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Results for “Combined Modality Therapy”

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PubMed1986

Combined modality therapy for adults with small noncleaved cell lymphoma (Burkitt's and non-Burkitt's types).

Between June 1979 and June 1984 18 adult patients with small noncleaved cell lymphoma (SNCL) (diffuse undifferentiated lymphoma, Burkitt's and non-Burkitt's types of the Rappaport classification) were treated with high-dose cyclophosphamide, doxorubicin, vincristine, prednisone, midcycle high-dose methotrexate, and intrathecal methotrexate. Early in the course of treatment, hyperfractionated radiotherapy (125 cGy, every two days, for 1,500 to 2,250 centigray [cGy]) was administered to unresected masses greater than 10 cm in their greatest dimension. Chemotherapy was administered every 21 days for six to ten cycles. Treatment was generally well tolerated; however, one patient died of probable tumor lysis syndrome. With a median follow-up of 1.2 years, actuarial survival was 66.8% and relapse-free survival (RFS) was 71.3% for the entire group. All treatment failures and deaths occurred in patients with stage D disease. RFS projected at 2 years was 100% for stages A and AR and 60.6% for stage B, C, and D (P = .13 Gehan). Two-year RFS for patients with stage A, AR, B, or C disease was 100 v 41% for those with stage D disease. Patients with adverse prognostic features (n = 7)--unresected bulk measuring greater than 10 cm, pretreatment serum lactate dehydrogenase (LDH) 500 IU/L (normal, 200) or involvement of CNS or bone marrow--had a projected RFS of 28.6% compared with 100% for those patients without these features (P = .002 Gehan). Too few patients received induction radiotherapy to assert its role in therapy. By using aggressive multiagent therapy, cure can be expected in a high percentage of adults with SNCL. In the subset with adverse prognostic features, more effective therapy is necessary.

Abdominal Neoplasms↗

PubMed1997

Combined modality therapy for stage II and stage III pancreatic carcinoma.

PURPOSE: To study the outcome achieved with three-drug chemotherapy and split-course external-beam radiotherapy as a treatment for unresectable stage II and III pancreatic carcinoma. PATIENTS AND METHODS: Radiotherapy was given in three cycles of 2 Gy/d on days 1 to 5 and 8 to 12 (total dose, 54 Gy) concurrently with fluorouracil (FU) 1,000 mg/m2/d by continuous infusion for 4.5 days, streptozocin (STZ) 300 mg/m2 on days 1, 2, and 3 and cisplatin (P) 100 mg/m2 on day 3 of each every-28-day cycle. Subsequent treatment consisted of leucovorin (LV) 200 mg/m2 and FU 600 to 1,000 mg/m2 every 14 days. RESULTS: The median survival time for the 35 patients was 15 months and 26% of patients were alive at 24 months. Fifteen patients (42.8%) had objective responses to therapy. Six (17%) had a complete response (CR). Three of nine patients with partial responses (PRs) achieved a radiographic CR within the next 3 months. Nine patients underwent attempts at surgical resection: five were resected (median survival time, 31 months; range, 12.8 to 44.7+), two had no residual disease found at complete resection, and three others also had a complete resection. Of four others who could not be resected, three underwent intraoperative radiotherapy and one had occult metastatic disease. Of primary tumors, 91% did not produce either back pain or local gastrointestinal complications for 2 years. The rates of severe side effects were stomatitis 15%, anemia 14%, granulocytopenia 6%, and thrombocytopenia 6%. CONCLUSION: Palliation and survival compare favorably with other series, including many surgical series. The response findings encourage studies of both unresectable and (as neoadjuvant therapy) resectable tumors.

Adenocarcinoma↗

PubMed1999

[Combined modality therapy for malignant lymphoma of the primary central nervous system: a preliminary report of a new chemotherapeutic regimen with "PEACE"].

Between 1994 and 1998, a total of 5 patients with primary central nervous system malignant lymphoma (PCNSML) were enrolled in this study. There were one man and four women, with a median age of 53 years. These patients were treated with a new systemic chemotherapeutic regimen "PEACE" therapy. After undergoing surgery (biopsy or resection), the patients received radiotherapy followed by adjuvant chemotherapy with combination of procarbazine (P) (100 mg/day, p.o., day 1 to day 5), cyclophosphamide (E) (200 mg/sqm/day, day 4), doxorubicin hydrochloride (A) (20 mg/sqm/day, day 4 and day 5), carboplatin (C) (300 mg/sqm/day, day 1), and etoposide (E) (30 mg/sqm/day, day 1 to day 3). This regimen was repeated for at least three cycles every 4 to 6 weeks. Intrathecal injection of methotrexate was also administrated in conjunction with systemic chemotherapy except in one case. Complete response was seen in one, and partial response in four patients. Toxicity was tolerable. Median survival time was 31.5 months. The results suggest the efficacy of this chemotherapeutic regimen and further emphasize a role for adjuvant chemotherapy in the initial treatment of PCNSML.

Adult↗

PubMed1995

Combined-modality therapy for advanced non-small cell lung cancer: paclitaxel and thoracic irradiation.

Despite advances in the modalities used to treat non-small cell lung cancer (NSCLC), the frequency of locoregional and distant relapses necessitates further enhancement of the therapeutic program. Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) has demonstrated clinical efficacy against NSCLC and in vitro studies support its role as a radiation potentiator at concentrations achievable in vivo. Thus, a phase I study of weekly paclitaxel and daily concurrent thoracic radiation was conducted in patients with advanced NSCLC to determine (1) the maximum tolerated dose of paclitaxel administered on an outpatient basis for 6 consecutive weeks with daily radiation and (2) the toxicities of the paclitaxel/radiation combination. Paclitaxel was administered as a 3-hour infusion, repeated weekly for 6 weeks with the usual premedication regimen for hypersensitivity prophylaxis. The starting dose of paclitaxel was 10 mg/m2/wk, which was increased by 10 mg/m2 in successive cohorts of three new patients, as tolerated. Radiation therapy was delivered as 40 Gy in 20 fractions to the original volume with a boost of 20 Gy in 10 fractions to the primary tumor. Doses were escalated from 10 to 70 mg/m2/wk. Of the 23 patients evaluable for response, one had stage II NSCLC, four had stage IIIA, 17 had stage IIIB, and one had stage IV. Severe esophagitis (grade 4) occurred in two of the three patients treated at 70 mg/m2 and was dose limiting. One patient discontinued therapy due to hypersensitivity, two developed grade 3 neutropenia, and one developed radiation pneumonitis. With a median follow-up of 7 months, 15 of the 23 patients remain alive. Four had a complete response and 13 had a partial response, for an overall response rate of 74% (95% confidence interval, 52% to 90%). The schedule of weekly paclitaxel and daily thoracic radiation appears active in NSCLC and can be delivered safely in the outpatient setting. The principal dose-limiting toxicity is esophagitis, and the maximum tolerated dose of paclitaxel for this schedule is 60 mg/m2/wk. A phase II trial of weekly paclitaxel 60 mg/m2 and radiation has been initiated in patients with NSCLC.

Ambulatory Care↗

PubMed1983

Myelopathy with severe structural derangement associated with combined modality therapy.

Myelopathy is a known complication of radiation therapy, but its association with chemotherapy has been less well documented. The authors report the case of a 12-year-old boy with medulloblastoma who had been followed for an 8 1/2-year period. In the context of accepted doses of intrathecal methotrexate and spinal irradiation, he developed an extensive myelopathy. At postmortem he was found to have profound fibrosis of the leptomeninges and necrosis with structural derangement of the spinal cord. It is speculated that these findings are secondary to a combination of radiation acting in synergism with methotrexate. The pertinent literature relating to myelopathy associated with radiation and chemotherapy is reviewed.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2003

Combined modality therapy for pancreatic cancer.

In spite of the high mortality in pancreatic cancer, significant progress is being made. This review discusses multimodality therapy for patients with pancreatic cancer. According to several phase II trials and Gastrointestinal Tumor Study Group results, improvements in locoregional control and survival may be achieved when chemotherapy is added to radiation for locally advanced pancreatic cancer. Radiosensitizing chemotherapy agents such as 5-fluorouracil, gemcitabine, paclitaxel, and cisplatin have shown promise. Selected patients with locally advanced disease have been downstaged with chemoradiation, facilitating surgical resection. For patients with resectable disease, the completion of Radiation Therapy Oncology Group study 97-04 represents a major achievement and brings gemcitabine into the forefront of adjuvant therapy. Neoadjuvant chemoradiation may eliminate the delay of initiating adjuvant treatment and spare unnecessary surgery for patients with rapid systemic progression. Molecular agents are being combined with chemoradiation in an attempt to delay or prevent systemic progression.

Antineoplastic Agents↗

PubMed1991

[Immunoactive drugs in the combined modality therapy of patients with hypothyroidism].

Comparative studies into the clinico-immunologic status of patient with primary hypothyrosis have shown that the multimodality treatment including differentiated administration of immunoactive agents (glucocorticoids, splenin) promoted more well-defined normalization of cellular, humoral immunity and nonspecific defence as well as reduction or disappearance of the clinical disease manifestations as compared to patients who did not receive those drugs as part of the multimodality therapy. The use of glucocorticoids and splenin may be recommended as part of the multimodality treatment of patients suffering from primary hypothyrosis marked by pronounced disorders in the immune system.

Adjuvants, Immunologic↗

PubMed2004

Phase I trial of combined-modality therapy for localized esophageal cancer: escalating doses of continuous-infusion paclitaxel with cisplatin and concurrent radiation therapy.

PURPOSE: To define the maximum-tolerated dose (MTD) of paclitaxel when given as a weekly 96-hour infusion with cisplatin and radiotherapy for patients with esophageal cancer. PATIENTS AND METHODS: Thirty-four patients with locally advanced esophageal cancer and three patients with local recurrence or positive resection margins were treated. Weekly paclitaxel doses of 10, 20, 30, 40, 60, and 80 mg/m(2), given as a continuous 96-hour infusion, were administered with weekly cisplatin, 30 mg/m(2) on day 1, weeks 1 to 6, and concurrent radiation (50.4 Gy). Plasma paclitaxel steady-state levels were measured. RESULTS: Dose-limiting toxicity, defined as a treatment break longer than 2 weeks for toxicity, occurred in one patient in the 80-mg/m(2)/wk dose level. Major causes for any (including < or = 2 weeks) treatment breaks were mediport complications and neutropenic fever, which occurred mostly at that dose level. At a paclitaxel dose of 60 mg/m(2)/wk, myelosuppression, mostly neutropenia, was relatively mild and transient; stomatitis, esophagitis, diarrhea. and peripheral neuropathy were uncommon and usually of grade 2 or less. Therefore, the MTD was established at 60 mg/m(2)/wk. The mean steady-state concentration of paclitaxel at the MTD was 17.2 nmol/L. Complete (R0) resection was possible in 16 (73%) of 22 patients who underwent subsequent surgery, and the pathologic complete response rate was 24%. CONCLUSION: Weekly, 96-hour infusion of paclitaxel 60 mg/m(2)/wk, given with concurrent cisplatin and radiotherapy, is a safe and tolerable regimen for patients with localized esophageal cancer. Preliminary efficacy data are encouraging. This regimen is the basis of ongoing Radiation Therapy Oncology Group phase II randomized trials in esophageal and gastric cancers.

Adult↗

PubMedDate not supplied

Successful treatment of a cardiac angiosarcoma with combined modality therapy.

The patient was a 34-year-old man with a primary angiosarcoma of the heart. Initial admission was for cardiac tamponade. He was treated with preoperative chemotherapy and radiation therapy and then underwent orthotopic heart transplantation. The patient had an uneventful postoperative recovery, received two postoperative regimens of chemotherapy, and, at 33 months after transplantation, had no evidence of recurrence or metastasis. We propose that a more aggressive management of these patients with difficult conditions is warranted.

Adult↗

PubMed1985

Cancer of the anal canal. Model for preoperative adjuvant combined modality therapy.

An analysis of preoperative multimodality adjuvant therapy with 5-fluorouracil, mitomycin-C, and radiation therapy revealed that 38 of 45 patients (84 percent) treated were rendered free of cancer after chemotherapy/radiation therapy. No recurrence of tumor has been noted in those patients rendered free of disease by the preoperative treatment. Seven patients (15 percent) with residual macroscopic or microscopic cancer after preoperative therapy have had recurrence, all in distant sites. These seven patients have died from the disease. The prognosis for patients in this series depended on the success of the preoperative therapy in eradicating all tumor prior to surgery. Mitomycin-C and 5-fluorouracil are cytotoxic for local disease and for microscopic distant disease as well. Abdomino-perineal resection is unnecessary for patients whose primary tumor is eradicated by the preoperative therapy. The role of the relatively low dose of radiation therapy needs to be further defined.

Adult↗

PubMed1996

Infradiaphragmatic Hodgkin's disease: long term results of combined modality therapy.

Hodgkin's disease (HD) confined below the diaphragm accounts for less than 5% of all patients with HD. Although the major characteristics of this presentation appear established, optimal modalities of treatment still remain difficult to define. From April 1972 to October 1988, 28 patients with newly diagnosed infra-diaphragmatic HD, clinical stages I or II have been treated with 3 successive prospective protocols combining initial chemotherapy and radiotherapy (40 gy). This series of patients accounted for 4,3% of patients with HD limited to clinical stages (CS) I and II. Overall survival and freedom from relapse at 15 years were 74,4% and 73% respectively, without significant differences between clinical stages I and II, presence or absence of B symptoms or histologic subtype. There is only a trend (p < 0,10) in favour of patients younger than 40 years. In all 7 clinically staged IA patients no relapses were seen and combined treatment does not appear to be better than inverted Y irradiation alone. On the other hand initial chemotherapy seems necessary in patients with CS II A and B since 15 of our 21 patients are alive in first CR whereas the crude rate of transdiaphragmatic nodal relapses may reach up to 53% following radiotherapy alone.

Adolescent↗

PubMed1984

Aggressive combined modality therapy for advanced local-regional breast carcinoma.

Thirty-two women with advanced local regional breast carcinoma, including nine patients with histologically diagnosed inflammatory cancer, were entered on a prospective pilot study. They were treated aggressively with initial surgery, two courses of induction chemotherapy with cyclophosphamide, methotrexate, 5-fluorouracil, +/- prednisone, +/- tamoxifen (CMF [P] [T]), local-regional radiotherapy, and then maintenance chemotherapy with CMF(P) (T) alternating with doxorubicin, vincristine, +/- tamoxifen (AV[T]). The patients have been followed for 19-70 months from the time of mastectomy and their actuarial three-year survival is 65% with a median survival that has not yet been reached. Median disease-free survival (time to progression) is currently 29.5 months. Women whose gross disease could not be totally resected surgically had shorter disease-free survivals than those rendered surgically free of disease (p = 0.01). Clinically evident cardiotoxicity was seen in 25% of the patients and was felt to be primarily due to the combination of doxorubicin and radiation therapy. It was significantly more common (Plt less than 0.05) in patients with left chest irradiation (seven of 18 women) as opposed to those with right-sided irradiation (one of 14).

Adult↗

PubMed1999

Adjuvant postoperative combined-modality therapy for rectal cancer.

A number of advances have been made in the use of adjuvant chemotherapy for resectable rectal cancer. Whereas pelvic radiation therapy has been shown to increase local control in patients with clinically resectable disease, systemic chemotherapy is needed in addition to further improve local control and overall survival. In this review, the experience treating patients with clinically resectable rectal cancer in the postoperative adjuvant setting will be examined. Data from ongoing and recently completed randomized trials as well as the design of innovative phase I/II programs will be discussed.

Aged↗

PubMed2004

Oncologic outcomes of salvage surgery for epidermoid carcinoma of the anus initially managed with combined modality therapy.

PURPOSE: Primary chemoradiation failure for epidermoid carcinoma of the anus is treated by surgical resection. This study evaluates the outcome of salvage surgery at one institution. METHODS: All patients (n = 177) with a diagnosis of epidermoid carcinoma of the anus undergoing surgery since 1980 were reviewed. After criteria-based exclusion (n = 115), the remaining patients (n = 62) were analyzed. Kaplan-Meier survival analysis was performed on abdominoperineal resection/low anterior resection patients. Variable comparisons were made using log-rank and Cox regression analyses. Inguinal lymph node dissection patients (n = 5) were analyzed separately. RESULTS: Median follow-up was 24.2 months. Actuarial five-year survival in all abdominoperineal resection/low anterior resection patients (n = 57) was 33 percent (median, 34.1 months). Univariate predictors of decreased survival were tumor size > 5 cm or adjacent organ involvement at salvage, positive nodal disease at salvage, and positive margins. Independent predictors of decreased survival were the same except for tumor size or adjacent organ involvement at salvage (not significant). Patients undergoing potentially curative resections (n = 47) had an actuarial five-year survival of 40 percent (median, 49 months). The univariate and multivariate predictors of both decreased survival and recurrence in this subgroup included: disease persistence after chemoradiation and nodal disease at salvage. Tumor size > 5 cm or adjacent organ involvement at salvage predicted recurrence with only univariate analysis. Interestingly, actuarial five-year survival after potentially curative resection for recurrence after chemoradiation was 51 percent (as opposed to 31 percent for persistence). After potentially curative resections, most documented recurrences (79 percent) occurred within two years and were locoregional (74 percent). Actuarial five-year recurrence-free survival was 46 percent. Three of five inguinal lymph node dissection patients were alive without disease at 21.2, 81.7, and 84.3 months. CONCLUSIONS: Salvage surgery after failed chemoradiation therapy has a reasonable chance of cure. Favorable independent prognostic factors include recurrence ( vs. persistence) after chemoradiation (when salvage is potentially curative), absence of nodal disease at salvage, and negative margins. Salvage inguinal lymph node dissection after failed chemoradiation therapy also is potentially curative.

Adult↗

PubMed1991

[Possibilities of using the biofeedback method in the combined modality therapy of patients with bronchial asthma].

The efficacy of biological feedback was studied in multimodality treatment of patients suffering from bronchial asthma. Use was made of a device modified by the authors themselves. In that device, the system of the patient's respiration control was synchronized with the block of diaphragmatic pacing. The method was shown to be highly effective. The clinical status of the patients improved. The changes in the capnographic parameters attest to a decrease of hyperventilation in patients suffering from bronchial asthma.

Adolescent↗

PubMed2002

Hodgkin's lymphoma in first relapse following chemotherapy or combined modality therapy: analysis of outcome and prognostic factors after conventional salvage therapy.

OBJECTIVES: To investigate the prognosis of patients with Hodgkin's lymphoma (HL) who relapse following a complete remission (CR) achieved by chemotherapy with or without radiotherapy (CT+/-RT), and to identify prognostic factors for freedom from second progression (FF2P). METHODS: We analyzed the prognostic significance of the initial CT regimen (4 vs. 7-8 drugs), treatment-free interval (TFI), and demographic, clinical, and laboratory factors at the time of relapse and diagnosis, in 113 patients with HL, who relapsed after a CR achieved by CT+/-RT. RESULTS: Conventional salvage CT+/-RT was administered in 107 patients, while six received RT only. The 5-yr FF2P was 24%, while the 10-yr survival after relapse (O2S) was 39% and was not afffected by the initial CT regimen. Multivariate analysis revealed that extranodal disease at relapse (P<0.001), TFI<6 month (P<0.001), > or =5 involved sites at diagnosis (P=0.04) and anemia at relapse (P=0.03) were independent predictors of FF2P. 55% of patients had 0 or 1 of these adverse prognostic factors. The 5-yr FF2P of patients with 0, 1 or 2 adverse factors was 58%, 34% and 5% (P<0.0001). The corresponding rates for 10-yr O2S were 68%, 51% and 25%, respectively (P=0.002). CONCLUSIONS: Our data confirmed the significance of TFI and extranodal relapse and demonstrated a potential role for anemia at relapse and number of involved sites at diagnosis, for the prognosis of patients with HL relapsing after CT+/-RT. The combination of these prognostic factors defines a sizeable subgroup of patients with favorable outcome following conventional salvage therapy.

Adolescent↗

PubMed1994

The promise of biochemical modulation in combined modality therapy.

This paper reviews evidence that interferon (IFN) potentiates the cytotoxicity of radiotherapy or chemotherapy. The results of preclinical models suggest that the radiation-enhancing effect may be due in part to cell-cycle synchronization. Clinical studies of small numbers of patients indicate that IFN may enhance the effect of radiotherapy in localized tumors, such as non-small cell lung cancer and head and neck cancer. Interferon augmented the cytotoxicity of cisplatin in a murine model, but two clinical studies of patients with non-small cell lung cancer had mixed results. Interferon clearly enhances the activity of 5-fluorouracil (5-FU) in a variety of laboratory models. Three studies are under way to evaluate the combined effects of IFN, cisplatin, and 5-FU in patients with head and neck cancer. Investigators at the University of Chicago are obtaining promising results with IFN and chemotherapy in patients with previously untreated stage IV head and neck cancer. The regimen consists of three cycles of induction cisplatin, 5-FU, high-dose leucovorin, and IFN followed by surgery and/or seven cycles of concomitant chemoradiotherapy. Although toxicity was formidable, 51% of 65 evaluable patients achieved complete responses to the chemotherapy. Another combination that holds promise is IFN and 13-cis-retinoic acid. This combination has shown activity in selected solid tumors. The results of available studies indicate that biochemical modulation is feasible and promising. Randomized clinical trials are needed to confirm the role of IFN as a biochemical modulator.

Animals↗

PubMed1998

Survival with combined modality therapy after intracerebral recurrence of pleuropulmonary blastoma.

BACKGROUND: We present and discuss the successful treatment of pleuropulmonary blastoma metastatic to the brain using a multimodality regimen with surgery, high-dose chemotherapy and radiation therapy. PROCEDURE: A 3-year-old boy referred to our institution with bilateral pulmonary cysts was diagnosed with pleuropulmonary blastoma (PPB). Initial treatment included surgery and multiagent chemotherapy with vincristine, dactinomycin, cyclophosphamide, cisplatin, and doxorubicin. One year after the completion of therapy, his PPB recurred as an intracerebral metastasis, and required further treatment with a multimodality salvage regimen. The child was successfully treated with a subtotal surgical resection, followed by high-dose cyclophosphamide, and radiation therapy. He is now disease-free 24 months later. RESULTS: Intracerebral metastases of PPB have been a uniformly fatal complication of this tumor. Postsurgical chemotherapy and radiation therapy appear to have contributed to the prolonged survival and potential for cure in our patient. CONCLUSIONS: The use of this multimodality regimen may be warranted in other patients with recurrent PPB metastatic to the brain.

Brain Neoplasms↗