Daily vs. weekly

McIntosh K, Cooper E, Xu J, Mirochnick M, Lindsey J, Jacobus D, Mofenson L, Yogev R, Spector SA, Sullivan JL, Sacks H, Kovacs A, Nachman S, Sleasman J, Bonagura V, McNamara J. Toxicity and efficacy of daily vs. weekly dapsone for prevention of Pneumocystis carinii pneumonia in children infected with human immunodeficiency virus. ACTG 179 Study Team. AIDS Clinical Trials Group. Pediatr Infect Dis J 1999 18(5) 432-9. 

The Northern California Oncology Group randomized 104 patients with unresectable disease to standard daily radiation therapy with or without concomitant bleomycin (5-FU iv twice weekly) followed by 16 wks of adjuvant chemotherapy (methotrexate 25 mg/m2 weekly) after the completion of radiation therapy (22). A locoregional CR of 67% was seen in the concomitant arm vs 45% in the control arm (p = 0.056). The 2-yr locoregional control rate was 64% vs 26% (p = 0.001) and the development of metastases was 38% vs 24% (p > 0.25), respectively. 

In 1991, the EORTC reported significantly improved 3-yr survival with concurrent reduced-dose cisplatin (either 30 mg/m2 weekly or 6 mg/m2 5 d per week) and split course RT (30 Gy/2 wk + 25 Gy/2 wk) compared to the same RT alone (26% vs 13%) (66). In contrast to the sequential chemoradiation strategy, failure analysis showed a reduced risk of in-field failure with the concurrent regimen (70% vs 81%). A smaller European phase III trial using twice daily RT with and without concurrent cisplatin and etoposide also reported more favorable outcome with the concurrent chemoradiation regimen and a similar reduction of local failure rates (67). 

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