Multimodality salvage therapy for anal cancer failing standard chemoradiation

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15635-e15635
Author(s):  
Y. N. You ◽  
D. W. Larson ◽  
E. J. Dozois ◽  
H. Nelson ◽  
E. Antpack Filho ◽  
...  
Keyword(s):  
Overall Survival ◽  
Recurrent Disease ◽  
Perineal Wound ◽  
External Beam Radiation ◽  
Intraoperative Radiation Therapy ◽  
Beam Radiation ◽  
Intraoperative Radiation ◽  
Multimodality Approach ◽  
Pelvic Resection

e15635 Background: Most squamous cell carcinomas of the anal canal (SCC) respond to chemoradiation, but effective therapy for locally-invasive(T4) or recurrent disease that fails standard chemoradiation and/or salvage abdominoperineal resection (APR) has not been clearly delineated. A multimodality approach including chemoradiation, extended pelvic resection and intraoperative radiation therapy (IORT) was assessed for survival impact and treatment morbidity.morbidities. Methods: A prospective registry including 26 patients with locally-invasive or recurrent disease treated between 1993 and 2007 was reviewed. Primary endpoint was overall survival (OS), obtained from prospectively collected patient questionnaires and medical record review, and analyzed by the Kaplan-Meier method. Short (60-day postoperative) and long-term (median followup: 1.6 years; 5.3 years among survivors) complications were assessed. Results: Patients (median age: 51 years) presented with (1) locally-invasive disease that persisted despite initial standard chemoradiation (n=10, 39%), (2) disease that recurred after initial standard chemoradiation (n=10, 39%; median 1.7 years to recurrence), or (3) re-recurrence after a salvage APR (n=6, 23%; median 1.3 years since APR). All patients received chemotherapy and external beam radiation preoperatively, and 19% received additional postoperative chemoradiation. Gross pelvic disease was completely resected in all (R0 in 73%; R1 in 27%). IORT (750–3250cGy) was delivered at single (92%) or two sites (8%). Median overall survival (OS) was 1.7 years. Five-year OS were: 50%, 10%, and 22% for patients with locally-invasive, recurrent, and re-recurrent disease respectively. Short-term complications predominantly related to the perineal wound. Fifteen patients reported long-term complications (>grade3): bowel obstruction in 8 (1 requiring operation), perineal wound fistula/non-healing in 9, leg paresthesia in 5, hydronephrosis in 3. Conclusions: For select patients with locally-persistent or recurrent SCC who fail standard primary treatment, a multimodality approach involving chemoradiation, extended pelvic resection and IORT offers a chance for improved survival. No significant financial relationships to disclose.

The Role of Intraoperative Radiation Therapy in the Management of Recurrent and Locally Advanced Gynecologic Cancers

2013 ◽  
Vol 23 (1) ◽  
pp. 9-15 ◽  
Author(s):  
Olivia W. Foley ◽  
J. Alejandro Rauh-Hain ◽  
Marcela G. del Carmen
Keyword(s):  
Radiation Therapy ◽  
Locally Advanced ◽  
Target Volume ◽  
External Beam Radiation ◽  
Intraoperative Radiation Therapy ◽  
Tumor Control ◽  
Gynecologic Cancers ◽  
Beam Radiation ◽  
Intraoperative Radiation

For patients with locally advanced primary or recurrent gynecologic cancers, prognosis is poor. Doses of external beam radiation therapy required to treat either gross or microscopic disease in patients previously irradiated or treated surgically exceed doses that are tolerated by normal anatomic structures. Intraoperative radiation therapy allows maximal tumor control achievable with radiation while minimizing radiation exposure of dose-limiting surrounding structures. Intraoperative radiation therapy is a unique treatment modality, allowing direct visualization of the target volume during a planned surgical procedure. Intraoperative radiation therapy has the potential to improve both long-term local control and overall survival especially in patients with para-aortic and/or pelvic sidewall recurrences.

Hemangiopericytoma: long-term outcome revisited

2011 ◽  
Vol 114 (3) ◽  
pp. 747-755 ◽  
Author(s):  
Marco Schiariti ◽  
Pablo Goetz ◽  
Hussien El-Maghraby ◽  
Jignesh Tailor ◽  
Neil Kitchen
Keyword(s):  
Overall Survival ◽  
Local Recurrence ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Long Term Outcome ◽  
Free Interval ◽  
Initial Surgery ◽  
The Mean

Object Hemangiopericytomas are rare tumors that behave aggressively with a high rate of local recurrence and distant metastases. With the aim of determining the outcome and response to various treatment modalities, a series of 39 patients who underwent microsurgical resection for primary meningeal hemangiopericytoma over a 24-year period is presented. Methods Patients with hemangiopericytoma were identified from histopathology records and their medical records were analyzed retrospectively by 2 independent reviewers to collect data on surgical treatment, adjuvant therapy, postoperative course, local or distant recurrence, and follow-up. Results Of the 39 patients, 19 were male and 20 were female. Mean patient age was 44.1 years. Thirty-four tumors were intracranial and 5 were spinal. The mean follow-up period was 123 months. Twenty-eight patients developed local recurrence. The recurrence rate at 1, 5, and 15 years was 3.5%, 46%, and 92%, respectively. Extraneural metastasis occurred in 8 patients (26%) at an average of 123 months after initial surgery. Recurrences and metastases were treated by surgical excision, external beam radiation therapy (EBRT), chemotherapy, and/or stereotactic radiosurgery. Adjuvant EBRT following initial surgery was found to extend the disease-free interval from 154 months to 254 months, although it did not prevent the development of metastasis. In those patients with EBRT and complete resection, the mean recurrence-free interval was found to be 126.3 months longer (p = 0.04) and overall survival 126 months longer than without EBRT. Furthermore, adjusting for resection, patients undergoing EBRT had 0.33 times increased risk of recurrence compared with those who did not (p = 0.03). A majority of patients remained able to live independently despite revision surgery for recurrence. Conclusions The mean follow-up of this patient series represents the longest follow-up duration published to date and demonstrates extended survival in a significant number of patients with hemangiopericytoma. Gross-total resection followed by adjuvant EBRT provides patients with the highest probability of an increased recurrence-free interval and overall survival. Prolonged survival justifies long-term follow-up and aggressive treatment of initial, recurrent, and metastatic disease.

Preoperative Paclitaxel and Concurrent Rapid-Fractionation Radiation for Resectable Pancreatic Adenocarcinoma: Toxicities, Histologic Response Rates, and Event-Free Outcome

2002 ◽  
Vol 20 (10) ◽  
pp. 2537-2544 ◽  
Author(s):  
Peter W. T. Pisters ◽  
Robert A. Wolff ◽  
Nora A. Janjan ◽  
Karen R. Cleary ◽  
Chusilp Charnsangavej ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Pancreatic Adenocarcinoma ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
Intraoperative Radiation Therapy ◽  
Preoperative Treatment ◽  
External Beam ◽  
Beam Radiation ◽  
Intraoperative Radiation ◽  
Grade 3

PURPOSE: To evaluate the toxicity of a preoperative regimen of paclitaxel and concurrent external-beam radiation therapy, pancreaticoduodenectomy, and electron-beam intraoperative radiation therapy (EB-IORT) for patients with resectable pancreatic adenocarcinoma. PATIENTS AND METHODS: Patients with localized, potentially resectable pancreatic adenocarcinoma were treated with 30 Gy external-beam radiation therapy and concomitant weekly 3-hour infusions of paclitaxel (60 mg/m2). Radiographic restaging was performed 4 to 6 weeks after chemoradiation, and patients with localized disease underwent pancreatectomy with EB-IORT. RESULTS: Thirty-five patients completed chemoradiation; 16 (46%) experienced grade 3 toxicity. Four patients (11%) required hospitalization for dehydration due to grade 3 nausea and vomiting. Twenty (80%) of 25 patients who underwent surgery underwent pancreatectomy; EB-IORT was used in 13 patients. There were no histologic complete responses to preoperative therapy; 21% of specimens demonstrated more than 50% nonviable cells (grade 2b treatment effect). With a median follow-up period of 46 months, the 3-year overall survival rate with chemoradiation and pancreatectomy was 28%. CONCLUSION: Preoperative paclitaxel-based concurrent chemoradiation is feasible. The toxicity of this regimen seems greater than that with fluorouracil. The histologic responses and survival are similar, suggesting no advantages to paclitaxel-based preoperative treatment.

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