Epirubicin/radiation therapy

Unfortunately, none of the seven randomized trials that have compared radiation therapy alone vs neoadjuvant cisplatin-containing chemotherapy plus radiation therapy demonstrated an improvement in overall or disease-free survival with combined-modality therapy (Table 2). Two studies actually demonstrated poorer survival with neoadjuvant chemotherapy. Souhami et al. (15) reported a significantly poorer survival rate with neoadjuvant chemotherapy in a small trial of patients with stage IIIB disease. This outcome was partly due to increased toxicity and poor compliance in patients who received chemotherapy. Another trial of neoadjuvant epirubicin and cisplatin was closed early when interim analysis revealed a significantly higher recurrence rate in the chemotherapy arm (16). These trials fail to provide any evidence that sequential cisplatin-containing chemotherapy and radiation therapy are of benefit. Possible explanations for the disappointing results include the effects of chemotoxicity, altered compliance, and possible accelerated repopulation of resistant clones after neoadjuvant chemotherapy. 

B = bleomycin, C = chlorambucil, CT = chemotherapy, DFS = disease-free survival, Ep = epirubicin, F = fluorouracil, I = ifosfamide, M = mitomycin C, Mtx = methotrexate, O = vincristine, OS = overall survival, P = cisplatin, RT = radiation therapy, V = vinblastine. 

The literature strongly suggests that concurrent chemoradiation is superior to neoadjuvant chemotherapy followed by radiation therapy. However, the effect of continuing chemotherapy after radiation is complete is uncertain. Two of the positive trials (the SWOG postoperative trial [19] and a study of concurrent epirubicin [28J) involved additional cycles of chemotherapy after concurrent chemoradiation was completed. In their report, Peters et al. (19) suggested that postradiation chemotherapy contributed importantly to their patients good outcomes because those who completed the full course of treatment appeared to have a better outcome than those who received only the concur-... 

The first clinical human trials using magnetic hyperthermia were reported by Liibbe, et al. [70, 129, 137, 190] who used 100-nm starch-coated iron-oxide particles bound with epirubicin for treatment of advanced solid cancers. Jordan recently reported positive results from ongoing trials of advanced cancer patients who received magnetic nanoparticle hyperthermia in conjunction with conformal external beam radiation therapy [191]. The therapy was well tolerated by the patients and significant increases in the length and quality of life were observed. 

External beam radiation used as sole therapy or in combination with 5-fluorouracil (5 FU) can be used to relieve dysphagia in over two-thirds of patients with SCC. Symptoms recur, however, due to recurrent cancer or fibrotic strictures. The most effective chemotherapeutic regimen in advanced esophageal cancer is epirubicin, cisplatin, and continuous infusion of 5 FU. Two-thirds of cases respond with improvement of dysphagia. ... 

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