To determine the toxicity, tolerability, and feasibility of delivering combina tion chemotherapy with subsequent radiation therapy to women with high-risk end ometrial cancer and to evaluate the long-term bowel toxici...To determine the toxicity, tolerability, and feasibility of delivering combina tion chemotherapy with subsequent radiation therapy to women with high-risk end ometrial cancer and to evaluate the long-term bowel toxicity of this regimen. T he trial was approved by the Dana Farber/Partners Cancer Care (DF-PCC) Institut ional Review Board (IRB). Patients with stage 3 or stage 4 endometrial cancer or patients with high-risk histology and any stage disease were prospectively ent ered. Complete surgical staging and a normal gated blood pool scan were required prior to entry. Patients were treated with three cycles of paclitaxel (160 mg/m 2), doxorubicin (45 mg/m2) and carboplatin (AUC 5) (TAC) all on day 1 of a 21-d ay schedule as an outpatient with G-CSF support. At the conclusion of chemother apy, patients received radiation therapy (4500 cGy to the whole pelvis) commenci ng within 35 days of the last cycle of chemotherapy. Paraaortic radiation and/or vaginal brachytherapy were allowed at the discretion of the treating radiation oncologist. Twenty patients were entered onto the trial from November 2000 throu gh February 2003. Eighteen patients successfully completed the trial, and two patients came off trial during chemotherapy (both later completed planned radiation therapy). Patients were initially stage 1 (n = 3), stage 3 (n = 14), and stage 4 (n = 3). Papillary serous was the dominant h istology with 13 patients. Chemotherapy was given on average within 32 days of s urgery (range 11-63 days) and radiation was initiated on average within 14 week s of surgery (range 10-18 weeks). Chemotherapy was well tolerated, with 57 tota l cycles delivered of a planned 60 cycles. Two patients required dose modificati on in two cycles (two patients in cycle 3 secondary to hematologic toxicity). No grade 3 or grade 4 neurotoxicity was reported. There were six episodes of grade 3 short-term toxicity with radiation therapy reported in a single patient. Lat e radiotherapy toxicity included bowel obstruction requiring laparotomy in two p atients and grade 3 constipation in one patient. Late radiation toxicity data ar e still being collected as follow-up continues. The TAC chemotherapy regimen is well tolerated and three cycles were delivered successfully with G-CSF support without evidence of the neurotoxicity or cardiac toxicity reported with the cis platin containing TAP regimen. Standard radiation was deliverable following TAC therapy without excessive toxicity. Further study of this regimen with subsequen t radiation therapy is warranted in patients at risk for systemic and regional r ecurrence of their malignancy.展开更多
Objectives. To evaluate the long- term treatment outcome of patients with carcinoma of the cervix treated with high dose rate brachytherapy (HDRB) using a small number of fractions. Methods. Between 1984 and 1997, 282...Objectives. To evaluate the long- term treatment outcome of patients with carcinoma of the cervix treated with high dose rate brachytherapy (HDRB) using a small number of fractions. Methods. Between 1984 and 1997, 282 patients with cervix cancer (stages IB to IVA) were treated with external beam radiotherapy to the whole pelvis (median dose of 45 Gy) and HDRB (median dose of 24 Gy at point A in 3 insertions given weekly). Endpoints assessed were survival, patterns of failure and complications. Multivariate analysis was performed to identify variables predictive for overall survival and local control. Variables investigated were stage, age, overall duration of treatment, HDRB scheduling and total dose to point A. Results. At a median follow- up of 86.3 months for patients at risk, the 5- , 10- and 15- year overall survival rates are 57% , 52% and 47% , respectively. On multivariate analysis, only stage and age correlated with improved survival. Treatment duration beyond 47 days was associated with poorer overall survival, although it did not reach statistical significance (P = 0.10). Brachytherapy scheduling and BED to point A had no impact on overall survival. Stage and age significantly correlated with pelvic disease control. Duration of therapy, scheduling of the brachytherapy and BED at point A were not individual predictors for overall local control. Overall, gastrointestinal and genitourinary actuarial complication rates were 15% and 8% , respectively. Conclusions. In our experience, HDRB using 3 insertions is well tolerated and the results are comparable to HDRB using larger number of fractions and to low dose rate brachytherapy.展开更多
To evaluate the risk factors for nonrectal radiation- induced intestinal injury (NRRIII) following adjuvant radiotherapy (RT) for cervical cancer using a retrospective review of medical records. From September 1992 to...To evaluate the risk factors for nonrectal radiation- induced intestinal injury (NRRIII) following adjuvant radiotherapy (RT) for cervical cancer using a retrospective review of medical records. From September 1992 to December 1998, 164 patients with uterine cervical cancer that had completed their allocated adjuvant radiotherapy at the Chinese Medical University Hospital were enrolled for NRRIII analysis. The patients were classified into two groups according to the extent of surgery. Group A consisted of 110 patients (International Federation of Gynecology and Obstetrics stage: IB, n = 87; IIA, n = 21; IIB, n = 2) undergoing radical hysterectomy and bilateral pelvic lymph node dissection, while Group B was composed of 54 analogs receiving adjuvant radiotherapy following incident extrafascial hysterectomy. Treatment consisted of external beam radiotherapy (EBRT) and high- dose- rate intravaginal brachytherapy (HDRIVB). Initially, the whole pelvis was treated with 10 MV X- rays. After irradiation (44 Gy in 22 fractions over 4- 5 weeks), the field was limited to the true pelvis and a further 10- 20 Gy delivered in 5- 10 fractions. For 21 patients in group A without pelvic lymph node metastasis or lymphovascular invasion, the radiation field was confined to the lower pelvis, with a prescribed dose of 50- 58 Gy delivered over 5- 6 weeks. HDRIVB was performed using an Ir- 192 remote after- loading technique at 1- week intervals. A total of 159 patients (97% ) received two insertions, while 5 had only one. The standard prescribed HDRIVB dose was 7.5 Gy to the vaginal surface. Logistic regression analysis was performed for assessment of the factors associated with NRRIII. After 38- 119 months of follow- up (median, 60), 22 patients (13.4% ) developed Radiation Therapy Oncology Group (RTOG) grade 2 or greater NRRIII at a median latency of 18 months (range, 5- 48). Four patients were diagnosed as grade 3 complications requiring surgery and three had expired. The independent factors for NRRIII were radical hysterectomy (P = 0.04, relative risk 2.45), lower- pelvic dose >54 Gy (P = 0.0001, relative risk 10.27), and age over 60 years (P = 0.001, relative risk 5.45). The incidence of NRRIII for patients receiving whole and lower- pelvic irradiation was 14.5% and 10.6% , respectively (P = 0.45). Although there was no statistical significance comparing the two external beam irradiation strategies in terms of NRRIII, all four patients with grade 3 NRRIII underwent whole pelvic irradiation. This study identifies three predictive factors for the development of NRRIII following adjuvant radiotherapy for cervical cancer. Limiting the EBRT dose to less than 54 Gy, meticulous patient selection in the elderly, careful planning of the irradiated field, and the constraint of vaginal brachytherapy are four approaches to optimization of postoperative adjuvant radiotherapy.展开更多
文摘To determine the toxicity, tolerability, and feasibility of delivering combina tion chemotherapy with subsequent radiation therapy to women with high-risk end ometrial cancer and to evaluate the long-term bowel toxicity of this regimen. T he trial was approved by the Dana Farber/Partners Cancer Care (DF-PCC) Institut ional Review Board (IRB). Patients with stage 3 or stage 4 endometrial cancer or patients with high-risk histology and any stage disease were prospectively ent ered. Complete surgical staging and a normal gated blood pool scan were required prior to entry. Patients were treated with three cycles of paclitaxel (160 mg/m 2), doxorubicin (45 mg/m2) and carboplatin (AUC 5) (TAC) all on day 1 of a 21-d ay schedule as an outpatient with G-CSF support. At the conclusion of chemother apy, patients received radiation therapy (4500 cGy to the whole pelvis) commenci ng within 35 days of the last cycle of chemotherapy. Paraaortic radiation and/or vaginal brachytherapy were allowed at the discretion of the treating radiation oncologist. Twenty patients were entered onto the trial from November 2000 throu gh February 2003. Eighteen patients successfully completed the trial, and two patients came off trial during chemotherapy (both later completed planned radiation therapy). Patients were initially stage 1 (n = 3), stage 3 (n = 14), and stage 4 (n = 3). Papillary serous was the dominant h istology with 13 patients. Chemotherapy was given on average within 32 days of s urgery (range 11-63 days) and radiation was initiated on average within 14 week s of surgery (range 10-18 weeks). Chemotherapy was well tolerated, with 57 tota l cycles delivered of a planned 60 cycles. Two patients required dose modificati on in two cycles (two patients in cycle 3 secondary to hematologic toxicity). No grade 3 or grade 4 neurotoxicity was reported. There were six episodes of grade 3 short-term toxicity with radiation therapy reported in a single patient. Lat e radiotherapy toxicity included bowel obstruction requiring laparotomy in two p atients and grade 3 constipation in one patient. Late radiation toxicity data ar e still being collected as follow-up continues. The TAC chemotherapy regimen is well tolerated and three cycles were delivered successfully with G-CSF support without evidence of the neurotoxicity or cardiac toxicity reported with the cis platin containing TAP regimen. Standard radiation was deliverable following TAC therapy without excessive toxicity. Further study of this regimen with subsequen t radiation therapy is warranted in patients at risk for systemic and regional r ecurrence of their malignancy.
文摘Objectives. To evaluate the long- term treatment outcome of patients with carcinoma of the cervix treated with high dose rate brachytherapy (HDRB) using a small number of fractions. Methods. Between 1984 and 1997, 282 patients with cervix cancer (stages IB to IVA) were treated with external beam radiotherapy to the whole pelvis (median dose of 45 Gy) and HDRB (median dose of 24 Gy at point A in 3 insertions given weekly). Endpoints assessed were survival, patterns of failure and complications. Multivariate analysis was performed to identify variables predictive for overall survival and local control. Variables investigated were stage, age, overall duration of treatment, HDRB scheduling and total dose to point A. Results. At a median follow- up of 86.3 months for patients at risk, the 5- , 10- and 15- year overall survival rates are 57% , 52% and 47% , respectively. On multivariate analysis, only stage and age correlated with improved survival. Treatment duration beyond 47 days was associated with poorer overall survival, although it did not reach statistical significance (P = 0.10). Brachytherapy scheduling and BED to point A had no impact on overall survival. Stage and age significantly correlated with pelvic disease control. Duration of therapy, scheduling of the brachytherapy and BED at point A were not individual predictors for overall local control. Overall, gastrointestinal and genitourinary actuarial complication rates were 15% and 8% , respectively. Conclusions. In our experience, HDRB using 3 insertions is well tolerated and the results are comparable to HDRB using larger number of fractions and to low dose rate brachytherapy.
文摘To evaluate the risk factors for nonrectal radiation- induced intestinal injury (NRRIII) following adjuvant radiotherapy (RT) for cervical cancer using a retrospective review of medical records. From September 1992 to December 1998, 164 patients with uterine cervical cancer that had completed their allocated adjuvant radiotherapy at the Chinese Medical University Hospital were enrolled for NRRIII analysis. The patients were classified into two groups according to the extent of surgery. Group A consisted of 110 patients (International Federation of Gynecology and Obstetrics stage: IB, n = 87; IIA, n = 21; IIB, n = 2) undergoing radical hysterectomy and bilateral pelvic lymph node dissection, while Group B was composed of 54 analogs receiving adjuvant radiotherapy following incident extrafascial hysterectomy. Treatment consisted of external beam radiotherapy (EBRT) and high- dose- rate intravaginal brachytherapy (HDRIVB). Initially, the whole pelvis was treated with 10 MV X- rays. After irradiation (44 Gy in 22 fractions over 4- 5 weeks), the field was limited to the true pelvis and a further 10- 20 Gy delivered in 5- 10 fractions. For 21 patients in group A without pelvic lymph node metastasis or lymphovascular invasion, the radiation field was confined to the lower pelvis, with a prescribed dose of 50- 58 Gy delivered over 5- 6 weeks. HDRIVB was performed using an Ir- 192 remote after- loading technique at 1- week intervals. A total of 159 patients (97% ) received two insertions, while 5 had only one. The standard prescribed HDRIVB dose was 7.5 Gy to the vaginal surface. Logistic regression analysis was performed for assessment of the factors associated with NRRIII. After 38- 119 months of follow- up (median, 60), 22 patients (13.4% ) developed Radiation Therapy Oncology Group (RTOG) grade 2 or greater NRRIII at a median latency of 18 months (range, 5- 48). Four patients were diagnosed as grade 3 complications requiring surgery and three had expired. The independent factors for NRRIII were radical hysterectomy (P = 0.04, relative risk 2.45), lower- pelvic dose >54 Gy (P = 0.0001, relative risk 10.27), and age over 60 years (P = 0.001, relative risk 5.45). The incidence of NRRIII for patients receiving whole and lower- pelvic irradiation was 14.5% and 10.6% , respectively (P = 0.45). Although there was no statistical significance comparing the two external beam irradiation strategies in terms of NRRIII, all four patients with grade 3 NRRIII underwent whole pelvic irradiation. This study identifies three predictive factors for the development of NRRIII following adjuvant radiotherapy for cervical cancer. Limiting the EBRT dose to less than 54 Gy, meticulous patient selection in the elderly, careful planning of the irradiated field, and the constraint of vaginal brachytherapy are four approaches to optimization of postoperative adjuvant radiotherapy.
