Combined Radiation Chemotherapy Research Articles

784P Perioperative multimodality treatment in high-risk node-positive penile cancer: A single institution study of patients treated in a supraregional centre

The role of perioperative treatment with adjuvant radiotherapy (RT), combination chemotherapy (CT) or both modalities in node-positive penile cancer following radical lymphadenectomy is unclear. Recent guidelines suggest a benefit of perioperative CT, but question the efficacy of adjuvant RT. Perioperative combination CT using paclitaxel/cisplatin/ifosfamade (TIP) or Cisplatin/5FU (CF) was added to our protocol of adjuvant RT in high-risk, node-positive squamous cell carcinoma of the penis. From 2007 to 2018 a total of 111 patients were treated with radical surgery including inguinal lymphadenectomy for pN2/pN3 disease at a supraregional centre. 9 were excluded due to metastatic disease at presentation and 10 were excluded due to lack of follow up. 92 patients were included in the analysis. Primary outcome was progression free survival (PFS) 2 years after surgery. Log-rank analysis of survival curves, and multivariate analysis (MVA) using Cox proportional hazard logistic regression was undertaken. Median age was 62 years. 57% (52/92) had extranodal extension (ENE). 43% (40/92) also underwent pelvic lymphadenectomy. 48% (44/92) received post-operative RT, the most recent 19% also had perioperative chemotherapy (most had TIP). The PFS at 24 months was 26% with post-operative surveillance alone, 54% with post-operative RT alone and 74% with both perioperative CT and post-operative RT. Surveillance versus RT alone resulted in PFS 7 versus 36 months, HR 2.01 (1.2-3.8) p=0.0079. Surveillance vs CT + RT PFS 7 months versus PFS not reached HR 3.4 (1.6-7) P=0.0008. MVA confirmed that CT + RT reduced risk of progression HR 0.2 (0.05-0.92) p=0.039 (Table).Table 784PPerioperative intervention2 year PFSMedian PFSHR95% CIPSurveillance26%7 months---Adj RT alone54%36 months2.81.2-3.80.0079CT and RT74%not reached3.41.7-7.00.0008MVA- variables associated with risk of progression after surgeryHR95% CIPsurveillance2.11.2-3.90.013Combination RT and CT0.20.1-0.90.039Extracapsular Spread2.11.1-3.90.019 Open table in a new tab Following inguinal lymphadenectomy in high-risk node-positive penile cancer patients PFS was significantly improved in patients who received adjuvant RT alone, but the greatest PFS was seen in those who receive both perioperative CT and adjuvant RT.

Treatment of pelvic Ewing's sarcoma: Pros and cons of chemotherapy plus definitive radiotherapy versus surgery.

The aim of this study was to compare the results of chemotherapy or combined chemotherapy-radiation therapy with surgical intervention following neodjuvant therapy in pelvic Ewing's sarcoma patients. The study population consisted of 39 patients with pelvic Ewing's sarcoma treated in our clinic between 1994 and 2014. Of these patients, 28 patients (11 boys and 17 girls; mean age: 19.57±6.8 years) were treated with chemotherapy and radiation therapy and the remaining 11 patients (9 boys and 2 girls; mean age: 18.64±8.1 years) patients underwent surgical intervention after neoadjuvant chemotherapy or chemotherapy plus radiation therapy. Internal hemipelvectomy was performed in 10 patients, and external hemipelvectomy was performed in one patient. Survival rates were compared between the surgical and non-surgical treatment groups. Predictive factors, such as treatment protocol (surgery, neoadjuvant chemotherapy, definitive radiotherapy), mass localisation, mass size, presence of metastasis at the time of diagnosis, and presence of late metastases were compared between the groups. The effects of each variable on survival were also examined. The overall 3- and 5-year survival rates of the 28 non-surgical patients were 41.4% and 26.1%, respectively, while those of the surgical patients were 53% and 35.4%, respectively (p=0.777). Large mass size, presence of metastasis at the time of diagnosis, and presence of late metastases were significantly associated with lower survival rates. The survival rates of the patients who underwent surgery were higher than those of non-surgical patients, although the difference was not statistically significant. Definitive radiation and chemotherapy would be preferable in selected cases, such as patients with sacral localisation, without surgical intervention. Level III, Therapeutic Study.

Differences in fatigue severity in a sample of adult cancer patients.

To describe differences in fatigue severity in a sample of adult Puerto Rican patients during and postcancer treatments. Hispanics, including Puerto Ricans, are an understudied population who are under-represented in clinical trials, especially in symptom research. Although symptom management is a clinical priority in oncology care, treatment-related differences in Puerto Rican cancer patients' report of fatigue severity have not been well described. A cross-sectional survey was conducted from data of self-report of 138 Puerto Rican patients during and postcancer treatments at two ambulatory facilities located in San Juan, Puerto Rico. Fatigue severity was assessed using the Fatigue subscale from the Functional Assessment of Cancer Therapy-Fatigue quality of life questionnaire Spanish version. Differences in fatigue severity across type of treatment (radiation therapy, chemotherapy, combined radiation chemotherapy and post-treatment) were evaluated using nonparametric (Kruskal-Wallis and Mann-Whitney test) statistical tests. The majority of the participants had prostate (33%) and breast (32%) cancers and were receiving radiation therapy (43%) or chemotherapy (28%). The Kruskal-Wallis test showed that there was a statistically significant difference in fatigue scores between the different four treatment conditions, χ2 (3)=39.1, p=.001 with patients on combined radiation chemotherapy or chemotherapy alone experiencing more severe fatigue. Findings from the current study suggest that type of treatment is a key component of the symptom burden of fatigue among the Puerto Rican oncology population. Specially, patients receiving combined therapy or chemotherapy alone were at increased risk for experiencing severe fatigue, compared to radiation therapy and post-treatment patients. With the worldwide increase in migration of Puerto Rican families, nurses need to recognise that type of treatment is a key component of the symptom burden of fatigue among the Puerto Rican population. The results of this study will improve understanding of treatment-related fatigue to identify therapeutic targets and improve quality of life of patients.

Efficacy and Safety of Promace-Cytabom Regimen with Sandwiched Radiotherapy Method in the Treatment of Newly Diagnosed, Stage IE to IIE, Extranodal NK/T-Cell Lymphoma, Nasal Type

Background: On the basis of the characteristics of extranodal natural killer T (NK/T)-cell lymphoma (ENKTL) which is predisposed to have the multidrug resistance phenotype and radiosensitivity, combined chemotherapy-radiotherapy is one of the effective options in localized early-stage, ENKTL, nasal type. However, frequent severe myelosuppression (grad 3/4 cytopenia), grade 3 radiation-related mucositis, and local/systemic relapse is a major obstacle. So we evaluated the proMACE-cytaBOM (prednisone, methotrexate, doxorubicin, cyclophosphamide, etoposide, cytarabine, bleomycin, vincristine, and methotrexate) as a slightly less intense regimen with sandwiched radiotherapy (36 Gy).Patients and Methods: From July 2005 to December 2014, Thirty-one patients with newly diagnosed, stage IE to IIE, nasal type ENKTL were analyzed retrospectively. Twenty patients received the chemoradiotherapy sandwiched method: Initially 3 cycles of proMACE-cytaBOM, followed by radiotherapy of 36 Gy, after sandwiched radiotherapy and additional 3 cycles of proMACE-cytaBOM were administered. The other eleven patients were treated with following: Two patients received the frontline autologous hematopoietic stem cell transplantation, five patients were treated with sequential chemoradiotherapy as VIPD (etoposide, ifosfamide, cisplatin, and dexamethasone) followed by radiation of 50 Gy. Four patients received the chemotherapy alone (4 to 6 cycles of proMACE-cytaBOM).Results: In twenty patients with completely proMACE-cytaBOM and sandwiched radiotherapy schedule, median age was 50-year (range 26 to 79), with male-dominant (85%). A median of 6 (range, 4-6) cycles of proMACE-cytaBOM were administered, and sandwiched radiotherapy was received with a median 36 Gy (range 34.5 to 36) (Table1). Interim analysis after 3 courses of proMACE-cytaBOM showed that an overall response rate (ORR) of 82.6%, with complete remission (CR) and partial remission (PR) achieved in 73.9% and 8.7%, respectively. On treatment completion with chemotherapy and sandwiched radiotherapy, the ORR was increased to 90.0%, with CR rate increased to 85%. One patient experienced disease progression, and the other one was within stable disease during therapy. With a median follow-up of 42 months (range 5.5 to 81.4), the 5-year overall survival and progression-free survival were 83.6% (95% CI, 69 to 95 %) and 45.9% (95% CI, 45 to 95%), respectively (figure 1). Grade 3/4 neutropenia developed in 25% (n=5) of patients and grade 3 radiation-related mucositis in 10% (n=2). There was no regimen treatment-related mortality (TRM) (Table 2).Conclusion: The proMACE-cytaBOM regimen with sandwiched radiotherapy (36 Gy) could be a promising and feasible option in the treatment of newly diagnosed localized ENKTL due to its favorable efficacy and tolerable low toxicities including of low radiation-related mucositis and no TRM. [Display omitted] [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Beneficial effects of animal-assisted visits on quality of life during multimodal radiation-chemotherapy regimens.

Animal-assisted visits (AAVs) are commonplace in cancer centers, but there is little evidence of their usefulness. To test the efficacy of AAVs in improving the quality of life in patients with head and neck cancer receiving combined chemotherapy-radiation therapy. 42 patients consented to daily AAVs during the time they received therapy for head and neck cancer. The Functional Assessment of Cancer Therapy-General Scale (FACT-G) was administered at baseline, week 3, and week 7 (at the end of therapy), and the Satisfaction With The AAV Intervention instrument, an 18-item scale adapted from the Pet Attitude Scale. 37 patients completed at least baseline and 1 follow-up assessment for a single group analysis of change over time. Means for Fact-G subscales showed significant declines in Physical Well-Being (PWB, P < .001) and Functional Well-Being (FWB, P = .003). In contrast, Social Well-Being increased (SWB, P = .03). Controlling for declines in PWB at each time point, increases in Emotional Well-Being (EWB) were also significant (P = .004). Scheduling and patient preference prevented conducting a randomized trial. FACT-G analysis showed significant increase in SWB and EWB despite high symptom burden and clinically evident and expected declines in PWB and FWB. Mean scores for satisfaction related to psychological symptoms, liking animals/pets, and contact with animals were consistently higher than neutral score or Unsure (all, P < .001). Satisfaction related to physical symptoms was not significantly different from neutral. Though self-selected for an affinity to pets, patients endorsed a high level of satisfaction, which supports the usefulness of this intervention.

1598 FEASIBILITY STUDY: A NOVEL ULTRA-SMALL FIDUCIARY MARKER DESIGN AND DELIVERY PROTOCOL TO IMPROVE CONFORMAL RADIATION THERAPY FOR BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Invasive1 Apr 20111598 FEASIBILITY STUDY: A NOVEL ULTRA-SMALL FIDUCIARY MARKER DESIGN AND DELIVERY PROTOCOL TO IMPROVE CONFORMAL RADIATION THERAPY FOR BLADDER CANCER Maurice Garcia, Alex Gottschalk, Jocelyn Speight, Badrinath Konety, and Peter Carroll Maurice GarciaMaurice Garcia San Francisco, CA More articles by this author , Alex GottschalkAlex Gottschalk San Francisco, CA More articles by this author , Jocelyn SpeightJocelyn Speight San Francisco, CA More articles by this author , Badrinath KonetyBadrinath Konety Minneapolis, MN More articles by this author , and Peter CarrollPeter Carroll San Francisco, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1648AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder radiation is an important management option for carefully selected patients with bladder cancer. However, unreliable visualization of the tumor site on CT imaging and day to day variability in bladder volume limit efficacy and increase side effects. The smallest area that can generally be targeted to receive higher (boost) radiation dosage is ¼ of total bladder area. More accurate and reliable target localization would likely improve treatment outcomes. METHODS Six consecutive patients with stage T2 bladder cancer elected management with combination radiation-chemotherapy. All underwent endoscopic placement of modified 24-K gold fiduciary markers (1.1 mm. x 3.2 mm., and 0.65 mm. x 2.1 mm.) into healthy submucosa 1 cm. from the margin of the tumor resection site using a custom-made steel coaxial needle. Retention and migration was confirmed by KUB, dosimetry-planning CT-scan, and portal imaging. Patients were assessed for adverse effects of marker placement. RESULTS A total of 22 markers (3–4 per tumor site) were placed. All markers were easily visualized by KUB (Figure 1), CT scan, and portal imaging, and no marker migration occurred. One patient did not undergo any radiation therapy, and was managed with surveillance. The other has not yet begun radiation therapy. Four patients completed radiation therapy. In 1 patient, during the last quarter of radiation therapy, 1 marker was spontaneously passed. All other markers (14/15) were present through the end of radiation therapy. No intraoperative or post-operative complications occurred. These markers allowed the area targeted to receive higher-dose radiation to be reduced to 1/2 to 1/6 of the area that would be irradiated without the markers. CONCLUSIONS The novel fiduciary marker design and placement protocol we present is technically simple to perform, well tolerated, and designed to minimize risk of marker migration. This allows the exact site of bladder tumor resection to be localized in 3-dimensions throughout dosimetry planning and therapy, while minimizing the high (boost)-dose treatment area. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e641-e642 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maurice Garcia San Francisco, CA More articles by this author Alex Gottschalk San Francisco, CA More articles by this author Jocelyn Speight San Francisco, CA More articles by this author Badrinath Konety Minneapolis, MN More articles by this author Peter Carroll San Francisco, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Osteoradionecrosis of the mandible

Osteoradionecrosis of the mandible is a serious complication of radiation therapy to the head and neck. Given the increased use of radiation therapy and combined chemotherapy-radiation therapy regimens in treatment of head and neck malignancies, it is anticipated that osteoradionecrosis will continue to be an important clinical problem. Recently, new concepts have been introduced regarding the pathogenesis of osteoradionecrosis, and these ideas help outline new guidelines for treatment. Current literature focuses on the probability of a fibroatrophic mechanism for the development of osteoradionecrosis, rather than the traditional vascular insufficiency mechanism. Because of the evolution of this new idea, as well as a double-blinded, placebo-controlled study finding no benefit from the use of hyperbaric oxygen for advanced osteoradionecrosis of the mandible, new treatment considerations have emerged. Ongoing research is also being conducted to clarify the role of osteoclasts in the pathogenesis of osteoradionecrosis. Restoration of blood supply or vascularized tissue to the affected area continues to be of primary importance in the resolution of osteoradionecrosis. It is clear that the cause and pathogenesis of osteoradionecrosis are far more complex than originally believed. Current and future research on this multifaceted topic will focus on the cellular basis of this condition, because as it is elucidated, more effective medical treatment regimens will become evident.

Docetaxel and concurrent radiotherapy after two cycles of induction chemotherapy with cisplatin and vinorelbine in patients with locally advanced non-small-cell lung cancer: A phase II trial conducted by the Groupe Français de Pneumo-Cancérologie (GFPC)

The most satisfactory treatment for patients with locally advanced non-small-cell lung cancer (NSCLC) is combination chemotherapy-radiotherapy (CT-RT). The optimal treatment modalities remain to be determined. We conducted a multicenter phase II trial of the docetaxel-radiotherapy combination after induction chemotherapy with cisplatin-vinorelbine. The main endpoint was the objective response rate. Patient with inoperable stage locally advanced NSCLC received induction chemotherapy consisting of two cycles of cisplatin 100 mg/m2 on D1 and vinorelbine 25 mg/m2 on D1, D8, D15 and D22. Patients with responses or stable disease then received concurrent RT-CT consisting of 25 mg/m2/week docetaxel and single-fraction radiotherapy (66 grays (Gy) in 33 fractions) over 6.5 weeks. Fifty-six patients were enrolled from 1 July 2000 to 31 December 2001. Sixteen patients left the trial after induction chemotherapy, eight for progression, five for toxicity, and two for intercurrent events. One patient underwent surgery after induction chemotherapy. In total, 40 of the 56 patients received RT-CT. Twelve (30%) of these 40 patients experienced grade III or IV pulmonary or esophageal toxicity. In the intention-to-treat analysis, the objective response rate was 46.4% (95% CI 33.0-60.2). The median time to progression was 6.2 months [1.1-26.0]. The median survival time was 13 months [0.3-44.9 months]. Nine patients progressed during RT-CT, six with brain metastases. Weekly docetaxel with concurrent radiotherapy, following chemotherapy is acceptable. The tumor response rate is moderate. Further trials are required to determine the risk-benefit relationship of this treatment schedule, and the possible benefit of adding other cytotoxic drugs.

Primary Central Nervous System Lymphoma.

Standard therapy does not exist for the treatment of primary central nervous system lymphoma. This is because of low patient numbers, slow accrual to clinical trials, and the absence of phase III randomized clinical trials. Neuro-oncologists agree that whole brain irradiation alone is no longer the best treatment option; treatment should include high-dose methotrexate chemotherapy, and treatment strategies must combine efficacy without untoward toxicity. However, beyond this, there is no widespread consensus. Significant neurocognitive toxicity has been associated with combined chemotherapy-radiation regimens, especially in elderly patients. This has prompted many to defer radiation therapy in all patients except those that refuse chemotherapy, those that have a partial response to chemotherapy, or those that have disease progression through chemotherapy. There is supporting evidence for this approach; however, confirmatory data from multicenter clinical trials and 5-year survival rates are unavailable. This underscores the importance of ongoing clinical trials.

Decision analysis in locally advanced non-small-cell lung cancer: is it useful?

The optimal management of locally advanced non-small-cell lung cancer (NSCLC) has not been established. While combined-modality treatments have been shown to increase the survival of patients with this illness, the appropriate balance between the benefit of increased quantity of life and the quality-of-life costs of the more toxic treatment combinations remains unresolved. Decision analysis has been promoted as useful when medical decisions must be made under conditions of uncertainty. We consider the potential of this method to guide therapy in locally advanced NSCLC. We developed two types of decision models that addressed the choice between radiation alone and combined chemotherapy-radiation therapy in locally advanced NSCLC. The models were constructed using the principles of decision analysis. The models successfully replicated results of relevant clinical trials published in the literature. The analyses of both models showed that the treatment decision was sensitive to patients' values, despite significant increases in survival rates. The models clarified a need for further validation of the three fundamental components: structuring the decision, determining the probabilities of events, and assigning utilities to treatment outcomes. In the setting of NSCLC, the models suggest that quality-of-life considerations are important in the treatment choice. Further research is required to identify the health states critical to the decision, the probabilities for occurrence of these health states, and valid measures of their utility.

The Evolution of Radiation Therapy Oncology Group (RTOG) protocols for nonsmall cell lung cancer

Over the past 2 decades, the Radiation Therapy Oncology Group (RTOG) has played a significant role in clarifying the role of radiation therapy (RT) in the treatment of nonsmall cell lung cancer (NSCLC). RTOG lung cancer research has evolved over this time period through a systematic succession of investigations. For unresectable NSCLC, the dependence of local tumor control and survival on total dose of standard fractionation RT, as well as pretreatment performance characteristics, was demonstrated in initial RTOG trials. Subsequently, further radiation dose intensification was tested using altered fractionation RT to total doses up to 32% higher than standard RT to 60 Gy, given as either hyperfractionation or accelerated fractionation, while attempting to retain acceptable normal tissue toxicity. These higher doses required rethinking of established RT techniques and limitations, as well as careful surveillance of acute and late toxicity. A survival advantage was shown for hyperfractionation to 69.6 Gy, in favorable performance patients, compared to 60 Gy. Further testing of high dose standard RT will use three-dimensional, conformal techniques to minimize toxicity. RTOG further extended the theme of treatment intensification for unresectable NSCLC by evaluating combined chemotherapy (CT) and RT. Improved local control and survival was shown for induction CT followed by standard RT to 60 Gy, compared to standard RT (60 Gy) and altered fractionation RT (69.6 Gy). The intent of current studies is to optimize dose and scheduling of combined CT and standard RT, as well as combined CT and altered fractionation RT. Noncytotoxic RT adjuvants, such as hypoxic cell sensitizers, nonspecific immune stimulants, and biologic response modifiers have also been studied. Resectable NSCLC has also been an RTOG focus, with studies of preoperative and postoperative RT, CT, and CT RT , including the prognostic value of serum and tissue factors. RTOG studies have yielded incremental improvements in treatment outcome for NSCLC, better understanding of the disease dynamics, and a strong foundation for future investigations.

Interdigitating Reticulum Cell Sarcoma with Unusual Features

A case of interdigitating reticulum cell sarcoma is reported in a cervical lymph node of a 67-year-old man who had a previously diagnosed nodular lymphocytic lymphoma in the same anatomic location. Ultrastructurally, the neoplastic cells contained cylindrical confronting cisternae, and associated benign lymphocytes had tubuloreticular structures in their cytoplasm. The patient was treated with combination chemotherapy-radiation therapy and is alive and well with no evidence of disease approximately 2 years after completing therapy. The clinical and pathologic features of previously reported cases of interdigitating reticulum cell sarcomas are compared to those of the reported case.

Combined chemotherapy--radiotherapy on spleen hypertrophy after C. parvum: combined treatment with 5-FU cyclophosphamide and radiation.

C. parvum (CP) acts as a powerful stimulant for cell proliferation in the normal spleen. CP, in combination with radiation or cytotoxic chemotherapeutic agents, interfered with their effect to a lesser or greater degree depending upon the sequence in which CP and the cytotoxic therapy was applied. In these experiments, cyclophosphamide (CY), 5-FU and radiation were studied singly or in combination during the resting or after CP-stimulation, and the effects of the different combinations of chemotherapy and radiotherapy determined. Interestingly, CY acted both as a stimulant and suppressant for the spleen growth response when combined with CP. This may contribute to the reported effectiveness of the combination used for therapy in certain antigenic tumour systems. Radiation had a strongly suppressive effect on spleen response to CP in any sequence studied.

Non-Hodgkin’s Lymphoma Following Treatment for Hodgkin’s Disease: Case Report and Review of the Literature

A patient in whom an undifferentiated non-Hodgkin's lymphoma developed after treatment for Hodgkin's disease is described. The second tumor occurred eight years after the initial diagnosis, two years after the completion of combined radiation therapy and combination chemotherapy. The pertinent literature is reviewed, with an emphasis on the potential risk of multimodal antineoplastic treatment's causing secondary neoplasms.

Combination chemotherapy-radiotherapy for advanced, inoperable head and neck cancer

Combination chemotherapy-radiotherapy for advanced, inoperable head and neck cancer

Use of nuclear medicine and computerized tomography techniques for the “time dependent optomization” of combined chemotherapy-radiation therapy

Use of nuclear medicine and computerized tomography techniques for the “time dependent optomization” of combined chemotherapy-radiation therapy

Long term follow-up of combination chemotherapy-radiotherapy of stage III Hodgkin's disease. A cancer and acute leukemia group B study

The Cancer and Acute Leukemia Group B studied the effect of combination chemotherapy-radiotherapy on Stage III Hodgkin's disease. Chemotherapy consisting of 4 weekly doses of vinblastine and one dose of mechlorethamine hydrochloride was followed by no therapy (CT), radiation to involved fields (CTIF) or total nodal radiation (CTTN). Two other treatment arms included total nodal radiation alone (TN) or total nodal radiation followed by chemotherapy (TNCT). Maximum follow-up is ten years. Complete remission percentages were 36 (8/22) for CT, 71 (17/24) for CTIF, 100 (21/21) for CTTN, 86 (19/22) for TNCT and 89 (16/18) for TN. Disease-free survival in patients receiving radiation +/- chemotherapy is 23% (19/73) at 5 years, but even after 9 years relapses were observed in two patients. Forty-one percent of all patients are alive and 32% have survived for five years. Ability to administer adequate therapy was the main determined for response duration and survival. Factors influencing the outcome of the disease include histology, age, splenectomy, initial white blood cell count and performance status, whereas symptomatology, initial absolute lymphocyte count and sex played no role on survival.

Combination chemotherapy and radiotherapy for acute lymphocytic leukemia in adults: Results of CALGB protocol 7113

One hundred and forty-nine adult patients with acute lymphocytic leukemia (ALL) were treated with protocol defined combination chemotherapy-radiotherapy by 25 member institutions of the Cancer and Leukemia Group B. Induction of remission was attempted with vincristine (V), prednisone (P), L-asparaginase (A), with or without intrathecal methotrexate (IT-MTX) and followed by daunorubicin (D) in those patients not in complete remission after 4 weeks. The overall complete remission (CR) rate was 72%; daunorubicin was needed to achieve CR in 20 of the 107 remitting patients. The administration of IT-MTX during remission induction, especially when given simultaneously with A, was found to increase toxicity without therapeutic benefit. Remissions were maintained with either parenteral courses of 6-mercaptopurine (6-MP), and methotrexate (MTX), plus intermittent doses of V, P, and bis-β-chloroethylnitrosourea(BCNU) or with daily oral 6-MP, weekly oral MTX, and periodic VP reinforcements. All patients remaining in remission for 3 months or longer received CNS chemoradiotherapy. Median remission duration was 15 months. Continuous oral maintenance proved at least equivalent to intermittent parenteral remission therapy. Median survival was 17 months for all patients and 29 months for qualified patients achieving CR. Frequency and duration of response, and duration of survival were independent of age between ages 30 and 60. Above age 60 the prognosis is significantly less good. Thirty-two percent of the responders (life table estimate) remain in continuous first remission at 5 y. Toxicity was acceptable, except for an excessive frequency and severity of infections: (1) when V, P. A, and IT-MTX were given simultaneously; and (2) early in remission when full doses of maintenance chemotherapy were employed prior to complete recovery of normal bone marrow function. Results of treatment of ALL in adults have improved markedly during the last decade but lag behind those observed in children for reasons as yet unexplained.

Combination chemotherapy-radiotherapy for stage 3 Hodgkin's disease. An acute leukemia group B study

Combination chemotherapy-radiotherapy for stage 3 Hodgkin's disease. An acute leukemia group B study

Combined chemotherapy radiotherapy management of stage 3 Hodgkin's disease.

Thirty-three stage IIIAand IIIBpatients with Hodgkin's disease have been treated with a combination chemotherapy-radiotherapy program for the past five years. In this program, chemotherapy was administered prior to radiotherapy. The primary purpose for administering preliminary chemotherapy was to insure completion of a scheduled program of radiotherapy. A possible secondary advantage may be a reduction in the incidence of subsequent new disease. Initially, our drug regimen consisted of one course of cyclophosphamide and vincrinstine sulfate. When procarbazine hydrochloride became available, our chemotherapy program was changed to a combination of mechlorethamine hydrochloride, vincristine sulfate (Oncovin), procarbazine hydrochloride, and prednisone (MOPP). Two courses of MOPP were used initially; later the number of courses was changed to three. Survival figures for three and five years are 70% and 68%, respectively.