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.

High-dose 3D chemoradiotherapy trials in stage III non-small cell lung cancer (NSCLC) at the University of North Carolina: Long-term follow up and late complications

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7145-7145 ◽  
Author(s):  
C. B. Lee ◽  
M. A. Socinski ◽  
L. Lin ◽  
D. T. Moore ◽  
D. E. Morris ◽  
...  
Keyword(s):  
Overall Survival ◽  
Late Complications ◽  
Concurrent Chemotherapy ◽  
Stage Iii ◽  
Second Primary ◽  
High Dose ◽  
Combined Modality Treatment ◽  
Combined Modality ◽  
Stage Iii Nsclc

7145 Background: Combined modality treatment is the standard of care for patients (pts.) with unresectable stage III NSCLC. Dose escalation of radiotherapy and the use of concurrent chemotherapy are two strategies attempting to improve survival and locoregional control. The intensification of therapy increases the risk of both early and late treatment related toxicities. Methods: From 5/1996 to 8/2004, 112 stage III NSCLC pts. were entered into 4 Phase I/II trials to assess the safety and feasibility of high-dose (74–90 Gy) thoracic conformal radiotherapy (TCRT) in QD or BID fractions. All pts. were treated with platinum-based induction chemotherapy; 3 of the trials also used concurrent chemotherapy. Results: The median follow up of survivors (29/112) on these trials was 4.9 years. The overall response rate after combined modality therapy was 47% (53/112) (CR 4%, 5/112; PR 43%, 48/112). 27% (30/112) had stable disease. The median survival (with 95% CI) was 24 months (18–31 months). 1-, 3-, and 5-year overall survival was 69% (60–77%), 36% (27–45%), and 24% (16–33%) respectively. Late complications of therapy (defined as >90 days post radiotherapy reported to date) are displayed in the table. Two pts. developed a second primary (1 lung, 1 liver carcinoid). In total, 22% (25/112) had late complications. These patients appear to have a significantly better overall survival (p = .007). 12% (13/112) had a brain-only recurrence, although this did not seem to significantly impact overall survival (p = .82). Conclusions: 1) High-dose TCRT is feasible and results in promising survival outcomes. 2) Late complications occur in a minority of patients suggesting the potential benefit of more aggressive TCRT is not outweighed by its risk. 3) Interestingly, brain-only recurrences did not significantly impact survival in these trials. [Table: see text] [Table: see text]

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.

Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer. The National Cancer Institute of Canada Clinical Trials Group.

1993 ◽  
Vol 11 (2) ◽  
pp. 336-344 ◽  
Author(s):  
N Murray ◽  
P Coy ◽  
J L Pater ◽  
I Hodson ◽  
A Arnold ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Combined Modality Therapy ◽  
Small Cell ◽  
Combined Modality Treatment ◽  
Small Cell Lung ◽  
Thoracic Irradiation ◽  
Limited Stage ◽  
Combined Modality

PURPOSE The importance of the timing of thoracic irradiation (TI) in the combined modality therapy of limited-stage small-cell lung cancer (SCLC) was assessed in a randomized trial. METHODS All 308 eligible patients received cyclophosphamide, doxorubicin, and vincristine (CAV) alternating with etoposide and cisplatin (EP) every 3 weeks for three cycles of each chemotherapy regimen. Patients randomized to early TI received 40 Gy in 15 fractions over 3 weeks to the primary site concurrent with the first cycle of EP (week 3), and late TI patients received the same radiation concurrent with the last cycle of EP (week 15). After completion of all chemotherapy and TI, patients without progressive disease received prophylactic cranial irradiation (25 Gy in 10 fractions over 2 weeks). RESULTS Although complete remission rates were not significantly different between the two arms, progression-free survival (P = .036) and overall survival (P = .008) were superior in the early TI arm. Patients in the late TI arm had a higher risk of brain metastases (P = .006). CONCLUSION The early administration of TI in the combined modality therapy of limited-stage SCLC is superior to late or consolidative TI.

Combined Modality Treatment for Osteosarcoma Occurring as a Second Malignant Disease

1999 ◽  
Vol 17 (4) ◽  
pp. 1164-1164 ◽  
Author(s):  
Stefan S. Bielack ◽  
Beate Kempf-Bielack ◽  
Ulrich Heise ◽  
Dorothea Schwenzer ◽  
Kurt Winkler
Keyword(s):  
Malignant Disease ◽  
Combined Modality Therapy ◽  
Latency Period ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Combined Modality Treatment ◽  
Local Tumor ◽  
Primary Osteosarcoma ◽  
Combined Modality ◽  
Multiple Drugs

PURPOSE: The prognosis of osteosarcoma occurring as a second malignant disease (OS-SMD) is thought to be poor. We attempted to evaluate whether this holds true when OS-SMD is treated with combined modality therapy as developed for primary osteosarcoma and if factors that influence survival might be identified. PATIENTS AND METHODS: All patients with OS-SMD registered at the Cooperative German-Austrian-Swiss Osteosarcoma Study Group (COSS) study center between 1980 and June 1996 were evaluated for patient- and treatment-related factors, local and systemic outcome, and survival. Therapy was to be given according to contemporary COSS protocols for primary extremity osteosarcoma, including surgery and multiagent chemotherapy. RESULTS: Thirty patients with OS-SMD were registered (median latency period, 9 years 2 months). The first malignancies had been retinoblastoma (10 patients), sarcoma (10 patients), lymphoma (five patients), carcinoma (four patients), and medulloblastoma (one patient). Treatment for these malignancies had included radiotherapy in 24 patients, surgery in 20, and chemotherapy in 14. Twelve osteosarcomas were located axially and 18 were located in an extremity; 17 were radiation-related. Twenty-seven patients presented with localized disease; three presented with primary metastases (two skip, one lung). All 30 patients received chemotherapy, 29 with multiple drugs. Twenty-eight patients underwent operation. At 7 years, actuarial overall survival, survival free from osteosarcoma progression, and survival free from progression of any cancer were 50%, 34%, and 30%, respectively. In 24 patients with local tumor control, the corresponding values were 63%, 46%, and 38%. All seven local failures occurred in patients with axial osteosarcomas who did not undergo operation with wide surgical margins. CONCLUSION: Provided that local tumor control is achieved, OS-SMD treated with combined modality therapy may have a prognosis that approaches that of otherwise comparable primary osteosarcoma.

Survival Outcomes for Combined Modality Therapy for Sinonasal Undifferentiated Carcinoma

2016 ◽  
Vol 156 (1) ◽  
pp. 132-136 ◽  
Author(s):  
Phoebe Kuo ◽  
R. Peter Manes ◽  
Zachary G. Schwam ◽  
Benjamin L. Judson
Keyword(s):  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Combined Modality Therapy ◽  
Undifferentiated Carcinoma ◽  
Treatment Modalities ◽  
Survival Outcomes ◽  
Combined Modality Treatment ◽  
National Cancer Database ◽  
Sinonasal Undifferentiated Carcinoma ◽  
Combined Modality

Objective Sinonasal undifferentiated carcinoma is a rare and aggressive malignancy of the nasal cavity and paranasal sinuses. Multi-institutional studies examining outcomes of combined modality treatment versus other treatment modalities have not been performed. The objective of our study was to present outcomes for multimodality therapy through use of the National Cancer Database. Study Design Retrospective cohort study. Setting National Cancer Database. Methods A total of 435 cases of SNUC diagnosed between 2004 and 2012 were identified. Kaplan-Meier analyses were performed to find 5-year cumulative survival rates. Multivariate Cox regression evaluated overall survival based on treatment when adjusting for other prognostic factors (age, primary site, sex, race, comorbidity, insurance, and TNM stage). Within the surgery + chemoradiotherapy group, survival analysis was also performed to compare outcomes for induction and adjuvant chemotherapy. Results The cumulative 5-year survival rate was 41.5%, and 36.1% of patients received surgery with chemoradiotherapy. In multivariate analysis, surgery + chemoradiotherapy was associated with significantly improved overall survival versus surgery + radiotherapy and radiotherapy but not significantly different from chemoradiotherapy. Within the surgery + chemoradiotherapy group, induction and adjuvant chemotherapy groups did not have associated differences in survival. Conclusion Combined modality therapy (chemoradiotherapy or surgery + chemoradiotherapy) is associated with improved survival outcomes versus other treatment modalities in patients with sinonasal undifferentiated carcinoma.

Adult Wilms' Tumor: Role of Combined Modality Treatment

1989 ◽  
Vol 28 (5) ◽  
pp. 647-650 ◽  
Author(s):  
M. P. Mehta ◽  
P. Langeland ◽  
K. Bertelrud
Keyword(s):  
Wilms Tumor ◽  
Combined Modality Treatment ◽  
Combined Modality

Second Neoplasms in Patients With Hodgkin's Disease Following Combined Modality Therapy—The Yale Experience

1986 ◽  
Vol 4 (5) ◽  
pp. 817-817
Author(s):  
Alan J. Koletsky ◽  
Joseph R. Bertino ◽  
Leonard R. Farber ◽  
Leonard R. Prosnitz ◽  
Daniel S. Kapp ◽  
...  
Keyword(s):  
Clinical Oncology ◽  
Hodgkin's Disease ◽  
Nitrogen Mustard ◽  
Maximum Dose ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Combined Modality ◽  
Second Neoplasms ◽  
Made In

In the article by Koletsky et al "Second Neoplasms in Patients With Hodgkin's Disease Following Combined Modality Therapy—The Yale Experience" (Journal of Clinical Oncology 4:311–317, 1986), an error was made in the footnote on page 311 which described the composition of MVVPP. The corrected footnote appears below. *MVVPP = nitrogen mustard (0.4 mg/kg on day 1 of cycle); vinblastine (6 mg/m2 on days 22, 29, and 36); vincristine (1.4 mg/m2, 2 mg maximum dose, on days 1, 8, and 15); procarbazine (100 mg/d on days 22 through 42); prednisone (40 mg/m2 on days 1 through 15 for cycles 1, 3, and 5 only).

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.

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