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Objective To evaluate prospectively the side effects and tolerance of docetaxel with concurrent late-course hyperfractionated radiotherapy after breast-conserving surgery for stage T1-T2 breast cancer, and to assess the value of this treatment in shortening the treatment time and reducing the economic burden among patients. Methods A total of 20 patients with T1-T2 breast cancer were recruited after they underwent breast-conserving surgery. The acute radiation response classification, treatment completion rate, disease-free survival, hospital stays, and treatment costs were observed. Radiotherapy for all patients was started before the last single-agent docetaxel chemotherapy. Results The completion rate of treatment and the good rate of cosmetic effect reached 100%. The main adverse reactions were hematological toxicity (leukopenia) and skin reactions, which were tolerated. The median follow-up time was 30.1 months, and the follow-up rate was 100%. The average total treatment time of this hyperfractionated radiotherapy with concurrent docetaxel was four weeks, and the total hospitalization cost savings was approximately 10, 000 yuan. The 21-month disease-free survival rate was 100%. Conclusion Stage T1-T2 breast cancer can tolerate hyperfractionated radiotherapy with concurrent chemotherapy after a breast-conserving operation. The procedure results in good local control and satisfactory cosmetic effects, with high health and economic value.
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Introduction: Lung cancer is the most common cancer worldwide and has a poor prognosis but integration of chemoradiationhas led to an increase in overall survival time and percentage of cured patients with acceptable toxicity.Purpose: The purpose of this study was to compare the efficacy of hyperfractionated (HFX) radiotherapy with conventionalradiotherapy and weekly concurrent paclitaxel in stage IIB/III non-small-cell lung cancer (NSCLC).Materials and Methods: A total of 60 patients were enrolled, of which 30 patients were given twice daily radiotherapy(1.2 Gy each) to a total of 72 Gy over 5–6 weeks and 30 patients were given single daily fraction (2 Gy) to a total of 66 Gy forthe same duration to achieve a comparable biological effective dose. Both groups received weekly 50 mg/m2 paclitaxel.Results: An overall response of 83.3% versus 56.6% with a partial response of 70% versus 53.3% and complete response(CR) of 13.3% versus 3% was seen in HFX radiotherapy versus conventional radiotherapy which was statistically significant(P = 0.04). 10 of 25 patients and 11 of 17 patients who achieved response in study and control groups, respectively, progressed.The median survival of patients in HFX radiotherapy arm was 18 months, compared to 9 months in conventional radiotherapyarm. The median time to local recurrence was 19 versus 11 months with local recurrence-free survival of 72% versus 66% at1 year follow-up. The 1 and 2 year survival rates were 76% and 40% in study arm and 50% and 26% in control arm (P - 0.005).Esophagitis (70% vs. 63.3%), skin reaction (70% vs. 63.3%), and radiation-induced pneumonitis (50% vs. 43.3%) were thecommon toxicities with no statistical significance between the two groups. Overall, there was mild chemotherapy-related toxicity.Conclusions: The combination of HFX radiation with weekly paclitaxel is effective treatment with a moderate degree of toxicityin stage IIB/III NSCLC. An average response to treatment and the use of lesser drugs have made us to consider this therapyin locally advanced NSCLC.
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Objective To evaluate the treatment efficacy and treatment-related toxicity of late course accelerated hyperfractionated radiotherapy (LCAHRT) combined with cisplatin-based chemotherapy (CHT) for locally advanced esophageal squamous cell carcinoma (ESCC).Methods A total of 46 patients with histologically confirmed ESCC,11 in the stage Ⅱa,3 in the stage Ⅱb,and 32 in the stage Ⅲ,underwent conventional fractioned radiation of 40 Gy in 20 fractions on the primary and metastatic lymph nodes,and high-risk lymph node drainage regions,and then the primary and metastatic lymph nodes were irradiated as boost with an additional dose of 19.6 Gy in 14 fractions (1.4 Gy twice a day),and the total prescribed dose was 59.6 Gy in 34 fractions.Two cycles of CHT were administered concurrently during the radiotherapy.The 1-,3-,and 5-year overall survival (OS) rates and local control rates (LCRs) were evaluated by Kaplan-Meier method,and treatment-related toxicity was analyzed based on the RTOG and CTCAE criteria 3.0.Results All patients received the whole course of treatment.The median followup time was 34.4 months (6-67 months).The overall response rate was 91.3％ (42/46).The median OS was 38.5 months (95％ CI 29.6-47.4 months).The 1-,3-,and 5-year OS rates and LCRs were 78.6％,49.4％,and 39.9％,and 84.3％,68.2％,and 61.4％ respectively.The incidence of ≥ G3 radiationinduced esophagitis was 23.9％.Three kinds of serious (≥G3) hematologic toxicities were recorded,including leucopenia (26.1％),thrombocytopenia (13.0％),and anemia (10.9％).Esophagotracheal fistula was recorded in 2 patients (4.3％).Conclusion LCAHRT plus CTH can be favorable for the patients with locally advanced ESCC,however,the treatment-related toxicities may be serious.
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Objective To compare the efficacy after conventional radiotherapy and late course accelerated fractionation radiotherapy for nasopharyngeal carcinoma (NPC).Methods A total of 200 NPC patients were enrolled and randomly assigned to conventional radiotherapy (CF) group with 99 cases or late course accelerated fractionation radiotherapy (LCAF) group with 101 cases,who received irradiation to 60Co γ or 6 MV X-rays.In the CF group,the total dose of nasopharynx was 70 Gy/35 fractions at 2 Gy daily.In the LCAF group,for the first two-thirds of the treatment,two daily fractions of 1.2 Gy were given to the primary lesion and the total dose was 48 Gy/40 fractions.For the last one third of the treatment,the dose per fraction was increased to 1.5 Gy and the total dose was 30 Gy/20 fractions.Results There were 25,16,25 in CF group and 16,13,18 patients in LCAF group who had recurrence of nasophaynx,cervical lymph nodes,and distant metastasis,respectively.The 5-year nasopharyngeal control and overall survival rates was 75.9％ and 87.6％ in CFgroup (x2 =4.066,P＜0.05),58.0％ and 74.1％(x2 =5.076,P ＜ 0.05) in LCAF group,respectively.Cervical lymph nodes local rates and distant metastasesfree rates at 5 years were 8 1.5％ and 90.0％ in CF group (P ＞ 0.05),74.1％ and 83.3％ (P ＞ 0.05) in LCAF group,respectively.Conclusions Compared with CF,LCAF can improve nasopharyngeal control and overall survival rates,but there are no significant difference in the recurrence rates of cervical lymph nodes and distant metastasis.
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Background and purpose: Most of the patients with esophageal cancers were late stage cases when diagnosed clinically. Since the prognosis is very poor, it is extremely important to improve the quality of life (QOL) of these patients. Concurrent chemoradiotherapy is an effective modality for esophageal cancer. However, effects on quality of life of chemoradiotherapy are rarely reported domestically. Our purpose was to assess the immediate effect on the quality of life in patients with primary esophageal carcinoma. Methods: QOL was assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) Chinese edition. Fifty-two patients were randomized to receive either concurrent chemoradiotherapy (CRT) or late course accelerated hyperfractionated radiotherapy (LAHF). QOL questionnaires were given before therapy and at the 4th week during radiotherapy, the completion of radiotherapy, and then after 1 and 3 months after the completion of radiotherapy, respectively. Results: It has been observed that the scores of global health status, physical functioning,role functioning and social functioning during the radiotherapy and from completion of radiotherapy to 1 month post radiotherapy in CRT and LAHF groups, deteriorated temporarily, but it were not significant when compared with those before radiotherapy (P>0.05). However, global health status scores, physical functioning scores, role functioning scores were significantly improved in patients who received CRT at 3 months post radiotherapy. Mean scores were improved by 12.0±3.7 (P=0.012),8.1±2.9 (P=0.023) and 14.8±5.2 (P=0.015), respectively. Nausea and vomiting, pain and appetite loss scales scores rapidly recovered to the baseline level after therapy, although they were worsened during therapy.Conclusion: Global health status scores, physical functioning scores and role functioning scores were significantly improved at 3 months after radiotherapy in patients treated by CRT. In terms of QOL, CRT is a feasible modality for esophageal cancer.
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Objective To evaluated the treatment results of late course accelerated fractionation radiotherapy for Stage Ⅲ and Ⅳa nasopharyngeal carcinoma. Methods 100 patients with stage Ⅲ and Ⅳa nasopharyngeal carcinoma were randomized into two groups. The late course accelerated hyperfractionated radiotherapy combine chemotherapy group(LCAF+CT group) received the induction chemotherapy for two cycles, followed by conventional fractionation radiotherapy to a dose 40 Gy, than changed into accelerated hyperfractionated radiotherapy to a total dose of 70 Gy, and use two cycles adjuvant chemotherapy, The conventional fractionation radiotherapy combine chemotherapy group(CF+CT group) received the chemotherapy that it similar to the LCAF+CT group, and use the conventional fractionation radiotherapy to a total dose of 70 Gy. Results The 3- and 5-year overall survival rate were 70.0% and 62.0% respectively in LCAF+CT group and 58.0 % and 46.0 % respectively in CF+CT group, had the significant difference (P 0.05). There were the cranial nerves complications in two patients of LCAF+CT group. Conclusions The results from this study show that the 3- and 5-year overall survival rate, the 3- and 5-year disease free survival rate and the 3- and 5-year local-regional free survival rate in LCAF+CT group was significant better than in CF+CT group, but the radiation-induced damage to the cranial nerves was improved in LCAF+CT group.
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Objective To evaluated the treatment results of late-course accelerated hyperfractionated radiotherapy combined with chemotherapy for advanced esophageal carcinoma. Methods 72 patients with advanced esophageal cancer were randomized into two groups. The late-course accelerated hyperfractionated radiotherapy combined with chemotherapy(LCAF+CT)group received the induction chemotherapy for two cycles, followed by conventional fractionation radiotherapy to a dose of 36 Gy, then changed into accelerated hyperfractionated radiotherapy to a total dose of 60 ~ 66 Gy. The conventional fractionation radiotherapy combined with chemotherapy(CF+CT)group received the chemotherapy that it was similar to LCAF+CT group, and used the conventional fractionation radiotherapy to a total dose of 60 ~ 66 Gy. Results The 1-, 3- and 5-year survival rates were 82.3 %, 51.6 %, 38.2 % in the LCAF+CT group, and 73.8 %, 31.5 %, 18.6 % in the CF+CT group. The differences of 3- and 5-year survival rates were statistically significant (P 0.05). Conclusion Late-coures accelerated hyperfractionated radiotherapy combined with chemotherapy might improve the treatment efficacy of advanced esophageal cancer and lengthen the suvival time. The toxic and side effects of LCAF+CT group were more severe than those of CF+CT group, but they were well tolerable.
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PURPOSE: The aim of this study was to evaluate local control and long-term survival of concurrent hyperfractionated radiotherapy with CDDP/VP-16 chemotherapy in limited stage small cell lung cancer. MATERIALS AND METHODS: From April 1992 to April 1997, twenty-nine patients with limited stage small cell lung cancer received cisplatin 25 mg/m plus etoposide 120 mg/m(2) on day 1, 2 and 3. Chemotherapy was repeated every 4 weeks for a total of 4 courses. Radiation was given to 60 Gy in 50 twice-daily fractionation separated by at least 6 hours, 5 days per week Thoracic radiotherapy was started with first coese of chemotherapy for 28.8 Gy. After 12 days break, radiotherapy was resumed with second course of chemotherapy for another 31,2 Gy. RESULTS: Twenty-eight patients (96.6%) were evaluable. Patient characteristics include: median age 58.4 years (range 45-67); clinical stage 1IIa 13 pts, stage IIIb 15 pts; ECOG performance status 0 (8 pts), 1 (16 pts) and 2 (4 pts). Objective responses were 21 complete response, 6 partial response, 1 stable disease with overall response rate of 96.4%. Grade III and IV toxicities were leukopenia in 23/28 pts, thrombocytopenia in 8/28 pts, stomatitis in 10/28 pts, and alopecia in 8/28 pts. The median survival time was 19.2 months with 1 year, 2 year, 3 year, and 4 year actuarial survival rates and RFS are 65.6%, 30.6%, 30.6%, 24.5%, and 65.3%, 52.8%, 52.8%, 42.2%, respectively. Overall survival rate according to TNM stage, weight loss, age and sex were not statistically significant. Pattems of relapse were local only in 2 pts, systemic only in 7 pts, and local plus systemic in 1 pt, and brain was the most frequent systemic recurrent site (4 pts). CONCLUSION: Concurrent hyperfractionated radiotherapy with CDDP/VP-16 chemotherapy seems to produce better local contml and survival rates in limited stage small cell lung cancer.
Subject(s)
Humans , Alopecia , Brain , Cisplatin , Drug Therapy , Etoposide , Leukopenia , Radiotherapy , Recurrence , Small Cell Lung Carcinoma , Stomatitis , Survival Rate , Thrombocytopenia , Weight LossABSTRACT
PURPOSE: The effect of hyperfractionated radiotherapy on locally advanced non-small lung cancer was studied by a retrospective analysis. MATERIALS AND METHODS: We analyzed sixty one patients of biopsy-confirmed, IIIA and IIIB non-small cell lung cancer. Using the ECOG performance scale, all the patients were scored less than 2. They were treated by curative hyperfractionated radiotherapy alone from Oct. 1992 to Oct. 1995 at the Department of Radiation Oncology. All the patients received 120cGy b.i.d with more than 6 hours interval between each fraction. The total dose of radiation was reached up to 6400-7080 cGy with a mean dose of 6934 cGy. The results were analyzed retrospectively. RESULTS: The overall survival rate was 53.1% in 1 year, 9.9% in 2 years with a median survival time (MST) of 13.9 months. The progression free survival (PFS) rate was 37.0% in 1 year, 8.9% in 2 years. Twenty two patients were classified as complete responders to this treatment and their MST was 19.5 months. When this was compared with that of partial responders (MST: 11.7months), it was statistically significant (p=0.0003). Twenty nine patients of stage IIIA showed a better overall survival rate (1yr 63.3%, 2yr 16.8%) than IIIB patients (1yr 43.3%, 2yr 3.6%), which was also statistically signifcant (p=0.003). Patients with adenocarcinoma showed a better survival rate (1yr 64.3%, 2yr 21.4%) than that of squamous cell counterpart (1yr 49.4%, 2yr 7.4%), although this was not significant statistically (p=0.61). Two patients developed fatal radiation-induced pneumonia right after the completion of the treatment which progressed rapidly and they all died within 2 months. One patient developed radiation-induced fibrosis after 13 months. He refused further treatment and died soon after the development of fibrosis. CONCLUSION: Among locally advanced NSCLC, hyperfractionated radiotherapy was effective on stage IIIA patients by increasing MST with acceptable toxicities. Acute radiation-induced pneumonia should be carefully monitored and must be avoided during or after this treatment.
Subject(s)
Humans , Adenocarcinoma , Carcinoma, Non-Small-Cell Lung , Disease-Free Survival , Fibrosis , Lung Neoplasms , Pneumonia , Radiation Oncology , Radiotherapy , Retrospective Studies , Survival RateABSTRACT
Since Jan. 1991 a prospective randomized study for Stage III unresectable non small cell lung cancer(NSCLC) has been conducted to evaluate the response rate and tolerance of induction chemotherapy with MVP followed by hyperfractionated radiotherapy and evaluate the efficacy of maintenance chemotherapy in Asan Medical Center. All patients in this study were treated with hypefractionated radiotherapy (120 cGy/fx BID, 0480 cGy/54 fx) following 3 cycles of induction chemotherapy, MVP (Mitomycin C 6 mg/m2, Vinblastin B mg/ m2, Cisplatin 60 Mg/ m2) and then the partial and complete responders from induction chemotherapy were randomized to 3 cycles of adjuvant MVP chemotherapy group and observation group. 48 patients were registered to this study until December 1992; among 48 patients 3 refused further treatment after induction chemotherapy and 6 received incomplete radiation therapy because of patient's refusal, 39 completed planned therapy. Twenty-three(58%) patients including 2 complete responders showed response from induction chemotherapy. Among the 21 patients who achieved a partial response after induction chemotherapy, 1 patient rendered complete clearance of disease and 10 patients showed further regression of tumor following hypefractionated radiotherapy. Remaining 10 patients showed stable disease or progression after radiotherapy. Of the sixteen patients judged to have stable disease or progression after induction chemotherapy, seven showed more than partial remission after radiotherapy but nine showed no response in spite of radiotherapy. Of the 35 patients who completed induction chemotherapy and radiotherapy, 25 patients(64%) including 3 complete responders showed more than partial remission. Nineteen patients were randomized after radiotherapy. Nine patients were allocated to adjuvant chemotherapy group and 4/9 shewed further regression of tumor after adjuvant chemotherapy. For the time being, there is no suggestion of a difference between the adjuvant chemotherapy group and observation group in distant metastasis rate and survival. Median survival time was 13 months. Actuarial survival rates at 6, 12 and 18 months of 39 patients who completed this study were 84.6%, 53.7% and 40.3%, respectively. The partial and complete responders from induction chemotherapy showed significantly bettor survival than non-responders(p=0.028). Incidence of radiation pneumonitis in this stuffy group was less than that in historical control group inspite of induction chemotherapy. All patients tolerated hyperfractionated radiotherapy without definite increase of acute complications compared with conventional radiotherapy group. The longer fellow up is needed to evaluate the efficacies of induction and maintenance chemotherapy and survival advantage by hypefractionated radiotherapy but authors are encouraged with an excellent tolerance, higher response rate and improvement of one year survival rate in patients of this study.
Subject(s)
Humans , Carcinoma, Non-Small-Cell Lung , Chemotherapy, Adjuvant , Cisplatin , Disulfiram , Drug Therapy , Incidence , Induction Chemotherapy , Lung , Maintenance Chemotherapy , Neoplasm Metastasis , Radiation Pneumonitis , Radiotherapy , Survival RateABSTRACT
Fractionation dose and number have been known as radiation factor affecting the radiation complication and the effectiveness in radiotherapy for brain tumors. In this study hyperfractionation technique with 115cGy/fractioin 2 fractions daily 5days/wk, upto 5750-6900cGy to partial brain volume was compared with conventional fractionation technique with daily 200cGy/fraction 5 fraction/wk, upto 5400-6000cGy, in regarding to the effectiveness of hyperfractionated radiotherapy and eraly and later radiation reavtion. The survival period was longer in hyperfractionated irradiated group particularly if the tumors were located in the posterior portion of brain, however there was no singificant statistics due to small number of patients. Mean survival period for glioblastoma multiforme was 11.8 months in hyperfractionated group vs 8.7 months in conventional fractionated group and for high grade astrocytoma 36month in hyperfractionated group, but in conventional fractionated group all was died in 18 months. Acute radiation reaction occurred less frequently in hyperfractionated group, 15.8% vs 47.8% in conventional fractionated group(p<0.024). Alopeci was developed in 31.6% of the hyperfractionated group vs 82.6% of the conventional fractionated group(p<0.0031). One case of later radiation necrosis in cancer region was suspected in the hyperfractionated group but we has been in a dilemma for confirmatory diagnosis in present available diagnostic technique. The hyperfractionated irradiation technique was proven to be superior to conventional fractionated technique regarding the radiation reaction and the effectiveness of the treatment.
Subject(s)
Humans , Astrocytoma , Brain , Brain Neoplasms , Diagnosis , Glioblastoma , Glioma , Necrosis , RadiotherapyABSTRACT
To evaluate the effect of MVP chemotherapy and hyperfractionated radiotherapy in Stage III unresectable non small cell lung cancer (NSCLC), authors have conducted a prospective randomized study since January 1991. Stage IIIa or IIIb unresectable NSCLC patients were treated with hyperfractionated radiotherapy (120 cGy/fx BID) up to 6500 cGY following 3 cycles of induction MVP (Mitomycin C 6 mg/m2, vinblastine 6 mg/m2, Cisplatin 60 mg/m2) and randomized for either oservation or 3 cycles of maintenance MVP chemotherapy. Until August 1991, 18 patients were registered to this study. 4 cases were stage IIIa and 14 were stage IIIb. Among 18 cases 2 were lost after 2 cycles of chemotherapy, and 16 were analyzed for this preliminary report. The response rate of induction chemotherapy was 62.5%; partial response, 50% and minimal response, 12.5%. Residual tumor of the one partial responder was completely disappeared after radiotherapy. Among 6 cases who were progressed during induction chemotherapy, 4 of them were also progressed after radiotherapy. All patients were tolerated BID radiotherapy without definite increase of acute complications, compared with conventional radiotherapy group. But at the time of this report, one patient expired in two month after the completion of the radiotherapy because of treatment related complication. Although the longer follow up is needed, authors are encouraged with higher response rate and acceptable toxicity of this treatment. Authors believe that this study is worthwhile to continue.