Chemoradiotherapy in the Management of Locally Advanced Pancreatic Carcinoma: A Qualitative Systematic Review

2009 ◽  
Vol 27 (13) ◽  
pp. 2269-2277 ◽  
Author(s):  
Florence Huguet ◽  
Nicolas Girard ◽  
Clotilde Séblain-El Guerche ◽  
Christophe Hennequin ◽  
Françoise Mornex ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Carcinoma ◽  
Induction Chemotherapy ◽  
Randomized Trials ◽  
Locally Advanced ◽  
Phase Iii ◽  
Level Of Evidence ◽  
Qualitative Systematic Review ◽  
Survival Level

PurposePancreatic carcinoma is one of the leading causes of cancer-related mortality. At time of diagnosis, 30% of patients present with a locally advanced unresectable but nonmetastatic pancreatic carcinoma (LAPC). The French program Standards, Options, and Recommendations was promoted to conduct a qualitative systematic review to evaluate the role of radiotherapy in patients with LAPC.MethodsA search to identify eligible studies was undertaken using the MEDLINE database. All phase III randomized trials and systematic reviews evaluating the role of radiotherapy in LAPC were included, together with some noncontrolled studies if no phase III trials were retrieved. The quality and clinical relevance of the studies were evaluated using validated checklists, which allowed associating each result with a level of evidence.ResultsTwenty-one studies were included, as follows: two meta-analyses, 13 randomized trials, and six nonrandomized trials. Chemoradiotherapy increases overall survival when compared with best supportive care (level of evidence C) or with exclusive radiotherapy (level B1), but is more toxic (level B1). Chemoradiotherapy is not superior to chemotherapy in terms of survival (level B1) and increases toxicity (level A). Recent data favor limited irradiation to the tumor volume (level C). Fluorouracil is still the reference chemotherapy in association with radiotherapy (level B1). Induction chemotherapy before chemoradiotherapy improves survival (level C).ConclusionNo standard treatment exists, but there are two options for treatment of LAPC; these are gemcitabine-based chemotherapy and chemoradiotherapy. Induction chemotherapy followed by a chemoradiotherapy is a promising strategy for selection of patients without early metastatic/progressing disease.

Induction Chemotherapy for Head and Neck Cancer: Will History Repeat Itself?

2005 ◽  
Vol 3 (3) ◽  
pp. 393-403 ◽  
Author(s):  
Athanassios Argiris
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Induction Chemotherapy ◽  
Neck Cancer ◽  
Randomized Trials ◽  
Concurrent Chemoradiotherapy ◽  
Objective Response ◽  
Locally Advanced ◽  
Multidisciplinary Teams

Locally advanced squamous cell head and neck cancer remains a therapeutic challenge for multidisciplinary teams. Despite high objective response rates, induction chemotherapy has not resulted in tangible benefit in multiple randomized trials. In recent years, as most evidence solidified the role of concurrent chemotherapy and radiation as either primary or postoperative therapy for locally advanced head and neck cancer, induction chemotherapy fell out of scope and practice. The failure of older randomized trials to show a survival benefit from induction chemotherapy can be attributed to several factors. It is possible that the predominance of locoregional failure did not allow any added benefit from better systemic control to translate into a survival advantage. Alternatively, seemingly active chemotherapy regimens may have been suboptimal. Nevertheless, recent developments have altered our perception of head and neck cancer and its treatment. Locoregional control has dramatically improved with concurrent chemoradiotherapy. Of note is that none of the previously conducted randomized trials of induction chemotherapy used concurrent chemoradiotherapy in the control arm. Moreover, we witnessed the development of better combination regimens that improved efficacy in the induction setting. The previously standard cisplatin/5-fluoruracil (5-FU) combination is being replaced by the triple combination of taxane/cisplatin/5-FU. Randomized trials showed that increased activity with the triplet regimen resulted in improved long-term disease control and survival. Finally, cetuximab, an active epidermal growth factor receptor inhibitor, is entering clinical practice and is expected to change the standard of therapy. With the emergence of more efficacious systemic therapies, the role of induction therapy warrants reevaluation. A number of randomized trials are planned or currently ongoing to investigate concurrent chemoradiotherapy with or without induction. These trials are anticipated to redefine the role of induction chemotherapy for head and neck cancer.

scholarly journals Role of induction chemotherapy in locally advanced T4b oral cavity cancers: A single Institute experience

2017 ◽  
Vol 28 ◽  
pp. v385
Author(s):  
K.N. Lokesh ◽  
T. Chaudhuri ◽  
K.C. Lakshmaiah ◽  
G. Babu ◽  
D. Lokanatha ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Induction Chemotherapy ◽  
Locally Advanced ◽  
Oral Cavity Cancers

A systematic review and meta-analysis of observational evidence for the use of bailout self-expandable stents following failed anterior circulation stroke thrombectomy

2018 ◽  
Vol 11 (7) ◽  
pp. 675-682 ◽  
Author(s):  
James Wareham ◽  
Richard Flood ◽  
Kevin Phan ◽  
Robert Crossley ◽  
Alex Mortimer
Keyword(s):  
Systematic Review ◽  
Scale Score ◽  
Rescue Therapy ◽  
Meta Analysis ◽  
Technical Failure ◽  
Anterior Circulation ◽  
Level Of Evidence ◽  
Stent Deployment ◽  
Symptomatic Intracerebral Hemorrhage

BackgroundThe crucial role of thrombectomy in the management of emergent large vessel occlusive stroke is not disputed but there is a technical failure rate in a significant minority of patients whose outcomes are often poor. Our objective was to perform a systematic review and meta-analysis to assess the safety and efficacy of permanent self-expandable stent deployment as a bailout procedure in cases of failed anterior circulation thrombectomy.MethodsTwo independent reviewers searched the Pubmed (Medline) database for studies reporting outcomes following failed endovascular thrombectomy with subsequent rescue therapy employing self-expandable stents.ResultsEight studies (one prospective, seven retrospective) originating from Europe, Asia, and America comprising 160 patients met the inclusion criteria. Estimated baseline National Institutes of Health Stroke Scale score was 17.1 (95% CI 15.7 to 18.4). Following failed thrombetcomy and stent deployment, the rate of favorable outcome (modified Rankin Scale score 0–2) was 43% (95% CI 34% to 53%). Pooled mortality was 21% (95% CI 13% to 33%). Successful recanalization (Thrombolysis in Cerebral Infarction (TICI) 2b–3 or Thrombolysis in Myocardial Infarction (TIMI) 2–3) was 71% (95% CI 63% to 77%). Symptomatic intracerebral hemorrhage was seen in 12% (95% CI 7% to 18%). The Solitaire stent (Medtronic) was the most commonly deployed stent following failed thrombectomy attempts (66%; 95% CI 31% to 89%). Pre- or post-stent angioplasty was performed in 39%of patients (95% CI 29% to 48%). Glycoprotein IIb/IIIa inhibitors were used in 89% (95% CI 71% to 97%). 95% of patients received postprocedural antiplatelet therapy.ConclusionA rescue stent procedure seems reasonable as a last resort following failed thrombectomy but currently the level of evidence is limited. Prospective registries may aid in guiding future recommendations.

Phase I Trial of Escalating-Dose Irinotecan Given Weekly With Cisplatin and Concurrent Radiotherapy in Locally Advanced Esophageal Cancer

2003 ◽  
Vol 21 (15) ◽  
pp. 2926-2932 ◽  
Author(s):  
David H. Ilson ◽  
Manjit Bains ◽  
David P. Kelsen ◽  
Eileen O’Reilly ◽  
Martin Karpeh ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Phase I ◽  
Induction Chemotherapy ◽  
Phase Ii ◽  
Phase I Trial ◽  
Locally Advanced ◽  
Phase Iii ◽  
Concurrent Radiotherapy ◽  
Minimal Toxicity ◽  
Grade 3

Purpose: To identify the maximum-tolerated dose and dose-limiting toxicity (DLT) of weekly irinotecan combined with cisplatin and radiation in esophageal cancer. Patients and Methods: Nineteen patients with clinical stage II to III esophageal squamous cell or adenocarcinoma were treated on this phase I trial. Induction chemotherapy with weekly cisplatin 30 mg/m2 and irinotecan 65 mg/m2 was administered for four treatments during weeks 1 to 5. Radiotherapy was delivered weeks 8 to 13 in 1.8-Gy daily fractions to a dose of 50.4 Gy. Cisplatin 30 mg/m2 and escalating-dose irinotecan (40, 50, 65, and 80 mg/m2) were administered on days 1, 8, 22, and 29 of radiotherapy. DLT was defined as a 2-week delay in radiotherapy for grade 3 to 4 toxicity. Results: Minimal toxicity was observed during chemoradiotherapy, with no grade 3 or 4 esophagitis, diarrhea, or stomatitis. DLT caused by myelosuppression was seen in two of six patients treated at the 80-mg/m2 dose level, thus irinotecan 65 mg/m2 was defined as the recommended phase II dose. Dysphagia improved or resolved after induction chemotherapy in 13 (81%) of 16 patients who reported dysphagia before therapy. Only one patient (5%) required a feeding tube. Six complete responses (32%) were observed, including four pathologic complete responses in 15 patients selected to undergo surgery (27%). Conclusion: Cisplatin, irinotecan, and concurrent radiotherapy can be administered on a convenient schedule with relatively minimal toxicity and an acceptable rate of complete response in esophageal cancer. Further phase II evaluation of this regimen is ongoing. A phase III comparison to fluorouracil or taxane-containing chemoradiotherapy should be considered.

scholarly journals Systematic Review of Radiofrequency Ablation and Pulsed Radiofrequency for Management of Cervicogenic Headache

2015 ◽  
Vol 2;18 (2;3) ◽  
pp. E109-E130
Author(s):  
Amit Asopa
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Randomized Trials ◽  
Primary Outcome ◽  
Cervicogenic Headache ◽  
Pulsed Radiofrequency ◽  
Rf Ablation ◽  
High Quality ◽  
Level Of Evidence

Background: Cervicogenic headache is a secondary headache that has a source in the upper cervical spine. There is a small but growing body of evidence to establish effectiveness of radiofrequency (RF) neurotomy, and the pulsed RF (PRF) procedure for management of cervicogenic headache. Objective: To investigate the clinical utility of RF neurotomy, and PRF ablation for the management of cervicogenic headache. Study Design: Systematic review. Methods: The review included relevant literature identified through searches of PubMed, Cochrane, Clinical trials, U.S. National Guideline Clearinghouse and EMBASE from 1960 to January 2014.The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria for randomized control trials and the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and poor based on the quality of evidence. Outcomes Measured: The primary outcome measures were reduction in pain scores and improvement in quality of life. Results: The primary outcome measures were headache relief and improved quality of life. Twenty five studies were identified for full text review of these, 9 studies met inclusion criteria. There were 5 non-randomized, among them 4/5 were of moderate quality, 3/5 showed RF ablation and 1/5 showed PRF as an effective intervention for cervicogenic headache. There were 4 randomized trials among them 2/4 were of high quality, 3/4 investigated RF ablation as an intervention for CHA, 1/4 investigated PRF ablation as an intervention for CHA and none of the randomized studies showed strong evidence for RF and PRF ablation as an effective intervention for CHA. Limitations: In the selected studies there were inconsistencies between randomized trials, flaws in trial design, and gaps in the chain of evidence. Conclusion: There is limited evidence to support RF ablation for management of CHA as there are no high quality RCTs and/ or multiple consistent non-RCTs without methodological flaws. There is poor evidence to support PRF for CHA as there are no high quality RCTs or Non-RCTs. Key Words: Chronic pain, cervicogenic headache, radiofrequency (rf) neurotomy, pulsed radiofrequency (PRF) ablation, reduction in pain, improvement in quality of life, level of evidence

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