PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Combined Modality Therapy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources
PubMed2000

Combined modality therapy including surgery for stage III small-cell lung cancer on the basis of the sensitivity assay in vitro.

Fifty-nine consecutive patients with clinical stage (cStage) I-III resectable small-cell lung cancer (SCLC) underwent surgery with adjuvant chemotherapy based on an in vitro sensitivity assay between April 1982 and March 1992. In 42 (71%) of these patients, a stable passage of cancer cells from resected specimens was possible and the sensitivity of these cultured SCLC cells to anticancer drugs was examined by the MTT method. In the sensitivity assay, vincristine (VCR) showed the most intense specific efficacy for SCLC, followed by cyclophosphamide (CPM) and cisplatin (CDDP). The 5-year survival rates for pathological stage (pStage) I, pStage II, and pStage III were 55%, 33%, and 23%, respectively. The 5-year survival of the patients with pStage III operated on in the first 5 years was 7% (1/14). On the other hand, 6 of the 16 pStage III patients (38%) operated on during the second 5-year period, who were generally treated with pre- and postoperative adjuvant chemotherapy combined with three drugs, survived over 5 years. In conclusion, these results suggest that combined modality therapy including surgery is necessary, and adjuvant chemotherapy combined with VCR, CPM, and CDDP may be useful in the treatment of Stage III SCLC disease, for the purpose of achieving a long-term survival with both a good performance status and quality of life for the patients.

Adult↗
PubMed1993

Intracranial choriocarcinoma causing precocious puberty and cured with combined modality therapy.

Precocious puberty can be caused by hormonally active tumours, which may arise intracranially. Treatment of these intracranial lesions traditionally involves biopsy and radiotherapy. Chemotherapy has been used recently, although radiotherapy has been given irrespective of the response to chemotherapy. We report a case of precocious puberty in an 8 year old boy due to a malignant intracranial germ cell tumour. Although one could speculate that he was cured by such combined modality therapy, the patient was left with several long-term problems. Radiotherapy was a major cause of these complications. Radiotherapy is now thought unnecessary for most extracranial germ cell tumours, as chemotherapy alone is curative in most patients. Therefore it seems appropriate to consider the elimination of radiotherapy for patients with intracranial disease.

Alopecia↗
PubMed1996

Combined modality therapy for cutaneous T-cell lymphoma.

BACKGROUND: Cutaneous T-cell lymphoma (CTCL) may respond to many therapies, but long-term disease-free survival is uncommon. Patients with advanced disease have a median survival of approximately 3 years. OBJECTIVE: Our purpose was to combine known effective agents sequentially to determine whether we could achieve remission in more patients or for longer duration. METHODS: Patients with mycosis fungoides (n = 23) or Sézary syndrome (n = 5) were treated with 4 months of recombinant interferon alfa together with isotretinoin, followed by total skin electron beam therapy alone (for stage I to II disease) or preceded by chemotherapy (for stage III to IV disease). Maintenance therapy consisted of interferon for 1 year and topical nitrogen mustard for 2 years. RESULTS: Twenty-eight patients were treated. The overall response rate (complete and partial remissions) was 82%. Although the median duration of remission was 5 months in patients with stage III to IV disease, two patients remain in complete remission at 39 + and 46 + months. In patients with stage I to II disease the median duration of remission has not been reached at a median follow-up of 18 months. Five patients, all with stage III to IV disease, have died. Overall, the regimen was well tolerated with one treatment-related death from neutropenic sepsis. CONCLUSION: Combined modality therapy may be effective for the treatment of CTCL with similar response rates to other current therapies.

Administration, Cutaneous↗
PubMed2007

A prospective pathologic analysis using whole-mount sections of rectal cancer following preoperative combined modality therapy: implications for sphincter preservation.

OBJECTIVE: The aims of this study were to use a comprehensive whole-mount pathologic analysis to characterize microscopic patterns of residual disease, as well as circumferential and distal resection margins, in rectal cancer treated with preoperative CMT; and to identify clinicopathologic factors associated with residual disease. SUMMARY BACKGROUND DATA: Recent studies have shown that preoperative combined modality therapy (CMT) for rectal cancer enhances rates of sphincter preservation. However, the efficacy of preoperative CMT in conjunction with a total mesorectal excision (TME)-based resection, in terms of resection margins using whole-mount sections, has not been reported. Furthermore, since patterns of residual disease and extent of distal spread following preoperative CMT are largely unknown, intraoperative determination of distal rectal transection remains a surgical challenge. METHODS: We prospectively accrued 109 patients with endorectal ultrasound (ERUS)-staged, locally advanced rectal cancer (T2-T4 and/or N1), located a median distance of 7 cm from the anal verge, requiring preoperative CMT, and undergoing a TME-based resection. Comprehensive whole-mount pathologic analysis was performed, with particular emphasis on extent of residual disease, margin status, and intramural tumor extension. Clinicopathologic factors associated with residual disease were identified. RESULTS: A sphincter-preserving resection was feasible in 87 patients (80%), and in all 109 patients, distal margins were negative (median, 2.1 cm; range, 0.4-10 cm). Intramural extension beyond the gross mucosal edge of residual tumor was observed in only 2 patients (1.8%), both < or =0.95 cm. There were no positive circumferential margins (median, 10 mm; range, 1-28 mm), although 6 were less than or equal to 1 mm. On multivariate analysis, residual disease was observed more frequently in distally located tumors (distance from anal verge <5 cm) (P = 0.03). CONCLUSION: Our comprehensive pathologic analysis suggests that, following preoperative CMT and a TME-based resection, distal margins of 1 cm may provide for complete removal of locally advanced rectal cancer. Although residual cancer following preoperative CMT was more likely in the setting of distally located tumors, occult tumor beneath the mucosal edge was rare and, when present, limited to less than 1 cm. Our results extend the indications for sphincter preservation, as distal resection margins of only 1 cm may be acceptable for rectal cancer treated with preoperative CMT.

Adenocarcinoma↗
PubMed2005

Combined-modality therapy for patients with regional nodal metastases from melanoma.

PURPOSE: To evaluate the outcome and patterns of failure for patients with nodal metastases from melanoma treated with combined-modality therapy. METHODS AND MATERIALS: Between 1983 and 2003, 466 patients with nodal metastases from melanoma were managed with lymphadenectomy and radiation, with or without systemic therapy. Surgery was a therapeutic procedure for clinically apparent nodal disease in 434 patients (regionally advanced nodal disease). Adjuvant radiation was generally delivered with a hypofractionated regimen. Adjuvant systemic therapy was delivered to 154 patients. RESULTS: With a median follow-up of 4.2 years, 252 patients relapsed and 203 patients died of progressive disease. The actuarial 5-year disease-specific, disease-free, and distant metastasis-free survival rates were 49%, 42%, and 44%, respectively. By multivariate analysis, increasing number of involved lymph nodes and primary ulceration were associated with an inferior 5-year actuarial disease-specific and distant metastasis-free survival. Also, the number of involved lymph nodes was associated with the development of brain metastases, whereas thickness was associated with lung metastases, and primary ulceration was associated with liver metastases. The actuarial 5-year regional (in-basin) control rate for all patients was 89%, and on multivariate analysis there were no patient or disease characteristics associated with inferior regional control. The risk of lymphedema was highest for those patients with groin lymph node metastases. CONCLUSIONS: Although regional nodal disease can be satisfactorily controlled with lymphadenectomy and radiation, the risk of distant metastases and melanoma death remains high. A management approach to these patients that accounts for the competing risks of distant metastases, regional failure, and long-term toxicity is needed.

Adolescent↗
PubMed1993

Massive chest wall tumor diagnosed as Askin tumor. Successful treatment by intensive combined modality therapy in an adult.

A 24-year-old woman was admitted due to dyspnea on exertion. A chest roentgenogram revealed a massive tumor originating from the right anterior chest wall when pleural effusion was drained. Diagnosis of Askin tumor was made based on light microscopic findings characterized by composing with small round cells, immunocytochemical findings suggestive of neuroectodermal origin, and cytogenetic analysis demonstrating the chromosomal translocation (11; 22). After intensive combined modality therapy, including chemotherapy, irradiation, and additional surgery, she was followed up as an outpatient and has remained disease-free for 16 months after initial diagnosis.

Adult↗
PubMed1988

Combined modality therapy for tumor stage mycosis fungoides: results of a 10-year follow-up.

Twenty-one patients with tumor stage mycosis fungoides (MF) with or without lymph node (LN) involvement, were treated with total skin electron beam irradiation (TSEB) followed by six monthly cycles of systemic chemotherapy (CT) of either mechlorethamine (HN2) or cyclophosphamide (CTX) with vincristine (VCR), procarbazine, and prednisone (PRD) (COPP or MOPP). All patients had complete clearing of the skin after TSEB. However, while receiving chemotherapy, two patients developed visceral involvement and eight patients relapsed with limited cutaneous plaques (LCP). The median duration of remission was 12 months from the completion of TSEB, and all patients relapsed with cutaneous plaques within 25 months. Complete remission was again achieved using additional electron irradiation and maintenance therapy in all but one patient. Multiple cutaneous recurrences occurred in all patients. Median survival from the initiation of TSEB is 6 years. Five patients are living beyond 8 years (four off treatment without disease for 1 to 7 years). LN involvement did not influence initial response or survival. Combined modality therapy for tumor stage MF using TSEB followed by systemic CT and subsequent maintenance therapy may lead eventually to prolonged disease-free survival (DFS) in selected patients.

Adult↗
PubMed1993

Survival after combined modality therapy for pancreatic cancer.

Twenty consecutive patients with unresectable, locally advanced pancreatic cancer were treated with split courses of radiotherapy (RT) and simultaneous multidrug chemotherapy consisting of 5 fluorouracil, continuous infusion, streptozotocin, and cisplatin. A separate, retrospective study identified a group of 28 contemporary patients with less advanced pancreatic cancers, all of which were successfully resected. The survival rate of the two groups were similar over the first 2 years, although it initially favored the unresectable group. This pattern of survival among patients treated with combined modality therapy provides a basis for new studies. At the two clinical extremes, these include treatment of unresectable tumors previously considered ineligible for this treatment and initial treatment before resection of stage I tumors.

Adenocarcinoma↗
PubMed1990

Sequential combined modality therapy for stage III non-small cell lung cancer.

These pilot trials clearly demonstrate the feasibility of administering neoadjuvant chemotherapy to patients with stage III NSCLC. Response rates in most of these trials reach or exceed 50%, indicating increased activity of chemotherapy in NSCLC when used at an earlier time in the natural history of the disease, as has been shown in other diseases. In addition, histologic confirmation of complete response can occasionally be achieved. Most of the studies reviewed here have included patients with unresectable disease, who would now frequently be classified as stage IIIB. For these patient cohorts the survival data reported are frequently disappointing, suggesting that the high response rates to neoadjuvant chemotherapy do not necessarily translate into improved survival of the patients. On the other hand, where patients with stage IIIA disease were treated and surgery was included in the overall treatment plan, the survival data are more encouraging. Although most chemotherapy regimens have included cisplatin, it is not clear which combination of drugs and which schedules are superior. Clinical research, therefore, clearly needs to continue to focus on the development of innovative drug combinations and the evaluation of new drugs in NSCLC in an attempt to further increase overall and complete response rates to neoadjuvant chemotherapy. At the same time, randomized studies are needed to unequivocally establish whether the addition of neoadjuvant chemotherapy to standard therapy improves survival for stage IIIA and/or stage IIIB NSCLC as compared with standard therapy alone. Results from one such randomized study, which was conducted by the Cancer and Leukemia Group B (CALGB), have recently been reported. One-hundred and eighty patients with unresectable NSCLC were randomized to receive radiotherapy alone or two cycles of cisplatin and vinblastine followed by radiotherapy. One-hundred and fifty-five eligible patients were analyzed for response. Of 77 patients receiving radiotherapy alone, 43% responded, including 16% with a complete response. Of 78 patients receiving neoadjuvant chemotherapy, 56% responded to both treatment modalities, including 19% with complete response. With a median follow-up of 19 months, the median survival was 16.5 months for patients receiving combined modality therapy and 8.5 months for patients receiving radiotherapy alone. The pattern of relapse was identical in both study arms, showing a predominance of local recurrence or of combined local and distant recurrence, whereas few patients experienced distant disease progression alone.(ABSTRACT TRUNCATED AT 400 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Prophylactic cranial irradiation with combined modality therapy for patients with locally advanced non-small cell lung cancer.

Central nervous system (CNS) metastasis is a significant problem for many patients with non-small cell lung cancer (NSCLC). The earlier data reported a high incidence of CNS metastasis in patients with locally advanced NSCLC who were treated with radiotherapy alone. However, poor control of both thoracic and extracranial systemic disease dominated the results of the early trials. The risk for CNS metastasis as the first site of failure remains a significant concern for patients who have completed modern combined modality therapy. With improvements in the treatment of thoracic and systemic disease, there is renewed interest in prophylactic cranial irradiation (PCI). The results from the Radiation Therapy Oncology Group (RTOG) trial of PCI to prevent CNS relapse in patients with locally advanced NSCLC are anticipated.

Carcinoma, Non-Small-Cell Lung↗
PubMed2000

Long-term survival of a patient with stage IV pulmonary large cell carcinoma achieved by combined-modality therapy: report of a case.

We describe herein the case of a 59-year-old-man with stage IV pulmonary large cell carcinoma and a giant brain metastasis, in whom two sublines with different growth characteristics and drug sensitivities in vitro were established from the primary tumor. Disease-free survival for more than 5 years after surgery was achieved by combined-modality therapy together with surgery to remove the primary tumor, radiation to the brain metastasis, and chemotherapy to presumed hematogenous dissemination. Subline 1 proliferated in a monolayer of epithelial-like cells, while subline 2 showed a floating colony pattern of proliferation, resembling the typical growth characteristics of small cell lung cancer (SCLC) cells in vitro. Subline 2 was sensitive to a number of drugs, namely, vincristine (VCR), cyclophosphamide (CPM), adriamycin (ADR), and cisplatin (CDDP), whereas subline 1 was resistant to many drugs. The patient was treated with a combination of 44 Gy of whole-brain irradiation and a number of cycles of chemotherapy comprised of ADR, VCR, and CPM, followed by CDDP, VCR, and CPM, based on the results of sensitivity testing of the subline 2 cells. As a result, the patient has been disease-free for more than 5 years postoperatively. In conclusion, this case report serves to demonstrate that meticulous combined-modality treatment taking tumor heterogeneity in human cancers into account may be necessary to achieve breakthroughs in current cancer therapy for advanced lung cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

Carcinomatous meningitis secondary to breast cancer: predictors of response to combined modality therapy.

PURPOSE: To identify the factors predictive of response and increased survival in patients with leptomeningeal metastases (LM) from breast cancer receiving multi-modal therapy. BACKGROUND: Leptomeningeal metastases (LM) are being diagnosed with increasing frequency as anti-cancer therapies become more effective and result in prolonged patient survival. PATIENTS AND METHODS: 32 women (range 28 to 74 years; median 49) with LM due to metastatic breast cancer were treated. Neurologic presentation included: cranial neuropathies (10 patients); headache (10); cauda equina syndrome (6); ataxia (6); meningismus (3); radioculopathy (2); myelopathy (2); confusion (2); and seizure (1). All patients underwent radiographic evaluation of the extent of CNS disease followed by radiotherapy (21 women) and intraventricular chemotherapy: (methotrexate 32 women; cytarabine 22; thio-TEPA 11). RESULTS: CNS imaging (cranial MR, spine MR and radionuclide ventriculography) demonstrated: interrupted CSF flow (21); subarachnoid nodules (8); parenchymal brain metastases (6); hydrocephalus (4); and epidural spinal cord compression (1). Cytologic responses were seen in 14 women to first-, 7 to second- and 3 to third-line chemotherapy. Treatment-related toxicity included 21 women with aseptic meningitis and 10 women with thrombocytopenia or neutropenia (5 related to intraventricular chemotherapy). Median survival was 7.5 months (range 1.5 to 16), 18 women died of progressive LM or combined LM and systemic disease progression. Women with persistent interruption of CSF flow fared worse than women with normal CSF flow (median survival 3 versus 10 months; p < 0.0001). CONCLUSION: LM in women with metastatic breast cancer may be palliated with combined modality therapy, however, success of therapy and survival is based upon pre-treatment CNS extent of disease evaluation.

Adult↗
PubMedDate not supplied

Results of combined-modality therapy for primary and secondary malignant lymphoma of the central nervous system (CNS).

PURPOSE: We consider that whatever the vital prognosis of secondary CNS lymphoma (SCNSL), its local control is as serious as that of primary CNS lymphoma (PCNSL). In this study, both the treatment outcomes and local control of patients with SCNSL and PCNSL were compared, with the aim of improving the treatment of SCNSL. MATERIALS AND METHODS: This study included 11 patients with PCNSL and 14 with SCNSL treated from January 1984 to October 1997. PCNSL patients underwent partial tumor resection and received systemic chemotherapy. All SCNSL patients received systemic chemotherapy, and eight also received intrathecal anticancer drug infusion. Nine PCNSL patients and 11 SCNSL patients underwent whole-brain radiation therapy with 4-MV photons. Among the SCNSL patients, three patients underwent localized-brain irradiation and two patients also received whole-spine irradiation. RESULTS: Five-year survival rates were 34% for PCNSL and 33% for SCNSL. In SCNSL, survival times after CNS involvement were very short, irrespective of treatment. One-year local control rates after CNS irradiation were 38% for PCNSL and 14% for SCNSL. Recurrence was mainly found in the cranial region, in seven of 11 PCNSL patients and 10 of 14 SCNSL patients. CONCLUSIONS: Patients with SCNSL had a poor prognosis, and local control in them was more problematic than in patients with PCNSL. It is necessary to develop new combined modality therapy for patients with SCNSL,including the participation of a radiation oncologist, before the disease becomes progressive.

Adult↗
PubMed2001

Effectiveness of combining plasma exchange and continuous hemodiafiltration (combined modality therapy in a parallel circuit) in the treatment of patients with acute hepatic failure.

Plasma exchange has gained widespread acceptance as an effective mode of blood purification in patients suffering from acute hepatic failure. However, it is still undetermined whether a single use of plasma exchange is capable of removing inflammatory cytokines completely or of preventing the development of citrate toxicity inherent with fresh frozen plasma. To clarify these issues we developed combined plasma exchange and continuous hemodiafiltration (CHDF) modality in which CHDF is performed in an opposite direction to plasma exchange. This study was designed to assess the effectiveness of combined modality therapy. Fifteen patients with acute hepatic failure were treated with plasma exchange (plasma exchange group) or plasma exchange and CHDF (plasma exchange + CHDF group), and various biochemical parameters were determined before and after treatment. Although citrate levels increased significantly after treatment compared with pretreatment levels in both the plasma exchange group and the plasma exchange + CHDF group, the percentage of the increase in citrate levels was significantly higher in the plasma exchange group than in the plasma exchange + CHDF group. Bilirubin levels were significantly lower after treatment in both the plasma exchange and plasma exchange + CHDF groups. There were no significant differences in tumor necrosis factor-alpha levels before and after treatment in the plasma exchange group, but they were significantly lower after treatment in the plasma exchange + CHDF group. Interleukin-6 (IL-6) levels increased significantly after treatment in the plasma exchange group, but there were no significant differences in the IL-6 levels before and after treatment in the plasma exchange + CHDF group. Interleukin-8 levels increased significantly after treatment in the plasma exchange group while decreasing significantly after treatment in the plasma exchange + CHDF group. These results indicate that combining plasma exchange and CHDF in a parallel circuit is an effective modality for suppressing the elevation of blood citrate levels and for removing inflammatory cytokines. This finding may have important implications for the development of an effective treatment for patients with acute hepatic failure.

Citrates↗
PubMed1997

Combined modality therapy for early Hodgkin's disease: heterogeneity in Australasian clinical practice.

Two case studies of locally extensive clinical stage IIA Hodgkin's disease (HD) were presented to radiation oncologists at a meeting of the Australasian Radiation Oncology Lymphoma Group, and subsequently to non-attending members who were asked to indicate their recommended treatment. This paper discusses the 25 responses which were notable by considerable heterogeneity in philosophy and detail. There is clearly no consensus among Australasian radiation oncologists at present, although combined modality therapy (CMT) with Adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by low-medium-dose involved field radiotherapy (25-36 Gy) was the most popular response. The literature on radiation dose and chemotherapy in CMT for HD is then reviewed. It seems very likely that low doses in the range of 25-30 Gy (at 1.5-2.0 Gy per fraction) are sufficient. The ABVD should be considered as the 'standard' regimen at present, although the optimal sequencing with radiation and number of cycles remain unknown. The heterogeneity of responses to management of the case studies raises questions about ongoing education processes in radiation and medical oncology. Hypothetical case management review may complement currently proposed methods of assessing continuing medical education.

Adult↗