Combined chemotherapy radiotherapy

Cancer treatment is a multimodality treatment, i.e., surgery is combined with radiotherapy and antineoplastic chemotherapy. The latter treatment mode is used mainly for cancers which have disseminated. Different forms of cancer differ in their sensitivity to chemotherapy with antineoplastic agents. The most responsive include lymphomas, leukemias, choriocarcinoma and testicular carcinoma, while solid tumors such as colorectal, pancreatic and squamous cell bronchial carcinomas generally show a poor response. The clinical use of antineoplastic agents is characterized by the following principles. 

Cytotoxic chemotherapy is the treatment of choice for chemotherapy-sensitive tumors such as SCLC and lymphoma. As indicated earlier, chemotherapy also may be combined with radiotherapy, especially in patients with lymphoma who have bulky mediastinal lymphadenopathy. 

Radiotherapy followed by combination chemotherapy is recommended for patients with symptomatic brain metastases. Dexamethasone and anticonvulsants are also administered for symptom control and seizure prevention, respectively. 

Herskovic A, Martz K, al-Sarraf M, et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med 1992 326 1593-1598. 

Boiardi A, Silvani A, Pozzi A, et al. Advantage of treating anaplastic gliomas with aggressive protocol combining chemotherapy and radiotherapy. JNeurooncol 1997 34 179-185. 

The MACH-NC study included a subset analysis of six randomized trials of 861 patients evaluating neoadjuvant with or without adjuvant chemotherapy combined with radiotherapy vs concomitant/alternating chemotherapy. No significant benefit was associated with adjuvant or neoadjuvant chemotherapy. A trend in favor of concomitant or alternating chemoradiotherapy was found but was not determined to be statistically significant (p =... 

Le Chevalier T, Arriagada R, Quoix E, et al. Radiotherapy alone versus combined chemotherapy and radiotherapy in resectable non-small cell lung cancer First analysis of a randomized trial in 353 patients. JNatl Cancer Inst 1991 83 417-423. 

Birch R, Omura GA, Greco FA, et al. Patterns of failure in combined chemotherapy and radiotherapy for limited small-cell lung cancer Southeastern Cancer Study Group experience. NCIMonogr 1988 6 265-270. 

Small cell lung cancer (SCLC) includes approximately 20-25% of all cases of lung cancer seen worldwide. SCLC differs from other types of lung cancer in its more aggressive course and its superior responsiveness to chemotherapy and radiotherapy. The main modality of treatment for SCLC is combination chemotherapy. Eor patients with limited disease achieving a major response on chemotherapy, this is usually combined with concurrent thoracic irradiation. Prophylactic whole brain irradiation is often administered to complete responders because of the high probability of CNS relapse with associated morbidity. 

In the field of radiation therapy, it is recognized that there are other promising approaches to improve the efficiency of the treatment such as better individual adaptation of fractionation or association with drugs to modulate the radiation sensitivity. Combination of radiotherapy with the two other classical methods of cancer treatment, surgery, and chemotherapy may also be optimized. 

In the majority of patients, this cancer remains occult and becomes symptomatic after it has already metastasized to the peritoneal cavity. At this stage, it usually presents with malignant ascites. It is important to accurately stage this cancer with laparoscopy, ultrasound, and CT scanning. Patients with stage I disease appear to benefit from whole-abdomen radiotherapy and may receive additional benefit from combination chemotherapy with cisplatin and cyclophosphamide. 

Combination chemotherapy administered concurrent with radiation has produced the most promising results in advanced, unresectable disease. The important study of Merlano et al. randomized 157 patients to conventional radiotherapy vs. cisplatin/5-FU given concurrent with radiation in alternating weekly fashion. They reported a 3-year survival rate of 41% with concurrent therapy vs. 23% with radiation alone (p < 0.05) and 5-year survival rate of 24% vs. 10% (p < 0.02) [136]. Taylor et al. reported significantly improved disease-free survival rates in patients treated with concomitant cis-platin/5-FU and radiation over sequential therapy (17 months vs. 13 months, p = 0.003) in their study of 214 patients with unresectable disease [137]. 

Because SCLC has the propensity to disseminate early on in the disease, surgery is not usually indicated. SCLC is radiosensitive, and radiotherapy is used in combination with chemotherapy in patients with limited disease. Prophylactic cranial irradiation is used in select patients to reduce the risk of CNS metastases. Combination chemotherapy will prolong the survival of most patients with SCLC. Patients with limited disease are more likely to have a complete response to chemotherapy and longer survival than those who have extensive disease at the time of diagnosis. The most widely used chemotherapy regimens for SCLC include cisplatin or carboplatin plus etoposide. Despite very high response rates to chemotherapy, most patients with SCLC eventually have disease progression and die from this disease. 

Both the NCCN and ASCO guidelines recommend the use of platinum-based (cisplatin or carboplatin) chemotherapy for unresect-able NSCLC. Duration of treatment with combination chemotherapy plus radiotherapy for advanced-stage NSCLC should be a minimum of two cycles to a maximum of eight cycles in most cases. - ... 

Trciitmcnt monitoring is the area in which most tumour markers have found a useful role. The decline in concentration of the tumour marker is an indication of the success of the treatment, whether that be surgery, chemotherapy, radiotherapy, ora combination of these. However, the rate of decline of marker concentration should match that predicted from knowledge of the marker s half-life. A slower than expected fall may well indicate that not all the tumour has been eliminated. 

Because of the HIF-la-dependent Warburg effect observed in tumors, inhibition of the glycolytic pathway, which has been proposed in the literature for decades [221], is an attractive therapeutic approach. Clinical studies in glioma patients have shown that administration of 2-deoxyglucose (2DG) was well tolerated in combination with radiotherapy [222]. In animal models, some groups have reported a synergy of 2DG with chemotherapy or radiation and... 

External beam radiotherapy (including three-dimensional radiotherapy, intensity modulated radiotherapy, and extracranial stereotactic radiotherapy) is the most common way radiation is used to eradicate solid tumors, often with combined chemotherapy. The key limitation of external beam radiotherapy is the tolerance of normal liver parenchyma to radiation, which is much less than the dose required to control the liver tumors. Direct implantation of radionuclides into the tumor (brachytherapy) using interstitial seeds... 

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