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PubMed2004

Concurrent chemoradiotherapy for unresectable thymic carcinoma.

BACKGROUND: Thymic carcinoma is a rare anterior mediastinal neoplasm. It is more invasive and has a poorer prognosis than ordinary thymoma. Complete curative resection is frequently impossible to achieve because of extensive invasion or metastasis at diagnosis. The role of systemic chemotherapy and the optimal regimen in thymic carcinoma remain uncertain. We report our experience with 16 patients with unresectable thymic carcinoma who underwent concurrent chemoradiotherapy. METHODS: Between July 1989 and July 2003, 29 patients were diagnosed with unresectable thymic carcinoma at our hospital. Sixteen of the 29 patients were treated with concurrent chemoradiotherapy. There were 10 men and 6 women whose ages ranged from 45 to 66 years old. Chemotherapy regimens consisted of either (A) cisplatin plus 5-fluorouracil or (B) doxorubicin, cisplatin, vincristine and cyclophosphamide every 4 weeks for at least 2 cycles. Radiotherapy was given concurrently and ranged from 34.2 to 70 Gy. RESULTS: There were 4 (25.0%) patients with complete responses, 4 (25.0%) with partial responses, 6 (37.5%) with stable disease and 2 (12.5%) with progressive disease. The overall response rate was 50%. The median follow-up was 64 months, and the median survival was 82 months. The overall cumulative survival rates at 1, 2, 3, and 5 years were 93.8%, 81.3%, 74.5%, and 67.7%, respectively. The most common side effects were Grade I/II toxicity, including vomiting, fatigue, and esophagitis. All patients experienced radiation pneumonitis. No life-threatening side effects were noted. CONCLUSIONS: Concurrent chemoradiotherapy seems effective for unresectable thymic carcinoma. Our experience, although preliminary, is encouraging and merits conducting a randomized trial to determine the impact of concurrent chemoradiotherapy on unresectable thymic carcinoma.

Aged↗

PubMed2006

[Effect of concurrent chemoradiotherapy on serum vascular endothelial growth factor in esophageal squamous cell carcinoma patients--a report of 43 cases].

BACKGROUND & OBJECTIVE: The prognosis of esophageal cancer is not only affected by TNM stage but also by the level of serum vascular endothelial growth factor (S-VEGF). This study was to investigate the effect of concurrent chemoradiotherapy on S-VEGF in esophageal squamous cell carcinoma (ESCC), and to explore the correlation of S-VEGF to the prognosis of ESCC. METHODS: Serum samples were obtained from ESCC patients, treated with concurrent chemoradiotherapy in Cancer Center of Sun Yat-sen University from Dec. 2002 to May 2004, before treatment and 1 month after treatment. The serum samples from sex- and age-matched healthy donors were used as controls. Two courses of chemotherapy, comprised of cisplatin and 5-fluorouracil, were given during radiotherapy at 4-week intervals. S-VEGF level was measured by ELISA. The changes of S-VEGF level before and after treatment were observed, and its correlation to progress-freely survival rate of ESCC patients was analyzed. RESULTS: S-VEGF level was significantly higher in ESCC patients before and 1 month after treatment than in healthy controls [(516.27+/-67.89) ng/L and (347.19+/-35.42) ng/L vs. (294.20+/-23.40) ng/L, P<0.01, P=0.002]; concurrent chemoradiotherapy significantly reduced S-VEGF level (P<0.01). S-VEGF level before treatment was significantly lower in the patients achieved complete remission than in those achieved partial remission or had progressive disease [(345.82+/-76.29) ng/L vs. (669.37+/-99.04) ng/L, P =0.020]. The 1-year progress-freely survival rate was 0 in the patients with S-VEGF level of > 516.27 ng/L before treatment and >347.19 ng/L after treatment, 17% in the patients with S-VEGF level of > 516.27 ng/L and <347.19 ng/L, respectively, 57% in the patients with S-VEGF level of < 516.27 ng/L and >347.19 ng/L, respectively, and 72% in the patients with S-VEGF level of < 516.27 ng/L and <347.19 ng/L, respectively (P= 0.005). CONCLUSIONS: S-VEGF level is higher in ESCC patients than in healthy control. Concurrent chemoradiotherapy could reduce S-VEGF level in ESCC. The changes of S-VEGF level before and after treatment may provide prognostic information for ESCC patients.

Adolescent↗

PubMed2004

[Concurrent chemoradiotherapy for head and neck squamous cell carcinoma with indication of total laryngectomy].

Subjects were 15 patients--13 men and 2 women--with squamous cell carcinoma of the head and neck, indicating total laryngectomy. Their median age was 62 years, ranging from 50 to 71 years. Three had stage III disease and 12 stage IV disease. These patients were treated with concurrent chemoradiotherapy and had been followed up for more than 2 years from the start of treatment. Primary sites were hypopharynx in 7, larynx in 6, or oropharynx in 2. Treatment consisted of 5-Fluorouracil (5-FU) on cis-platinum (CDDP). 5-FU was given at 1000 mg/m2 per day as continuous infusions during 4 days, and 60 mg/m2 of CDDP was given on day 4 beginning on day 1 and 35 of a concurrent chemoradiotherapy course. Radiation was given in single daily fractions of 2 Gy and 5 fractions per week to a total dose of 60 to 70 Gy. Radiation break was scheduled from day 26 to 35. The median total delivered dose of radiation was 66 Gy. Toxicities included mucositis (grade 3, 33.3%, grade 4, 13.3%), vomiting (grade 3, 33.3%), leukopenia (grade 3, 20%). Twelve PT (80%) received scheduled treatment. Seven (46.7%) had clinical complete response and 8 (53.3%) partial response. Median overall survival was 27.2 months (5.6-33.9 m) and progression-free survival was 26.5 months (5.6-33.9 m). The larynx was preserved and free of disease in 60% of patients overall. Two-year overall survival (OS) was 71.8% and progression free survival (PFS) rates was 60%. Failure patterns showed 5 with locoregional recurrence and 1 with distant metastasis. Concurrent chemoradiotherapy improved two-year OS and PFS compared to radiotherapy alone with a significant difference. Concurrent chemoradiotherapy is thus effective in preserving the larynx in a high percentage of patients and improving two-year OS and PFS rates without compromising QOL.

Aged↗

PubMed2005

Cervix carcinoma, concurrent chemoradiotherapy, and salvage of isolated paraaortic lymph node recurrence.

PURPOSE: To determine the effect of concurrent chemoradiotherapy on the outcome of invasive cervical carcinoma patients with disease recurrence isolated to the paraaortic lymph nodes. METHODS AND MATERIALS: Between 1987 and 2003, 816 cervical carcinoma patients received radiotherapy at Mallinckrodt Institute of Radiology. Of these 816 patients, 14 had clinically or radiographically detected isolated paraaortic lymph node metastases. Before 1998, imaging was done if warranted by the presence of one or more classic findings, including lower extremity edema, sciatic pain, and hydronephrosis. After 1998, radiographic imaging was a routine part of follow-up for all patients. The median age at recurrence was 42.5 years (range, 32-54 years). Follow-up for all living patients was current at last follow-up. Full-dose radiotherapy equaled at least 45 Gy. RESULTS: All 7 patients with a classic finding of recurrence, none of whom had been treated to at least 45 Gy and concurrent chemotherapy, were dead of disease within 1.5 years. The 7 patients without a classic finding of recurrence, all of whom had been treated with salvage full-dose concurrent chemoradiotherapy, had a 5-year overall survival rate of 100% (p <0.01). CONCLUSION: Salvage concurrent full-dose chemoradiotherapy afforded excellent survival of patients who did not have classic findings but had disease recurrence exclusively in the paraaortic lymph nodes. The effectiveness of salvage concurrent full-dose chemoradiotherapy in patients with symptomatic disease recurrence remains unclear. However, chemotherapy or radiotherapy alone produced dismal survival in patients with classic findings of recurrence.

Adult↗

PubMed2004

A critical overview of concurrent chemoradiotherapy in cervical cancer.

In February 1999, the National Cancer Institute of the US National Institutes of Health issued a communication stating that concurrent chemoradiotherapy should be considered as standard treatment for cervical cancer. This statement was based on the publication of five randomized prospective trials. On the basis of a critical review of these papers and others that identified different results, questions, doubts, and concerns have arisen about this therapeutic method. We analyzed the quality of the control groups managed with the standard treatment, noting data that may have altered these results, as well as analyzing the quality of chemotherapy, radiotherapy, and treatment compliance. In light of this analysis, we believe that further trials should be carried out with fairly balanced prognostic factors to demonstrate beyond a doubt that concurrent chemoradiotherapy is superior to radiotherapy alone. In developing countries where resources are scarce, this type of tumor is found frequently. Concurrent chemoradiotherapy would involve increased costs and supportive care, taking away resources from other vital areas.

Antineoplastic Agents↗

PubMed2004

Concurrent chemoradiotherapy with pirarubicin and 5-fluorouracil for resectable oral and maxillary carcinoma.

OBJECTIVE: We present the response rate and adverse effects of our regimen of concurrent chemoradiotherapy with pirarubicin (THP) and 5-fluorouracil (5-FU) for oral and maxillary carcinoma. PATIENTS AND METHODS: Fifteen patients with oral (10 cases) or maxillary (5 cases) squamous cell carcinoma who underwent our concurrent chemoradiotherapy with the combination of intraarterial pirarubicin, intravenous continuous 5-fluorouracil, and radiation between March 2001 and February 2003 in our department were entered in this study. THP (5 mg/day) was infused into the lingual or maxillary artery one hour before radiation on days 1-5 and 8-12, while intravenous 5-FU (150 mg/m2/day) was instilled continuously on days 1-5, 8-12, 15-19, and 22-26 in accordance with the radiation schedule (2 Gy/day). Consequently, total doses of THP, 5-FU, and radiation were 50 mg, 3000 mg/m2 and 40 Gy, respectively. After the treatment series, response rate and adverse effects were evaluated. RESULTS: Response rate achieved 100% (12 cases exhibited a complete response and the remaining 3 a partial response). Notably, all 10 patients with oral carcinoma exhibited complete response. The main adverse effects were leucopenia (6/15) and mucositis (6/15), both of which were acceptable. CONCLUSIONS: This concurrent chemoradiotherapy is very useful for oral and maxillary carcinoma as a preoperative modality with remarkably high response rate and acceptable adverse events.

Aged↗

PubMed2001

p53, BCL-2, and Ki-67 expression according to tumor response after concurrent chemoradiotherapy for advanced rectal cancer.

BACKGROUND: Concurrent chemoradiotherapy (CCRT) for locally advanced rectal cancer is an important modality for curative resection, but tumors show wide spectrum response. The purpose of this study was to investigate any correlation among related genetic mutations, proliferative index, and tumor response after CCRT. METHODS: This study included 23 patients with rectal cancer, who were preoperatively staged as at least T3 N1 or T4 (determined by transrectal ultrasonography and MRI). Enrolled patients were given 5-FU 450 mg/m2/day and leucovorin 20 mg/m2/day intravenously for 5 days during weeks 1 and 5 of radiotherapy (45-54 Gy). Surgical resection was performed 4 weeks after completion of the scheduled treatment. Tumor response was classified as CR (complete response), PR (partial response: 50% diminution of tumor volume and downstaging), and NR (no response). Paraffin-embedded tissue obtained before chemoradiotherapy was studied by immunohistochemical staining for p53, BCL-2, and Ki-67. The extent of tumor response was correlated with proliferative activity and was measured by immunostaining Ki-67 proliferative antigen and the expression of p53 and BCL-2 oncoproteins. RESULTS: All patients were resectable. CR was obtained in 4 patients, PR in 10 patients, and NR in 9 patients. The p53 mutation was noted in 16 patients: NR in 5 patients, PR in 9 patients, and CR in 2 patients (P = .638). BCL-2 expression was noted in 11 patients: NR in 4 patients, PR in 3 patients, and CR in 4 patients (P = .799). The Ki-67 labeling index was NR: 615.4+/-47.2; PR: 663.2+/-20.4; and CR: 765.5+/-58.3 (CR + PR vs. NR, P = .029). CONCLUSIONS: Immunohistochemical expression of p53 and BCL-2 does not correlate with tumor response after CCRT, but Ki-67 labeling may be a useful parameter for radiosensitive tumors selected for CCRT.

Adenocarcinoma↗

PubMed2004

Concurrent chemoradiotherapy for head and neck cancer.

Concurrent chemoradiotherapy (CRT) has been shown to be superior to radiotherapy (RT) alone in several clinical therapeutic settings for head and neck cancer (HNC). In unresectable disease, CRT is superior to RT alone, and for resectable advanced disease, it may serve as a substitute for initial surgery, with planned salvage surgery as a backup. In the postoperative setting, clinical trials suggest that CRT is superior to RT alone. Recent results of phase II studies suggest that the addition of induction chemotherapy to CRT may further enhance outcome through eradication of systemic metastases, although this will require prospective evaluation in randomized clinical trials. Additionally, chemotherapy given with hyperfractionated RT leads to improved outcome versus hyperfractionated RT alone. The optimal CRT regimen is still a matter of debate and ongoing study.

Combined Modality Therapy↗

PubMed2005

Concurrent chemoradiotherapy and adjuvant chemotherapy with Topotecan for patients with glioblastoma multiforme.

PURPOSE: The prognosis for patients with glioblastoma multiforme remains poor. Phase II studies, meta-analyses and a phase III study show that concurrent chemoradiotherapy has an advantage over irradiation alone. In this study the effectiveness of concurrent chemoradiotherapy with Topotecan and an adjuvant chemotherapy with Topotecan was investigated. PATIENTS AND METHOD: Forty-two patients with predominantly unfavourable prognosis factors were included in the study and treated as follows: hyperfractionated accelerated radiotherapy (2x1.75Gy to 45.5 + 12.25 Gy (RP)) with a concurrent, continuous infusion of Topotecan (0.5 mg/m(2)/d, days 1-21). On day 28 the adjuvant chemotherapy (three courses) was begun according to the same scheme. RESULT: Haematological toxicities were 13/42 (30%) grade III leucopenia, 2/42 (4%) grade IV, as well as 5/42 (10%) grade III thrombopenias and 1/42 (2%) grade IV. 30/42 (71%) patients showed improvement or stabilisation of an existing neurological symptomatic complex. The median time to progression was 7.2 (+/- 0.8) months, the median total survival was 10 (+/- 1.2) months, the 2 year survival rate 4.7 (+/- 0.3)%. Prognostic factors were age, surgical radicality, performance status and the tumour volume before therapy. SUMMARY: Concurrent chemoradiotherapy and an adjuvant chemotherapy with Topotecan is feasible at acceptable toxicity levels also for patients with a moderate performance status. The patients benefit from the improvement of the clinical symptomatic complex and, even with unfavourable prognosis factors, have a higher median survival in comparison to data published on similar groups of patients given only radiotherapy.

Adult↗

PubMedDate not supplied

Portal vein gas after concurrent chemoradiotherapy for advanced oesophageal carcinoma.

Portal vein gas is a rare but potentially lethal condition commonly caused by mucosal damage, bowel distention and sepsis. However, the association between portal vein gas and concurrent chemoradiotherapy has not been documented. We present the case of a 56-year old woman with portal vein gas revealed on computed tomography (CT) after concurrent chemoradiotherapy for advanced oesophageal carcinoma. The portal vein gas totally disappeared 10 days later without any specific treatment. This case demonstrates that the option of close observation for portal vein gas after concurrent chemoradiotherapy is appropriate for consideration. If physical examination, CT findings and laboratory data are unremarkable, it is essential that the patient undergoes close observation and repeated follow-up CT.

Biopsy↗

PubMedDate not supplied

Tumor shrinkage before intracavitary brachytherapy for cancer of the cervix: radiotherapy alone versus concurrent chemoradiotherapy.

PURPOSE: The purpose of this study was to compare the tumor shrinkage between radiotherapy alone and concurrent chemoradiotherapy before intracavitary brachytherapy (ICBT). MATERIALS AND METHODS: Nineteen consecutive patients (three stage IB2, nine stage IIB, seven stage IIIB) were selected for measurement of tumor regression. Ten patients underwent radiotherapy alone, and nine patients underwent concurrent cisplatin-based chemoradiotherapy. The average dose of pelvic radiation was given at 45 Gy over a 5-week period in both groups. Computed tomography-based tumor measurement before treatment was compared with measurement after treatment but before intracavitary brachytherapy. The largest width and thickness of the cervical mass were measured from the axial computed tomographic images. RESULTS: Tumor regression before intracavitary brachytherapy varied widely, ranging from 15% to 65%. However, the tumor regression in patients who underwent chemoradiotherapy was higher, ranging from 41% to 65% (mean, 55%), compared with radiotherapy alone, which ranged from 15% to 52% (mean, 38%). CONCLUSION: Our results show that significant tumor shrinkage occurs with concurrent chemoradiotherapy compared with radiotherapy alone. This finding supports the results of recent clinical trials demonstrating improvement of pelvic control and survival with concurrent chemoradiotherapy for advanced cancer of the cervix.

Antineoplastic Agents↗

PubMed2006

Concurrent chemoradiotherapy with carboplatin and uracil-ftegafur in patients with stage two (T2 N0 M0) squamous cell carcinoma of the glottic larynx.

This study aimed to evaluate the efficacy and toxicity of concurrent chemoradiotherapy as a primary treatment modality for larynx preservation in patients with stage two squamous cell carcinoma (SCC) of the glottic larynx. Between February 2000 and August 2003, a total of 20 patients received concurrent chemoradiotherapy. Carboplatin was given intravenously once a week during the period of radiotherapy. The weekly carboplatin dose was based on the area under the curve 1 to 1.25. Uracil-ftegafur (UFT) was given in a daily oral dose of 300 mg as tegafur. Radiotherapy was delivered five days a week using a once-daily fractionation of 2.0 Gray (Gy), to a total dose of 66-72 Gy. The three-year overall survival rate with larynx preservation was 100 per cent. Concurrent chemoradiotherapy with carboplatin and UFT for stage two SCC of the glottic larynx was safe and effective in improving local control with larynx preservation.

Adult↗

PubMedDate not supplied

Primary tumors and mediastinal lymph nodes after neoadjuvant concurrent chemoradiotherapy of lung cancer: serial CT findings with pathologic correlation.

PURPOSE: The purpose of this work was to describe the changes of primary tumor and mediastinal lymph nodes on CT after neoadjuvant concurrent chemoradiotherapy and to correlate the CT findings with pathology. METHOD: Twenty-one consecutive patients [N2 disease (n = 19) or resectable T4 and N2 disease (n = 2)] with non-small cell lung cancer underwent neoadjuvant concurrent chemoradiotherapy. Changes of primary tumor and mediastinal nodes before and after the therapy were assessed using CT. The CT findings were correlated with pathologic findings. RESULTS: With neoadjuvant therapy, decrease in T stage was achieved in 9 of 21 (43%) patients on CT. On pathology, the remaining tumor consisted mostly of fibrosis and necrosis with little proportion of viable tumor cells (mean volume 17%, range 0-55%). Decrease in nodal stage was achieved in 14 of 21 (67%) patients on pathologic examination. Seven patients had cancer cells in mediastinal lymph nodes: in 6 of 9 (67%) patients with adenocarcinoma and 1 of 12 (8%) patients with squamous cell carcinoma (p = 0.016). CONCLUSION: With neoadjuvant concurrent chemoradiotherapy, the remaining tumor consists mostly of fibrosis or necrosis. Decreased nodal stage on pathology is achieved especially in patients with N2 disease of squamous cell carcinoma. The CT findings of the tumor and mediastinal nodes are not helpful in predicting the pathology after the therapy.

Adenocarcinoma↗

PubMed2006

[Concurrent chemoradiotherapy (CRT) with S-1 and cisplatin (CDDP) in patients (pts) with locally advanced head and neck cancer (HNC)].

The standard care for unresectable locally advanced head and neck cancer (HNC) is concurrent chemoradiotherapy (CRT). Although there is no standard regimen of CRT, a platinum-based regimen has shown a better survival benefit than other regimens. The control arm in a randomized trial for unresectable locally advanced HNC is radiotherapy concurrent with CDDP (100 mg/m2, every 3 weeks), which has been considered to be too toxic for clinical practice in Western countries and has required frequent dose modifications. Because the Japanese also have been considered unable to tolerate this regimen, no prospective study of it has been conducted in Japan. Most Japanese patients with locally advanced head and neck cancer have received concurrent chemoradiotherapy with 5-FU and CDDP (70-80 mg/m2). S-1 has shown high activity in HNC with a response rate of 34%. Furthermore, a combination of cisplatin and S-1 therapy for HNC has been reported to have good efficacy. With this rationale in mind, we conducted a phase I study of CRT with S-1 and CDDP for unresectable locally advanced squamous cell carcinoma of the head and neck. The CR rate was very promising, though preliminary, and warrants further investigation. The Japan Clinical Oncology Group (JCOG) is planning a multicenter phase II study of concurrent chemoradiotherapy with S-1 and CDDP for locally advanced unresectable HNC.

Adult↗

PubMed2001

Correlation of clinicopathological parameters and biological markers related to apoptosis and proliferative activity with a clinical outcome in squamous cell carcinoma of the larynx treated with concurrent chemoradiotherapy.

OBJECTIVE: This study was designed to determine whether biological markers related to apoptosis or proliferative activity are associated with the clinical outcome in patients with squamous cell carcinoma (SCC) of the larynx treated with concurrent chemoradiotherapy. METHODS: Immunostaining with antibodies specific to p53, bcl-2, bax, and MIB-1 was performed to evaluate expression of these proteins in formalin-fixed, paraffin-embedded specimens of 59 patients treated with concurrent chemoradiotherapy (carboplatin, 100 mg/m2, four to six times every week; total radiation dose of 40-65 Gy over 4-6.5 weeks). RESULTS: Multivariate analysis indicated that nodal status was a significant indicator of overall survival (OS: P = 0.001). Patients with bcl-2 positive tumors had better OS than those with bcl-2 negative tumors in both univariate (P = 0.002) and multivariate analyses (P < 0.001 ). In the univariate analysis, a considerable difference in OS was observed among the expressions of bax (P = 0.077), MIB-1 proteins (P = 0.071). and OS. but the difference was not statistically significant. CONCLUSION: This study indicates that nodal status is the major prognostic tactor in patients with SCC of the larynx treated with concurrent chemoradiotherapy. These results provide useful information for predicting prognosis. Further analysis of biological factors is needed to evaluate the value as predictive markers.

Apoptosis↗

PubMed2004

Another way to estimate outcome of advanced nasopharyngeal carcinoma--is concurrent chemoradiotherapy adequate?

PURPOSE: To evaluate a simple risk grouping system and determine whether concurrent chemoradiotherapy (CCRT) is adequate for patients with advanced nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: A total of 284 patients with 1992 American Joint Committee on Cancer (AJCC) Stage III to IV (M0) NPC were analyzed retrospectively. They were treated by either radiotherapy (RT) alone or CCRT. We divided patients into high-risk and low-risk subgroups according to our experience. High-risk patients met at least one of the following criteria: (1) nodal size >6 cm, (2) supraclavicular node metastases, (3) 1992 AJCC stage T4N2, (4) multiple neck node metastases with 1 node >4 cm. The disease extent of each patient was stratified by our risk grouping system, AJCC 1992 and 1997 staging systems. Survival analyses-including nasopharynx disease free (TS), neck disease free (NS), distant metastasis disease free (MS), overall survival (OS), and progression-free (PFS) survival curves-were compared between these three different classifications. RESULTS: According to the 1992 AJCC staging system, 80.3% (228/284) of NPC patients are Stage IV, whereas only 19.7% are Stage III. Most patients are downstaged by the 1997 AJCC staging system with 28.5% (81/284) Stage IV and 71.5% (203/284) Stage III/II. Our risk criteria stratify more even patient distribution, because 119 patients (41.9%) are assigned to the high-risk group and 165 patients (58.1%) to the low-risk group. Log-rank test of Kaplan-Meier survival curves, multivariate comparison of the Cox proportional hazards model, and 3 goodness-of-fit indices validated that our risk grouping system seemed to be at least as efficacious as, or slightly superior to, the 1992 and 1997 AJCC systems. The 5-year TS (95.1% vs. 76.8%, p = 0.0012), NS (100% vs. 95.7%, p = 0.0974), MS (90.5% vs. 78.1%, p = 0.0282), OS (83.2% vs. 59.7%, p = 0.0041), and PFS (87.3% vs. 61.5%, p = 0.0003) were significantly better in patients receiving CCRT than RT alone for the low-risk group. However, the corresponding survival rates between CCRT and RT for high-risk patients were 74.9% vs. 67.6% (p = 0.2545) for TS, 92.1% vs. 86.8% (p = 0.4744) for NS, 59.7% vs. 60.0% (p = 0.5537) for MS, 55.8% vs. 46.3% (p = 0.1761) for OS, and 44.5% vs. 43.1% (p = 0.3911) for PFS, respectively. CONCLUSIONS: Concurrent chemoradiotherapy is superior to RT alone for low-risk patients but inadequate for high-risk patients. Adding neoadjuvant and/or adjuvant chemotherapy would be a reasonable approach for high-risk patients. Our risk grouping criteria are a simple and useful guide that will have important implications in the design of future therapeutic trials.

Adolescent↗

PubMed2006

Surgery after concurrent chemoradiotherapy and brachytherapy for the treatment of advanced cervical cancer: morbidity and outcome: results of a multicenter study of the GCCLCC (Groupe des Chirurgiens de Centre de Lutte Contre le Cancer).

OBJECTIVES: To evaluate the morbidity and therapeutic value of surgery after concurrent chemoradiotherapy and brachytherapy in a multicentric series of patients with advanced cervical cancer. METHODS: Patients with stage IB2 to IVA cervical cancer treated with concurrent chemoradiotherapy and pelvic radiotherapy followed by brachytherapy and surgery from seven participating French comprehensive cancer centers were enrolled. The surgical treatment consisted of a hysterectomy, which ranged from radical hysterectomy to anterior pelvic exenteration, and lymph node resection. Acute toxicity, pathological response, overall, and disease-free survival were assessed for each pathological response to therapy. RESULTS: One hundred seventy-five patients were enrolled from September 1987 to June 2002. The median age was 44 years [27;75]. Patients distribution according to clinical classification was as follows: 41 stage IB2, 18 IIA, 77 IIB, 12 IIIA, 14 IIIB, and 13 IVA. Forty-six patients experienced 51 postoperative complications. Thirty-three patients experienced grade 2 morbidity (18.9%, 33/175), among whom 19 experienced urinary complications (57.5%, 19/175). No post treatment mortality was observed. Grade 3 toxicity rate was 6.9% (12/175). Pathological complete response rate was 38% (67/175). After a median follow-up of 36 months, overall survival and disease-free survival were significantly better in patients who had a pathological complete response to therapy than those who achieved a partial pathological response (P < 0.0001). CONCLUSION: Surgery after concurrent chemoradiotherapy and brachytherapy for advanced cervical cancer leads to an acceptable morbidity. Furthermore, surgery allows evaluation of the pathological response to therapy and improves local control in the case of partial pathological response.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2000

[Concurrent chemoradiotherapy for locally unresectable head and neck cancer].

In patients with locally unresectable head and neck cancer with large nodal involvement, the expected five-year survival is as low as 1-2%. To improve the prognosis of these patients, we studied the usefulness of concurrent chemoradiotherapy in a phase II trial. Between September 1996 and May 1999, thirty-five patients with locally unresectable head and neck cancer were administered concurrent chemoradiotherapy consisting of low-dose and long-term treatment with cisplatin (CDDP) plus 5-fluorouracil (5FU), or (L-CF); the L-CF regimen consisted of CDDP, 3 mg/m2 on 5 days of the week and 5FU, 150 mg/m2 as a 24-hour infusion on 5 days of the week. Concurrently, conventional radiotherapy was given up to total dose of around 60 Gy. In the 33 patients evaluable for response, 17 complete and 9 partial responses were noted, with an overall response rate of 79%. Oral mucostis and myelosuppression were the major side effects and mucositis was a dose limiting toxicity. This study demonstrates increase in survival among the responders (complete + partial) in the concurrent chemoradiotherapy setting. However 8 local relapses were eventually noted in the 17 complete responders. We concluded that this treatment strategy was beneficial in patients with locally unresectable head and neck cancer.

Adult↗