Clinical outcomes of elective nodal irradiation (ENI) compared with involved field radiotherapy (IFRT) in NSCLC

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 7541-7541
Author(s):  
A. Fernandes ◽  
J. Faerber ◽  
J. Finlay ◽  
J. Shen ◽  
L. Lin ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Clinical Outcomes ◽  
Locally Advanced ◽  
Stage Iv ◽  
Local Relapse ◽  
Local Failure ◽  
Failure Rates ◽  
Definitive Radiotherapy ◽  
Involved Field ◽  
Nodal Failure

7541 Background: Local failure rates in patients treated with definitive radiotherapy for non-small cell lung cancer (NSCLC) remain high. IFRT allows higher radiation doses to the primary tumor with the goal of reducing local failure rates while minimizing toxicity. This approach, however, raises concern for increased nodal failures. Our retrospective analysis evaluates clinical outcomes of patients treated at our institution with ENI or IFRT. Methods: We assessed all patients (pts) with stage III locally advanced or stage IV oligometastatic NSCLC treated with definitive radiotherapy (RT) from January 1, 2003 to August 21, 2008. The decision to treat with ENI vs. IFRT was based on physician treatment philosophy. We compared baseline demographics in each group as well as toxicities and therapeutic outcomes. Involved nodal failures (INF) were defined as radiographic progression in lymph nodes that were initially involved at the time of treatment. Elective nodal failures (ENF) were defined as progression in initially uninvolved lymph nodes. Results: A total of 104 consecutive pts (56 ENI vs. 48 IFRT) were assessed. Pts in both groups had similar characteristics with respect to age, baseline KPS, and percentage receiving chemotherapy. The average RT dose was 6,345 cGy in the ENI group and 6988 cGy in the IFRT group. The median follow-up time was 8.4 mos (0.3–43.4) for all pts and 9.7 mos (1.5–40.1) for survivors. The results follow in the table below. Conclusions: Our data suggest that IFRT does not result in increased nodal failures or decreased survival compared to ENI, and may result in increased local control. The majority of patients who experienced a local failure also experienced nodal failure, suggesting that local relapse may be linked to subsequent nodal failure. This may explain the increased nodal failure rates in patients treated with ENI. Decreased esophagitis rates in patients treated with IFRT may allow the integration of concurrent, full dose systemic therapy in a greater proportion of patients, as well as higher RT doses. [Table: see text] No significant financial relationships to disclose.

Docetaxel, cisplatin, and 5-fluorouracil-based induction chemotherapy followed by concurrent chemoradiotherapy with cisplatin in locally advanced stage III and IV nasopharyngeal cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16015-e16015
Author(s):  
Faysal Dane ◽  
Beste Melek Atasoy ◽  
Zuleyha Akgun ◽  
Fulden Yumuk ◽  
Devrim Cabuk ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Induction Chemotherapy ◽  
Locally Advanced ◽  
Nasopharyngeal Cancer ◽  
Stage Iv ◽  
Conformal Radiotherapy ◽  
Stage Iii ◽  
Conventional Fractionation ◽  
Supraclavicular Lymph Nodes ◽  
Level I

e16015 Background: Concomitant chemoradiatiotherapy (CRT) is the standard treatment in locally advanced nasopharyngeal cancer (LANPC). We studied the activity and tolerability of docetaxel, cisplatin and 5-fluorouracil-based induction chemotherapy (IC) followed by concurrent CRT with cisplatin in LANPC. Methods: Between 2004 and 2010 a total of 33 (15 stage III, 18 non-metastatic stage IV) patients were included into this retrospective analysis. Median age was 51 (range, 19 to 75) years. Twenty-five patients were male. IC was planned for three courses in all patients. IC was consisted of docetaxel and cisplatin (DC) in 11 patients and fluoropyrimidine, dosetaxel and cisplatin (DCF) in 22 patients. G-CSF and ciprofloxacin were given prophylactically to all patients received DCF. 3D conformal radiotherapy (RT) was administered in conventional fractionation (2Gy/fr, 5 fraction per week) using 6-18MV photon energy and appropriate electron energies. Therefore, nasopharynx, level I-V and supraclavicular lymph nodes received 46 Gy (phase I) whereas, nasopharynx and clinically positive or initially bulky lymph nodes received 70 Gy (phase II). Cisplatin (75 mg/m2/21days) was administered during RT concomitantly. Results: Median follow up for surviving patients was 48 months. There was no progression after IC. Complete (CR) and partial responses (PR) were achieved in 6 and 23 patients in nasopharynx, respectively. We observed CR and PR in 19 and 13 patients in neck, respectively. All patients were given 3 cycles of IC. The dose of chemotherapy was reduced in 8 patients during IC. Sixty-six percent of the planned cisplatin dose could be given in the concomitant setting. In 11 patients, cisplatin was either reduced or permanently stopped. Thirty-one patients completed RT as planned. Five years PFS and OS rates were 65.5% and 72.2% respectively. Conclusions: In our LANPC patients, induction DC(F) chemotherapy followed by concomitant CRT was promising. This strategy should be evaluated in prospective studies.

scholarly journals Involved-field irradiation in definitive chemoradiotherapy for T4 squamous cell carcinoma of the esophagus

2016 ◽  
Vol 23 (2) ◽  
pp. 131 ◽  
Author(s):  
M. Li ◽  
F. Zhao ◽  
X. Zhang ◽  
F. Shi ◽  
H. Zhu ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Therapeutic Option ◽  
Locally Advanced ◽  
Target Volume ◽  
Carcinoma Of The Esophagus ◽  
Failure Patterns ◽  
Involved Field ◽  
Nodal Failure

Objectives Definitive concurrent chemoradiotherapy (ccrt) is currently a therapeutic option for locally advanced esophageal cancer. However, clinical practice differs with respect to the target volume for irradiation. The purpose of the present study was to analyze failure patterns and survival, and to determine the feasibility of using involved-field irradiation (ifi) with concurrent chemotherapy for T4 squamous cell carcinoma (scc) of the esophagus.Methods Between January 2003 and January 2013, 56 patients with clinical T4M0 scc of the esophagus received ccrt using ifi. The radiation field included the primary tumour and clinically involved lymph nodes. Target volumes and sites of failure were analyzed, as were treatment-related toxicity and survival time.Results In this 56-patient cohort, 13 patients (23.2%) achieved a complete response, and 21 (37.5%) achieved a partial response, for a total response rate of 60.7%. The major toxicities experienced were leucocytopenia and esophagitis, with 14 patients (25.0%) experiencing grade 3 toxicities. At a median follow-up of 34 months, 48 patients (85.7%) had experienced failure: 39 (69.6%) in-field, 7 (12.5%) elective nodal, and 19 (33.9%) distant. Only 1 patient (1.8%) experienced isolated elective nodal failure. The 1-, 2-, and 3-year survival rates were 39.3%, 21.4%, and 12.5% respectively.Conclusions For patients with T4M0 scc of the esophagus, definitive ccrt using ifi resulted in an acceptable rate of isolated elective nodal failure and an overall survival comparable to that achieved with elective nodal irradiation. A limited radiation therapy target volume, including only clinically involved lesions, would therefore be a feasible choice for this patient subgroup.

scholarly journals The role of radiotherapy in combined treatment for locally advanced breast cancer with ipsilateral supraclavicular metastases

2003 ◽  
Vol 11 (3) ◽  
pp. 148-148
Author(s):  
Jasmina Mladenovic ◽  
Slavica Zoranovic ◽  
Jelena Sasic ◽  
Marko Dozic ◽  
Ivana Inic ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Advanced Breast Cancer ◽  
Locally Advanced Breast Cancer ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Stage Iv ◽  
Advanced Breast ◽  
Regional Lymph Nodes

Background: Locally advanced breast cancer (LABC) includes a heterogeneous group of breast neoplasms classified from stage IIB, IIIA to IIIB. LABC with ipsilateral supraclavicular adenopathy without evidence of distant disease is included in the stage IV (but regional stage IV). Purpose of this study was to assess the role of radiotherapy (RT) in combined treatment with systemic therapy (chemotherapy and hormonotherapy) in LABC with ipsilateral supraclavicular adenopathy. Methods: In 5-year period 45 patients with LABC and ipsilateral supraclavicular metastases were treated with radiotherapy and chemo- or hormonotherapy depending on the physical condition, age and steroid receptors (ER, PGR) content. Twenty patients received TD 30 Gy in 10 fractions on breast and regional lymph nodes and 25 patients received TD 51 Gy in 15 fractions on the breast and TD 45 Gy in 15 fractions on regional lymph nodes. Twenty-three patients received chemotherapy (CMF or FAC), 10 received hormonotherapy, and 12 received both chemo- and hormonotherapy. Results: After finishing complete treatment the overall response rate was 93.3%. Complete response was 20% and partial response was 73.3%. Locoregional relapse occurred in 5 patients and distant metastases occurred in 10 patients. Conclusion: Treatment of LABC with ipsilateral supraclavicular lymph node involvement should be aggressive, what means combined radiotherapy and systemic chemo-hormonotherapy. Such treatment provides for these patients maximum chance of long-term disease - free and overall survival.

Recent Strategies for Treating Stage IV Gastric Cancer: Roles of Palliative Gastrectomy, Chemotherapy, and Radiotherapy

2016 ◽  
Vol 25 (1) ◽  
pp. 87-94 ◽  
Author(s):  
Kunihiko Izuishi ◽  
Hirohito Mori
Keyword(s):  
Gastric Cancer ◽  
Performance Status ◽  
Locally Advanced ◽  
Growth Factor Receptor ◽  
Stage Iv ◽  
Stage Iv Gastric Cancer ◽  
Palliative Gastrectomy ◽  
Advanced Tumor ◽  
Esophagogastric Cancer ◽  
Previously Treated

Recently, many strategies have been reported for the effective treatment of gastric cancer. However, the strategy for treating stage IV gastric cancer remains controversial. Conducting a prospective phase III study in stage IV cancer patients is difficult because of heterogeneous performance status, age, and degree of cancer metastasis or extension. Due to poor prognosis, the variance in physical status, and severe symptoms, it is important to determine the optimal strategy for treating each individual stage IV patient. In the past decade, many reports have addressed topics related to stage IV gastric cancer: the 7th Union for International Cancer Control (UICC) TNM staging system has altered its stage IV classification; new chemotherapy regimens have been developed through the randomized ECF for advanced and locally advanced esophagogastric cancer (REAL)-II, S-1 plus cisplatin versus S-1 in RCT in the treatment for stomach cancer (SPIRITS), trastuzumab for gastric cancer (ToGA), ramucirumab monotherapy for previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD), and ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW) trials; and the survival efficacy of palliative gastrectomy has been denied by the reductive gastrectomy for advanced tumor in three Asian countries (REGATTA) trial. Current strategies for treating stage IV patients can be roughly divided into the following five categories: palliative gastrectomy, chemotherapy, radiotherapy, gastric stent, or bypass. In this article, we review recent publications and guidelines along with above categories in the light of individual symptoms and prognosis. Abbreviations: APC: argon plasma coagulation; AVAGAST: anti-angiogenic antibody bevacizumab, the avastin in gastric cancer; BSC: best supportive care; CF: cisplatin and fluorouracil; CRP: C-reactive protein; DCF: docetaxel, cisplatin, and 5-FU; FISH: fluorescent in-situ hybridization; GJ: gastrojejunostomy; GPS: Glasgow Prognostic Score; HER: human epidermal growth factor receptor; HR: hazard ratio; NLR: neutrophil-to-lymphocyte ratio; OS: overall survival; PS: performance status; QOL: quality of life; RAINBOW: ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma; RCTs: randomized controlled trials; REAL: randomized ECF for advanced and locally advanced esophagogastric cancer; REGARD: ramucirumab monotherapy for previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma; REGATTA: reductive gastrectomy for advanced tumor in three Asian countries; SEER: Surveillance Epidemiology and End Results; SEMS: self-expandable metal stents; SPIRITS: S-1 plus cisplatin versus S-1 in RCT in the treatment for stomach cancer; ToGA: trastuzumab for gastric cancer; TTP: time-to-progression; VEGFR: vascular endothelial growth factor receptor.

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