Chemoradiation

VlLLAFRANCA E, OKRUZHNOV Y, DOMIN-guez MA et al. Polymorphisms of the repeated sequences in the enhancer region of the thymidylate synthase gene promoter may predict downstaging after preoperative chemoradiation in rectal cancer. J Clin Oncol 2001 19 1779-1786. 

For unresectable tumors, neoadjuvant (preoperative) 5-FU or capecitabine chemoradiation followed by surgery is recommended. All patients who receive preoperative chemotherapy should receive postoperative chemotherapy, with or without RT. 

Biology Complicates the Delivery of Radiation Biology Also Complicates the Delivery of Chemotherapy Principles Guiding the Integration of Chemoradiation Ideal Radiosensitizer ... 

From Chemoradiation in Cancer Therapy Edited by H. Choy Humana Press Inc., Totowa, NJ... 

Although the focus of this entire book is on chemoradiation, there are several notable areas where the use of concurrent chemoradiation has managed to change patterns of practice and had significant impact on treatment outcomes and overall quality of life. 

Randomized Trials of Concurrent Chemoradiation in Carcinoma of the Anus... 

Randomized Trials Illustrating the Benefit of Cisplatin-Based Concurrent Chemoradiation... 

While the natural history of this malignancy involves early seeding of distant metastases, those patients who have localized or limited-stage small-cell carcinoma of the lung have potentially curable tumors where combined chemoradiation is important. 

The challenge for the future is to begin to better integrate the information that is rapidly accumulating from the revolution in the field in molecular biology to the chemoradiation armamentarium. Currently the accumulating data in a variety of research areas in oncology needs to become incorporated into the clinic, where no doubt it will make important contributions to disease outcome and patient care. Several examples of this are as follows. 

Herscher LL, Cook JA, Pacelli R, et al. Principles of chemoradiation theoretical and practical considerations. Oncology (Huntingtj 1999 Oct 13(10 Suppl 5) 11-22. 

Flam M, John M, Pajak TF, et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoidcarcinoma of the anal canal results of a phase III randomized intergroup study. J Clin Oncol 1996 14 2527-2539. 

There are four hypotheses that underline the combined effect of chemoradiation therapy employing fluoropyrimidines ... 

Yoon W-H, Choi J-H, Kim J-R, et al. Enhanced Tumoricidal Effect of Preoperative Chemoradiation Using Capecitabine for Locally Advanced Rectal Cancer. ASCO 2001, 104b. 

Bonomi P, Faber LP. Neoadjuvant chemoradiation therapy in non-small cell lung cancer The RusUniversity experience. Lung Cancer 1993 9 383-390. 

Lau et al. have reported on their experience of administering radiation with taxol dosed twice a week for locally advanced nonsmall-cell lung cancer (53). Their phase II trial was conducted combining low-dose radiosensitizing chemotherapy with concurrent radiation followed by consolidation chemotherapy (62). The induction chemoradiation consisted of paclitaxel, 30 mg/m2 iv over 1 h, twice weekly for 6 wk carboplatin, AUC of... 

Traditionally carcinoma of the bladder has been treated by radical cystectomy in the United States. There is, however, an emerging interest in organ preservation as seen in other disease sites (93). Certainly the experience from trials including a phase III trial that was not powered to detect a survival difference, is that combined chemoradiation usually using a cisplatin-based chemotherapy regimen and concurrent radiation leads to increased levels of local control (94). 

A similar small phase II trial from Germany has reported on seven patients receiving concurrent chemoradiation for transitional cell carcinoma of the bladder with cisplatin and paclitaxel (96). The authors conclude that this combination is at least feasible given an acceptable acute toxicity profile and reasonable efficacy. Another small series is reported by Nichols et al. (97) where eight patients received radiation with concurrent paclitaxel and carboplatin in an attempt at bladder preservation. Three of the patients remain free of distant metastases, and local recurrence has occurred in three. 

The common link with many clinical studies of chemoradiation in head and neck cancers is the significant mucositis that patients experience during therapy. Acrein has reported on a trial that attempts to deliver Ethyol as a protective agent to lessen the side effects of weekly paclitaxel (134). 

Langer CJ. Concurrent chemoradiation using paclitaxel and carboplatin in locally advanced non-small cell lung cancer. SeminRadiat Oncol 1999 9(2 Suppl 1) 108—116. 

Phase I trials are now underway using CPT-11 plus irradiation for patients with advanced or recurrent colorectal cancer. In one study, a single weekly dosage of 30 mg/kg of CPT-11 is given intravenously in combination with infusional 5-FU (300 mg/m2/d) and concurrent pelvic radiotherapy (50 Gy). This approach builds onto an existing standard practice of infusional chemoradiation and uses a dose modification of the common... 

Radiation Therapy Oncology Group RTOG R-0012 Randomized Phase II Trial of Preoperative Combined Modality Chemoradiation for Distal Rectal Cancer... 

The Scandinavian Glioblastoma Study Group reported the results of a prospective randomized trial for patients with grades II-IV supratentorial astrocytoma to evaluate the results of radiation therapy and combined chemoradiation treatment in the postoperative setting (4). One hundred eighteen patients were randomized to one of three groups ... 

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