Biomedical subjects

N Coachman

Publications and source records attributed to N Coachman.

3 recordsLinked to original sources

PubMed1997

Low acute gastrointestinal and genitourinary toxicities in whole pelvic irradiation of prostate cancer.

PURPOSE: This retrospective study was done to determine the frequency and severity of acute gastrointestinal (GI) and genitourinary (GU) toxicity associated with whole pelvic radiotherapy of localized prostate cancer. METHODS AND MATERIALS: Between 1989 and 1994, we treated 156 patients with localized prostate cancer, ranging in age from 54 to 86 (median 71), of which 86 were older than 70 years of age. No attempt at selection was made, and many were from the Veteran's Administration Hospital where they had been precluded from their surgical program because of comorbidities and/or advanced age. Of 156 patients, 45 (28.8%) underwent pretreatment laparoscopic lymphadenectomy (LAP); 40 had negative findings. Four-field box technique was used for all patients. We treated the whole pelvis to 45 Gy, followed by a cone-down and a final boost to a total dose of 72 Gy. The cone-down to the lower pelvis and boost to the prostate were based on computed tomography and/or magnetic resonance imaging findings for volume reconstruction with field size of approximately 8 x 8 and 6 x 6 cm, respectively. Diet instructions were given before treatment and emphasized weekly. Toxicities were evaluated weekly by physicians and nurses independently using Cancer and Leukemia Group B (CALGB) grading criteria. RESULTS: The acute GI and GU toxicities gradually increased from Week 2, peaked at Week 5, and then declined after that. During Week 5, acute Grade 1-3 GI morbidities were observed in 19 (12.2%), 2 (1.3%), and 1 (0.6%) patients, respectively. Genitourinary toxicity was similar, accounting for 17 (10.9%), 6 (3.8%), and 1 (0.6%), respectively. Overall Grade 2 toxicities occurred in 30 of 156 patients (19%). Comorbidity was associated with more GI toxicity. Patients over 70 years of age tended to reach the maximal GI and GU toxicity 1-2 weeks earlier than did patients under the age of 70. Of the patients who did not follow the diet instruction, all experienced side effects. CONCLUSIONS: Whole pelvic irradiation was very well tolerated in this group of patients. The frequency of acute Grade 2 GI and GU toxicity compared favorably with the reported results of conformal treatment. Diet restriction and psychosocial input may have had a positive impact. Late sequelae will be evaluated in long-term follow-up.

Acute Disease↗

PubMed1997

Recurrence patterns with concurrent platinum-based chemotherapy and accelerated hyperfractionated radiotherapy in stage III and IV head and neck cancer patients.

BACKGROUND: Stage III and IV squamous cell cancers of the head and neck are often unresectable at presentation and are associated with poor disease-free and overall survival rates. A phase II study using concurrent cisplatin and radiotherapy in advanced head and neck cancer indicated impressive local-regional control and survival with organ preservation. METHODS: A multicentered phase II study was undertaken consisting of 1.8 Gy fraction radiotherapy for 2 weeks followed by 1.2 Gy BID hyperfractionation to 46.8 Gy. Continuous infusion cisplatin 20 mg/m2 was given on days 1 through 4 and 22 through 25. Biopsy of the primary tumor was done at this point, and patients with clinical and pathologic complete response continued with hyperfractionated radiotherapy to 75.6 Gy plus simultaneous carboplatin 25 mg/m2 BID for 12 consecutive days. Residual disease at 46.8 Gy required curative surgery. RESULTS: Seventy-four patients entered the study, and 73 completed their treatment. Twenty were stage III and 54 were stage IV. Fifty patients had involved regional lymph nodes. Treatment was well tolerated with only one grade IV hematologic toxicity. At 46.8 Gy, biopsy revealed a complete response in 75% of the primary sites and 47% of the nodes. Only 12 patients required resection of the primary lesion. At 4 years (median follow-up is 26 months), 29 patients have recurred. CONCLUSIONS: Accelerated hyperfractionated radiotherapy with concurrent chemotherapy in stage III and IV head and neck cancer yields excellent local-regional control with organ preservation. This protocol is intensive, and some patients have distant failures.

Antineoplastic Agents↗

PubMed1994

Concurrent cis-platinum and radiation with or without surgery for advanced head and neck cancer.

PURPOSE: This study was undertaken to assess the efficacy of concurrent cis-platinum and radiation in patients with advanced head and neck cancer and to determine if patients responding to the preoperative regimens may be cured without radical surgery. METHODS AND MATERIALS: One hundred and one patients with potentially operable Stage III and IV squamous cell carcinoma of the head and neck received 45 Gy at 1.8 Gy fractions and continuous infusion cis-platinum 20 mg/m2 over 24 h on days 1 through 4 and 22 through 25 of the radiation schedule. Three to 4 weeks later, radical surgery of the primary site and neck dissections for patients presenting with cervical adenopathy was undertaken or if a complete response had been achieved, continued with radiation to 72 Gy with another course of concurrent continuous infusion cis-platinum. RESULT: Complete and partial responses were achieved in 92% of the primary sites and 95% of the nodes. Over 80% of the patients were rendered tumor free at surgery after only the initial course of chemotherapy and radiation. There were no grade 3 or 4 toxicities from chemotherapy and radiation. Ninety-five percent of the patients who initiated treatment completed it. With a median follow-up of 41 months for all patients, 49% of the patients have survived disease free up to 9 years, independent of whether or not their primary tumors were resected or were treated definitively by further chemotherapy sensitized radiation. The disease-specific survival is 78% after 3 years with no local failures thereafter. CONCLUSION: These findings suggest that continuous infusion cis-platinum administered concurrently with radiotherapy can improve survival in advanced head and neck cancer. Patients responding to the preoperative regimen may be cured without radical surgery, which can be reserved for salvage.

Actuarial Analysis↗