Tumor response and patient outcome after preoperative radiotherapy in locally advanced non-inflammatory breast cancer patients.

PURPOSE: The purpose of this analysis was to assess the tumor response and long-term outcome in patients treated with preoperative radiotherapy (PRT) without systemic therapy. METHODS: Between 1997 and 2000, 134 patients with non-inflammatory locally advanced breast cancer (LABC) were treated with PRT. The tumor dose was 45 Gy in 15 fractions to the breast and to regional lymph nodes over 6 weeks. Radical mastectomy was performed 6 weeks after PRT to all patients and adjuvant systemic therapy was administered as per protocol. The measures of disease outcome were overall survival (OS) and disease-free survival (DFS) which estimated using the Kaplan-Meier method. RESULTS: Median follow-up was 74 months (range 4-216). Objective clinical tumor response after PRT was observed in 77.6% of the patients. Clinical complete tumor response (cCR) was achieved in 21.6% of the patients. Pathological CR in the breast was achieved in 15% of the patients. The 5- and 10-year OS were 55.1 and 37.8%, respectively. The 5- and 10-year DFS were 39.2 and 27%, respectively. Patients who achieved cCR had significantly longer OS in comparison with patients achieving clinical partial response (cPR) and clinical stable disease (cSD). Similarly, DFS of patients in the cCR group was longer compared with patients with cPR and cSD, yet without statistical significance. CONCLUSIONS: Our results showed that local control in LABC patients achieved by primary PRT, followed by radical mastectomy was comparable with the results reported in the literature. Complete pathologic response to PRT identified a subgroup of patients with a trend toward better DFS and OS.

Preoperative radiotherapy with capecitabine and mitomycin C in locally advanced rectal carcinoma.

PURPOSE: To evaluate the efficacy and safety of preoperative radiotherapy with capecitabine and mitomycin C in patients with locally advanced rectal cancer. METHODS: A prospective, open-label, non-randomized, phase II study was performed on 49 patients with locally advanced rectal cancer. Preoperative radiotherapy was conducted on linear accelerators (15 or 18 MV) with a tumor dose of 45 Gy in 25 fractions over 5 weeks, combined with mitomycin C 7 mg/m(2) on days 1 and 29 and oral capecitabine 825 mg/m(2) twice daily on days 1-35. Surgery was performed 5-6 weeks after the end of chemoradiation. The primary study endpoint was histopathological complete regression rate (pCR; Dworak grade 4). RESULTS: Disease stage at diagnosis was T3 in 34 patients (69%) and T4 in 15 patients (31%). Positive lymph nodes were diagnosed in 28 patients (57%). Toxicity (all grades) was documented in 35 patients (71%). Grade 3 toxicities were radiation dermatitis (25%), diarrhea (2%), neutropenia (2%), and granulocytopenia (2%). No patient experienced grade 4 toxicity. A pCR was seen in 8 (16%, 95% CI 9-29%) patients, a major response was noted in 24 (49%) patients and a minor response in 14 (29%) patients. R0 resection was performed in 46 patients (93.9%) and R1 in 3 patients (6.1%). Histopathological tumor downstaging was documented in 26 patients (53%). One-year disease-free survival was 93.3% and 1-year survival was 97.7%. CONCLUSION: Preoperative chemoradiation with capecitabine and mitomycin C appeared to be effective with low toxicity in patients with locally advanced rectal cancer.

Resources and management strategies for the use of radiotherapy in the treatment of lung cancer in Central and Eastern European countries: results of an International Atomic Energy Agency (IAEA) survey.

PURPOSE: To assess resources and management strategies for the use of radiotherapy (RT) in the treatment of lung cancer in developing Central and Eastern European countries. MATERIALS/METHODS: Questionnaires on patterns of care of NSCLC and SCLC were sent to radiation oncologists of Central and Eastern Europe. Comparisons were made between two groups of countries-ex-USSR states and other Eastern and Central European countries. RESULTS: Twenty-four out of twenty-eight surveyed countries responded. There were significant differences in access to modern treatment facilities (3D planning systems, number of linear accelerators), percentage of patients with lung cancer receiving radiotherapy, schedules of palliative RT, use of postoperative RT for early stages between both analysed groups of countries. 3D systems were in use in 25% of centres for an entire treatment, in 28% for a part of the treatment, and in 47% curative RT was 2D planned. Sequential chemo-RT was the most common approach to radical management of NSCLC, followed by RT alone and concomitant chemo-RT; median percentages of patients receiving respective treatments per centre were 57%, 30%, and 10%. For SCLC, the concurrent approach was declared by 56%, and the sequential approach by 42% of responders. CONCLUSIONS: Patterns of care of lung cancer in the analysed countries differed in some part from existing, evidence-based data on lung cancer. In particular, this difference was observed between ex-USSR countries and the rest of European developing countries in the equipment available and specific diagnostic and treatment parameters in radiotherapy of lung cancer, the latter group's practices more resembling those of developed European countries.