Concurrent Intensity-modulated Radiotherapy Research Articles

Clinical effect of Biafine in preventing and treating radioactive skin destruction of nasopharyngeal carcinoma patients caused by concurrent intensity-modulated radiotherapy and chemotherapy

Objective To observe the clinical effect of Biafine cream in preventing and treating radioactive skin destruction of nasopharyngeal carcinoma (NPC) patients induced by synchronized intensity-modulated radiotherapy and chemotherapy.

Phase I/II trial of docetaxel and concurrent radiation therapy in localized high risk prostate cancer (AGUSG 03-10)

Purpose A Phase I/II trial was conducted to assess the radiosensitizer docetaxel administered weekly (20 mg/m 2) with concurrent intensity modulated radiation therapy (72 Gy at 1.8 Gy/fraction) in high risk prostate cancer. Patients and Methods Patients with high risk prostate cancer (clinical stage ≥T3; Gleason score 8, 9, or 10; Gleason score 7 and PSA > 10) received IMRT (Clinac 600 CD with 6 MV photons and sliding window technique) and concurrent weekly docetaxel (20 mg/m 2) as a continuous 30 minute infusion for 8 weeks. Patients desirous of concurrent androgen suppression were not excluded. Results Twenty men (median age: 64 years; range, 50–78 years) were enrolled in the chemoradiation protocol. Three patients experienced treatment interruptions: dehydration requiring inpatient hydration ( n = 2); NSAID induced GI bleed ( n = 1). An additional patient required outpatient hydration (<24 hours) with no treatment interruption. Overall, the most frequently observed toxicities were grade 2 diarrhea (40%), grade 2 fatigue (40%), grade 2 urinary frequency (35%), taste aversion (20%), grade 2 constipation (20%), and rectal bleeding (15%). No significant hematologic toxicity (grades 2–4) was encountered among the 20 patients. Although the follow-up interval was relatively short, no significant subacute gastrointestinal toxicities have been observed. At a median follow-up duration of 11.7 months, 17 patients were free of biochemical disease recurrence, and all patients are alive. Conclusion The radiosensitizer docetaxel administered weekly (20 mg/m 2) with concurrent IMRT is well tolerated with acceptable toxicity. Early oncologic outcomes in this challenging patient cohort are encouraging.

Concurrent Chemotherapy and Intensity-Modulated Radiation Therapy for Anal Canal Cancer Patients: A Multicenter Experience

To report a multicenter experience treating anal canal cancer patients with concurrent chemotherapy and intensity-modulated radiation therapy (IMRT). From October 2000 to June 2006, 53 patients were treated with concurrent chemotherapy and IMRT for anal squamous cell carcinoma at three tertiary-care academic medical centers. Sixty-two percent were T1-2, and 67% were N0; eight patients were HIV positive. Forty-eight patients received fluorouracil (FU)/mitomycin, one received FU/cisplatin, and four received FU alone. All patients underwent computed tomography-based treatment planning with pelvic regions and inguinal nodes receiving a median of 45 Gy. Primary sites and involved nodes were boosted to a median dose of 51.5 Gy. All acute toxicity was scored according to the Common Terminology Criteria for Adverse Events, version 3.0. All late toxicity was scored using Radiation Therapy Oncology Group criteria. Median follow-up was 14.5 months (range, 5.2 to 102.8 months). Acute grade 3+ toxicity included 15.1% GI and 37.7% dermatologic toxicity; all acute grade 4 toxicities were hematologic; and acute grade 4 leukopenia and neutropenia occurred in 30.2% and 34.0% of patients, respectively. Treatment breaks occurred in 41.5% of patients, lasting a median of 4 days. Forty-nine patients (92.5%) had a complete response, one patient had a partial response, and three had stable disease. All HIV-positive patients achieved a complete response. Eighteen-month colostomy-free survival, overall survival, freedom from local failure, and freedom from distant failure were 83.7%, 93.4%, 83.9%, and 92.9%, respectively. Preliminary outcomes suggest that concurrent chemotherapy and IMRT for anal canal cancers is effective and tolerated favorably compared with historical standards.

Intensity-Modulated Radiation Therapy (IMRT) With Concurrent Taxane-Based Chemotherapy for Locally-Advanced Head and Neck Cancer (LAHNC): Toxicities and Efficacy

The addition of chemotherapy to radiotherapy improves survival in LAHNC at the expense of higher toxicity. IMRT for LAHNC provides a means to minimize dose to normal tissue. Our experience with concurrent IMRT and taxane-based chemotherapy in 128 sequential LAHNC patients is presented.

Can Bone Marrow Dosimetric Parameters Predict for Myelotoxicity in Cervical Cancer Patients Treated With Concurrent Chemotherapy and Extended-Field Intensity-Modulated Pelvic Radiotherapy (EF-IMRT)?

Can Bone Marrow Dosimetric Parameters Predict for Myelotoxicity in Cervical Cancer Patients Treated With Concurrent Chemotherapy and Extended-Field Intensity-Modulated Pelvic Radiotherapy (EF-IMRT)?

P2-223: Analysis of clinical and dosimetric factors associated with severe radiation pneumonitis in locally advanced Non–Small–Cell–Lung–Cancer patients treated with concurrent chemotherapy and intensity–modulated radiotherapy (IMRT)

To retrospectively evaluate clinical and dosimetric factors associated with severe (grade≥3) radiation pneumonitis in patients after concurrent chemotherapy and intensity-modulated radiotherapy (IMRT). We retrospectively analyzed 94 locally advanced NSCLC patients treated with concurrent chemotherapy and IMRT between May 2005 and September 2006. Radiation pneumonitis was graded according to Common Terminology Criteria for Adverse Events version 3.0. The following clinical parameters were considered: gender, age, smoking and diabetes history, history of chronic obstructive pulmonary disease (COPD), induction chemotherapy, concurrent chemotherapy regimens, performance status and forced expiratory volume in 1 second (FEV1). Dosimetric factors including mean lung dose (Dmean), rV5-V60 relative volumes of lung receiving more than a threshold dose D of radiation (rVD), where values of D considered were 5°C 60 Gy in increments of 5 Gy), prescribed dose (63GY/35f/7w vs 60Gy/30f/6w), and normal tissue complication probability (NTCP) values were analysed. DVHs data and NTCP values were collected for both lungs considered as a parallel organ. Pearson Chi-Square test was performed to compare clinical parameters between patients who developed severe RP and those who did not. Univariate and multivariate logistic regression analyses were performed to evaluate data for association between clinical and dosimetric factors and severe RP. The study was approved by the institutional reviewboard. Of 94 patients, 11 (11.7%) develop severe (grade≥3) radiation pneumonitis; 6 (6.4%), grade 3; 2(2.1%), grade 4; and 3 (3.2%)grade 5. Univariate analyses show that Sex, age (≤60vs>60), smoking and diabetes history, induction chemotherapy, concurrent chemotherapy regimens, PS(≤70vs>70) and prescribed dose did not significantly differ between patients who developed severe RP and those who did not. However, NTCP, MLD, rV5-V60, COPD and FEV1 were associated with severe RP (p<0.05). In multivariate analysis, NTCP (p=0.001) and rV10(p=0.015) was the most significant factors associated with severe (grade≥3) radiation pneumonitis. The incidences of Grade≥3 pneumonitis in the group with NTCP>4.2% and NTCP <4.2% were 43.5% and 1.4%, respectively (p<0.01). The incidences of Grade≥3 pneumonitis in the group with rV10 <51.2% and rV10 >51.2% were 5.6% and 30.4%, respectively (p<0.01). NTCP and rV10 is useful indicator of risk for development of severe (grade≥3) radiation pneumonitis in NSCLC patients after concurrent chemotherapy and intensity -modulated radiotherapy (IMRT).

Concurrent platinum-based chemotherapy with intensity modulated radiation therapy (IMRT) for locally advanced squamous cell carcinoma of the head and neck (SCCHN): A retrospective single institution analysis

16511 Background: Randomized clinical and meta-analysis data support the use of concurrent chemoradiation for treatment of locally advanced (SCCHN). IMRT is increasingly being used in treating SCCHN. We present outcome data from Emory University Winship Cancer Institute (WCI) with concurrent platinum based chemotherapy and IMRT, and analyze results according to primary site and nodal status. Methods: Between February 2003, and November 2005, 87 patients with locally advanced SCCHN underwent concurrent IMRT and platinum based chemotherapy. A total of 62 patients were treated with Cisplatin 100 mg/m2 d1,21,43, while 19 were treated with paclitaxel and carboplatin weekly for 7 weeks. Five patients were treated with other platinum based regimens. Follow up was documented in all cases with a median of 520 days (range 107 - 1269 days). Results: Patients were distributed among primary sites as follows: Hypopharynx (HP) 7 (8.0%), Larynx (L) 11(12.4%), Nasopharynx (NP) 13 (14.6%), and Oropharynx (OP) 56 (63.0%). T stage distribution was: T1: 16 patients (18.0%); lesions more advanced than T1 (&gt;T1): 68 (76.4%). N stage distribution was, N0 :16 patients (18.0%), N1: 8 (9.0 %),nodal stage N2a or higher: 61 (68.5%). Median age was 57 years (range 32–75), and 63 patients (71.0%) were male. The median overall survival (OS) and disease-free survival (DFS) post-therapy was not reached. The 3 year OS rate for the entire cohort was 86% (L 82%, NP 89 %, OP 86 % HP 80%). The 3 year DFS rate for the entire cohort was 74%, (L 85%, NP 60%, and OP 75%, HP 76%). There was no correlation between OS and T or N stage (p=0.143 and 0.44 respectively), or between DFS and T-stage (p=0.4). A significant correlation was found between DFS and N stage (p=0.008). Conclusion: With moderate follow up, this retrospective analysis reveals an excellent outcome for patients with locally advanced SCCHN treated with chemotherapy and IMRT concurrently, supporting concurrent therapy as the current standard of care. The significant correlation of DFS and nodal status suggests a possible greater impact future approaches such as induction therapy may have on patients with advanced nodal disease. No significant financial relationships to disclose.

1141 POSTER Postoperative radiotherapy (PORT) for non-small-cell lung cancer (NSCLC): Results of the 1999–2001 patterns of care study (PCS) nationwide process survey in Japan

The aim of this study was to correlate clinical and dosimetric variables with acute esophageal toxicity (AET) following Intensity Modulated Radiotherapy (IMRT) with concurrent chemotherapy for locally advanced non-small cell lung cancer (NSCLC). In addition, timeline of AET was reported.153 patients with locally advanced NSCLC treated with 66 Gy/2.75 Gy/24 fractions of radiotherapy and concurrent daily low dose cisplatin were selected. Medical records and treatments of these patients were retrospectively reviewed. Maximum AET grade ⩾2 and maximum grade 3 were the endpoints of this study. Dates for onset, maximum and recovery (to baseline) of AET were reported. Univariate and multivariate analysis were applied to correlate clinical, tumor, dosimetric and chemotherapy dose variables to AET grade ⩾2 and grade 3.AET grade 2 occurred in 37% and grade 3 in 20% of the patients. The median onset of AET was around day 15 for all grades. The median onset of the maximum grade was day 30 for both grades 2 and 3. The median duration was 43 days for grade 1, 50 days for grade 2 and >80 days for grade 3. Of the grade 3 AET patients, 48% recovered within 3 months. Esophagus V50, ethnic background, and the number of cisplatin administrations were significantly correlated with grade 3 AET.For NSCLC patients treated with concurrent chemotherapy and IMRT A higher number of cisplatin administrations, non-Caucasian background and higher V50oes were associated with grade 3 AET. The median onset of AET grade 3 is 15 days after the start of treatment, maximized at day 30, with a median duration of >80 days.

Phase II study to assess the efficacy of conventionally fractionated radiotherapy followed by a stereotactic radiosurgery boost in patients with locally advanced pancreatic cancer

To determine the efficacy of concurrent 5-fluorouracil (5-FU) and intensity-modulated radiotherapy (IMRT) followed by body stereotactic radiosurgery (SRS) in patients with locally advanced pancreatic cancer. In this prospective study, all patients (19) had pathologically confirmed adenocarcinoma and were uniformly staged. Our treatment protocol consisted of 45 Gy IMRT with concurrent 5-FU followed by a 25 Gy SRS boost to the primary tumor. Sixteen patients completed the planned therapy. Two patients experienced Grade 3 toxicity (none had more than Grade 3 toxicity). Fifteen of these 16 patients were free from local progression until death. Median overall survival was 33 weeks. Concurrent IMRT and 5-FU followed by SRS in patients with locally advanced pancreatic cancer results in excellent local control, but does not improve overall survival and is associated with more toxicity than SRS, alone.

Intensity-modulated radiation therapy (IMRT) with concurrent taxane-based chemotherapy for locally-advanced head and neck cancer(LAHNC): Feasibility, technique, and toxicities

5536 Background: Chemotherapy given concurrently with radiation is proven to improve tumor survival in LAHNC at the expense of higher toxicity. IMRT for LAHNC provides a means to minimize dose to sensitive organs. Our initial experience with concurrent IMRT and taxane-based chemotherapy in 83 LAHNC patients is presented. Methods: In order to simplify IMRT planning, a differential IMRT dose plan is developed for all head and neck structures. Daily fractions of 2.1Gy are delivered to gross disease with +/-5% homogeneity (69.3Gy in 33 fxs), simultaneously with 1.7Gy to prophylactic nodes (56.1Gy, homo +8 to -5%). 50% of the volume of sensitive tissue (oral cavity, parotids, back of neck, and larynx/trachea) are limited to ≤25Gy. Weekly paclitaxel 30mg/m2 and carboplatin AUC 1 were given concurrently to all 83 patients, and 40 with N2 or N3 disease also received weekly induction chemotherapy with paclitaxel 60mg/m2 and carboplatin AUC2. Chemo was held for ANC<1000, plts<100k, or gr4 mucositis Results: All 83 patients had AJCC III or IV nonmetastic disease: sinus-5, NPC-9, OP-44, OC-6, larynx-13, hypo-6. This regimen is highly feasible. 2 patients discontinued treatment early into treatment for non-toxicity related reasons (progression in lungs). Only 2 patients required a radiation break greater than 1 week. 28% required temporary PEG (none long-term). Only one patient (T4N0 hypopharynx) is still trach-dependent but has good swallowing function. Grade 3 mucositis occurred in 57% (2%Gr4) and gr3 dermatitis in 37%. There were no pts with nadir sepsis nor sig nephropathy or GI toxicity. One patient with a large base of skull tumor died 1 month after completion from carotid rupture. Xerostomia is ≤gr1 in all patients. Conclusions: IMRT with paclitaxel and carbo for LAHNC is extremely feasible using differential IMRT target dosing. Doses to sensitive non-target structures (oral cavity, trachea/larynx, back of neck, parotids) can be minimized (≤25Gy) and dose homogeneity to gross tumor held within +/-5% to avoid long-term morbidity. Early toxicities are low. Tumor control and survival data will also be presented. No significant financial relationships to disclose.