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Results for “Combined Modality Therapy”

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At least 343 records · Page 19Linked to original sources

PubMed1988

Responses of tumor cell subpopulations to single modality and combined modality therapies.

By centrifugal elutriation, viable cell subpopulations were isolated directly from KHT sarcomas treated with 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea, mitomycin (MIT C), cyclophosphamide (CTX), or radiation. Survival in these subpopulations was determined by a clonogenic cell survival assay either immediately (radiation) or 24 hours after treatment with drugs. Following irradiation, late S and G2/M cells were found to be sensitive, but G1 cells were preferentially spared. For all chemotherapeutic agents evaluated, survival of cells at the G1/S boundary 24 hours after drug exposure was at a nadir, whereas cells in the late S and G2/M at this time were always drug resistant. The response of cells in early G1 24 hours after drug treatment ranged from sensitive (MIT C) to resistant (CTX). Because of these results, the combination of MIT C and radiation was investigated in detail. When MIT C was administered 24 hours before tumor irradiation, the chemotherapeutic agent significantly reduced the radiation-resistant subpopulations, whereas the radiation treatment effectively killed cells spared by the chemotherapeutic agent. Isobologram analysis further indicated that this treatment combination led to "supra-additive" cell kill in the tumor.

Animals↗

PubMed1984

Combined modality therapy for first recurrence of breast cancer. A Southwest Oncology Group study.

The Southwest Oncology Group has completed a study of 213 women with the first recurrence of breast cancer. Eligibility included a radical or modified radical mastectomy for cure and recurrence which had received no other form of therapy. Patients were started on tamoxifen (TAM) 20 mg daily (Phase I). Failures, or responders who subsequently failed, had an oophorectomy if the ovaries were intact, and TAM was continued (Phase II). During Phase III, eligible patients underwent an adrenalectomy, and lastly, in Phase IV, patients received chemotherapy. Responses to TAM were seen in 40% of 56 premenopausal patients, 46% of 95 postmenopausal women, and 44% of 62 patients without intact ovaries. Oophorectomy plus TAM gave responses only in premenopausal women who failed to respond on TAM or in postmenopausal patients who had a prior response to TAM. Adrenalectomy was successful in 7 of 21 patients. Chemotherapy resulted in 13% complete and 47% partial responses. Median overall survival was 108, 155, and 115 weeks, respectively, for the three patient groups. The authors believe that until results with chemotherapy improve significantly, hormonal therapy is the preferred first-line management of recurrent breast cancer.

Adrenalectomy↗

PubMed1991

Combined modality therapy.

Encouraging results continue to emerge with the use of chemoradiotherapy. This review of the current literature demonstrates some of the advances that have been achieved in a variety of common malignancies with strategies based on well-defined rationales. Preliminary randomized trials now reveal a survival advantage for chemoradiotherapy in patients with inoperable non-small cell lung cancer and patients with rectal cancer at high risk for recurrence following resection. Other studies report that concurrent chemoradiotherapy may improve local control in patients with limited-stage, small cell lung cancer or esophageal malignancies. The additional toxicity of these approaches is discussed.

Combined Modality Therapy↗

PubMed1996

Primary penile lymphoma: the case for combined modality therapy.

A patient with non-Hodgkin's lymphoma with a penile mass as the only apparent site of clinical involvement is presented, and the literature reviewed. Our patient was treated initially with partial penile amputation. A year later the lymphoma recurred in the chest and the right tonsil. Further chemotherapy failed to salvage the patient, who died of disseminated lymphoma. We suggest that, for patients presenting with a lymphomatous penile mass as the initial manifestation of non-Hodgkin's lymphoma, chemotherapy with or without radiotherapy as the initial treatment. Surgery should be reserved only for failures.

Aged↗

PubMed1984

Differential effect of IP- and IV-injected nitrogen mustard on subsequently-irradiated intestinal crypts: implications for 'dose-effect factors' predicted by experimental, combined modality therapy.

In experimental chemotherapy-radiotherapy, cytotoxic drugs are almost invariably injected by the intraperitoneal (IP) route. This contrasts with normal clinical practice, which is to employ the intravenous (IV) route. We have used a clonogenic assay of gastrointestinal (GI) injury in mice to show that a given administered dose of nitrogen mustard (HN2), injected IP, results in a much greater reduction in the subsequent radiation dose required to achieve an isoeffect, than if the drug is injected IV. At an administered dose of 3.5 mg kg-1 of HN2 (the animal LD10/30 for IP injection), the radiation dose-reduction factor for 10% survival of intestinal crypts, was 1.94 for IP HN2 and only 1.28 for IV HN2. Even the grossly-equitoxic (mouse LD10/30) dose of IV HN2 resulted in a smaller predicted radiation dose reduction for GI injury, by a factor of 1.45. The validity of using the IP route in combined chemotherapy-radiotherapy studies designed to generate quantitative estimates of toxicity is discussed.

Animals↗

PubMedDate not supplied

Combined modality therapy in low risk (T2N0) rectal cancer.

The authors' experience with local excision (LE) and adjuvant radiotherapy in the treatment of selected cases of rectal cancer, is reported. 41 patients with distal rectal cancer underwent elective LE for cure. Selection criteria were: the site of tumor in the lower rectum, exophytic growth, maximum diameter equal to or lower than 4 cm, tumor "freely" mobile on the rectal wall, clinical staging T1-2 N0M0, histological grading G1-2. Patients shown to be T2 on definitive histology underwent adjuvant radiotherapy to the site of tumor and to pelvic lymph nodes. LE was performed via transanal route under general anesthesia. Operative mortality was 0% and morbidity 7.3%. In 37 cases (90%) surgery was considered radical and curative. The incidence of local recurrence was 5.4%, overall evidence of disease 8.1%, cancer-specific mortality 5.4% and 5-year actuarial survival 90%. The combination with radiotherapy has achieved similar results in T1 (22 cases) and T2 (15 cases) tumors. It is concluded that LE combined with radiotherapy in T2 tumors in selected cases represent a valid therapeutic alternative to more demolitive surgery.

Adenocarcinoma↗

PubMed2000

Functional and quality-of-life outcomes in patients with rectal cancer after combined modality therapy, intraoperative radiation therapy, and sphincter preservation.

PURPOSE: Locally advanced primary and recurrent rectal cancers treated with external beam radiation therapy, intraoperative radiation therapy, and chemotherapy represent a complex group of patients in the setting of extensive pelvic surgery and sphincter preservation. We sought to define functional outcome and quality of life in this subset of patients. METHODS: We retrospectively reviewed our experience with locally advanced primary and recurrent rectal cancer patients who underwent intraoperative radiation therapy with either low anterior resection (n = 12) or coloanal anastomosis (n = 6) between 1991 and 1998. Current functional outcome and quality of life were evaluated by a detailed questionnaire. RESULTS: Median time from operation to assessment was 24 (range, 6-93) months. Using a standardized Sphincter Function Scale, incorporating the number of bowel movements per day and degree of incontinence, patients were graded as poor, fair, good, or excellent function. Of all patients, 56 percent reported unfavorable (poor or fair) function. Of the subset of patients with coloanal anastomosis or very low low anterior resection, 88 percent had unfavorable function as compared with 30 percent with standard low anterior resection. (P = 0.02; Fisher's exact probability test). A quality-of-life satisfaction score based on social, professional, and recreational restrictions demonstrated 56 percent of patients to be dissatisfied with their bowel function. CONCLUSIONS: The majority of patients with advanced rectal cancers who require external beam radiation therapy, extensive pelvic surgery, and intraoperative radiation therapy report unfavorable functional and quality-of-life outcomes after sphincter preservation. In this setting patients being considered for coloanal anastomosis or very low anterior resection may be better served by permanent diversion.

Adult↗

PubMed1994

Cervical metastases of occult origin: the impact of combined modality therapy.

BACKGROUND: We have updated our experience with metastatic carcinoma to the neck of occult origin to assess whether increasing use of adjunctive radiation therapy has had a significant impact. METHODS: This retrospective review of 115 patients treated between 1977 and 1990 includes 73 (63%) with squamous cell carcinoma. These 73 patients were analyzed for survival, control of disease in the neck, and incidence of subsequent primary tumors. RESULTS: There has been no change in the proportion of patients with advanced neck disease (N2/N3 = 52; 71%) when compared to our last report. Surgery included comprehensive neck dissection in 59 (81%) and adjunctive radiotherapy was employed in 54 (83% of surgically treated patients). Primary carcinomas within the head and neck were identified subsequently in 9 (12%) patients, including 4 of 11 (36%) who did not have adjunctive radiotherapy and 5 of 54 (9%) who did (P = 0.038). Control of the treated neck (54/73; 74%) has improved significantly (P = 0.005) when compared to our earlier experience (37/74; 50%), and this was most apparent in those with extensive neck disease. However, cumulative survival at 5 years (45%) was not significantly different from that previously reported. CONCLUSION: Our data support the increased use of adjunctive radiation therapy for metastatic squamous cell carcinoma in the neck of occult origin. Control of neck disease has improved and the likelihood that a primary will be identified has been reduced, but there has been no improvement in survival when compared to historical controls.

Adult↗

PubMed1994

Has combined modality therapy improved the outlook in carcinoma of the esophagus?

Carcinoma of the esophagus or the gastroesophageal junction is uncommon, accounting for approximately 1% of all malignancies in the United States. Approximately 11,000 new cases and 10,400 deaths are estimated in 1994. The diagnosis is often made late in Western countries, thus T3, T4, and N-positive lesions are encountered frequently. Nearly 50% of patients have advanced incurable disease at the time of diagnosis. Therefore, the prognosis of patients with carcinoma of the esophagus remains poor and the overall 5-year survival rates are still under 10%. The answer to the question in the title is yes, at least for some patients, on a short-term basis.

Adenocarcinoma↗

PubMed1986

A 10-year experience with combined modality therapy for stage III small cell lung carcinoma.

During the past 10 years, 240 patients with Stage III small cell lung carcinoma (SCLC) were treated with one of five chemotherapy programs plus thoracic irradiation. In addition, prophylactic cranial irradiation was administered concurrently with thoracic irradiation to 194 patients receiving CAML-HC, VCAM, or MOCA. Seventy-two patients had disease confined to the chest (Stage IIIM0), 30 patients had disease in the chest plus ipsilateral supraclavicular nodal involvement (Stage IIIM0SCN+), and 138 patients had distant metastatic disease (Stage IIIM1); the median survivals were 15.2 months, 12.6 months, and 8.4 months, respectively. The overall complete response rate was 30% and the overall response rate (complete and partial) was 76%. The overall response rates by stage were 86% for Stage IIIM0, 90% for Stage IIIM0SCN+, and 67% for Stage IIIM1. Eight patients (3%) were alive and free of disease at 24 months. Due to continued disease relapse in this group (four of eight patients), long-term survivors should not be identified for a minimum of 3.5 years from the time of initial therapy. Prophylactic cranial irradiation (PCI) effectively reduced the incidence of central nervous system (CNS) relapse in patients with a complete response to therapy (44% relapse without PCI versus 13% relapse with PCI, P less than 0.01). More effective chemotherapy is required for the successful treatment and improved long-term survival of patients with SCLC.

Altretamine↗

PubMed1988

[Adjuvant chemotherapy in the combined modality therapy of nephroblastoma in children].

The paper discusses the end results of complex treatment of 31 children comprising preoperative therapy, nephrectomy and adjuvant chemotherapy. Two-year survival was 64.5% and two-year recurrence-free survival--48.4%. Adjuvant chemotherapy (vincristine, dactinomycin and adriamycin) was given to 25 cases. Complete treatment consisting of 4 courses of adjuvant chemotherapy was carried out in 12 patients only, tumor progression and toxic hepatitis being the most frequent causes of adjuvant treatment suspension. Survival was shown to depend on such prognostic factors as the efficacy of preoperative chemotherapy, stage and morphological pattern of tumor rather than adjuvant chemotherapy duration. Therefore, a short course of adjuvant chemotherapy may be recommended for localized nephroblastoma in pediatric patients.

Adolescent↗

PubMed1994

Combined-modality therapy in the treatment of primary central nervous system lymphoma in AIDS.

PURPOSE: Conventional therapy--ie, treatment with corticosteroids and cranial radiotherapy (RT)--is inadequate to treat AIDS-related primary central nervous system lymphoma (PCNSL), as it achieves a median survival of only 2 to 5 months. Chemotherapy added to RT in non-AIDS PCNSL improves disease control and prolongs survival. We studied the efficacy of this approach with RT in AIDS-related PCNSL. METHODS: Ten AIDS patients with PCNSL were treated with chemotherapy--nine at diagnosis and one at recurrence. None had evidence of systemic lymphoma. All patients treated at diagnosis received pre-RT methotrexate--eight also received thiotepa and procarbazine--followed by whole-brain RT. The patient treated at recurrence (who had been previously irradiated) received chemotherapy alone, including methotrexate, thiotepa, and procarbazine. RESULTS: All had enhancing lesions on MRI and five (50%) had a single lesion (seven [70%] had a ring-enhancing mass). No patient had a response to corticosteroids. Four of seven (57%) assessable patients had a partial or complete response to chemotherapy prior to RT. Six of seven (86%) assessable patients had a complete response at the end of treatment. Median survival was 3.5 months for all 10 patients and 7 months for the eight patients who completed therapy. Two patients survived for 1 year or longer. Eight patients died--six from infection (two treatment-related), one from progressive dementia, and one from a gastrointestinal hemorrhage. CONCLUSION: AIDS-related PCNSL responds to chemotherapy and RT, but only a few patients benefit with prolonged survival.

Adult↗

PubMed1984

Limb salvage in extremity soft-tissue sarcoma: combined modality therapy.

Thirty-two consecutive patients with high-grade soft-tissue sarcoma of an extremity were treated preoperatively with concomitant intra-arterial infusion of Adriamycin (doxorubicin) (10 mg/m2 daily for 10 days) and radiotherapy (2500 rad [25 Gy] in 10 fractions in 2 weeks). En bloc resection was then performed. Postoperatively, depending on the surgical specimen findings, radiotherapy was given to a dose ranging from 5000 rad (50 Gy) in 5 weeks to 6000 rad (60 Gy) in 6 weeks equivalent continuous schedules. No residual tumor was found in 28% of the surgical specimens and only minimal tumor in 41%. A functionally intact limb was preserved in 30 patients (94%). Local recurrence developed in one patient (3%). The actuarial overall survival at three years was 70% and disease-free survival 57%.

Adult↗

PubMed1983

Combined modality therapy for esophageal squamous cell carcinoma.

Of 55 patients with esophageal squamous cell carcinoma, 30 with localized disease were treated with a combined modality for curative intent. Treatment consisted of mitomycin C (10 mg/m2 day 1) and continuous infusion 5-FU (1000 mg/m2 day, days 1-4, 29-32) (CT), radiation (XRT) (3000 rad, days 1-21) with nutritional support, and surgery (days 49-64). Surgery consisted of celiotomy, esophagectomy and esophagogastrostomy +/- postoperative ventilatory support. Postoperative CT plus an additional 2000 rad XRT was restricted to patients with histologic positive tumor. Since five resected patients with subclinical metastatic tumor had an inferior survival equal to 25 patients treated essentially for palliation, pretreatment celiotomy seems warranted to identify patients with an inferior prognosis. Of 18 resected patients without disseminated tumor evaluable for this combined modality: six were tumor free, three had intramural and nine transmural tumor; the median survival is 76 weeks and five of six living patients are disease free at 95-190 weeks; and local recurrence occurred in two and in two of seven unresected patients. Since toxicity was minimal except for postoperative pneumonitis (13%) and local recurrence low (13%), two courses of chemotherapy and 5000 rad XRT perhaps obviates the need for resection.

Abdomen↗

PubMed1975

Combined modality therapy for localized Hodgkin's disease. A seven-year update of an early study.

Some clinical trials have indicated that combination therapy with intensive radiation therapy followed by chemotherapy significantly prolongs the disease-free interval of patients with Hodgkin's disease confined to lymph nodes. The present report updates the results of a small previously published study of combined-modality treatment of stages I and II Hodgkin's disease. Although patients tested with radiation therapy followed by chemotherapy have the longest median complete remission duration, patients treated with radiation alone have a superior survival rate. Follow-up in this study ranges from 34 to 93 months after the completion of all therapy.

Adolescent↗

PubMed1990

The role of adjuvant surgery in the combined modality therapy of small-cell bronchogenic carcinoma after a chemotherapy-induced partial remission.

Twenty-six patients with a limited-disease presentation of small-cell bronchogenic carcinoma (SCBC) had surgery after achieving a partial remission with three cycles of chemotherapy. Persistent SCBC was found in 15 patients (58%), non-small-cell bronchogenic carcinoma (NSCBC) in six patients (23%), and no malignancy in five patients (19%). Twelve patients have died since surgery. Tumor-node-metastasis (TNM) staging prior to or after chemotherapy was not predictive of outcome, but an N0 status found at pathological examination of the surgical specimen was predictive of long-term survival. Median survival for this group of patients was 25 months. Adjuvant surgery is feasible and may be beneficial.

Adult↗

PubMed2001

Combined-modality therapy for limited-stage small cell lung cancer.

While the International Union Against Cancer system can be used in staging small cell lung cancer (SCLC) patients, the staging distinction of "extensive stage" versus "limited stage" is commonly used. This system defines limited stage as the ability to encompass all known disease within a "reasonable" radiation field. The standard management of limited-stage SCLC is concurrent platinum-based chemotherapy with thoracic radiotherapy (RT). Total RT doses range from 40 to 55 gy in most trials. A recently completed randomized trial showed an advantage to twice-daily accelerated hyperfractionated RT over standard RT alone. Most current clinical protocols for limited-stage SCLC use the "involved field" technique of thoracic RT, in which the RT target volume includes the known extent of primary tumor and lymph node involvement and one additional nodal station. Large fields including more extensive elective nodal irradiation are discouraged. Semin Oncol 28 (suppl 4):14-22.

Antineoplastic Agents↗

PubMed1993

Overview of combined modality therapies for head and neck cancer.

The survival rate is 40% for patients with advanced squamous cell carcinoma of the head and neck whose tumors are completely resected and 20% for those with unresectable tumors treated with radiotherapy alone. During the past 10 years, combined modality approaches have been developed in an effort to enhance locoregional disease control, reduce distant metastases, and preserve anatomic function. They include the following: (a) neoadjuvant chemotherapy followed by standard therapy with surgery and/or radiation, (b) adjuvant chemotherapy after surgery or radiotherapy with or without neoadjuvant chemotherapy, and (c) neoadjuvant chemotherapy concurrent with radiotherapy. Even early studies of cisplatin plus fluorouracil (5-FU) reported 50%-90% overall response rates, and this is the main drug combination used in clinical trials. In the Veterans Affairs Cooperative Study Program, 5-FU and cisplatin followed by radiotherapy achieved a 49% complete response rate and preservation of the larynx in 64% of the patients. These results supported the findings of other nonrandomized trials that sequential induction chemotherapy and radiotherapy results in laryngeal preservation without compromising overall survival. The Head and Neck Cancer Intergroup Trial compared adjuvant postoperative cisplatin plus 5-FU prior to radiotherapy with postoperative radiotherapy. Survival at 4 years was 44% with radiotherapy alone and 48% with chemotherapy and radiotherapy. Biochemical modulation of 5-FU with leucovorin and biologic response modifiers such as interferon has achieved complete response rates as high as 66%, but severe mucositis continues to be the dose-limiting toxic effect. Standard radiotherapy for advanced nasopharyngeal carcinoma--a unique type of head and neck cancer--resulted in 5-year survival of 10%-40%, but neoadjuvant chemotherapy plus radiotherapy has achieved overall complete response rates greater than 80% with median survival of 5 or more years. We conclude that curability of nasopharyngeal carcinoma with a combined modality approach appears to be an achievable goal, but adequate evaluation in large-scale randomized trials is hampered by low accrual to clinical trials. In summary, neoadjuvant therapy for squamous cell head and neck carcinoma results in complete response rates of 22%-66%, but addition of adjuvant therapy may be necessary for a survival advantage over standard therapy. Although concurrent chemoradiotherapy has produced increased survival, additional trials are needed to determine optimal dosages.

Combined Modality Therapy↗