Laryngeal preservation in cases of advanced laryngeal cancer treated with platinum based induction chemotherapy befire local treatment

1991 ◽  
Vol 105 (11) ◽  
pp. 930-933 ◽  
Author(s):  
A. Nikolaou ◽  
G. Fountzilas ◽  
P. Kosmidis ◽  
C. Banis ◽  
K. Sobolos ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Induction Chemotherapy ◽  
Laryngeal Cancer ◽  
Performance Status ◽  
Locally Advanced ◽  
Local Treatment ◽  
Locoregional Treatment ◽  
Large Groups ◽  
Disease Free

AbstractIn this study we analyse our preliminary results after treating 28 patients with locally advanced laryngeal cancer with platinum based induction chemotherapy followed by radiation therapy or surgery.The median age of our patients was 60 (46–75) years and median performance status was 80 (60–100). In 18 of the 28 patients locoregional treatment was radiation therapy with an overall response of 94.4 per cent.After a median follow-up of 26 (15–40) months 39.3 per cent of the whole group of patients are alive and disease-free and six (21.4 per cent) patients are alive and disease-free preserving their larynx.We conclude that although more extensive studies with large groups of patients and longer follow-up is needed to reach definite conclusions, it seems that platinum based induction chemotheraophy can be used successfully in locally advanced laryngeal cancer followed by radiotherapy. In those cases who respond well. the patient's larynx is preserved without compromizing the overall survival.

Childhood nasopharyngeal carcinoma: A 4-year single institution experience

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 9069-9069
Author(s):  
A. A. Patel ◽  
P. M. Shah ◽  
K. M. Patel ◽  
S. N. Shukla ◽  
B. J. Parikh ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Complete Remission ◽  
Induction Chemotherapy ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Disease Extent ◽  
Free Survival ◽  
Major Response ◽  
Disease Free

9069 Background: Pediatric nasopharyngeal carcinoma (PNC) represents a locally advanced undifferentiated tumor. In this study, clinical experience and therapeutic results of 24 children with newly diagnosed PNC, treated in a single oncology institution in India over a period of 5 years, are analyzed. Methods: 24 patients (23 males and 1 female) 7–14 years old (median = 12) from Jan 2000 to Sep 2005 with PNC were retrospectively evaluated. 18/24 patients were evaluable. 16 patients received induction chemotherapy followed by radiotherapy while 1 patient was offered concurrent chemoradiotherapy, 1 patient received radiotherapy alone. 15/16 patients received postradiation chemotherapy. The agents used in induction and adjuvant therapy were cisplatin (100 mg/m2) on day 1 and 5-fluorouracil 750 mg/m2 for 5 days. The dose of radiotherapy used was 60 gray in 30 fractions. Results: The time of onset of symptoms to diagnosis ranged from 1 month to 9 months with a median of 5.5 months. Histopathology was lymphoepithelioma in 5 patients (27.7%) while 13 patients (72.2%) had poorly differentiated carcinoma. Disease extent was T2 (n = 7), T3 (n = 6), and T4 (n = 5); N1 (n = 5), N2 (n = 7), and N3 (n = 5). 7 patients had intracranial invasion. None had metastatic disease on presentation. 13 patients (72.2%) achieved major response which included 7 (38.8%) complete remission and 6 (33.3%) partial remission after the induction chemotherapy and radiotherapy. 4 (22.2%) had progressive disease. Another 3 (16.6%) attained complete remission after post radiation chemotherapy which consisted of two cycles of cisplatin and 5-flourouracil. The follow up ranged from 5 months to 84 months with a median follow up of 35 months. The disease free survival ranged from 10 months to 53 months with a median of 33 months. The patients who had a better response to induction chemotherapy had a better disease free survival. Out of 7 patients who attained complete remission 2 relapsed with a median time to first relapse of 9.5 months. Toxicity to therapy was modest. Only one patient had grade 4 neutropenia and mucositis. There was no therapy related mortality. Conclusion: Chemoradiotherapy for nasopharyngeal carcinoma in children is an effective treatment modality with minimal toxicity. No significant financial relationships to disclose.

Induction chemotherapy + gefitinib followed by concurrent chemotherapy/radiation therapy/gefitinib for patients (pts) with locally advanced squamous carcinoma of the head and neck: A phase I/II trial of the Minnie Pearl Cancer Research Network

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 5543-5543 ◽  
Author(s):  
H. H. Doss ◽  
F. A. Greco ◽  
A. A. Meluch ◽  
J. R. Gray ◽  
D. R. Spigel ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Induction Chemotherapy ◽  
Combined Modality Therapy ◽  
Locally Advanced ◽  
Squamous Carcinoma ◽  
Concurrent Chemotherapy ◽  
Combined Modality ◽  
Grade 3

5543 Background: Concurrent chemotherapy/radiation therapy (RT) improves treatment outcome in pts with locally advanced unresectable squamous cancers of the head and neck. We previously reported a 51% 3-year disease-free survival with induction paclitaxel/carboplatin/5-FU followed by concurrent paclitaxel/carboplatin/RT. In this phase II trial, we added gefitinib, an EGFR inhibitor, to a similar chemoradiation regimen. Methods: All pts had squamous carcinoma of the head and neck, with at least one of the following: N1-N3 disease, T3 or T4 primary lesion, nasopharynx primary (except T1N0M0). Additional eligibility: no previous therapy, ECOG PS 0 or 1, adequate bone marrow, kidney, liver function; informed consent. All pts received initial docetaxel 60mg/m2 D1, 22; carboplatin AUC 5.0 D1, 22; 5-FU 200mg/m2, 24-hour CI, D1–43; gefitinib 250mg PO qd, D1–43. Beginning week 8, pts received RT, 1.8Gy single daily dose to total 68.4 Gy, and concurrent docetaxel 20mg/m2 weekly × 6 doses + gefitinib 250mg PO daily. At completion of therapy, pts were reevaluated with CT scans and endoscopy. Results: 45 pts entered this trial between 8/04 and 8/05. Pertinent clinical characteristics: clinical T3/T4, 17; N2/N3, 23. 42 pts (93%) completed induction chemotherapy. 34 pts (76%) have completed combined modality therapy and have been restaged. Response to treatment: 11 CR (32%); 18 PR (53%); 5 stable/progression (15%). After median follow-up 7 months, 9 patients (20%) have developed progressive cancer. Actuarial PFS and OS at 1 year are 68% and 86%, respectively. Grade 3/4 myelosuppression was common, and grade 3/4 mucositis occurred in all pts during combined modality therapy. One pt had a treatment-related death during combined modality therapy. The addition of gefitinib did not substantially increase toxicity. Conclusions: This combined modality regimen was feasible and produced high response rates in pts with locally advanced head and neck cancer. Toxicity was consistent with other effective combined modality regimens for these pts. Further follow-up is needed to better assess the benefit of this approach. [Table: see text]

Definitive concurrent chemoradiation versus laryngectomy and postoperative radiation using IMRT in locally advanced laryngeal cancer: experience from a regional cancer centre of Eastern India

2020 ◽  
pp. 1-7 ◽  
Author(s):  
Subhadip Das ◽  
Debarshi Lahiri ◽  
Aniruddha Dam ◽  
Tapas Maji ◽  
Sanjoy Roy ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Laryngeal Cancer ◽  
Organs At Risk ◽  
Locally Advanced ◽  
Concurrent Chemotherapy ◽  
Concurrent Chemoradiation ◽  
Adjuvant Radiation ◽  
Low Grade ◽  
Weekly Cisplatin

Abstract Introduction: For patients with locally advanced laryngeal cancer, two main treatment options are either up-front surgery [total laryngectomy (TL)] followed by postoperative adjuvant radiation therapy (RT) or definitive concurrent chemoradiation (CCRT) with surgery retained as salvage. The objectives were to study the feasibility of CCRT using intensity-modulated radiation therapy (IMRT) in locally advanced laryngeal cancer with respect to response, toxicities, and quality of life (QoL) and comparison with other modality—TL with post-operative RT. Material and Methods: The records of 48 patients with locally advanced laryngeal cancer (T3/T4aN0-2), registered between years 2014 and 2017, treated with IMRT (definitive or adjuvant postoperative IMRT) were analysed from the hospital database. The patients received RT either as definitive CCRT or as adjuvant treatment after TL. RT in all patients was delivered with IMRT-SIB(simultaneous integrated boost) technique and concurrent chemotherapy with weekly cisplatin. The response was assessed at 12 weeks. Toxicities and QoL were assessed and compared between patients receiving definitive CCRT and adjuvant RT. Results: 92·3% patients who received definitive CCRT achieved complete response. Toxicities were of low grade in patients receiving both definitive and adjuvant treatments. All the patients (except two partial responders of CCRT) remained disease-free at the last follow-up. At 2 years of follow-up of each patient—Global QoL, emotional and social functioning were better in definitive CCRT patients. Laryngectomy patients had more dyspnoea, insomnia and financial difficulties. Although the problems of dry mouth, sticky saliva and swallowing were comparable, laryngectomy patients faced more problems with speech, senses, social eating, social contact and cough. Conclusions: Definitive CCRT using IMRT-SIB with weekly cisplatin is a feasible option for patients of locally advanced laryngeal cancer with acceptable response rate. IMRT yields better toxicity outcomes with sparing of organs at risk. CCRT patients have better QoL than laryngectomy patients in several parameters.

Resection and surgically targeted radiation therapy for locally recurrent GBM.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 2054-2054
Author(s):  
David Brachman ◽  
Peter Nakaji ◽  
Kris Smith ◽  
Theresa Thomas ◽  
Christopher Dardis ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Local Control ◽  
Local Treatment ◽  
Post Hoc Analysis ◽  
Locally Recurrent ◽  
Targeted Radiation Therapy ◽  
Post Hoc ◽  
Recurrent Gbm

2054 Background: Recurrent GBM (rGBM) is a diffuse disease, and resection (R) alone does not provide durable local control (LC) or prolong overall survival (OS). Hypothesizing R plus immediate radiation (RT) may achieve durable LC and secondarily improve OS by permitting time for subsequent potentially effective but biologically slower treatments to have an impact, we prospectively evaluated R combined with a novel surgically targeted radiation therapy (STaRT) device utilizing Cs-131 embedded in bioresorbable collagen tiles. Methods: From 2/13-2/18 patients (pts) with locally recurrent GBM were treated on a prospective single arm trial (ClinicalTrials.gov, NCT#03088579) of maximum safe resection and immediate RT (GammaTile, GT Medical Technologies, Tempe AZ). Upon resection the at-risk areas of the surgical bed were lined with the GammaTile (GT) device, delivering 60-80 Gy at 5 mm. Follow up treatments were not specified but captured; no pt. underwent additional local therapy without progression, and no pt. was lost to follow up. We present study specified endpoints of local control (LC), overall survival (OS), and adverse events (AE), and a post hoc, hypothesis-generating analysis of outcomes by receipt of systemic (Sys) therapy. Results: 28 locally recurrent GBM were treated, 20 at first progression (range 1-3). Median age was 58 years (yrs.) (range 21-80), KPS 80 (60-100), female: male ratio 10:18 (36/64%). MGMT was methylated in 11%, unmethylated in 18%, and unknown in 71%. For all pts., median OS was 10.7 months (mo.) (range.1-42.3), and radiographic LC was 8.8 mo. (range.01-34.5). LC (defined as < 15 mm from surgical bed) was maintained in 50% of pts., and no first failure was local. 12 mo. OS was 75% for pts. < 50 yrs. vs. 43% for > 50 yrs. (HR.46, p =.009). MGMT, KPS, and sex were non-predictive. After R+GT, 17 pts. received > 1 cycle of systemic therapy (Sys), either as adjuvant or salvage, alone or in combination . Sys was bevacizumab (BEV) in 15 pts., temozolomide (TMZ) in 12, and lomustine (CCNU) in 8 (N > 17 as some pts. received > 1 Sys). Post hoc analysis disclosed a 15.1 mo. OS for pts. receiving > 1 cycle of Sys (Sys+, N = 17) vs. 6.5 mo. for no Sys (Sys-, N = 11) (hazard ratio (HR).38, p =.017)). LC was 11.4 mo. for Sys+ and 2.1 mo. for Sys- (HR.44; p =.16)). Median OS (mo.) for BEV+ vs. BEV- was 16.7/4.5 (HR.38, p =.017), for TMZ+ vs. TMZ- 17.5/6.7 (HR.40, p =.025) and for CCNU+ vs. CCNU- 17.5/7.9 (HR.61, p =.25), respectively. Three attributed AE occurred, 1 dehiscence requiring surgery and 2 radiation brain effects, medically treated. 4 unrelated deaths occurred < 60 days post-op, all in the Sys- cohort, impacting their opportunity for subsequent treatment. Conclusions: In this study local treatment alone was insufficient to achieve prolonged OS. Post hoc analysis suggests R+GT coupled with Sys may have potential to impact OS in rGBM patients. GT was FDA cleared in 2020 for use in newly diagnosed malignant and all recurrent intracranial neoplasms. Clinical trial information: NCT#03088579.

Pre-irradiation chemotherapy for infants and children with medulloblastoma: a preliminary report

1989 ◽  
Vol 71 (6) ◽  
pp. 820-826 ◽  
Author(s):  
Cynthia S. Kretschmar ◽  
Nancy J. Tarbell ◽  
William Kupsky ◽  
Beverly L. Lavally ◽  
Jay S. Loeffler ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
High Risk ◽  
Complete Response ◽  
Drug Regimen ◽  
Direct Evaluation ◽  
Term Survival ◽  
Content Type ◽  
Disease Free

✓ From March, 1984, through June, 1987, 21 newly diagnosed children with high-risk medulloblastoma (Chang Stage T3 to T4) were treated on a 9-week postoperative, pre-irradiation chemotherapy regimen consisting of vincristine and cisplatin. The children over 2 years old then received radiation therapy. Six infants (aged 6 to 18 months) were maintained on chemotherapy consisting of MOP (nitrogen mustard, vincristine, and procarbazine) until the age of 2 years, at which time they were referred for irradiation. Of 13 children with measurable disease following surgery, five showed a definite response on computerized tomography scans to vincristine and cisplatin (one complete response and four partial responses) and five others showed clear marginal responses. Four of the six infants were disease-free at 19, 32, 35, and 57 months from diagnosis. One infant developed progressive disease at the completion of the vincristine and cisplatin course, and a second infant had progression during MOP administration. Three of the 21 children developed hearing loss within the speech frequencies during cisplatin treatments, but there were no other major toxicities. Fifteen children remained disease-free with a median follow-up period of 35 months (range 19 to 57 months). Chemotherapy given between surgery and radiotherapy may allow for the direct evaluation of a specific drug regimen and permit the postponement of radiation therapy in infants. Pre-irradiation vincristine and cisplatin was well tolerated and effective in shrinking the tumor in most children with medulloblastoma. Such chemotherapy regimens have the potential for extending long-term survival in high-risk children.

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