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Background: Cisplatin based Concurrent chemo-radiation (CTRT) is the corner stone for treatment of locally advanced head and neck carcinoma. Epidermal growth factor receptor(EGFR) expression by squamous cell carcinoma which is associated with cancer development and progression,leads to emergence of anti-EGFR agents as a therapeutic option. In this study we compare cisplatin based CTRT against gefitinib based CTRT in terms of disease control and acute toxicity profile. Material and Methods: Stage III and IV squamous cell carcinoma of Head and neck region (excluding nasopharynx) were randomised into two groups. Control group received conventionally fractionated radiotherapy of 66Gy in 33fractions, over six and half weeks with concurrent weekly cisplatin. Study group received same dose of radiation with concurrent daily oral Gefitinib. All patients were followed up weekly during the treatment and then 6-8 weeks after completion of treatment and thereafter 3 monthly. Results: Overall response rate (complete response + partial response) was comparable for both arms (75% vs 76.2%, p value-0.881). Radiation with cisplatin was associated with significantly higher skin (28.6% vs 15%,p value-0.037) and mucosal (23.8% vs 5%,p-value-0.047) toxicities. Gefitinib containing arm showed significantly higher grade 3 diarrhoea (10% vs 0%, p-value-0.01) and skin rash (6% vs 0%, p -value-<0.001).With a median follow-up of 12.5 months Disease free survival (DFS) was not significantly different between the arms(12 vs 13 months). Conclusion: Gefitinib based CTRT is non-inferior to cisplatin based CTRT for the treatment of locally advanced head and neck carcinoma with acceptable toxicity profile.
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Background: Cisplatin-based concurrent chemoradiation is the standard treatment for carcinoma cervix. However, there is a need to explore alternative chemotherapeutic agents to further improve the treatment outcome. In this study, weekly paclitaxel and cisplatin-based chemoradiation was compared with weekly cisplatin-based chemoradiation in terms of disease control and toxicity profile. Materials and Methods: Sixty-four patients with FIGO stage IB2-IIIB squamous cell carcinoma of the uterine cervix were divided (by simple random sampling) into two groups: control arm patients who received radiotherapy (50 Gy in 25 fractions over 5 weeks) with concurrent weekly cisplatin (40 mg/m 2 ) and study arm patients received same radiation dose with weekly cisplatin (30 mg/m2 ) and paclitaxel (40 mg/m2 ). After that, all patients received brachytherapy 21 Gy/three fractions, one fraction/week. All patients were followed up weekly during treatment, then 4–6 weeks after treatment completion, and thereafter monthly for at least 6 months. Results: The overall treatment response (complete+ partial response) was numerically higher in the cisplatin- containing control arm, but not significant (93% vs. 80%, P-value = 0.406). High-grade early rectal (60% vs. 25%, P-value = 0.014) and acute gastrointestinal toxicity (66% vs. 6%, P-value <0.001) were significantly higher in the cisplatin and paclitaxel-containing arm. Hematological, renal, late rectal, and bladder toxicities were also numerically higher in the study arm, but not statistically significant. Conclusion: There was no significant benefit of weekly paclitaxel and cisplatin as an alternative to weekly cisplatin-based chemoradiation in the treatment of carcinoma cervix.
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Background: Aim of the study was to compare the response of altered fractionation schedule with concurrent chemo-radiation in patients with primary and the nodal disease.Methods: Total of 40 patients (20 in each arm) with stage 1- 4 squamous cell carcinoma of the head and neck with a performance status of 0-2 (ECOG) were included in the study. Arm A was altered fractionation schedule where in patients received 6 fractions per week to a total dose of 6600 cGy in 33 fractions. In Arm B, patients received conventional radiotherapy with concurrent chemotherapy three weekly Inj. of cisplatin (100 mg/m2). Patients were evaluated for acute toxicity every week using the Acute Radiation Morbidity Scoring Criteria. The response was assessed after 6 weeks and 12 weeks post treatment using the RECIST criteria. Data was statistically analyzed.Results: Seventeen patients in Arm A and 18 patients in Arm B completed the treatment. At the end of three months, In Arm A, 7 patients had complete response and in Arm B, 9 patients had complete response of the primary (p>0.05). When the complete nodal response was compared in both the arms, there was no difference (2 vs 4 in Arm A vs Arm B resp.). But there were more partial nodal responders in Arm B (p = 0.016). The acute toxicities were comparable in both the arms.Conclusions: Altered fraction radiotherapy can be used in early lesions with minimal nodal burden but with locally advanced disease or large nodal burden addition of chemotherapy should not be avoided.
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Background: Concurrent chemoradiation is considered the standard care for locoregionally advanced non-small cell lung cancer. This study aimed to compare the treatment response, progression free survival and treatment toxicities between cisplatin and carboplatin based concurrent chemoradiation.Methods: Between October 2015 and September 2017, 60 eligible patients were enrolled and divided into two arms of 30 patients each. Arm A received EBRT to chest (60Gy/30 fractions) with concurrent weekly Injection Cisplatin 35mg/m2. Arm B received EBRT to chest (60Gy/30 fractions) with concurrent weekly Injection Carboplatin at a dose of AUC-2. Early treatment response was assessed at 1 month and late treatment response at 6 months after completion of radiation using RECIST criteria. Treatment toxicities was assessed using RTOG toxicity criteria. All statistical analysis was carried out using SPSS version 21.Results: Most patients were in the age range of 61-70 years. Mean age of presentation was 67.53±11.038 years in Arm A and 66.03±12.794 years in Arm B. Median follow up was 16 months for both arms. Response rate of was slightly better in Arm A (73.3% versus 60%). 1 year PFS rate was 53.33% in Arm A and 36.67% in Arm B. Median time to progression was better in Arm A (11 months vs 10 months). Toxicities were almost comparable in both the arms.Conclusions: Use of carboplatin in combination with radiation therapy is comparable to cisplatin in terms of treatment outcomes with better compliance and lower toxicity.
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introduction: Despite many advances in both surgery and radiotherapy, the treatment of esophageal cancer remains a challenge for both surgeons and oncologists. The treatment of choice for patients with carcinoma esophagus is controversial. Recent studies have suggested that combined chemotherapy and radiation therapy may result in improved survival. Aim: The aim of our study was to analyze the role of concurrent chemoradiation in inoperable carcinomas esophagus. Materials and Methods: This single-arm prospective study was conducted in the Department of Radiotherapy, Thanjavur Medical College Hospital from August 2018 to August 2019 to analyze the role of concurrent chemoradiation in inoperable carcinomas esophagus. A total of 26 cases of inoperable cases of carcinoma esophagus were treated with once-weekly cisplatin 30 mg/ m2 along with radiotherapy 60 Gy in 30 fractions in 6 weeks on telecobalt machine. Results: Of 26 patients 16 patients were males, 10 patients were females, 17 patients had age <60 years, 9 patients had age above 61 years, 22 patients had squamous cell carcinoma, 4 patients had adenocarcinoma, 4 patients had lesion in upper part of esophagus, 14 patients had lesion in middle part, 8 patients had lesion in lower part, 4 patients had tumor dimension <5 cm, 22 patients had dimension >5.1 cm, 2 patients had tumor stage T1, 22 patients had T2, 2 patients had T3, 1 patient had Nx, 21 patients had No, 4 patients had N1, 15 patients had mild dysphagia, 8 patients had moderate dysphagia, 3 patients had severe dysphagia1 patients had diarrhea, 1 patient had fatigue, 4 patients had leukopenia, and 1 patient had neutropenia. Conclusion: Combined modality therapy plays a significant role in the treatment of patients with carcinoma esophagus. Concurrent chemoradiation is a superior treatment in inoperable carcinoma esophagus in terms of local control and survival. Hence, concurrent chemoradiation can also be tried in early cases and surgical morbidity survival and quality of life can be improved.
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Background: Although concurrent chemoradiation (CCRT) is the standard of care for stage III non-small cell lung cancer(NSCLC), the five years overall (OS) survival is very poor. Most of the patients developed distant metastasis later which can be improved by induction chemotherapy. Aims: This study was designed to observe the difference in epidemiology, acute toxicities, overall responses [complete response (CR)+partial response (PR)] after treatment completion, disease-free survival (DFS) and progression-free survival (PFS) at the end of the study. Settings and Design: This was a prospective, interventional, randomized hospital-based study. Methods and Material: Eligible patients were randomized into arm A (CCRT with weekly paclitaxel(P) + Carboplatin(C) with 66 Gray radiation) and arm B (two cycles of induction chemotherapy consisted of P+C followed by CCRT as of arm A. During treatment weekly, after completion of treatment at 6th week and thereafter 3 monthly evaluation was done till the end of study. S tatistical analysis used: Chi-Square and Fisher Exact test did statistical analysis, t-test with 95%CI, Kaplan Meier survival analysis, Log Rank test using SPSS version 18. Results: Among 44 patients, male (88.6%), Smokers (85.1%) were predominant with the most common histology was squamous cell carcinoma (52.4%). Overall response (Complete Response +Partial Response) was higher in Arm B 66.66% but statistically non-significant. Acute toxicities in both the arms were comparable and similar. DFS and PFS in the induction chemotherapy arm (Arm B) were numerically superior to concurrent chemoradiation arm (Arm A) but statistically nonsignificant Conclusion: To conclude there were no significant differences in results between two arms in the present study population. Further studies with the larger sample size and longer duration of follow up are necessary.
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Cervical cancer is one of the leading causes of cancer-related deaths in developing countries. Between 80% and 90% of cervical carcinomas are squamous cell carcinomas. Concurrent chemo radiation with Inj. Cisplatin given every week followed by intracavitary Brachytherapy has become the standard of treatment in locally advanced cervical carcinoma Methods: 60 biopsy proven cases of locally advanced cervical cancer attending the Out Patient Department of Radiotherapy from November 2017 to April 2019, meeting specified Inclusion and Exclusion Criteria, willing to participate in the study were included. Acute toxicities and locoregional control were assessed using the common terminology criteria for adverse events (CTCAE) version 4.0. During treatment patients will be reviewed weekly. After treatment completion, patients will be reviewed monthly for six months. And after that, they will be reviewed every 3 months for 9 months. Results: The median age was 50 years (range: 40–60 years) in both the arms. On analysing the pattern of response, in Arm A the number of patients having complete response was 29 (96.66%), partial response was 1 (3.34%). In the Arm B all patients have complete response. The incidence of Emesis, Dermatitis, Neutropenia, and Vaginal Mucocytis were more in Arm B as compared to Arm A. Conclusion: In locally advanced squamous cell carcinoma of uterine cervix, addition of concurrent injection Cisplatin to ICRT did not significantly improve loco regional response but increases incidence of haematological and mucosal toxicity, which being manageable, were not associated with increased mortality.
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Introduction: Induction chemotherapy in locally advancedhead and neck cancers prior to local therapy has beendemonstrated to be non-inferior to concurrent chemoradiationin terms of overall survival (OS). Despite possible lack ofsurvival advantage, downsizing of tumours, allowing organpreservation along with the possible benefit of eradication ofmicrometastases earlier in the course of therapy makes thisa desirable approach for many heads and neck oncologistsworldwide. Study aimed to assess the immediate locoregionalresponse rates and to assess the toxicity profile of sequentialtherapy with three cycles of induction PFT followed byConcurrent Chemo-Radiation with weekly Cisplatin inLocally Advanced Head and Neck Cancers.Material and methods: 30 consecutive patients with locallyadvanced head and neck cancers attending the OPD at ourinstitute were included in the study. All patients were treatedwith 3 cycles of Induction chemotherapy with PFT regimen(Paclitaxel 175mg/m2 Day1, Cisplatin 100 mg/m² split to(Day 1-3), 5-FU 750 mg/m² Day 1 to 3) every 21 days. Thepatients were then taken up for concurrent chemoradiation(66 Gy RT along with weekly Cisplatin 40mg/sq.m.). Theimmediate locoregional response rates were assessed byclinical and radiological imaging. The toxicity profile of thetreatment was assessed with RTOG acute morbidity scoringcriteria and CTCAE Version 4.Results: 30 patients (3 female) were recruited for the study.Among them 3 were laryngeal cancer patients and thehypopharyngeal, oropharyngeal and the oral cavity cancerswere 9 each. 63% of them had complete response and 30%had partial response. The sub-sites of the hypopharynx andthe oropharynx had the best outcomes from this treatmentprotocol. 2 patients did not complete the planned treatment.11patients had grade 3 leukopenia and 2 patients had grade 4/febrile neutropenia. There was no grade 3 thrombocytopeniain the study group.Conclusion: Sequential therapy with three cycles of inductionPFT followed by concurrent chemoradiation is a feasiblealternative for moderately advanced and very advanced headand neck cancer. Patient selection and supportive care duringtreatment are very important for successful outcome.
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Objective To investigate the impact of the changes of posttreatment karnofsky performance status (KPSpost) on the overall survival (OS) for patients with stage Ⅳ non-small cell lung cancer (NSCLC) underwent concurrent chemoradiation.Methods A total of 279 patients (male 198 and female 81) with histological confirmed stage Ⅳ NSCLC were enrolled in this study with a median age of 58 years old (range 22 to 80 years old).There were 166 cases of squamous carcinoma,87 cases of adenocarcinoma,and 22 cases of unclassified carcinoma,respectively.All enrolled patients received more than 2 cycles of chemotherapy and more than 36 Gy of concurrent radiotherapy.Kaplan-Meier method and Log-rank test were applied to evaluate OS.Multivariate analyses were carried out by the Cox proportionalhazard model.Chi-square test and logistic regression analysis were used to explore the related factors of KPSpost.Results There were 198 patients with improved KPSpost and 81 patients with decreased KPSpost,respectively.Univariate and multivariate analyses indicated that the improvement of KPSpost was associated with longer OS.Logistic regression analysis showed that the improvement of KPSpost was positively related with treatment of more than 4-6 cycles chemotherapy concurrent with over 63 Gy radiation to primary tumor.The improvement of KPSpost also correlated positively with disease control rate (DCR),but negatively with PLT toxicity and radiation esophagitis.Conclusions KPSpost was an independent prognostic factor of OS for patients with stage Ⅳ NSCLC underwent concurrent chemoradiation.Chemotherapy of 4-6 cycles and concurrent over 63 Gy radiotherapy dose to primary tumor,as well as DCR were positive factors for KPSpost improvement.However,stage 3-4 PLT toxicities and radiation esophagitis decreased the KPSpost.
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PURPOSE: This study is to report clinical outcomes of salvage concurrent chemo-radiation therapy (CCRT) in treating patients with loco-regional recurrence (LRR) following initial complete resection of non-small cell lung cancer. MATERIALS AND METHODS: Between February 2004 and December 2016, 127 patients underwent salvage CCRT for LRR. The median radiation therapy (RT) dose was 66 Gy and clinical target volume was to cover recurrent lesion with margin without elective inclusion of regional lymphatics. Majority of patients (94.5%) received weekly platinum-based doublet chemotherapy during RT course. RESULTS: The median follow-up time from the start of CCRT was 25 months. The median survival duration was 49 months, and overall survival (OS) rates at 2 and 5 years were 72.9% and 43.9%. The 2- and 5-year rates of in-field failure-free survival, distant metastasis free survival, and progression free survival were 82.4% and 73.8%, 50.4% and 39.9%, and 34.6% and 22.3%, respectively. Grade ≥ 3 radiation-related esophagitis and pneumonitis occurred in 14 (11.0%) and six patients (4.7%), respectively. On both univariate and multivariate analysis, higher biologically equivalent dose (BED₁₀) (≥ 79.2 Gy₁₀ vs. 80 cm³; HR, 0.403), and longer disease-free interval (> 1 year vs. ≤ 1 year; HR, 0.489) were significantly favorable factors for OS. CONCLUSION: The current study has demonstrated that high dose salvage CCRT focused to the involved lesion only was highly effective and safe. In particular, higher BED₁₀, smaller CTV, and longer disease-free interval were favorable factors for improved survival.
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Humans , Carcinoma, Non-Small-Cell Lung , Disease-Free Survival , Drug Therapy , Esophagitis , Follow-Up Studies , Multivariate Analysis , Neoplasm Metastasis , Pneumonia , RecurrenceABSTRACT
Background: Carcinoma of cervix is the most common malignancy of women at our center and the majority of cases present locally advanced stages. The aim of this study was to assess the efficacy and toxicity of carboplatin based concurrent chemoradiation in patients with locally advanced cervical carcinoma. Methods: Fifty seven locally advanced cervical cancer patients were enrolled in this study and fifty eligible patients were received weekly carboplatin at dose of area under curve 2, along with radical radiotherapy. The total dose of 50 Gy in 25 fractions over a period of 5 weeks was given during external beam radiotherapy and 19.5 Gy (6.5 Gy per fraction/week) was given during high dose rate achytherapy. Results: After two months of completion of treatment the complete response rate was observed in 37(74%) patients, with 11 (22%) patients had partial response and 02 (04%) patients had stable disease or no response to treatment. The hematological toxicities with grade III were observed in 06(12%) patients and grade IV observed in 02(04%) patients. Conclusion: Despite initial promising results with acceptable toxicities, further large randomized study is needed to judge the efficacy of carboplatin along with radical radiotherapy in cervical cancer patients.
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BACKGROUND AND OBJECTIVES: Nasopharyngeal carcinoma is an uncommon disease that is usually found in the advanced stage becuase its anatomical location makes early detection difficult. Radiation therapy or concurrent chemoradiation therapy is mainstay for treatment of nasopharyngeal carcinoma. We evaluated clinical characteristics and treatment outcomes of nasopharyngeal carcinoma and assessed prognostic factors related to survival. SUBJECTS AND METHOD: We retrospectively reviewed medical records of 87 patients who were treated for nasopharyngeal carcinoma from 1994 to 2013. Clinical characteristics, pathologic type, stage, treatment modality, recurrence and survival were investigated. RESULTS: The mean follow-up period was 66.7 (12-232) months. Recurrence rates were not significantly different between the radiation therapy group and combined chemoradiation groups in the early stage (27.3% vs. 21.6%, p=0.644) and the advanced stage (21.4% vs. 31.3%, p=0.496). Five-year overall survival and disease free survival rate was 74.0% and 58.9%, respectively. Five-year overall survival rate of the combined chemoradiation therapy group was significantly lower than that of the radiation therapy group (64.4% vs. 94.1%, p=0.001). Distant metastasis was significantly correlated with survival in multivariate analysis. CONCLUSION: In this study, the five-year overall survival rate was better in the radiation therapy group than in the combined chemoradiation group. This might be related to the fact that advanced stage disease was more common in the combined chemoradiation group. Further studies with larger study samples and longer follow-up are necessary to verify these results and determine optimal modalities for the treatment of nasopharyngeal carcinoma.
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Humans , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Medical Records , Multivariate Analysis , Neoplasm Metastasis , Prognosis , Recurrence , Retrospective Studies , Survival RateABSTRACT
Objective To investigate the feasibility and clinical efficacy of intra-arterial infusion chemotherapy within concurrent chemoradiation therapy (CCRT)for local advanced cervical cancer (LACC:Stage Ⅰb2 - Ⅳa).Methods 42 LACC patients were treated with CCRT combining with intra-arterial infusion chemotherapy (CCRT group),and another 60 LACC patients were under-went radiotherapy alone (control group).The clinical efficacy,adverse reactions and overall survivals (OAS)were evaluated,be-tween the two groups,respectively.Results Overall response rate was 92.8% in CCRT group.Of 42 patients,24 had achieved complete response (CR)in CCRT group (57.1%).The 5-year overall survival rate in CCRT group was 76.2%,which was signifi-cantly higher than that of control group (49.3%),respectively (P =0.01).Multivariate COX proportional hazards model revealed that the clinical stage(P =0.01 6),pelvic positive lymph nodes (P =0.007)were independent factors of monitoring prognosis of LACC patients treated with CCRT combining with intra-arterial infusion chemotherapy.Conclusion CCRT with intra-arterial infu-sion chemotherapy is a safe and effective method for LCCA,and clinical stage and pelvic positive lymph node were independent fac-tors of the prognosis of patients.
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Locally advanced hepatocellular carcinoma (HCC) with portal vein thrombosis carries a 1-year survival rate <10%. Localized concurrent chemoradiotherapy (CCRT), followed by hepatic arterial infusion chemotherapy (HAIC), was recently introduced in this setting. Here, we report our early experience with living donor liver transplantation (LDLT) in such patients after successful down-staging of HCC through CCRT and HAIC. Between December 2011 and September 2012, eight patients with locally advanced HCC at initial diagnosis were given CCRT, followed by HAIC, and underwent LDLT at the Severance Hospital, Seoul, Korea. CCRT [45 Gy over 5 weeks with 5-fluorouracil (5-FU) as HAIC] was followed by HAIC (5-FU/cisplatin combination every 4 weeks for 3-12 months), adjusted for tumor response. Down-staging succeeded in all eight patients, leaving no viable tumor thrombi in major vessels, although three patients first underwent hepatic resections. Due to deteriorating liver function, transplantation was the sole therapeutic option and offered a chance for cure. The 1-year disease-free survival rate was 87.5%. There were three instances of post-transplantation tumor recurrence during follow-up monitoring (median, 17 months; range, 10-22 months), but no deaths occurred. Median survival time from initial diagnosis was 33 months. Four postoperative complications recorded in three patients (anastomotic strictures: portal vein, 2; bile duct, 2) were resolved through radiologic interventions. Using an intensive tumor down-staging protocol of CCRT followed by HAIC, LDLT may be a therapeutic option for selected patients with locally advanced HCC and portal vein tumor thrombosis.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Carcinoma, Hepatocellular/complications , Chemoradiotherapy , Cisplatin/therapeutic use , Disease-Free Survival , Fluorouracil/therapeutic use , Liver Neoplasms/complications , Liver Transplantation , Living Donors , Neoplasm Recurrence, Local , Portal Vein , Venous Thrombosis/complicationsABSTRACT
Concurrent chemoradiation has been the main treatment of locally advanced non-small cell lung cancer (LA-NSCLC).However, there is a controversy whether giving the induction chemotherapy before treatment.The survival advantage of consolidation chemotherapy doesn't reach a consensus.When the dose of initial chemotherapy is insufficient, consolidation chemotherapy is necessary.With the development of radiotherapy and the renewal of the chemotherapy drugs, concurrent chemoradiation is expected to bring better survival benefit for the patients with LA-NSCLC.
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Objective To evaluate the predictive value of NLR in response to radiation therapy alone or concurrent chemoradiation therapy and the prognostic outcome. Methods Pretreatment NLR was evaluated in 230 paitents, with clinically staged cervical cancer (Ⅰ~Ⅳ), received RT or CCRT therapy, Receiver operating characteristic curves were applied to establish optimal cutoff points, and all 230 patients were therefore divided into two groups based on the NLR value, and univariate and multivariate analyses were used to estimate radiation response, Kaplan-Meier method was used to estimate the OS and DFS. Results ROC curve analysis demonstrated the best cut-of values for NLR (≥ 2.84)for radiation response. Results of Cox regression showed that NLR was significantly associated with the overall survival (OS). The high NLR group was poor in 1-year OS and 3-year OS compared with those in the low NLR group (65.5% vs 86.2%,32.4% vs 62.5%;P < 0.001). Conclusions Pre-treatment blood NLR could predict a good response to RT or CCRT, and could be a useful biomarker for cervical cancer patients before RT or CCRT, with the merits including easy measurement, reproducible and unexpensive marker of systemic inflammation.
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PURPOSE: The aim of this study was to evaluate long-term oncologic outcomes after concurrent chemoradiation treatment for anal cancer. MATERIALS AND METHODS: Between January 1979 and December 2008, the records of 50 consecutive patients with anal cancer and who were treated by chemoradiation or radiation only with a curative intent were retrospectively reviewed. The oncologic outcomes and the risk factors for recurrence were analyzed. RESULTS: Of the 50 patients, 49 underwent concurrent chemoradiation and one underwent radiation only. After these definitive treatments, 43 (86.0%) achieved a clinical complete response. During the median follow-up of 60 months (range: 2-202 months), the 5-year overall survival, disease-free survival, and locoregional recurrence-free survival were 84.2%, 72.7%, and 69.9%, respectively. Multivariate analysis revealed that the performance status (p=0.031) and a clinical complete response (p=0.039) were the independent predictors for overall survival; lymph node involvement (p=0.031) was the only independent predictor for disease-free survival. CONCLUSION: The performance status and a clinical complete response may be reliable predictors of survival after chemoradiation for anal cancer. The addition of irradiation to the inguinal area may not be significantly associated with the outcomes.
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anus Neoplasms/drug therapy , Chemoradiotherapy/methods , Disease-Free Survival , Follow-Up Studies , Lymphatic Metastasis , Prognosis , Proportional Hazards Models , Recurrence , Time Factors , Treatment OutcomeABSTRACT
PURPOSE: To determine the effectiveness of salvage radiation therapy (RT) in patients with loco-regional recurrences (LRR) following initial complete resection of non-small cell lung cancer (NSCLC) and assess prognostic factors affecting survivals. MATERIALS AND METHODS: Between 1994 and 2007, 64 patients with LRR after surgery of NSCLC were treated with high dose RT alone (78.1%) or concurrent chemo-radiation therapy (CCRT, 21.9%) at Samsung Medical Center. Twenty-nine patients (45.3%) had local recurrence, 26 patients (40.6%) had regional recurrence and 9 patients (14.1%) had recurrence of both components. The median RT dose was 54 Gy (range, 44-66 Gy). The radiation target volume included the recurrent lesions only. RESULTS: The median follow-up time from the start of RT in survivors was 32.0 months. The rates of in-field failure free survival, intra-thoracic failure free survival and extra-thoracic failure free survival at 2 years were 52.3%, 33.9% and 59.4%, respectively. The median survival after RT was 18.5 months, and 2-year overall survival (OS) rate was 47.9%. On both univariate and multivariate analysis, the interval from surgery till recurrence and CCRT were significant prognostic factors for OS. CONCLUSION: The current study demonstrates that involved field salvage RT is effective for LRR of NSCLC following surgery.
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Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma, Non-Small-Cell Lung/mortality , Lung Neoplasms/mortality , Neoplasm Recurrence, Local/radiotherapy , Survival Rate , Treatment OutcomeABSTRACT
OBJECTIVE: Concurrent chemoradiation therapy (CCRT) is the standard treatment for locally advanced cervical cancer. Although the optimal chemotherapeutic regimen is not yet defined, previous randomized trials have demonstrated that 5-fluorouracil (5-FU) plus cisplatin every 3 weeks and weekly cisplatin are the most popular regimens. The purpose of this study was to compare the outcomes of weekly CCRT with cisplatin and monthly CCRT with 5-FU plus cisplatin for locally advanced cervical cancer. METHODS: We retrospectively reviewed data from 255 patients with FIGO stage IIB-IVA cervical cancer. Patients were classified into two CCRT groups according to the concurrent chemotherapy: weekly CCRT group, consisted of CCRT with weekly cisplatin for six cycles; and monthly CCRT group, consisted of CCRT with cisplatin and 5-FU every 4 weeks for two cycles followed by additional consolidation chemotherapy for two cycles with the same regimen. RESULTS: Of 255 patients, 152 (59.6%) patients received weekly CCRT and 103 (40.4%) received monthly CCRT. The mean follow-up period was 39 months (range, 1 to 186 months). Planned CCRT was given to 130 (85.5%) patients in weekly CCRT group and 84 (81.6%) patients in monthly CCRT group, respectively. Severe adverse effects were more common in the monthly CCRT group than in the weekly CCRT group. There were no statistically significant differences in progression-free survival and overall survival between the two groups (p=0.715 and p=0.237). CONCLUSION: Both weekly CCRT and monthly CCRT seem to have similar efficacy for patients with locally advanced cervical cancer, but the weekly cisplatin is better tolerated.
Subject(s)
Humans , Cisplatin , Consolidation Chemotherapy , Disease-Free Survival , Fluorouracil , Follow-Up Studies , Retrospective Studies , Uterine Cervical NeoplasmsABSTRACT
OBJECTIVE: Concurrent chemoradiation therapy (CCRT) is the standard treatment for locally advanced cervical cancer. Although the optimal chemotherapeutic regimen is not yet defined, previous randomized trials have demonstrated that 5-fluorouracil (5-FU) plus cisplatin every 3 weeks and weekly cisplatin are the most popular regimens. The purpose of this study was to compare the outcomes of weekly CCRT with cisplatin and monthly CCRT with 5-FU plus cisplatin for locally advanced cervical cancer. METHODS: We retrospectively reviewed data from 255 patients with FIGO stage IIB-IVA cervical cancer. Patients were classified into two CCRT groups according to the concurrent chemotherapy: weekly CCRT group, consisted of CCRT with weekly cisplatin for six cycles; and monthly CCRT group, consisted of CCRT with cisplatin and 5-FU every 4 weeks for two cycles followed by additional consolidation chemotherapy for two cycles with the same regimen. RESULTS: Of 255 patients, 152 (59.6%) patients received weekly CCRT and 103 (40.4%) received monthly CCRT. The mean follow-up period was 39 months (range, 1 to 186 months). Planned CCRT was given to 130 (85.5%) patients in weekly CCRT group and 84 (81.6%) patients in monthly CCRT group, respectively. Severe adverse effects were more common in the monthly CCRT group than in the weekly CCRT group. There were no statistically significant differences in progression-free survival and overall survival between the two groups (p=0.715 and p=0.237). CONCLUSION: Both weekly CCRT and monthly CCRT seem to have similar efficacy for patients with locally advanced cervical cancer, but the weekly cisplatin is better tolerated.