Accelerated Fractionation Radiotherapy Research Articles

Accelerated Fractionation Radiation Therapy for Advanced Squamous Cell Carcinoma of the Head and Neck

We treated 14 patients who had advanced head and neck cancer with an accelerated fractionation schedule of irradiation consisting of two fractions given 6 hours apart. In the morning a volume of 1.7 Gy was given to an area that encompassed the entire tumor, enlarged lymph nodes, and all areas at risk for microscopic disease. Six hours later, 1.1 Gy was given to an area that included only the tumor and any enlarged lymph nodes, with a 2-cm margin. The treatment was well tolerated; of the 13 patients who completed therapy, six did not require a break in therapy, and seven patients did. The median rest period was 2 days. There was no grade 4 toxicity. Grade 3 toxicity included skin changes (one case), mucositis (two), dysphagia (two), weight loss (three), and a decrease in the hemoglobin level (one case). The response rate in the 13 who completed therapy was 13/13 (100%); 11 of the 13 (83%) had a complete response. Only one of the 11 who achieved a complete response had failure at the primary site. At a median follow-up of 24 months, the absolute survival was 7/13 (54%) and the corrected survival was 7/10 (70%). This technique permits radiation therapy to be given on an accelerated schedule without a planned break in treatment. The overall response rate and survival at 2 years was excellent.

Treatment of advanced gynecologic malignancies with intraarterial chemotherapy and accelerated fractionation radiation therapy: A preliminary report

The results of a pilot study employing the administration of intraarterial chemotherapy and accelerated fractionation radiotherapy for advanced gynecologic malignancies are reported. The protocol consisted of three treatment sessions every 3 to 4 weeks. Each session consisted of bilateral or unilateral catheterization of the hypogastric artery with the infusion of cisplatin 100 mg/m2 on Day 1 and 2-deoxy-5-fluorouridine (FUDR) 300 mg/m2 on Day 2. An accelerated fractionation schedule of external-beam radiation was begun on Day 1 consisting of 200 rads twice daily for 4 days (1600 rads per session). Eight patients entered the protocol, and seven completed external-beam radiotherapy. Five completed three intraarterial sessions, and three, two sessions. Five of seven evaluable patients had a complete local response. Local control was sustained fom 6 to 24 months in four patients. Complications included three sensorimotor neuropathies, one clinically insignificant catheter-related thrombosis, and three clinically significant radiation injuries. This multimodality treatment for locally advanced gynecologic tumors appears feasible with modification, and continued work exploring this approach is encouraged.

The predictive value of cell kinetic measurements in a European trial of accelerated fractionation in advanced head and neck tumors: An interim report

The value of cell kinetic measurements in head and neck tumors in predicting which patients will benefit from accelerated fractionation radiotherapy regimens is being tested in a multicenter European trial (EORTC trial 22851). This paper reports on the first analysis of the correlation of kinetics with outcome in this trial. A proportion of patients in both the accelerated arm (72 Gy in 5 weeks, 1.6Gy per fraction, 45 fractions) and the conventional arm (70–72 Gy in 7–8 weeks, 1.8–2.0 Gy per fraction, 35–40 fractions) were given an i.v. injection of 100 mg/m2 IUdR (iododeoxyuridine) before treatment, and a tumor biopsy was taken several hours later. The potential doubling time of the tumor (Tpot) was obtained from a flow cytometric analysis of tumor cell nuclei using an anti-IUdR antibody. From a total of 260 patients entered in the trial, 53 have undergone kinetic analysis. Adequate IUdR labeling was seen in 47 patients (88.7%), from which the mean value for Tpot was found to be 4.5 ± 2.5 days (±S.D.). Of the IUdR labeled patients, 30 have now been followed up for at least 1 year, 17 with conventional and 13 with accelerated radiotherapy. These patients were split into those with fast and those with slowly growing tumors, the dividing line being the median Tpot value of 4.6 days. After conventional 7-week radiotherapy, 2 of 6 patients with “fast” growing tumors obtained local control compared with 8 of 11 with “slow” growing tumors. A smaller difference in local control was seen been fast and slow tumors in the accelerated arm (59 vs. 34). These preliminary data support the hypothesis that patients with fast growing tumors do poorly with conventional radiotherapy and that pretreatment kinetic measurements can select patients at risk. The predictive power of the method must await the final analysis of trial results.

Accelerated fractionation radiotherapy for hospitalized glioblastoma multiforme patients with poor prognostic factors

The standard 6 week course of post-operative radiotherapy for glioblastoma multiforme (astrocytoma grade IV) is lengthy, considering the poor prognosis. The standard schedule is especially unsuitable for hospitalized patients and for those with poor prognostic factors (such as old age and poor performance status) since their survival is particularly short. In order to improve the survival-treatment time ratio, we entered a total of 14 hospitalized patients with glioblastoma multiforme (GBM) and poor prognostic factors (mean age 62, mean KPS 57%) into a Phase I trial of accelerated fractionation (AF) external beam radiotherapy. A total tumor dose of 5400-5500 cGy was given in 3 weeks: 4300-4500 cGy whole brain using 100 cGy tid fractions on weekdays plus a 900-1200 cGy boost using single daily fractions of 150-200 cGy on weekends. Only one patient entered did not complete therapy, due to the development of pulmonary embolism resulting in death. Mean survival for all 14 patients from the time of surgical diagnosis was 30.4 weeks. The schedule was well tolerated and resulted in a substantial decrease in treatment time compared to conventional fractionation in these patients. AF schedules should continue to be explored since they may be more appropriate than conventional fractionation schedules for GBM patients with poor prognostic factors, particularly when hospitalized.

Accelerated fractionation radiotherapy for advanced head and neck cancer

Between 1981 and 1986, 89 patients with advanced head and neck squamous cancer were treated with a continuous accelerated fractionation radiotherapy (AFRT) regimen. Three fractions of 1.80 Gy, 4 h apart, were given on three treatment days per week (Monday, Wednesday, Friday), and the tumour dose was taken to 59.40 Gy in 33 fractions in 24–25 days. Acute mucosal reactions were generally quite severe, but a split was avoided by providing the patient with intensive support, often as an in-patient, until the reactions settled. Late radiation effects have been comparable to those obtained with conventional fractionation. The probability of local-regional control was 47% at 3 years for 69 previously untreated patients, whereas it was only 12% at one year for 20 patients treated for recurrence after radical surgery. Fifty-eight previously untreated patients with tumours arising in the upper aero-digestive tract were analysed in greater detail. The probability of local-regional control at 3 years was 78 % for 17 Stage III patients and 15% for 31 Stage IV patients. This schedule of continuous AFRT is feasible and merits further investigation.

Treatment of advanced gynecologic malignancies with intraarterial chemotherapy and accelerated fractionation radiation therapy: A preliminary report

The results of a pilot study employing the administration of intraarterial chemotherapy and accelerated fractionation radiotherapy for advanced gynecologic malignancies are reported. The protocol consisted of three treatment sessions every 3 to 4 weeks. Each session consisted of bilateral or unilateral catheterization of the hypogastric artery with the infusion of cisplatin 100 mg/m 2 on Day 1 and 2-deoxy-5-fluorouridine (FUDR) 300 mg/m 2 on Day 2. An accelerated fractionation schedule of external-beam radiation was begun on Day 1 consisting of 200 rads twice daily for 4 days (1600 rads per session). Eight patients entered the protocol, and seven completed external-beam radiotherapy. Five completed three intraarterial sessions, and three, two sessions. Five of seven evaluable patients had a complete local response. Local control was sustained fom 6 to 24 months in four patients. Complications included three sensorimotor neuropathies, one clinically insignificant catheter-related thrombosis, and three clinically significant radiation injuries. This multimodality treatment for locally advanced gynecologic tumors appears feasible with modification, and continued work exploring this approach is encouraged.

Accelerated fractionation radiation therapy for liver metastases: Selection of an optimal patient population for the evaluation of late hepatic injury in rtog studies

The palliation of hepatic metastases represents a major therapeutic problem in oncology. The generally unfavorable prognosis of patients with liver metastasis may complicate the evaluation of the efficacy and toxicity of various therapeutic modalities. The Radiation Therapy Oncology Group (RTOG) is evaluating new accelerated fractionation schemes for hepatic irradiation. In designing this study it became necessary to identify a favorable subpopulation of patients with an expected median survival of 6 months in whom the late effects of treatment could be evaluated. Data from two RTOG liver metastases studies (7605 and 8003) were analyzed using multi-variate techniques. Cases with a serum bilirubin level of greater than 1.5 mg%, performance score of less than 50, and gastric or pancreatic primary carcinomas were initially excluded because of the adverse influence of these factors on survival. One hundred and ninety cases met the criteria for inclusion in this analysis. A loglinear model was used to identify the patient characteristics associated with a favorable prognosis for survival. These included a performance score of 80–100, colorectal carcinoma primary, and no extrahepatic metastases. A logistic regression equation was derived and confirmed that the probability of surviving at least 6 months depended on the effects of performance score, primary site and the presence or absence of extra-hepatic metastases. Patients with all three favorable factors constituted 30% of the evaluable study population and had a predicted survival of 50% at 6 months. A patient population with these characteristics will be used to study the late effects of accelerated fractionated radiation therapy on the liver.

Preliminary results of combination chemotherapy (CT) and sequential accelerated fractionation radiation therapy (RT) in limited stage small cell carcinoma of the lung

Preliminary results of combination chemotherapy (CT) and sequential accelerated fractionation radiation therapy (RT) in limited stage small cell carcinoma of the lung

Accelerated fractionation radiotherapy alternated with chemotherapy for locally advanced non-small-cell carcinoma of lung (NSCCL). A pilot study

Accelerated fractionation radiotherapy alternated with chemotherapy for locally advanced non-small-cell carcinoma of lung (NSCCL). A pilot study

Preliminary results of combination chemotherapy and sequential accelerated fractionation radiation therapy in limited-stage small cell carcinoma of the lung. Evaluation of measures for reduction of toxicity and effect on complete response rate.

Preliminary results of combination chemotherapy and sequential accelerated fractionation radiation therapy in limited-stage small cell carcinoma of the lung. Evaluation of measures for reduction of toxicity and effect on complete response rate.

Effective palliation of advanced non-small cell lung cancer by short duration irradiation

As a preliminary study before starting a combination (irradiation-chemotherapy) protocol, 18 patients with non-small cell carcinoma of the lung (NSCCL) were treated with a short course of accelerated fractionation radiotherapy alone. Early results were equivalent to results reported in the literature after radiotherapy of higher doses, given in longer periods. Distressing symptoms were effectively controlled whereas side effects were not excessive.