Short-term Radiotherapy Research Articles

Preoperative short-term radiotherapy of resectable gastric cancer: complete 20-years follow up of a randomized trial

Preoperative short-term radiotherapy of resectable gastric cancer: complete 20-years follow up of a randomized trial

Adjuvant radiochemotherapy--what is the patients benefit?

Local relapse is a major problem after potentially curative rectal cancer surgery. Although the incidence of local recurrences may be reduced by specialized surgical techniques such as total mesorectal excision (TME), local relapse rates of 20% or higher are the surgical reality today. Studies using adjuvant postoperative radiotherapy, chemotherapy, radiochemotherapy or immunotherapy have tried to reduce local relapse rates and distant progression. Postoperative radiochemotherapy has been the recommended standard, after complete resection of Union Internationale Contra la Cancrum (UICC) stages II and III rectal cancers. In view of recent positive results with preoperative radiotherapy of TME without adjuvant therapy, we found it important to review the literature to update the recommendable adjuvant procedure in rectal cancer. The literature from 1985 to May 1998 was reviewed for studies trying to either confirm or improve adjuvant therapy in rectal cancer. Only randomized controlled trials were analyzed with regard to their effectiveness in reducing the absolute rates of local recurrence and improving survival. Two trials applying adjuvant radiotherapy were able to demonstrate the reduction of local relapse rates, one trial with marginal significance, both without impact on survival. Four trials involving 1104 patients with rectal cancer stages UICC II-III compared postoperative radiochemotherapy with either surgical controls, adjuvant radiotherapy or conventional radiochemotherapy. In these trials, local relapse rates were significantly reduced by 11-18%, and survival rates significantly improved by 10-14%. Severe acute toxicities occurred in 50-61% of the patients, compromising compatibility, and caused death in 0-1%. Small-bowel obstruction leading to surgery was noted in 2-6% and to death in up to 2% of the patients. Intraoperative radiotherapy (IORT) improved local control and survival after surgery of locally advanced disease/local relapse. In view of four trials demonstrating a significant benefit of postoperative radiochemotherapy and with regard to recent still-debatable results of preoperative short-term radiotherapy optimal surgery with lowest local relapse rates plus postoperative radiochemotherapy remains the actual recommendable standard for rectal cancer surgery in R0 resected tumors stages UICC II+III.

Radiotherapy in the elderly

Older patients with cancer are frequently victims of discriminatory treatment strategies according to parameters unrelated to the tumour itself. The general approach is influenced by the belief that good tolerance to radiotherapy might be compromised in older patients and that the course of cancer might be less aggressive in this age group. Substandard treatment is therefore often offered to older patients, although this attitude is supported neither by clinical nor by scientific evidence, but rather stems from a lack of specific knowledge of the actual cancer prognosis and the tolerance to radiotherapy in the elderly. In clinical practice advanced age may result in undertreatment, even though patients may have no other medical illness and no functional impairment. Some comorbid conditions which are more frequent in older patients may complicate the outcome of treatment. However, these impaired vital functions are not an intrinsic feature of the elderly. Overall, noncompliance in radiotherapy, related to comorbidity or technical condition, is rare. Short-term radiotherapy using a large daily fraction is often advocated in elderly patients; however, this should only be considered if a palliative treatment option has previously been selected due to the high risk of late side-effects. Acute side-effects often result in decreasing doses of radiotherapy. Data on acute tolerance of radiotherapy for different types of tumours did not demonstrate a radical difference in occurrence of toxicities. 'Reducing' radiotherapy is never a solution, unless the life expectancy of the patient is obviously so short that the tumour recurrence is unlikely to occur or at least to produce substantial morbidity before the patient has died from other causes.

Five-year Followup of a Prospective Trial of Radical Cystectomy and Neoadjuvant Chemotherapy: Nordic Cystectomy Trial 1

Purpose Chemotherapy is widely used in patients with locally advanced bladder cancer but until now there has been no conclusive evidence that this therapy improves survival. The Nordic Cooperative Bladder Cancer Study Group conducted a randomized phase III study to assess the possible benefit of neoadjuvant chemotherapy in patients with bladder cancer undergoing radical cystectomy after short-term radiotherapy. Materials and Methods Our trial included 325 patients with locally advanced stage T1 grade 3 or stages T2 to T4aNXMO bladder cancer allocated randomly into a chemotherapy or no chemotherapy group (control). The chemotherapy schedule consisted of 2 cycles of 70 mg./m. 2 cisplatin and 30 mg./m. 2 doxorubicin with a 3-week interval between the cycles. Results After 5 years the overall survival rate was 59 percent in the chemotherapy group and 51 percent in the control group (p = 0.1). The corresponding cancer specific survival rate was 64 and 54 percent, respectively. In regard to treatment, no difference was observed for stages T1 and T2 disease, while there was a 15 percent difference in overall survival for patients with stages T3 to T4a disease (p = 0.03). In a multivariate analysis only chemotherapy and T category emerged as independent prognostic factors. The relative death risk for patients who received chemotherapy was 0.69 (95 percent confidence interval 0.49 to 0.98) compared to the control group after adjustment for the other tested factors. Conclusions Neoadjuvant chemotherapy seems to improve long-term survival after cystectomy in patients with stages T3 to T4a bladder carcinoma, while no survival benefit was found for stages T1 to T2 disease.

Early Complications and Survival Following Short-Term Palliative Radiotherapy in Invasive Bladder Carcinoma

Purpose We studied the early side effects and survival rates after short-term radiotherapy (7 Gy. 3 times or 5 Gy. 4 times) in patients with muscle invasive bladder carcinoma. Materials and Methods Between 1981 and 1992, 96 patients (median age 80 years) were treated. Followup was complete until 1994 or death. Results Early side effects caused the hospitalization of 22 patients and may have contributed to the death of 5 elderly patients. Median survival for patients with stages, T2M0, T3M0, T4M0 and T2 to 4M + disease was 27 months, 6.3 months, 5.6 months and 2.9 months, respectively. Conclusions Short-term radiotherapy is of doubtful benefit to elderly patients with advanced bladder carcinoma and may even be harmful.

Early Complications and Survival Following Short-Term Palliative Radiotherapy in Invasive Bladder Carcinoma

Early Complications and Survival Following Short-Term Palliative Radiotherapy in Invasive Bladder Carcinoma

The Stockholm I trial of preoperative short term radiotherapy in operable rectal carcinoma

From 1980 to 1987, 849 patients with clinically resectable rectal adenocarcinoma were randomized into a controlled clinical trial to evaluate the role of preoperative radiotherapy. Patients were given either 25 Gy during 5 to 7 days before surgery or underwent surgery alone. At a median follow-up time of 107 months (range, 62-144 months) the incidence of pelvic recurrence among 684 "curatively" operated patients was significantly lower among those who also received radiotherapy (P < 0.001) in all Dukes' stages. No significant difference was observed between the treatment groups with regard to frequency of distant metastases or overall survival. The time to local recurrence or distant metastasis and survival was significantly prolonged in the irradiated group. However, the postoperative mortality was 8% in the radiotherapy group compared with 2% in the surgery only group (P = 0.01). Preoperative short term radiotherapy reduced the incidence of pelvic recurrences and prolonged survival related to rectal cancer compared with surgery alone. The postoperative morbidity was significantly higher in the irradiated group.

Short-term Radiotherapy as Palliative Treatment in Patients with Transitional Cell Bladder Cancer

We report the results and complications of treatment with palliative, short-term radiotherapy in 162 elderly or disabled patients. Improvement in tumour-associated symptoms was noted in 75 of these patients and 72 survived for more than a year. Those who responded to radiotherapy had a 5-year cancer-free survival rate of 58% compared with 4% in patients who did not respond to treatment. Survival was also affected by stage and indications for radiotherapy. In 85 patients without severe symptoms, where the tumour was judged curable but the patient was unsuitable for a full course of radiotherapy, the 5-year cancer-free survival rate was 21%, which is in accordance with what can be achieved with full-course radiotherapy; 42% had various minor acute side effects. The 5-year late complication rate was 7%.

Short-term Moderate-dose Pelvic Radiotherapy of Advanced Bladder Carcinoma. A Questionnaire-based Evaluation of its Symptomatic Effect

Thirty-nine patients with advanced bladder cancer received pelvic radiotherapy (3 Gy x 10 during 2 weeks) with palliative aim. Except for improvement of urinary incontinence, no improvement regarding urinary symptoms or general well-being could be demonstrated in 19 completely evaluable patients who were assessed by a mailed questionnaire 3 months after treatment. The median survival for all 39 patients was 7.5 months. Other forms of palliative treatment (chemotherapy combined with radiotherapy or accelerated radiotherapy, palliative surgery) should be evaluated by randomized trials in these poor-prognosis bladder cancer patients. Self-administrated questionnaires seem to be useful for assessing the subjective morbidity of such patients.