter, capillary lymphatic space invasion, and depth of stromal penetration were assessed in all patients. Recurrence pattern, disease-specific survival, and recurrence-free interval were determined in the intermediate-risk group and compared with the remaining patients of the group with tumor confined to the cervix. RESULTS: A significant difference in disease-specific survival (89% versus 97%, P < 0.03) and 5-year recurrence-free interval (86% versus 95%, P < 0.02) was noted in the intermediate-risk group (n = 56) compared with the total group with tumor confined to the cervix. Three patients in the intermediate-risk group died of disease with a pelvic recurrence. Two of these patients had a combined pelvic and distant recurrence. CONCLUSION: Our retrospective results fail to support a survival benefit of extending indications for adjuvant radiotherapy other than postive nodes, parametrial extension, and positive margins.

Female↗
PubMed2005

[Prognostic factors after surgery and adjuvant radiotherapy in cervical cancers. A retrospective analysis of 298 patients after surgery and adjuvant radiotherapy].

PURPOSE: To determine prognostic factors in patients with cervical cancer treated with surgery followed by radiotherapy. PATIENTS AND METHODS: In a retrospective analysis, patients treated at the Department of Radiotherapy, University of Halle-Wittenberg, Germany, from 1980 through 1993 were evaluated for local control, survival and treatment sequelae with special emphasis on prognostic factors. 298 patients (age 23-81 years, median 46 years) with cervical cancers were treated with surgery followed by radiotherapy to a minimum of 50 Gy. 250 patients received radiotherapy after radical hysterectomy with pelvic lymphadenectomy and 48 patients after hysterectomy. Most of the cancers were squamous cell carcinomas (81%) with few adenocarcinomas (12.4%). Grading was G1/G2 in 28.9% of the patients and G3/G4 in 39.6%. RESULTS: The 5-year overall survival was 68.8% for the whole group, 70.5% for squamous cell carcinomas (n = 241), 64.4% for adenocarcinomas (n = 37; not significant), 80% for G1/G2 tumors (n = 86), and 69% for G3/G4 carcinomas (n = 118; p = 0.074). Survival dependent on tumor size and positive nodes was 76.2% (n = 94) for pT1N0, 65.8% for pT1N+ (n = 31), 68.2% for pT2N0 (n = 62), and 41.4% for pT2N+ (n = 35). An impact of grading on 5-year survival was only found in patients with positive nodes: G1/G2N0 84% (n = 62) versus G1/G2N+ 64.8% (n = 23); G3/G4N0 79.6% (n = 71) versus G3/G4N+ 39.9% (n = 31). The number of positive nodes was the strongest prognostic factor. Multivariate analysis (Cox regression) established a risk factor of 3.06 (p < 0.01) for positive nodes, of 1.7 for grading G1/G2 versus G3/G4 (p = 0.087), and of 1.3 for tumor size (pT1 vs. pT2; p = 0.079). There were no differences in the clinical outcome between patients in stage pT1 with or without lymphadenectomy (75% [n = 130] vs. 79% [n = 39]). CONCLUSION: In patients with cervical cancers treated with surgery and radiotherapy, positive nodes were an independent prognostic factor for local control and survival and should be an indication for additional chemotherapy. A value of lymphadenectomy for survival in this group of irradiated patients could not be established.

Adult↗
PubMed1997

Symposium on rectal cancer: 3. The case for adjuvant radiotherapy for rectal cancer.

Adjuvant radiotherapy for rectal cancer is intended to eradicate subclinical deposits of cancer cells not removed at surgery. These residual cells are found most commonly at the resection margin of the primary tumour and in transected cancer-bearing lymphatics or vessels. Refinements in surgical technique have been associated with a reduction in the risk of pelvic recurrence in some nonrandomized series. However, clinical trials have shown that the combinations of radiotherapy and chemotherapy, and in some instances radiotherapy alone, reduce the risk of recurrence and may improve survival rates compared with those of surgery alone. It is premature to consider that adjuvant pelvic radiotherapy is unnecessary.

Humans↗
PubMed1986

Local recurrence of adenocarcinoma of the rectosigmoid. Is postoperative adjuvant radiotherapy justified?

Adjuvant postoperative radiation therapy has been suggested for adenocarcinoma of the rectum and sigmoid colon to reduce the incidence of local recurrences. Determination of this incidence is necessary to optimally employ such adjuvant therapies. Ninety-nine patients with adenocarcinoma of the rectum or sigmoid who had surgery from 1976-1984 were reviewed. Follow-up ranged from one to eight years (average 4.1 years). Twenty-three patients had gross unresected residual tumor due to local invasion. Fifteen of the remaining 76 have developed recurrences (20 percent). Two patients (2.6 percent) had local recurrences without concurrent regional or distant metastases. Thus local recurrences rarely are encountered without concurrent regional or distant metastases. Therefore, postoperative radiation therapy to prevent local recurrences is not justified, given the small number of patients potentially benefited. Treatment modalities will need to address regional and distant metastases in addition to local recurrences.

Adenocarcinoma↗
PubMed2004

Stromal invasion of the cervix can be excluded from the criteria for using adjuvant radiotherapy following radical surgery for patients with cervical cancer.

BACKGROUND: Regarding complications of radiotherapy, the indications for adjuvant radiotherapy should be restricted. We conducted the present study to determine whether deep stromal invasion of the cervix could be excluded from the criteria used to identify patients for this treatment surgery. METHODS: This study included 115 patients with FIGO stage Ib to IIb cervical cancer who underwent radical hysterectomy and pelvic lymph node dissection. Patients had the following tumors: 61 nonkeratinizing squamous cell carcinoma, 21 keratinizing squamous cell carcinoma, 26 adenocarcinoma, and 7 adenosquamous cell carcinoma. Our study criteria for using adjuvant radiotherapy included positive lymph node involvement, a compromised surgical margin, or parametrial extension. Deep stromal invasion of the cervix was excluded from the criteria in this study. RESULTS: Seventy-two of the 115 patients (62.6%) underwent radical surgery only and all were alive. The remaining 43 patients received a complete course of external irradiation following radical surgery. The estimated 5-year survival rate is 100% for patients with stage Ib, 93.3% for stage IIa, and 52.7% for stage IIb. Fifty-five patients (47.8%) had deep stromal invasion. The prognosis for patients with deep stromal invasion was significantly worse than that for patients without deep stromal invasion (5-year survival rate, 69.8% vs. 98.0%). However, 21 patients (18.3%) with deep stromal invasion, but without positive lymph node involvement, compromised surgical margin, or parametrial extension, were alive without recurrence. Multivariate analysis showed that lymph node involvement and parametrial extension were independent prognostic factors, but that deep stromal invasion was not. CONCLUSION: Deep stromal invasion of the cervix can be excluded from the list of criteria for selecting patients with cervical cancer who would benefit from adjuvant radiotherapy following radical surgery.

Adenocarcinoma↗
PubMed2005

Cardiac morbidity of adjuvant radiotherapy for breast cancer.

PURPOSE: Adjuvant breast irradiation has been associated with an increase in cardiac mortality, because left-sided breast radiation can produce cardiac damage. The purpose of this study was to determine whether modern adjuvant radiotherapy is associated with increased risk of cardiac morbidity. PATIENTS AND METHODS: Data from the Surveillance, Epidemiology, and End Results-Medicare database were used for women who were diagnosed with nonmetastatic breast cancer from 1986 to 1993, had known disease laterality, underwent breast surgery, and received adjuvant radiotherapy. The Cox proportional-hazards model was used to compare patients with left- versus right-sided breast cancer for the end points of hospitalization with the following discharge diagnoses (International Classification of Diseases, 9th Revision codes): ischemic heart disease (410-414, 36.0, and 36.1), valvular heart disease (394-397, 424, 35), congestive heart failure (428, 402.01, 402.11, 402.91, and 425), and conduction abnormalities (426, 427, 37.7-37.8, and 37.94-37.99). RESULTS: Eight thousand three hundred sixty-three patients had left-sided breast cancer, and 7,907 had right-sided breast cancer. Mean follow-up was 9.5 years (range, 0 to 15 years). There were no significant differences in patients with left- versus right-sided cancers for hospitalization for ischemic heart disease (9.9% v 9.7%), valvular heart disease (2.9% v 2.8%), conduction abnormalities (9.7% v 9.6%), or heart failure (9.7% v 9.7%). The adjusted hazard ratio for left- versus right-sided breast cancer was 1.05 (95% CI, 0.94 to 1.16) for ischemic heart disease, 1.07 (95% CI, 0.89 to 1.30) for valvular heart disease, 1.07 (95% CI, 0.96 to 1.19) for conduction abnormalities, and 1.05 (95% CI, 0.95 to 1.17) for heart failure. CONCLUSION: With up to 15 years of follow-up there were no significant differences in cardiac morbidity after radiation for left- versus right-sided breast cancer.

Aged↗
PubMed1998

Adjuvant chemotherapy after radical hysterectomy for cervical carcinoma: a comparison with effects of adjuvant radiotherapy.

OBJECTIVE: To compare the efficacy of adjuvant chemotherapy after radical hysterectomy with that of adjuvant radiotherapy. METHODS: One hundred one women with invasive cervical carcinoma (stage IB through early stage IIB) underwent radical hysterectomy at Saga Medical School Hospital. Of these patients, 53 with squamous or adenosquamous carcinoma were classified as high risk, based on the presence of one or more of the following high-risk factors for recurrence: 1) lymph node metastasis, 2) deep cervical stromal invasion (greater than 3/4 thickness), and 3) parametrial invasion. Adjuvant chemotherapy with a combination of cis-diamminedichloroplatinum (CDDP), vincristine, mitomycin C, and peplomycin (POMP), was prescribed. The outcome was compared with that for 127 patients who were classified as high risk under the same criteria and who received adjuvant radiotherapy at Kyushu University Hospital. RESULTS: The 5-year survival rates were much the same: 83.0% for adjuvant chemotherapy and 81.7% for adjuvant radiotherapy. In the chemotherapy group, intra- and extrapelvic recurrences accounted for 85 and 23% of all recurrences, respectively, whereas recurrences were noted for 38 and 71% in the radiotherapy group, respectively (P < .01). CONCLUSION: The use of adjuvant chemotherapy reduces extrapelvic recurrences. The combination of both adjuvant therapies may improve the prognosis for high-risk patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Surgery and adjuvant radiotherapy vs concurrent chemoradiotherapy in stage III/IV nonmetastatic squamous cell head and neck cancer: a randomised comparison.

We compared concurrent combination chemotherapy and radiotherapy with surgery and adjuvant radiotherapy in patients with stage III/IV nonmetastatic squamous cell head and neck cancer. Patients with non-nasopharyngeal and nonsalivary resectable squamous cell head and neck cancer were randomised to receive either surgery followed by adjuvant radiotherapy (60 Gy over 30 fractions) or concurrent combination chemotherapy and radiotherapy (66 Gy in 33 fractions). Combination chemotherapy comprised two cycles of i.v. cisplatin 20 mg m(-2) day(-1) and i.v. 5-fluorouracil 1000 mg m(-2) day(-1), both to run over 96 h given on days 1 and 28 of the radiotherapy. A total of 119 patients were randomised. At a median follow-up of 6 years, there was no significant difference in the 3-year disease-free survival rate between the surgery and concurrent chemoradiotherapy (50 vs 40% respectively). The overall organ preservation rate or avoidance of surgery to primary site was 45%. Those with laryngeal/hypopharyngeal disease subsite had a higher organ-preservation rate than the rest (68 vs 30%). Combination chemotherapy and concurrent irradiation with salvage surgery was not superior to conventional surgery and postoperative radiotherapy for resectable advanced squamous cell head and neck cancer. However, this form of treatment schedule with a view to organ-preservation can be attempted especially for those with laryngeal/hypopharyngeal and possibly oropharyngeal disease subsites.

Adult↗
PubMed1996

[Is timing important in adjuvant radiotherapy?].

UNLABELLED: The timing of adjuvant radiotherapy is subject of debate at clinical and administrative levels and of concern for the treating physician and also the patient. There is a lack of prospective randomized studies dealing with this point and it is highly unlikely that they could be carried on. However there is evidence coming from the laboratory and retrospective clinical studies which could be of help. Data from the laboratory tell us that the Tpot (potential doubling time) of a solid tumor is brief, which means that a tumor can grow easily while the patient waits for treatment. This means that will be an increase in the risk of local and distant relapse. Clinical evidence coming from studies of head and neck cancer, breast cancer and small cell lung cancer suggest that delay should be limited only to a few weeks. IN CONCLUSION: radiotherapy should be started as soon as possible.

Breast Neoplasms↗
PubMed1998

The impact of adjuvant radiotherapy on carcinosarcoma of the uterus.

BACKGROUND: The role of adjuvant radiotherapy in the setting of uterine carcinosarcoma has not been clearly established. METHODS: A retrospective review of 60 patients receiving definitive therapy for carcinosarcoma of the uterus was undertaken at a single institution. Twenty-nine of 60 patients were treated with adjuvant radiotherapy. RESULTS: The addition of radiotherapy significantly reduced the local recurrence rate from 55% (17 patients) to 3% (1 patient). Adjuvant radiotherapy reduced the risk of distant failure and death in patients with disease confined to the uterus but did not impact distant recurrence or survival in stage III patients. Increasing stage and depth of myometrial tumor invasion were negatively associated with overall survival and disease-free survival but had no impact on local recurrence rates. The nuclear grade of the epithelial component was predictive of local recurrence (P = 0.0592), but epithelial architectural grade, grade of stromal component, and stromal versus epithelial predominance did not provide prognostic information. The relative risk of local recurrence of unirradiated patients versus irradiated patients was 17.54 (P = 0.0055) after adjusting for nuclear grade of the epithelial component. CONCLUSIONS: Local failure represents a significant site of failure in the absence of adjuvant radiotherapy. The improvement in local failure rates with the addition of radiotherapy translates into an improvement in distant failure rates and survival only for patients with stage I/II disease. Epithelial nuclear grade, in addition to depth of myometrial invasion and stage, provides important prognostic information. Epithelial architectural grade, stromal grade, type of stromal component (homologous versus heterologous), and predominance of either stromal or epithelial component were not found to be significant prognostic factors.

Aged↗
PubMed1990

Endometrial adenocarcinoma, adjuvant radiotherapy tailored to prognostic factors.

The optimal adjuvant radiotherapy for surgically treated endometrial cancer has not yet been defined. We report on 389 patients treated between 1970 and 1985 with adjuvant radiotherapy. The treatment was tailored to the known prognostic factors: myometrial invasion and grade of differentiation of the tumor. Ten-year overall survival was 67%, 10-year relapse-free survival 77%; 23% relapse, of which 21% distant and 6% locoregional relapse. In a multivariate analysis, stage (pT), grade, and myometrial invasion were prognostic factors. The number of locoregional failures was very small (n = 23). This small number, the fact that radiation treatment was tailored to prognostic factors, and the absence of a nontreated control group precluded an analysis of the effect of the adjuvant irradiation. Large randomized studies with a control (no treatment) arm should be performed to determine the value of adjuvant radiotherapy.

Adenocarcinoma↗
PubMed1995

[Adjuvant radiotherapy of rectal cancer].

During the past decades the effect radiotherapy as adjuvant treatment of rectal cancer has been investigated in several prospective randomized trials. Only a marginal effect has been demonstrated on overall survival rate (3-4%) whereas the local recurrence rate can be significantly reduced by 33-50%. Using modern techniques the side-effects can be reduced to an insignificant level. Patients with rectal cancer who are not entering randomized prospective trials should be considered for pre-operative radiotherapy. Patients should be staged by preoperative CT-scanning and endoluminal ultrasound. Additionally, a down-staging effect and a reduction in tumor-size can be expected and accordingly an increase in resectability rate and a higher rate of sphincter-saving operations for large of fixed tumors is likely to be obtained.

Humans↗
PubMed1987

Stage IB cervical carcinoma treated with radical hysterectomy and pelvic lymphadenectomy: role of adjuvant radiotherapy.

A retrospective review of 194 patients with stage IB cervical carcinoma treated with radical hysterectomy between January 1977 and December 1984 revealed 30 patients (15%) with pelvic node metastases. Twenty patients with pelvic node metastases received postoperative radiotherapy and ten patients did not. Five of 20 patients who received adjuvant radiotherapy had recurrence, compared with five of ten patients who did not receive radiotherapy. No pelvic recurrences occurred in the adjuvant radiotherapy group compared with two in the no radiotherapy group. Only one serious complication occurred in a patient receiving radiotherapy. Adjuvant postoperative radiotherapy may reduce pelvic recurrences and improve survival in patients with pelvic node metastases treated with radical hysterectomy and pelvic lymphadenectomy.

Adenocarcinoma↗