Postoperative chemoradiation

In a nonrandomized trial, Spitz et al. (50) compared the preoperative chemoradiation approach with standard adjuvant chemoradiotherapy. Preoperative radiotherapy was delivered either in the standard regimen of 50.4 Gy over 5.5 wk or at 30 Gy as rapid fractionation over 2 wk postoperative irradiation was given up to a total dose of 50.4 Gy in standard fractionation. Both preoperative and postoperative radiotherapy were delivered concurrently with a continuous infusion 5-FU at 300 mg/m2/d for 5 d weekly. At a median follow-up of 19 mo, patients who underwent preoperative and postoperative chemoradiation had similar treatment toxicity, patterns of recurrence, and survival. 

Spitz FR, et al. Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas. J Clin Oncol 1997 15(3) 928-937. 

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. 

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 ... 

Postoperative Radiation Therapy Postoperative Chemotherapy or Chemoradiation NeOADJUVANT THERAPY, In GENERAL Preoperative Radiation Therapy Preoperative Chemotherapy Preoperative Chemoradiation... 

Vanderbilt University Medical Center has recently completed accruing patients to a Phase II study of neoadjuvant chemoradiation, which consists of preoperative paclitaxel (175 mg/m2,3-h infusion) followed by cisplatin 75 mg/m2 d 1 and 21. Concurrent radiation was given to a total dose of 3000 cGy, in 200 cGy/fraction. Patients who are resectable go on to surgery 4 wk after completion of chemoradiation, whereas those who are unresectable (i.e., cervical esophageal cancer) continue to a total dose of 60 Gy without treatment interruptions. One month following surgery, patients receive two cycles (q 21-28 d) of postoperative chemotherapy, which consists of paclitaxel 175 mg/m2 over 3 h d 1,5-FU 350 mg/m2, d 1-3, and leucovorin 300 mg d 1-3. Preliminary analysis of this... 

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-... 

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