Combined therapies for squamous-cell carcinoma of the esophagus, a Southwest Oncology Group Study (SWOG-8037).

1987 ◽  
Vol 5 (4) ◽  
pp. 622-628 ◽  
Author(s):  
E Poplin ◽  
T Fleming ◽  
L Leichman ◽  
H G Seydel ◽  
Z Steiger ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Progressive Disease ◽  
Residual Disease ◽  
Combined Modality Therapy ◽  
Initial Therapy ◽  
Combined Modality Treatment ◽  
Aggressive Approach ◽  
Carcinoma Of The Esophagus ◽  
Combined Modality ◽  
Gi Symptoms

Conservative treatment of esophageal cancer with radiation therapy has afforded few long-term survivors. In order to improve outcome, patients with locoregional disease were treated using a combined modality approach. Patients were treated with chemotherapy consisting of a 96-hour continuous infusion of 5-fluorouracil (5-FU), 1,000 mg/m2/d, days 1 to 4 and days 29 to 32; cisplatin 75 mg/m2, day 1 and 29; and radiation 3,000 rad, days 1 to 19. In the absence of progressive disease, patients underwent esophagectomy. One hundred twenty-eight patients were registered of whom 113 were eligible and 106 were evaluable. Toxicity included gastrointestinal (GI) symptoms, mucositis, and myelosuppression. One hundred two patients completed chemoradiotherapy. Following its completion, 11 patients refused surgery, six were considered poor surgical risks, and 14 had progressive disease. Of the remaining 71 patients, 16 had unresectable disease, 13 had residual disease which was incompletely resected, 24 had disease which could be completely resected, and 18 were without disease on pathologic examination. The overall operability rate was 63% and the overall resectability rate, 49%. Surgical mortality was 11%. Eighty-nine of 113 eligible patients have died, with a median survival of 12 months and a 2-year survival of 28%. The median postsurgical survival for all 71 patients was 14 months and was 32 months for those patients attaining complete remission (CR). Combined modality therapy remains an investigational approach. Attempts should be directed at increasing response rate to initial therapy. A randomized comparison between combined modality treatment and radiation therapy is necessary to definitively determine the usefulness of this more aggressive approach.

Rapid-fractionation preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for resectable pancreatic adenocarcinoma.

1998 ◽  
Vol 16 (12) ◽  
pp. 3843-3850 ◽  
Author(s):  
P W Pisters ◽  
J L Abbruzzese ◽  
N A Janjan ◽  
K R Cleary ◽  
C Charnsangavej ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Pancreatic Adenocarcinoma ◽  
Combined Modality Therapy ◽  
Pancreatic Head ◽  
Preoperative Chemoradiation ◽  
Intraoperative Radiation Therapy ◽  
Combined Modality Treatment ◽  
Intraoperative Radiation ◽  
Combined Modality ◽  
Grade 3

PURPOSE To evaluate the toxicities, radiographic and pathologic responses, and event-free outcomes with combined modality treatment that involves preoperative rapid-fractionation chemoradiation, pancreaticoduodenectomy, and electron-beam intraoperative radiation therapy (EB-IORT) for patients with resectable pancreatic adenocarcinoma. PATIENTS AND METHODS Patients with radiographically resectable localized adenocarcinoma of the pancreatic head were entered onto a preoperative protocol that consisted of a 2-week course of fluorouracil (5-FU) 300 mg/m2 daily 5 days per week and concomitant rapid-fractionation radiation 30 Gy, 3 Gy daily 5 days per week. Radiographic restaging was performed 4 weeks after chemoradiation, and patients with localized disease underwent pancreaticoduodenectomy with EB-IORT 10 to 15 Gy. RESULTS Thirty-five patients were entered onto the study and completed chemoradiation, 34 (97%) as outpatients. Three patients (9%) experienced grade 3 nausea and vomiting; no other grade 3 or 4 toxicities were observed. Of the 27 patients taken to surgery, 20 patients (74%) underwent pancreaticoduodenectomy with EB-IORT. All patients had a less than grade III pathologic response to preoperative chemoradiation. At a median follow-up of 37 months, the 3-year survival rate in patients who underwent combined modality therapy was 23%. CONCLUSION Combined modality treatment with preoperative rapid-fractionation chemoradiation, pancreaticoduodenectomy, and EB-IORT is associated with minimal toxicity and excellent locoregional control. This represents one approach to maximize the proportion of patients who receive all components of combined modality therapy and avoids the toxicity of pancreaticoduodenectomy in patients found to have metastatic disease at the time of restaging.

scholarly journals Burden of acute toxicities in head-and-neck radiation therapy: A single-institutional experience

2019 ◽  
Vol 08 (02) ◽  
pp. 120-123
Author(s):  
Sandeep Muzumder ◽  
Nirmala Srikantia ◽  
Avinash H. Udayashankar ◽  
Prashanth Bhat Kainthaje ◽  
M. G. John Sebastian
Keyword(s):  
Radiation Therapy ◽  
Supportive Care ◽  
Head And Neck ◽  
Combined Modality Therapy ◽  
Locally Advanced ◽  
Significant Proportion ◽  
Tube Feeding ◽  
Treatment Compliance ◽  
Combined Modality Treatment ◽  
Combined Modality

Abstract Introduction: Combined modality therapy is the standard of care in locally advanced head-and-neck cancer (HNC). The incidence of acute toxicities increases with additional therapy. The present study investigated the incidence and patterns of mucositis, dysphagia, aspiration, feeding tube use, admission for supportive care, and treatment compliance in patients with HNC treated curatively with radiation therapy (RT) with or without chemotherapy. Methods and Material: A retrospective review of 164 consecutive HNC patients treated with RT at St. John's Medical College Hospital, Bengaluru, from January 2013 to June 2017 was done. Results: A total of 148 HNC patients were treated with a curative intent and 122 (82.4%) were locally advanced HNC. Combined Modality treatment was received by 119 (80.4%) patients. Eighty-four (56.7%) patients were treated by concurrent chemo-radiation. IMRT technique was used in 125 (84.5%) patients. The incidence of grade 3-4 mucositis, dysphagia and aspiration was 25%, 46%, and 10%, respectively. Nasogastric tube feeding was necessitated in 18.9% (n=28) and 27% (n = 40) required inpatient admission for supportive care. Twenty-nine (19.6%) patients did not complete planned RT dose and 46 (31%) patients had unscheduled RT break (>2days). Fifty-six (66.7%) patients did not receive planned chemotherapy. Conclusions: Acute toxicity due to RT in HNC remains a challenge despite using modern techniques. A significant proportion of patients require supportive therapy for more than 12 weeks and did not complete the scheduled treatment.

Chiasmatic optic glioma treated with chemotherapy

1985 ◽  
Vol 63 (6) ◽  
pp. 862-866 ◽  
Author(s):  
Jeffrey G. Rosenstock ◽  
Roger J. Packer ◽  
Larissa Bilaniuk ◽  
Derek A. Bruce ◽  
Jerri-Lynne Radcliffe ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Young Children ◽  
Progressive Disease ◽  
Actinomycin D ◽  
Initial Therapy ◽  
Optic Glioma ◽  
Newly Diagnosed ◽  
Content Type ◽  
Novel Approach ◽  
Clinical Stabilization

✓ Chiasmatic optic glioma is a rare tumor with an erratic natural history, usually seen in young children. A prior study from this institution demonstrated that these lesions were frequently lethal, despite initial clinical stabilization following radiation therapy, and that visual, intellectual, and late endocrinological disabilities were prevalent. A novel approach was developed in 1977, when an initial clinical response to vincristine was recorded in a child with a recurrent optic glioma. Since then, all children with recurrent optic glioma and all children aged 6 years old and under with newly diagnosed optic glioma have been offered a program of initial therapy with vincristine and actinomycin D for six cycles over 18 months. The four children with recurrent tumor who were treated with that regimen remain clinically stable 13 to 115 months after chemotherapy. Twelve children (eight under 24 months old) with newly diagnosed optic glioma have been treated with this program, and three are still on therapy. Four developed progression while on therapy, and five remain stable from 1 to 60 months posttherapy. The four children who developed progressive disease have been treated with radiation therapy and remain stable. Six of the 12 children showed shrinkage of their tumor on computerized tomography while receiving chemotherapy. This program may serve as an alternative to initial radiation therapy in young children.

Wilms' Tumor and Neuroblastoma in Children

1984 ◽  
Vol 6 (1) ◽  
pp. 10-19
Author(s):  
Giulio J. D'Angio
Keyword(s):  
Wilms Tumor ◽  
Combined Modality Therapy ◽  
Good Prognosis ◽  
Late Complications ◽  
Combined Modality Treatment ◽  
Malignant Diseases ◽  
Multiple Agent ◽  
Combined Modality ◽  
Cure Rates ◽  
Made In

Major advances have been made in the understanding and management of the malignant diseases of childhood. More than 50% of children with cancer can now be expected to survive five or more years; a few decades ago, most of these patients died within 1 year. These good results have been obtained through the use of combined-modality therapy; that is, the conjoined use of surgery, radiation therapy, and multiple-agent chemotherapy. Wilms' tumor provides a spectacular example (Fig 1). Although achieving higher cure rates, combined-modality treatment is often rigorous, and has its associated early and late complications. The goals of modern pediatric oncology reflect both of these facts. Higher cure rates continue to be sought, but there is a growing recognition that not all patients need maximum treatment. Therapy can now be modulated according to well-defined prognostic factors for most of the malignant conditions. In that way, the most aggressive therapies are reserved for those at highest risk, while those with a good prognosis can be managed less intensively. The objectives of modern management, then, are to cure most patients while at the same time minimizing, as much as possible, the associated deleterious late consequences of successful treatment. wilms' tumor and neuroblastoma serve as good examples to demonstrate the above points.

Combined therapy for stage III-IV head and neck cancer: preliminary results.

1984 ◽  
Vol 2 (7) ◽  
pp. 804-810 ◽  
Author(s):  
S H Krasnow ◽  
M H Cohen ◽  
A Johnston-Early ◽  
M L Citron ◽  
B E Fossieck ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Response Rate ◽  
Combined Modality Therapy ◽  
Combined Therapy ◽  
Stage Iii ◽  
Combined Modality Treatment ◽  
Combined Modality ◽  
Rbc Deformability

As part of a combined modality treatment program using chemotherapy, surgery, and/or radiotherapy, 25 patients with previously untreated stage III or IV head and neck cancer received initial combination chemotherapy. Pathologically confirmed complete remission was noted in nine patients (36%). The overall objective major response rate (with all patients included in analysis) was 68%. The chemotherapy regimen included bleomycin, cisplatin, vinblastine, methotrexate, and 5-fluorouracil. A novel concept of drug scheduling was used, based on chemotherapy-induced improvement in RBC deformability. The underlying concept is that improved RBC deformability results in improved capillary blood flow and thereby, increased drug delivery to tumor cells. Treatment resulted in moderate hematologic and renal toxicity with no treatment-related deaths. This exceptionally high, pathologically confirmed complete response rate will hopefully provide a mechanism by which combined modality therapy can adequately be tested for its ability to prolong survival of patients with advanced head and neck cancer.

Metachronous Skeletal Osteosarcoma in Patients Treated with Adjuvant and Neoadjuvant Chemotherapy for Nonmetastatic Osteosarcoma

2003 ◽  
Vol 21 (2) ◽  
pp. 342-348 ◽  
Author(s):  
LeLe Aung ◽  
Richard Gorlick ◽  
John H. Healey ◽  
Weiji Shi ◽  
Howard T. Thaler ◽  
...  
Keyword(s):  
New York ◽  
Combined Modality Therapy ◽  
Initial Therapy ◽  
Cancer Center ◽  
Small Subset ◽  
High Grade ◽  
Combined Modality ◽  
Individualized Chemotherapy

Purpose: The prognosis for patients who develop metachronous skeletal osteosarcoma (OS) has been considered grave compared with that for patients with relapse limited to the lungs. We investigated the incidence and outcome of metachronous skeletal OS after initial treatment of the primary tumor. Patients and Methods: Twenty-three (median age 18.7 years) of 426 patients with nonmetastatic, high-grade primary OS treated at Memorial Sloan-Kettering Cancer Center (New York, NY) between February 1973 and May 2000 developed metachronous skeletal OS. Initial therapy included combination chemotherapy and surgery. Treatment of subsequent relapses consisted of chemotherapy or radiation alone or surgery with or without additional individualized chemotherapy. Results: The median time from the diagnosis of primary OS to the development of metachronous OS was 1.4 years (range, 0.2 to 11.3 years). Median survival was 1.5 years (95% confidence interval [CI], 0.8 to 6.9 years). Two- and 5-year postmetachronous overall survival was 43.5% (95% CI, 23.2% to 63.7%) and 33% (95% CI, 13% to 53%), respectively. At last follow-up (range, 0.1 to 12.8 years), five (30.4%) patients were alive with no evidence of disease (range, 1.7 to 12.8 years; median, 4.4 years). For 11 patients who developed metachronous OS 24 months or more from initial diagnosis, 5-year postmetachronous survival rate for patients receiving combined modality versus monotherapy was 83% (95% CI, 54% to 100%) and 40% (95% CI, 0% to 83%), respectively. Conclusion: In a small subset of patients who developed late metachronous OS, combined-modality therapy with surgery and aggressive chemotherapy may result in long-term postmetachronous survival. This implies that principles used in treatment of primary OS may be applied to patients with late metachronous skeletal OS.

Combined Modality Treatment With Chemotherapy, Radiation Therapy, Bevacizumab, and Erlotinib in Patients With Locally Advanced Squamous Carcinoma of the Head and Neck

2011 ◽  
Vol 17 (5) ◽  
pp. 267-272 ◽  
Author(s):  
John D. Hainsworth ◽  
David R. Spigel ◽  
F. Anthony Greco ◽  
Dianna L. Shipley ◽  
James Peyton ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Locally Advanced ◽  
Squamous Carcinoma ◽  
Combined Modality Treatment ◽  
Combined Modality

Paclitaxel in combination chemotherapy with radiotherapy in patients with unresectable stage III non-small-cell lung cancer.

1996 ◽  
Vol 14 (5) ◽  
pp. 1642-1648 ◽  
Author(s):  
F A Greco ◽  
S L Stroup ◽  
J R Gray ◽  
J D Hainsworth
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Combined Modality Therapy ◽  
Small Cell ◽  
Stage Iii ◽  
Small Cell Lung ◽  
Combined Modality ◽  
Grade 3

PURPOSE The addition of combination chemotherapy to standard radiation therapy has improved treatment for locally unresectable non-small-cell lung cancer. In this phase II study, we evaluated the toxicity and efficacy of a novel chemotherapy regimen that included paclitaxel, cisplatin, and etoposide plus concurrent radiation therapy in this group of patients. PATIENTS AND METHODS Thirty-three patients with previously untreated, unresectable stage III non-small-cell lung cancer (stage IIIA, 11 patients; stage IIIB, 22 patients) initially received two courses of chemotherapy, which included paclitaxel 135 mg/m2 by 1-hour infusion on day 1, cisplatin 60 mg/m/ intravenously (i.v.) on day 2, and etoposide 100 mg/m2 i.v. on days 1, 2 and 3. On week 6, radiation therapy (60 Gy in 30 fractions) was initiated in conjunction with two additional courses of chemotherapy: paclitaxel 135 mg/m2 i.v. by 1-hour infusion on day 1, cisplatin 5 mg/m2 i.v. on days 2- to 10, and etoposide 25 mg/m2 on days 1 to 10. RESULTS This combined modality program was feasible and well tolerated by most patients. During the two courses of induction chemotherapy, grade 3 or 4 myelosuppression occurred in only six patients (18%). Esophagitis was common during combined modality therapy (grade 3, 10 patients; grade 4 five patients). Forty-two percent of patients had partial response after two courses of induction therapy, and 82% of patients had an objective response at completion of therapy. Twelve patients (36%) had a complete response. Nineteen patients remain progression-free at a median of 8 months; the median survival time has not been reached. CONCLUSION This paclitaxel-containing combined modality therapy is feasible and highly active in patients with inoperable stage III lung cancer. Esophagitis is the most common severe toxicity with this program. Further studies with paclitaxel-containing combination regimens in patients with stage III non-small-cell lung cancer are indicated.

Involved node radiation therapy in the combined modality treatment for early-stage Hodgkin lymphoma: Analysis of relapse location and long-term outcome

2020 ◽  
Vol 150 ◽  
pp. 236-244
Author(s):  
Karin Nielsen ◽  
Maja Vestmoe Maraldo ◽  
Anne Kiil Berthelsen ◽  
Annika Loft ◽  
Peter de Nully Brown ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Hodgkin Lymphoma ◽  
Early Stage ◽  
Combined Modality Treatment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Combined Modality

Combined-modality treatment of osteogenic sarcoma of the skull

1985 ◽  
Vol 63 (4) ◽  
pp. 562-567 ◽  
Author(s):  
Narayan Sundaresan ◽  
Andrew G. Huvos ◽  
Gerald Rosen ◽  
Joseph H. Galicich
Keyword(s):  
De Novo ◽  
Osteogenic Sarcoma ◽  
Surgical Excision ◽  
Combined Modality Treatment ◽  
Aggressive Approach ◽  
Content Type ◽  
Combined Modality ◽  
Additional Surgery ◽  
Long Term Survivors

✓ The authors present the results of combined-modality treatment in eight patients with osteosarcoma of the skull. Six patients had de novo tumors, and two others had secondary sarcomas resulting from malignant transformation in Paget's disease. Wide surgical excision and combination chemotherapy were used in seven patients, and surgery and radiation therapy were employed in one case. Following chemotherapy, six patients underwent additional surgery. This aggressive approach resulted in four long-term survivors among the patients with de novo tumors. These data suggest that surgery in combination with chemotherapy provides the best potential for long-term disease control in patients with osteosarcoma of the skull.

Sign in / Sign up

Export Citation Format

Share Document