Survival and toxicity with intensity modulated radiation therapy (IMRT) and chemotherapy for esophageal carcinoma, with or without surgery.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 125-125
Author(s):  
Kristin Kowalchik ◽  
Elizabeth Johnson ◽  
George P. Kim ◽  
C. Daniel Smith ◽  
Siyong Kim ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Acute Toxicity ◽  
Esophageal Carcinoma ◽  
Locally Advanced ◽  
Late Toxicity ◽  
Concurrent Chemotherapy ◽  
Conformal Radiation Therapy ◽  
Trimodality Therapy ◽  
Grade 3 ◽  
3D Crt

125 Background: Treatment for locally advanced esophageal carcinoma is radiation and chemotherapy, with or without surgery. Radiation has traditionally been delivered with 3D conformal radiation therapy (3D CRT). This study evaluates late toxicity in patients treated with IMRT as well as early outcomes and acute toxicity. Methods: This is a retrospective review of 32 patients with esophageal carcinoma treated with IMRT at Mayo Clinic Florida from 2008 -2012. Pathology includes squamous cell and adenocarcinomas. Tumor sites include middle and lower thoracic and GE junction. Clinical stages are TX-T3, N0-3, M0-1. All patients received at least one cycle of concurrent chemotherapy. IMRT dose was 50.4 Gy in 28 fractions prescribed to a target volume including the tumor and regional lymphatics. IMRT plans utilized coplaner beams in a 7-9 beam arrangement or volumetric modulated arc therapy. Results: Median follow-up is 8.9 months (range 2.4-23.0) for all patients and 13.1 months (range 2.8-23.0 months) in surviving patients. Median patient age is 69 (range 46-87). Trimodality treatment was completed in 20 patients (62.5%). Surgery was either an open or minimally invasive esophagogastrectomy. The incidence of grade 3 or greater late toxicity at 1 year was 48% in surgery patients and 26% in non-surgery patients. The most common grade 3 or higher toxicity was esophageal strictures in 25%. The incidence of any grade 3 or greater acute toxicity was 65% in the surgery patients and 75% in the non-surgery patients. Overall survival (OS) for all patients at 18 months is 57% (CI 37-86%) and progression-free survival (PFS) is 60% (36-99%). OS and PFS for trimodality therapy at 12 months is 83% (66-100%) and 81% (63-100%) respectively and for bimodality therapy is 34% (12-93%) and 70% (33-100%) respectively. Conclusions: Increased late toxicity occurs in surgery patients, and increased acute toxicity in non-surgery patients. Lower survival in non-surgery patients may be due to early progression, morbidities which preclude surgery or improved survival with surgery. Overall, IMRT is a feasible treatment modality, which may be equally efficacious to 3D CRT for the treatment of esophageal carcinoma.

Concurrent and adjuvant docetaxel with three dimensional conformal radiation therapy (3-D CRT) for poor-risk localized prostate cancer: A phase II trial

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5003-5003 ◽  
Author(s):  
J. FERRERO ◽  
M. Bolla ◽  
P. Maingon ◽  
J. Buffet-Miny ◽  
A. Bougnoux ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Acute Toxicity ◽  
Locally Advanced ◽  
Three Dimensional ◽  
Distant Metastases ◽  
Phase Iii ◽  
Respiratory Morbidity ◽  
Conformal Radiation Therapy ◽  
Poor Risk ◽  
Grade 3

5003 Background: Docetaxel increases survival in hormone refractory prostate cancer. The objective of this trial is to evaluate the feasibility of concomitant weekly docetaxel with 3-D CRT and adjuvant docetaxel in unfavorable localized or locally advanced prostate carcinoma. Methods: Sixteen patients with poor risk localized carcinoma (T1c-2b N0M0) and 34 with locally advanced tumors (T3N0- 1M0) according to the 1997 UICC classification, underwent 3-D CRT (72Gy/36 fractions); docetaxel 20mg/m2 iv was delivered concurrently on weeks 1–2-3–5-6–7; adjuvant docetaxel 60mg/m2 q3w started 4 weeks after the completion of radiotherapy for 3 cycles. The patients had to receive LHRH agonist, 6 months to 3 years, according to the number of poor prognostic factors. Acute toxicity was assessed with the NCI CTC v:2.0. Results: From November 2003 to November 2005, 50 patients were included (438 cycles) from six institutions. Median age was 50 years (48–76), median PSA 17.7 ng/ml (3.4–260) and median follow-up 17 months (9–38). Forty six patients completed the chemoradiation regimen (423 cycles), with full dose of docetaxel, 4 patients did not, due to: 1 grade 4 GI toxicity during the cycle 3, 1 grade 3 dysuria after cycle 6, 1 grade 4 myocardial infarction after cycle 6, 1 grade 4 anal fistula between two cycles of adjuvant docetaxel; these patients were excluded. The percentage of grade 3 acute toxicity was 10.8% (5/46): 1 grade 3 neutropenia, 1 grade 3 rectal bleeding, 2 grades 3 diarrhea, 1 grade 3 dysuria. Grade 2 toxicity (nausea, diarrhea and rectitis) were observed, in a percentage of 26%; no grade 2–3 toxicity occurred as regard hypotension, venous thrombosis, peripheral neuropathy, respiratory morbidity, oedemas. Twelve months after the end of the treatment, 44 patients were in complete remission (clinical and biological) and two patients suffer from distant metastases. Conclusion: The feasibility of this combined chemo-radiation regimen deserves to be followed by a phase III trial. No significant financial relationships to disclose.

scholarly journals Trimodality therapy for stage II-III carcinoma of the esophagus: A dose-ranging study of concurrent capecitabine, docetaxel, and thoracic radiotherapy.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14514-e14514
Author(s):  
Matthew D. Wood ◽  
Bassem I. Zaki ◽  
Stuart R. Gordon ◽  
John E. Sutton ◽  
Mikhail Lisovsky ◽  
...  
Keyword(s):  
Esophageal Carcinoma ◽  
Phase Ii ◽  
Locally Advanced ◽  
Stage Ii ◽  
Thoracic Radiotherapy ◽  
Trimodality Therapy ◽  
Weekly Docetaxel ◽  
Dose Ranging ◽  
Grade 3 ◽  
Recommended Phase Ii Dose

e14514 Background: This dose escalation study was performed to determine the recommended phase II dose of capecitabine to be delivered concurrently with thoracic radiation therapy and weekly docetaxel in patients with locally advanced esophageal carcinoma. Methods: Patients with operable stage II or III esophageal carcinoma were staged by endoscopic ultrasonography and CT. Two cycles of docetaxel (80 mg/m2) and carboplatin (target AUC of 6) were delivered over 6 weeks, followed by concurrent weekly docetaxel (15 mg/m2), thoracic radiotherapy (50.4 Gy in 28 fractions), and increasing doses of capecitabine (500-3500 mg) given prior to each fraction of radiotherapy. After re-staging, responding patients continued to esophagectomy. Results: Forty-four patients were enrolled and 40 were evaluable for the dose-ranging component of chemoradiotherapy. The median age was 63 (range 47-87), 32 patients (80%) were male, and 36 (90%) had adenocarcinoma while 4 (10%) had squamous cell carcinoma. EUS stages at enrollment were T3N1 (29), T3N0 (4), T2N1 (6), and T4N0 (1). The maximum tolerated dose of capecitabine was 3500 mg. Common non-hematologic grade 3 or 4 toxicities were dysphagia (n=6, 15%) and nausea/vomiting (n=3, 8%). Common grade 3 or 4 hematologic toxicities were ANC and WBC abnormalities (n=10, 25% and n=9, 23% respectively). Overall, 58% of patients had no stage 3 or 4 toxicity. Thirty-six patients had surgery; 83% had R0 (curative) resection and 14% had complete pathological response (pCR). With a median follow-up time of 18.9 months, the median overall survival was 23.5 months, with 34% and 27% alive at three and five years, respectively. The three- and five-year relapse-free survival was 37%. In patients who had pCR or microscopically residual disease, 5-year survival was 74% (n=8). Conclusions: The recommended phase II dose of capecitabine is 3500 mg when given concurrently with 50.4 Gy in 28 fractions of thoracic radiotherapy with weekly docetaxel. This trimodality therapy for locally advanced esophageal carcinoma was well-tolerated and remarkably active. This regimen holds promise for treatment of esophageal carcinoma and warrants further investigation.

NTENSITY-MODULATED RADIATION THERAPY WITH CONCURRENT CHEMOTHERAPY FOR NASOPHARYNGEAL CARCINOMA

2018 ◽  
Vol 8 (6) ◽  
pp. 105-113
Author(s):  
Tin Vo Nguyen ◽  
Tuong Pham Nguyen ◽  
Thanh Dang
Keyword(s):  
Radiation Therapy ◽  
Nasopharyngeal Carcinoma ◽  
Radiation Therapy Oncology Group ◽  
Nasopharyngeal Cancer ◽  
Tumour Response ◽  
Late Toxicity ◽  
Concurrent Chemotherapy ◽  
European Organization ◽  
Intensity Modulated ◽  
Grade 3

Purpose: To evaluate tumour response, acute and late toxicity in nasopharyngeal cancer (NPC) patients treated with intensity modulated radiotherapy (IMRT) with cisplatin chemotherapy. Materials and Methods: 33 NPC patients, received IMRT concurrently with four to six cycles of cisplatin (30 mg/m2/day) every six weeks between May 2016 and July 2018, were evaluated prospectively. The doses to the planning target volumes of primary tumor and involved lymph nodes, uninvolved regional nodal areas were 70 Gy and 50 Gy respectively. All patients were evaluated for tumour and node response using response evaluation criteria in solid tumour (RECIST) criteri, acute and late toxicities according to CTCAE version 3.0 (common terminology criteria for adverse events), RTOG/EORTC (Toxicity criteria of the Radiation Therapy Oncology Group/the European Organization for Research and Treatment of Cancer). Results: At three months after chemoradiation, 81.8% and 18.2% of patients achieved complete and partial response, respectively. Grade 3 acute toxicities were oral mucositis (6.1%), dermatitis (3%). Grade 3 late toxicities were xerostomia 2/33(6.1%). There was no grade 3 to grade 4 neck fibrosis and trismus, none of the patients developed mandibular bone necrosis. Conclusion:Cisplatin concurrently with IMRT provided excellent tumour response, manageable toxicities and good compliance. Key words: intensity-modulated radiation therapy, Concurrent chemotherapy and radiation therapy, nasopharyngeal carcinoma

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]

Stereotactic body radiation therapy for pancreatic cancer: Single institutional experience.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 328-328 ◽  
Author(s):  
Shalini Moningi ◽  
Siva P. Raman ◽  
Avani Satish Dholakia ◽  
Amy Hacker-Prietz ◽  
Timothy M. Pawlik ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Radiation Therapy ◽  
Acute Toxicity ◽  
Local Control ◽  
Stereotactic Body Radiation Therapy ◽  
Locally Advanced ◽  
Stereotactic Body Radiation ◽  
Early Results ◽  
Grade 3

328 Background: Stereotactic Body Radiation Therapy (SBRT) is emerging as a possible standard treatment for pancreatic cancer; however, there is limited data to support its efficacy. This study reviews our institution’s experience using SBRT in the treatment of pancreatic cancer (PCA). Methods: Charts of all PCA patients receiving SBRT from January 2010 to June 2013 were retrospectively reviewed. The primary end points were overall survival (OS) and tumor response assessed by RECIST criteria. 95% of the PTV (GTV + 2-3 mm) received a total dose of 20-33 Gy in five fractions (4-6.6 Gy/fraction), with up to 20% heterogeneity allowed. Pre- and post-SBRT chemotherapy regimens included gemcitabine, cisplatin, FOLFIRINOX, 5-FU or paclitaxel. Results: 84 patients received SBRT, with a median follow-up time of 15.3 months. Median age was 66.5 years, 57.1% were male and 65.5% had head tumors. 66 patients received definitive SBRT for locally advanced or borderline resectable PCA, 4 patients were treated with adjuvant SBRT, and 14 received SBRT for treatment of recurrent disease. Median OS from the date of diagnosis for patients receiving definitive radiation was 17.8 mos (95% CI 14.9-20.9).For recurrent patients the median OS from first day of SBRT was 11.8 mos (95%CI 8.3-15.3). In the definitive SBRT group, among patients who were alive and had follow-up scans, the 6 and 12 month local control rate (stable or partial response) based on RECIST criteria was 84.6% and 81.8%, respectively. Five patients underwent surgery following SBRT and all had negative resection margins. Acute toxicity was minimal with most experiencing grade 1 or 2 fatigue and no grade 3/4 acute toxicity. Late grade 3/4 GI toxicity was seen in 5% (4/84) and 1 patient had a grade 5 GI bleed due to direct tumor invasion into the duodenum. Conclusions: Our early results using SBRT in the definitive and recurrent settings show favorable local control, toxicity, and survival when compared to historical outcomes using chemoradiation. Acute and late toxicity was minimal however the optimal dose and fractionation as well as normal tissue dose constraints need to be determined. Integration of SBRT with more aggressive chemotherapy may result in improved outcomes in patients with PCA.

Sign in / Sign up

Export Citation Format

Share Document