ABSTRACT
PURPOSE: Despite the lack of evidence to support its implementation in the clinical practice, induction chemotherapy (IC) before chemoradiotherapy (CRT) is often used in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). We retrospectively examined the tolerability, feasibility, and clinical outcome of both concepts in a single center analysis. PATIENTS AND METHODS: In all, 83 patients were treated between 2007 and 2010 with IC + CRT (n = 42) or CRT alone (n = 41). IC consisted of docetaxel, cisplatin and 5-fluorouracil (TPF), or cisplatin and 5-fluorouracil (PF). All patients were scheduled to receive 2 cycles of PF during concurrent CRT. Adverse events were assessed according to the common toxicity criteria of adverse events (CTCAE v. 3.0). Associations were tested using the χ² test, and survival estimates were calculated according to Kaplan-Meier. RESULTS: The median follow-up was 30.35 months (range 2.66-61.25 months). At 2 years, the overall survival rate was significantly higher for primary CRT compared to IC + CRT group (74.8 % vs. 54 %, respectively; p = 0.041). Significantly more treatment-related overall grade 4 toxicities were documented in the IC + CRT group compared to the CRT group (42.9% vs. 9.8%; p = 0.001). Renal toxicity ≥ grade 2 occurred in 52.4 % vs. 7.3 % (p < 0.001), respectively. In all, 93 % of the patients with primary CRT compared to 71 % with IC + CRT received the planned full radiotherapy dose (p = 0.012). CONCLUSION: This is, to our knowledge, the largest retrospective study to compare IC + CRT with primary CRT. IC showed high acute toxicity, compromised the feasibility of concurrent CRT, and was associated with reduced overall survival rates compared to primary CRT. The lack of clinical benefit in conjunction with the increased toxicity does not support implementation of IC.
Subject(s)
Carcinoma, Squamous Cell/therapy , Chemoradiotherapy, Adjuvant , Chemoradiotherapy , Induction Chemotherapy , Otorhinolaryngologic Neoplasms/therapy , Aged , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Squamous Cell/pathology , Cisplatin/administration & dosage , Cisplatin/adverse effects , Combined Modality Therapy , Docetaxel , Feasibility Studies , Female , Fluorouracil/administration & dosage , Fluorouracil/adverse effects , Humans , Kaplan-Meier Estimate , Lymphatic Metastasis/pathology , Lymphatic Metastasis/radiotherapy , Male , Middle Aged , Neoplasm Staging , Otorhinolaryngologic Neoplasms/pathology , Retrospective Studies , Taxoids/administration & dosage , Taxoids/adverse effectsABSTRACT
BACKGROUND: Acute and late injuries of vulva and vagina are frequent and potentially serious complications in radiotherapy of gynecologic tumors. They still are reported poorly in literature. METHODS: Based on a literature search a survey will be given of the modalities, which are used or recommended for prophylaxis or treatment of these radiation injuries. The principles of the different measures will be discussed with available study results. RESULTS: Hygiene measures and the topical application of antimicrobial or granulation stimulating substances, which is mostly based on long standing clinical experience, are the principles of the treatment of acute reactions of vulva and vagina. The topical use of estrogen, which promotes proliferation of epithelium, is generally described in connection with treatment and prophylaxis of late radiation injuries. As a prophylaxis for the late reaction of vaginal stenosis, vaginal dilatation is recommended in literature. CONCLUSIONS: With the exception of a few reports on estrogen, there are no data about the effectiveness of the currently used medical substances. The local application of estrogen as prophylaxis of the acute reactions will therefore be examined in a prospective study.
Subject(s)
Genital Neoplasms, Female/radiotherapy , Radiation Injuries/therapy , Radiotherapy/adverse effects , Vaginal Diseases/therapy , Vulvar Diseases/therapy , Acute Disease , Administration, Topical , Dilatation , Estrogens/administration & dosage , Estrogens/therapeutic use , Female , Humans , Hygiene , Radiation Injuries/etiology , Radiation Injuries/prevention & control , Vagina/radiation effects , Vaginal Diseases/etiology , Vaginal Diseases/prevention & control , Vulva/radiation effects , Vulvar Diseases/etiology , Vulvar Diseases/prevention & controlABSTRACT
The combined radiochemotherapy with mitomycin C and 5-fluorouracil is an effective and well tolerable treatment modality. Its superiority in comparison with radiotherapy alone could not be reliably demonstrated. The goal of this paper was to analyse the results of routinely used combined modality in patients with anal carcinoma. From 1989 to 1994 simultaneous radiochemotherapy was performed in 20 patients with carcinoma of the anal canal. The 3- and 5- year survival rate was 79%, the 3- and 5-year local tumor control rate was 88% and 77%, respectively. In 2 patients a recurrence-related colostomy was performed. The acute side effects were tolerable, 2 patients (10%) suffer from moderate late effects (partial incontinence, proctitis). Our results, being of high validity due to accurate follow-up are similar to the data reported in international trials and support the hypothesis of superiority of combined radiochemotherapy compared to radiotherapy alone. In our opinion, the combined modality treatment should also be applied preferentially in practice, beyond the clinical trials.
