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(1/605) Neoadjuvant chemotherapy followed by concurrent chemoradiation for locally advanced nasopharyngeal carcinoma.

BACKGROUND AND OBJECTIVE: Concurrent chemoradiation therapy (CCRT) is the standard treatment for patients with locally advanced nasopharyngeal carcinoma (NPC). The effect of neoadjuvant chemotherapy followed by CCRT has not been determined. Therefore, we conducted 2 phase II studies to evaluate the efficacy and safety of neoadjuvant chemotherapy with a regimen of docetaxel, cisplatin, and 5 fluorouracil (5-Fu) (TPF) followed by radiotherapy and concurrent cisplatin in patients with stage III and IV(A - B) NPC. This article is the preliminary report on treatment related toxicities and response. METHODS: Graded according to the 2002 American Joint Committee on Cancer (AJCC) staging criteria, only patients with stage III or IV(A-B) poorly differentiated or undifferentiated NPC (World Health Organization type II/III) were included. We planned to recruit 52 patients with stage III disease and 64 patients with stage IV(A - B) disease. All patients received neoadjuvant chemotherapy with TPF (docetaxel 75 mg/m(2), day 1; cisplatin 75 mg/m(2), day 1; 5 Fu 500 mg/(m2 x day), continuous intravenous infusion for 120 h), every 3 weeks for 3 cycles, followed by weekly cisplatin (40 mg/m(2)) concurrent with radiotherapy. Three dimensional conformal radiotherapy (3D CRT) and intensity modulated radiotherapy (IMRT) were used. Gross disease planning target volume (PTV), high risk and low risk subclinical PTV doses were prescribed at 70-76 Gy, 66-70 Gy, and 60-61.25 Gy at 1.75-2.0 Gy per fraction. The lower neck or supraclavicular fields may be treated with conventional AP/PA fields for a total of 54 Gy at 1.8 Gy per fraction. Patients were evaluated for tumor response after the completion of neoadjuvant chemotherapy, and at 3 months after radiation according to the Response Evaluation Criteria In Solid Tumors (RECIST). The latest version of the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI CTCAE 3.0) was used for grading all adverse events. RESULTS: Fifty nine patients were evaluable for treatment response. Thirty patients had stage III disease and 29 patients had stage IV(A-B). All patients completed RT to the prescribed dose and 2 cycles of neoadjuvant chemotherapy, with 51 patients (86.4%) completing 3 cycles. A total of 50 (84.7%) and 39 patients (66.1%) completed 4 weeks and 5 weeks of cisplatin during CCRT, respectively. The overall response rate in the primary site and the neck region were 94.9% [complete response (CR) in 25.4%] and 100% (CR in 19.6%) after completing neoadjuvant chemotherapy. At 3 months after RT, the CR rates increased to 96.6% and 90.2%, respectively. After a median follow up of 14.3 months, we observed 5 treatment failures and 2 deaths. The 1 year overall survival, distant metastasis free survival, and locoregional relapse free survival rates were 100%, 95.7%, and 97.7%, respectively. The rates of grade 3/4 myelosuppression and anorexia/nausea/vomiting during neoadjuvant chemotherapy were 55.9% and 16.9%, respectively. The corresponding rates were 11.9% and 23.7% during CCRT. Grade 3/4 mucositis, skin desquamation, and xerostomia occurred in 6.8%, 44.1%, and 27.1% of patients, respectively. There were no treatment related deaths. CONCLUSIONS: Neoadjuvant chemotherapy with TPF followed by CCRT was well tolerated with a manageable toxicity profile. Preliminary results are encouraging and warrant further investigation.  (+info)

(2/605) Radiotherapy in the treatment of patients with unresectable extrahepatic cholangiocarcinoma.

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(3/605) Esophageal cancer: diagnosis and management.

Esophageal cancer is the 7th leading cause of cancer deaths worldwide. While squamous cell carcinoma is the most prevalent histology internationally, adenocarcinoma of the distal esophagus accounts for nearly 50% of cases in developed countries due to the differences in the etiologic factors such as gastroesophageal reflux disease (GERD) and obesity that predominate. While surgery is the mainstay of treatment of this disease, the utilization of chemoradiation, either used postoperatively or neoadjuvantly, has become a standard practice in the United States. What is the optimal management approach is still an area of contention, however, and may be different in different regions around the world. This article reviews some of these controversies, including the role for surgery in patients treated with definitive chemoradiation. At the end, we will also outline recommendations regarding radiotherapy procedures and techniques.  (+info)

(4/605) Treatment guideline of radiotherapy for Chinese esophageal carcinoma (draft).

Esophageal carcinoma is one of the most common human cancers in China. Radiotherapy plays an important role in combination therapy of esophageal carcinoma. With regret, there is still no unified standard for the treatment of esophageal carcinoma in China, and there are many controversies in the treatment regimens, indications, methods and efficacy. Clinically, the clinical practice guidelines of the National Comprehensive Cancer Network (NCCN) of the United States were often consulted, but the data of them were mainly from the patients from Europe and America, and they might not be applicable for Chinese patients. In order to standardize clinical process of radiotherapy for esophageal carcinoma in China, the Esophageal Carcinoma Cooperative Group of Radiation Oncology Society of Chinese Medical Association wrote a consensus and controversies on the radiotherapy for esophageal carcinoma (draft) after years of research and discussion. We hope it be tried out and discussed with advice and valuable suggestions, in order to accelerate the process of standardization of esophageal carcinoma treatment in China.  (+info)

(5/605) Considerations of treatment standardization from the procession of NCCN guideline of esophageal cancer.

Esophageal carcinoma is one of the most common malignant tumors, especially in China which is the high incidence area. As a result of mild symptoms of early-stage esophageal cancer, the majority of patients cannot be diagnosed until they develop to advanced cancer, and the treatment outcome of surgery or chemoradiotherapy is still unsatisfactory at present. The guidelines of esophageal cancer issued by National Comprehensive Cancer Network (NCCN) are regarded as important reference tools by clinical oncologists, and provide uniform criteria for the diagnosis and treatment of esophageal carcinoma. However, the guidelines are not always suitable for Chinese patients because the data come from European and American population which have significant ethnical difference from Chinese. We retrospectively analyzed the changes of treatment strategy of esophageal cancer in NCCN guidelines and the advance of treatment for esophageal carcinoma in China, aiming to provide our oncologists with new research ideas. We also hope to set up clinical cancer cooperation organizations, and release our own cancer guidelines to serve Chinese patients and oncologists.  (+info)

(6/605) Literature analysis of radiotherapy for esophageal cancer in China.

BACKGROUND AND OBJECTIVE: Many patterns of treatment have been used to treat esophageal carcinoma in the past years, however, an optimal treatment is still the key issue to be explored. Therefore, we analyzed the published literature about radiotherapy for esophageal cancer in recent 15 years in China, and observed the survival rate, local control rate, adverse events, and so on. METHODS: A total of 56 eligible papers about radiotherapy for esophageal squamous cell carcinoma published in Chinese core periodicals between 1994 and 2009 were selected. The survival rates, local control rates, and adverse events were analyzed. RESULTS: The 1-, 2-, 3-, and 5-year overall survival rates of the patients reported in the 56 papers were (67.99 +/- 12.55)%, (49.59 +/- 11.79)%, (34.50 +/- 11.49)%, and (23.31 +/- 10.21)%, respectively. The 1-, 2-, 3-, and 5-year local control rates were (73.04 +/- 13.37)%, (61.60 +/- 15.50)%, (51.77 +/- 15.00)%, and (50.15 +/- 21.36)%, respectively. The acute esophageal toxicity rate was (44.84 +/- 25.71)% in 32 papers reported in recent 15 years, and the acute esophageal toxicity over grade II accounted for (35.93 +/- 22.90)%. The rates of acute esophageal toxicity were (26.84 +/- 13.12)% for conventional radiation, (53.72 +/- 21.82)% for late course accelerated hyperfractionation radiation, (61.33 +/- 28.69)% for concurrent chemoradiotherapy, and (40.31 +/- 27.22)% for other ways of radiation. The late toxicity rate described in 23 papers was (5.13 +/- 4.07)% in recent 15 years. The late toxicity rates were (5.66 +/- 3.42)% for conventional radiation, (4.53+/- 4.07)% for late course accelerated hyperfractionation radiation, (2.24+/-1.31)% for concurrent chemoradiotherapy, and (7.34 +/- 5.06)% for other ways of radiation. The Meta analysis indicated that concurrent chemoradiotherapy was better than late course accelerated hyperfractionation radiation and conventional radiation. CONCLUSIONS: The long-term survival of patients with esophageal cancer is still disappointed in recent years. Concurrent chemoradiotherapy shows advantages in treating esophageal cancer and, currently, is the best non-surgical treatment of esophageal cancer.  (+info)

(7/605) A phase I trial of tipifarnib with radiation therapy, with and without temozolomide, for patients with newly diagnosed glioblastoma.

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(8/605) Efficacy of concurrent chemoradiotherapy plus adjuvant chemotherapy on advanced cervical cancer.

BACKGROUND AND OBJECTIVE: Concurrent chemoradiotherapy for cervical carcinoma develops rapidly and has become a common and standard therapy in recent years. Both the local control rate and survival rate of patients were increased and the risk of death fell by 30%-50%. This study aimed to explore the efficacy of concurrent chemoradiotherapy plus adjuvant chemotherapy on and the treatment compliance of the patients with advanced cervical squamous cell carcinoma. METHODS: A total of 156 patients with stage IIa-IIIb cervical squamous cell carcinoma were randomly divided into the concurrent chemoradiotherapy group (experimental group) and radiotherapy group (control group). Intracavity and external beam radiation therapy were administered. At point A, 40-48 Gy were given by 10-12 fractions; at point B, 46-50 Gy were given by 23-25 fractions. In the same time, experimental group was treated by cisplatin (DDP, 40 mg) on day 1, repeated every week. Ten days after radiation therapy, TP regimen was administered as adjuvant chemotherapy. RESULTS: For the experimental and control groups, the objective response rates were 88.61% and 75.32%, 1-year survival rates were 88.57% and 70.77%, 1-year local control rates were 81.43% and 64.62%, 3-year survival rates were 82.14% and 57.69%, and 3-year local control rates were 75.00% and 46.15%, with significant differences (P<0.05). Quality of life of all patients were significantly improved after treatment (P<0.05). CONCLUSION: Concurrent chemoradiotherapy plus adjuvant chemotherapy for advanced cervical cancer can improve short-term and long-term survival and local control rates of patients, improve the quality of life, and the toxicity can be tolerated.  (+info)