111 Concurrent twice-a-day continuous radiotherapy and cisplatin-5fluorouracil chemotherapy (BIRCF) in locally advanced unresectable pharyngeal squamous-cell carcinoma—Final results of a French multicentric phase II study (clinical and pharmacological data)
R.J. BensadounO. DassonvilleMartina SchneiderG. MilanoPatrick ChauvelS. BourdinB. PrévostBernard Coche‐DequeantG. PoissonnetYves LaudoyerJ VallicioniJ SantiniMarcy PyF Démard
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Jejunal free-flap reconstruction is a well recognized, reliable technique commonly used for reconstruction of the upper aero-digestive tract following surgery for malignancy, and radiotherapy is commonly used as an adjuvant treatment in such cases. Unfortunately, post-irradiation sarcomas are a well recognized complication of radiotherapy and generally have a poor prognosis. We report what we believe to be the first case of radiation-induced sarcoma in a free-flap jejunal graft and discuss the information that should be given to patients undergoing radiotherapy to head and neck tumours.
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This article reviewed the latest developments in radiotherapy for locally advanced non small cell lung carcinomas (LANSCLC) in the past three years. ①Induction therapy before surgery, which includes chemotherapy and chemo radiotherapy. ②Chemo radiotherapy for resectable LANSCLC. It is suggested that chemo radiotherapy would be one of the choices, besides surgery. ③Chemo radiotherapy for unresectable LANSCLC. Chemotherapy is emphasized to play an important role for these patients. The models of combination of chemotherapy and irradiation are also discussed, and so are the efficacy, toxicity and tolerance. ④Three dimensional conformal radiotherapy (3DCRT). It has been demonstrated that 3DCRT could protect normal lung well, which surrounds the tumor. Therefore, irradiation dose could be increased, and local control as well as survival would be improved by this way. ⑤Unconventional fractionated irradiation. Accelerated hyperfractionated radiation therapy, which shortens the total treatment time and still remains a high dose, has resulted in good outcome. Therefore, there is a room for further studies. ⑥Application of radioprotector in lung irradiation. Amifostine has been tried and shown to have protection for normal tissues, especially in decreasing the incidences of radiation induced esophagitis and pneumonitis.
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To define the best sequence of radiotherapy and chemotherapy for inoperable stage III non-small cell lung (NSCL) tumours.A systematic review was performed on the clinical results of radiotherapy, combined or not with chemotherapy, for inoperable NSCL cancer stage III. The mean median survival time (MST) and mean overall survival (OS) percentages were derived for radiotherapy only, for sequential and for concurrent chemo-radiotherapy.The mean median survival duration +/- standard deviation for radiotherapy only was 10.4 +/- 1.8 months. For sequential chemo- and radiotherapy it was increased to 13.0 +/- 1.2 months. When radiotherapy in the sequential regimen was accompanied by chemotherapy, the mean median duration was 15.8 +/- 2.6 months. For concurrent radio-chemotherapy it was further increased to 16.4 +/- 2.7 months. The mean 2- and 3-year overall survivals for radiotherapy alone, sequential and concurrent radio-chemotherapy were 17.1 +/- 4.6 and 10, 23.8 +/- 6.3 and 18.5 +/- 7.0, and 32.5 +/- 8.7 and 25.7 +/- 6.3%, respectively.Concurrent chemo-radiotherapy demonstrated increased efficacy over sequential chemotherapy and radiotherapy and should be the treatment of choice. Further improvements may be obtained by optimising the conditions for concurrent chemo-radiotherapy.
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Objective Prospective comparison was done on concurrent chemo-radiotherapy and se- quential chemo-radiotherapy for unresectable stageⅢnon-small cell lung cancer(NSCLC) and to evaluate three different regimens of concurrent chemo-radiotherapy.Methods Ninety-six such patients were ran- domized into four groups:1.sequential chemo-radiotherapy group received two cycles of induction chemother- apy with 40 mg/m~2 of cisplatin on D 1-3,29-31 and 100 mg/m~2 of etoposide on D 1-3,29-31 before conven- tional radiotherapy,2.concurrent chemo-radiotherapy group 1 received 100 mg/m~2 etoposide on D 1-3 and DDP 40 mg/m~2 on D 1-3,D 29-31,iv.drip,3.concurrent chemo-radiotherapy group 2 received concurrent chemotherapy with 40 mg/m~2 of paclitaxel every Monday during conventional radiotherapy,4.concurrent chemo-radiotherapy group 3 received concurrent chemotherapy with 40 mg/m~2 of paclitaxel every Monday during three-dimensional conformal radiotherapy.All patients were irradiated with 2.0 Gy/fraction,5 frac- tions/week,to a total dose of 60-64 Gy.They all received two cycles of consolidation themotherapy with 40 mg/m~2 of cisplatin on D 1-3 and 100 mg/m~2 of etoposide on D 1-3.Results The overa/1 response rate was 67%,71%,71% and 79% for sequential ehemo-radiotherapy group,concurrent chemo-radiotherapy group 1,2 and 3,respectively.There was a significant difference between the concurrent chemo-radiotherapy and sequential chemo-radiotherapy(P＜0.05).The 1-,3-and 5-year overall survival rate(OS) was 54%,8% and 4%;71%,17% and 8%;79%,17% and 8%;83%,46% and 13%,respectively for the four groups. The difference among all these groups(P=0.017) was significant.It was also significant between the con- current chemo-radiotherapy group 1 and 3 (P=0.046).The difference of distant metastasis rate among all the groups was statistically insignificant (P＞0.05) also was the difference of toxicity (P＞0.05),but the severe toxicity of concurrent chemo-radiotherapy groups 1 and 2 were higher than the sequential chemo-radio- therapy group and concurrent chemo-radiotherapy group 3.Conclusions Better locoregional progression- free survival and overall survival of unresectable stageⅢnon-small cell lung cancer could be achieved by concurrent chemo-radiotherapy as compared with sequential chemo-radiotherapy though at the expense of in- crease in toxicity.With the combination of concurrent chemo-radiotherapy and conforrnal radiotherapy,the o- verall survival rate could be much improved with miider toxicity.
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Objective To explore the effect and security of concurrent and sequential chemo-radiotherapy in the treatment of patients with non-small cell lung cancer at stage Ⅲ.Methods.The clinical data of 86 patients with non-small cell lung cancer at stage Ⅲ from February 2006 to February 2009 were retrospectively analyzed,which included 46 cases undergoing concurrent chemo-radiotherapy and 40 cases receiving sequential chemo-radiotherapy treatment.Short term curative effect,median survival time and side effects were compared between two groups.Results The effective rates of treatment were 69.6% and 50.0% respectively in the concurrent chemo-radiotherapy group and in the sequential chemo-radiotherapy group with significant difference(P0.05).The median survival time in the concurrent chemo-radiotherapy group was superior to the sequential chemo-radiotherapy group(17.9 months vs 12.3 months,P0.05).The main adverse reactions were myelosuppression,radiation esophagitis,radiation pneumonitis and gastrointestinal reaction in the two groups.The incidence of Ⅲ~Ⅳ grade side effects in the concurrent chemo-radiotherapy group were higher than that in the sequential chemo-radiotherapy group with no significant difference(P0.05).Conclusion While compared with sequential chemo-radiotherapy,concurrent chemo-radiotherapy can greatly improve short term curative effects and survival time for patients with non-small cell lung cancer at stage Ⅲ.
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Concurrent chemo-radiotherapy is a commonly employed curative treatment approach for locally advanced cancers but is associated with considerable morbidity. Chemo-radiotherapy using proton therapy may be able to reduce side effects of treatment and improve efficacy, but this remains an area of controversy and data are relatively limited. We comment on recently published studies and discuss future directions for proton therapy.
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Objective: To compare efficacy of chemo radiotherapy and single radiotherapy treatment on advanced cervical cancer and its side effects.Methods: A total of 46 cervical cancer cases at II b-IV stage confirmed by pathological analysis were selected and randomly divided into chemo radiotherapy group and radiotherapy group by half.The method and dosage of radiotherapy were the same in two groups.And patients in chemo radiotherapy group also had cisplatin combination chemotherapy for 3 times.every four weeks.Short-term,long-term treatment effects and side effects were observed and compared.Results:The short-term efficacy of chemo radiotherapy group was 95.23%(22/23),significantly higher than 69.20%(16/23) of the radiotherapy alone group(P0.05);3 and 5-year survival rates of chemo radiotherapy group were 86.96% and 65.22%,significant higher than that of the radiotherapy alone group(60.87% and 43.48%)(P0.05);toxicity and radiation adverse reactions of of the radiotherapy alone group was significantly higher than the radiotherapy alone group(P0.05),but after treatment they were tolerable.Conclusions: Synchronous radiochemical therapy have better clinical efficacy than that with radiotherapy alone in treatment of advanced cervical cancer,although with higher toxicity and side effect.But after treatment it can be tolerated,and does not affect the efficacy.
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To compare the results obtained following treatment, from a group of patients with locally advanced cervical cancer (Stage IB or higher) treated with concurrent chemotherapy and radiotherapy in relation to a group of patients treated exclusively with radiotherapy.All patients treated with concurrent chemotherapy and radiotherapy at the Gynaecologic Oncology Unit of the University Hospital Materno Infantil of the Canaries between 1999 and 2000, both inclusive, were included. The first group to be considered was formed by patients who received combined treatment. The second group of patients received radiotherapy exclusively, having been treated in previous years (1997-1998 period). The results were compared in relation to survival in the two following years from treatment (2000-2001) in the group of combined treatment and years 1999-2000 in the group that received only radiotherapy. To compare the survival of both groups the chi-square test and Odds Ratio were utilised.The groups compared are homogeneous when looking at the stage of the disease when diagnosed, the histological type of tumour and its degree of cellular differentiation, the CAT results and tumoral markers. Survival of more than two years was observed in the group treated with concurrent chemotherapy and radiotherapy in relation to the group treated exclusively with radiotherapy; chi-square 9.92, p < 0.01, OR: 0.1 (0.01-0.6).
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The biological effect induced in the cell by a fixed dose of radiotherapy (e.g. 1 Gy) can be increased, reduced or significantly altered when chemotherapeutic or hormonal agents interact. A different timing of the combination between chemo/hormonotherapy and radiotherapy may also influence the cascade of effects induced by the dose of 1 Gy. Furthermore, patient, tumor and treatment-related factors are individual parameters which should be carefully considered for their potential impact on the radiation dose.
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