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1.
Am J Clin Oncol ; 38(4): 395-400, 2015 Aug.
Article in English | MEDLINE | ID: mdl-26214084

ABSTRACT

OBJECTIVES: To assess the effectiveness of a SHort-course Accelerated RadiatiON therapy (SHARON) in the treatment of patients with multiple brain metastases. MATERIALS AND METHODS: A phase II clinical trial was designed. Eligibility criteria included patients with at least 3 brain metastases or metastatic disease in >3 organ systems, and Eastern Cooperative Oncology Group performance status of ≤3. Fifty patients were treated with whole brain radiotherapy at 18 Gy (4.5 Gy per fraction) in 2 days with a twice daily fractionation. The primary endpoint was the assessment of efficacy in terms of overall survival. RESULTS: Characteristics of the 50 enrolled patients were: male/female: 24/26; median age: 65 years (range, 45 to 80 y). Eastern Cooperative Oncology Group performance status was <3 in 42 patients (84%). Nineteen patients (38%) were considered to have recursive partitioning analysis class 3 disease. Grade 1-2 acute neurological (46%) and skin (24%) toxicities were recorded. Three patients (6%) experienced neurological grade 3 acute toxicity. With a median follow-up time of 6 months (range, 1 to 18 mo) 2 skin grade 1 late toxicities has been observed. Seventeen of 27 symptomatic patients showed an improvement or resolution of baseline symptoms (overall palliative response rate: 63.0%; 95% confidence interval, 36.6%-82.4%).Two-month overall survival was 86% (median survival time=7 mo). CONCLUSIONS: Short-course accelerated whole brain radiotherapy of 18 Gy in twice daily fractions for 2 consecutive days is tolerated and effective in terms of symptom relief and median survival time. These results justify a phase III comparison against the standard-of-care in this patient population (30 Gy in 10 fractions).


Subject(s)
Brain Neoplasms/radiotherapy , Carcinoma/radiotherapy , Neoplasms/pathology , Radiotherapy/methods , Aged , Aged, 80 and over , Brain Neoplasms/secondary , Carcinoma/secondary , Disease-Free Survival , Dose Fractionation, Radiation , Female , Humans , Male , Middle Aged , Radiation Injuries/etiology , Radiodermatitis/etiology , Radiotherapy/adverse effects , Treatment Outcome
2.
Int J Hematol ; 90(1): 81-86, 2009 Jul.
Article in English | MEDLINE | ID: mdl-19529980

ABSTRACT

Autologous stem cell transplantation is considered the best post-induction therapy for multiple myeloma (MM). Therefore, therapy for myeloma should be chosen not only on the basis of efficacy, but also taking into account their impact on the hematopoietic stem cell compartment. We describe the case of a MM patient in which a successful mobilization of peripheral stem cells was obtained with bortezomib, cyclophosphamide and G-CSF, after two failed attempts in the framework of Total Therapy 2. The patient underwent an autologous transplantation, showing a rapid and complete post-transplant hematological recovery. Our experience suggests that bortezomib is an effective anti-myeloma agent without negative impact on stem cell mobilization, even in patients with a previous history of failed harvest.


Subject(s)
Antineoplastic Agents, Alkylating/administration & dosage , Boronic Acids/administration & dosage , Cyclophosphamide/administration & dosage , Granulocyte Colony-Stimulating Factor/administration & dosage , Hematopoietic Stem Cell Mobilization , Immunoglobulin Light Chains , Multiple Myeloma/therapy , Peripheral Blood Stem Cell Transplantation , Pyrazines/administration & dosage , Adult , Bortezomib , Humans , Male , Transplantation, Autologous
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