Radiotherapy and

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. 

The two commonly used methods for radiation therapy are external-beam radiotherapy and brachytherapy.26 In external-beam radiotherapy, doses of 70 to 75 Gy are delivered in 35 to 41 fractions in patient with low-grade prostate cancer and 75 to 80 Gy for those with intermediate- or high-grade prostate cancer. Brachytherapy involves the permanent implantation of radioactive beads of 145 Gy of 125I or 124 Gy of 103Pd and generally is reserved for individuals with low-risk cancers. 

Since the late 1940s, when Farber treated leukemia with methotrexate, cancer therapy with cytotoxic drugs made enormous progress. Chemotherapy is usually integrated with other treatments such as surgery, radiotherapy, and immunotherapy, and it is clear that postsurgery, it is effective with solid tumors. This is due to the fact that only systemic therapy can attack micrometastases. 

The above data are based on the review of studies reported by Xin et al.29 Note that ECT was conducted on patients who were either in advanced stages of lung cancer and/or had failed radiotherapy and/or chemotherapy. 

There is another important aspect of DNA damages. A uniqne featnre of many cancerons tumors is the existence of hypoxic regions, that is, regions of oxygen-poor cells (Brown 1999). Snch cells are often resistant to more conventional forms of antitnmor treatment snch as radiotherapy and chemotherapy (Denny and Wilson 2000). There has been considerable effort for the identification... 

Bartehnk H, Roelofsen F, Eschwege F, et al. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol 1997 15 2040-2049. 

Flam M, John M, Pajak TF, et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoidcarcinoma of the anal canal results of a phase III randomized intergroup study. J Clin Oncol 1996 14 2527-2539. 

Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999 340(15) 1144—1153. 

Gy) or to two courses of chemotherapy with fluorouracil and semustine followed by concomitant fluorouracil and radiotherapy and two additional courses of chemotherapy... 

Wodinsky I, Swiniarski J, Kensler CJ, Venditti JM. Combination radiotherapy and chemotherapy for P388 lymphocytic leukemia in vivo. Cancer Treat Rep 1974 4 73. 

Bachaud J-M, David J-M, Boussin G, Daly N. Combined radiotherapy and weekly cisplatin infusion for advanced squamous cell carcinoma of the head and neck preliminary report of a randomized trial. Int J Radiat Oncol Biol Phys 1991 20 243-246. 

Cheng SH, Jian J J-M, Tsai SYC, et al. Long-term survival of nasopharyngeal carcinoma following concomitant radiotherapy and chemotherapy. Int J Radiat Oncol Biol Phys 2000 48 1323-1330. 

Koh W-J, Wallace J, Greer BE, et al. Combined radiotherapy and chemotherapy in the management of local-regionally advanced vulvar cancer. Int J Radial Oncol Biol Phys 1993 26 809-816. 

Koukourakis MI, B ahlitzanakis N, Froudarakis M, et al. Concurrentconventionally fractionated radiotherapy and weekly docetaxel in the treatment of stage IIIB non-small cell lung carcinoma. BrJ Cancer 1999 80 1792-1796. 

Lederman G, Arbit E, Odaimi M, Wertheim S, Lombardi E. Recurrent glioblastoma multiforme potential benefits using fractionated stereotactic radiotherapy and concurrent taxol. Stereotact Fund Neurosurg 1997 69(1—4 Pt 2) 162-174. 

De Palo G, Cerrotta A, Gardani G, et al. Concurrent Radiotherapy and Taxol as Radiosensitizer in Locally Advanced or Recurrent Carcinoma of the Uterine Cervix (abstract 1404). Pro Am Soc Clin Oncol 1998 17 364a. 

Frigerio L, Mangili G, Aletti G, Carnelli M, Garavaglia E, Beatrice S, Ferrari A. Concomitant radiotherapy and paclitaxel for high-risk endometrial cancer first feasibility study. Gynecol Oncol 2001 81(1) 53—57. 

Steinberg L, Hassan M, Olmsted L, et al. A phase I trial of radiotherapy and simultaneous 24-hour paclitaxel in patients with locally advanced head and neck squamous cell carcinoma. Semin Oncol 1997 24(6 Suppl 19) S 19-51-S19-56. 

Walker MD, Green SB, ByarDP, etal. Randomized comparisons of radiotherapy and nitrosureas for the treatment of malignant glioma after surgery. N Engl J Med 1980 303 1323-1329. 

The study population was stratified by T and N stage, pathology, and performance status. Patients received 35-39 fractions of daily radiotherapy and were randomized to concomitant cisplatin (100 mg/m2 on d 1,22, and 43) followed by three cycles of adjuvant cisplatin (80 mg/m2, d 1) and continuous infusion 5-FU (1000 mg/m2, d 1 —4) every 28 d. Overall, superiority of treatment was seen in the concomitant chemoradiation therapy arm in comparison to radiotherapy alone with the 3-yr progression-free survival (PFS) of 69% vs 24% (p < 0.001) and 3-yr OS of 78% vs 47% (p = 0.005). Hence, the recommended standard of care in treating patients with nasopharygneal carcinoma is concomitant chemoradiotherapy. 

We then chose to expand on the FHX regimen with the addition of paclitaxel (TFHX) for poor-prognosis patients HNC patients in a phase I study (60). Included in this study were patients that developed a relapse following radiotherapy or surgery with curative intent, unresectable disease, metastatic disease requiring localized radiotherapy, and a... 

Based on this initial study by Rischin et al., the University of Chicago is currently accruing for a phase I trial of previously irradiated patients. Patients will receive standard daily radiotherapy and tirapazamine (wk 1-3) combined with cisplatin (wk 3 and 5), converting to hyperfractionated radiotherapy for wk 4—6. 

Fu KK, Phillips TL, Silverberg IJ, et al. Combined radiotherapy and chemotherapy with bleomycin and methotrexate for advanced inoperable head and neck cancer update of a Northern California Oncology Group randomized trial. J Clin Oncol 1987 5 1410-1418. 

Eschwege F, Sancho-Garnier H, Gerard JP, et al. Ten-year results of randomized trial comparing radiotherapy and concomitant bleomycin to radiotherapy alone in epidermoid carcinomas of the oropharynx experience of the European Organization for Research and Treatment of Cancer. NCI Monogr 1988 6 275-278. 

Al-Sarraf M, Pajak TF, Marcial V A, et al. Concurrent radiotherapy and chemotherapy with cisplatin in inoperable squamous cell carcinoma of the head and neck. An RTOG Study. Cancer 1987 59 259-265. 

Hoffmann W, Belka C, Schmidberger H, et al. Radiotherapy and concomitant weekly 1-hour infusion of paclitaxel in the treatment of head and neck cancer—results from a Phase I trial. Int J Radiat Oncol Biol Phys 1997 38 691-696. 

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