Postoperative radiation therapy

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

Payne DG. Is preoperative or postoperative radiation therapy indicated in non-small cell cancer of the lung Lung Cancer 1994 10(Suppl 1) S205-S212. 

Patients with locally advanced colon cancer and suspected microscopic or gross residual disease after surgery pose a difficult management problem. Postoperative radiation therapy in addition to standard chemotherapy may have some utility in sterilizing residual disease. In retrospective studies, local radiation therapy with or without concurrent chemotherapy achieves local control in46-70% of patients with microscopic residual... 

Advantages and Disadvantages of Preoperative vs Postoperative Radiation Therapy... 

Willett CG, Fung CY, Kaufman DS, Efird J, Shellito PC. Postoperative radiation therapy for high-risk colon carcinoma. J Clin Oncol 1993 11(6) 1112-1117. 

Allee PE, Tepper JE, Gunderson LL, Munzenrider JE. Postoperative radiation therapy for incompletely resected colorectal carcinoma. Int J Radiat Oncol Biol Phys 1989 17 1171-1176. 

Tepper JE, Cohen AM, Wood WC, et al. Postoperative radiation therapy of rectal cancer. Int J Radiat Oncol Biol Phys 1987 13 5-10. 

Raimondi AJ, Tomita T The disadvantages of prophyiactic whole CNS postoperative radiation therapy for medulloblastoma, in Multidisciplinary Aspects of Brain Tumor Therapy. Edited by Paoletti P, Walker MD, Butti G, et al Amsterdam, Elsevier, 1979, pp 209-218... 

The effects of postoperative radiation therapy combined with adjuvant chemotherapy and tamoxifen therapy have been studied (Rll). The results indicated that postoperative radiation therapy played an important role in the primary management of postmenopausal women with high-risk breast cancer and that the addition of tamoxifen may further improve the results among ERP+ patients. There was a significant improvement in status in the ERP+ patients treated with tamoxifen and radiation therapy compared with women who received chemotherapy. There was also a trend toward improved overall survival. In contrast no benefit was observed among ERP- patients. It has been reported (B7, R3) that chemotherapy and tamoxifen improved the results achieved by chemotherapy alone, particularly in postmenopausal patients tamoxifen was particularly effective in patients with higher ERP content. Side effects were more numerous and more severe in patients receiving chemotherapy (with or without tamoxifen). These studies support the view that the choice of therapy for postmenopausal ERP+ breast cancer patients... 

Rll. Rutqvist, L. E., Cedermark, B., Glas, U., Johansson, H., Rotstein, S., Skoog, L., Somell, A., Theve, T., Wilking, N., Ashergren, J., and Hjalmar, M.-L., Randomized trial of adjuvant tamoxifen combined with postoperative radiation therapy of adjuvant chemotherapy in postmenopausal breast cancer. Cancer (Philadelphia) 66, 89-96 (1989),... 

Rutqvist LE, Johansson H (2006) Long-term follow-up of the Stockholm randomized trials of postoperative radiation therapy versus adjuvant chemotherapy among high risk pre- and postmenopausal breast cancer patients. Acta On-col45 517-527... 

Metal implants also interfere with radiological studies and postoperative radiation therapy. The use of metal miniplate and microplate fixation has also been shown to result in restricted skeletal growth when placed across suture lines (1,2,4). 

Another unique aspect of rectal cancer is the use of neoadjuvant therapy. Preoperative radiation with or without chemotherapy is given to downstage the tumor prior to surgical resection to improve sphincter preservation by making the surgical procedure easier to perform. The issue of preoperative versus postoperative radiation is a subject of debate and investigation in the United States and will require further data to determine the superiority of one method over the other. 

Patients must be monitored to assess their response to treatment and to detect recurrent diseases. PSA as a specific marker for prostate cancer is most useful in monitoring patients who have been treated with radical prostatectomy, radiation therapy, or endocrine therapy. The concentration of PSA falls to undetectable levels following a radical prostatectomy because all prostate tissue has been removed. Generally, PSA is measured at periodic intervals. In studies, the extent of disease at the time of surgery correlated well with the postoperative PSA concentration. A significant measurable PSA concentration after prostatectomy indicates that residual tumor may be present. PSA concentrations decline gradually after radiation therapy (36). 

Takeda et al. (64) performed a phase I/II study consisting of low-dose CDDP (6-10 mg/m2/d) and UFT (600 mg/d) combined with radiotherapy (50 Gy/25 fractions) as postoperative adjuvant therapy following curative resection for patients with nonsmallcell lung cancer (NSCLC). The combined therapy was well tolerated and resulted in a disease-free survival rate of 78% at 2 yr. Another study in a small number of patients with unresectable stage III nonsmall-cell lung cancer, UFT (400 mg/m2 on d 1-52) and CDDP (80 mg/m2 on d 8,29, and 50) were administered with radiation therapy (total dose of 60.8 Gy in 38 fractions on d 1-52). Among 17 evaluable patients, 94% (16 patients) achieved partial responses with median time to tumor progression of 30 wk, and the... 

The initial combination modality clinical studies with cisplatin and fractionated radiation therapy was carried out in head and neck cancer with weekly cisplatin (120-160 mg/m2) and conventional single daily fraction radiation (95). In a follow-up intergroup study, patients were randomized to radiation therapy alone or to radiation therapy plus 20 mg/ m2/wk cisplatin (96). Both studies showed no major increase in normal tissue toxicity in the radiation field and showed an increase in response rate. There was no increase in complete response rate or in survival. Bachaud et al.(97) carried out a randomized study comparing radiation therapy alone with concurrent cisplatin (50 mg/m2) and radiation therapy in postoperative patients. This trial produced a significant reduction in local recurrence and improved disease-free survival with 59% of the patients receiving the full planned dose of cisplatin. 

Hoffman JP, McGinn CJ, Szarka C, et al. A phase I study of preoperative gemcitabine with radiation therapy followed by postoperative gemcitabine for patients with localized resectable pancreatic adenocarcinoma. Proc Am Soc Clin Oncol 1998 17 283a. 

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 BCNU offers an additional modest survival benefit to radiation therapy only (BTCG 7201 and 7501). 

The improvement in local control with adjuvant radiation therapy demonstrated in randomized trials does not reach the magnitude seen in retrospective studies. In the postoperative setting, trials have shown a moderate but statistically significant reduction in local failure when comparing radiation to no-radiation arms, but no impact on overall survival (Table 3). In the absence of chemotherapy, pelvic irradiation reduced local failure from 25% to 16% in the first NSABP R-01 trial (24). In the NSABP R-02 study, all patients received some form of 5-FU-based chemotherapy (MOF was available for males), and patients were randomized to pelvic radiation or no radiation. Approximately 75% of patients had transmural primary lesions, although an exact T-stage breakdown was not provided. Local failure was reduced from only 13% to 8% with radiation therapy... 

Fisher B, Wolmark N, Rockette H, et al. Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer results from NSABP protocol R-01. J Natl Cancer Inst 1988 80 21-29. 

Tepper JE, O Connell MJ, Petroni GR, et al. Adjuvant postoperative fluorouracil-modulated chemotherapy combined with pelvic radiation therapy for rectal cancer initial results of Intergroup 0114. J Clin Oncol 1997 15(5) 2030-2039. 

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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