Radiotherapy combinations

Malignant mesothelioma, described more than 100 years ago, is a comparatively rare tumor that occurs in the pleura and peritoneum, membranes that surround the lungs, line the thoracic cavity, surround the gut, and line the abdominal cavity. The survival time of mesothelioma patients is often less than a year, in spite of chemotherapy and radiotherapy. Combined therapy and surgical resection in cases of early diagnosis, a treatment currently being tested, has produced a few long-term (more than five years) survivors (Ant-man, et ah, 1980 Antman et ah, 1983), usually in cases with peritoneal rather than pleural involvement. 

GOG-9803 Phase I/II Study of Radiotherapy Combined With Paclitaxel and Cisplatin in Patients With Stage IB2, IIA, IIB, IIIB, or IVA Invasive Carcinoma of the Cervix. 

A randomized study comparing carboplatin/5-FU/radiotherapy vs radiotherapy in patients with locally advanced oropharyngeal carcinoma was recently reported by the French Group of Radiation Oncology for HNC (GORTEC) (54). Two hundred twenty-six patients were randomized to conventional radiotherapy or identical radiotherapy combined with three cycles of the 4-d regimen of carboplatin (70 mg/m2/d) and continuous infusion 5-FU (600 mg/m2/d) on d 1,22, and 43 of radiation. Increased mucositis was reported in the combined modality arm 67% vs 36%. No difference in skin toxicity was... 

Kapiteijn E, Marijnen CAM, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001 345(9) 638-646. 

Time Factor of Fractionated Radiotherapy Combined with Other Treatment Modalities 295... 

Bendel [29] 50 toxicity of radiotherapy combination angustifolia + pallida root untreated open no protective effects observed observed ... 

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. 

Note that application in the particular indications is usually restricted either to patients expressing the target (e.g. trastuzumab, cetuximab, lapatinib, imatinib) and/or after failure of prior therapies (e.g. cetuximab, erlotinib, lapatinib, sutinib, dasatinib). Furthermore, for cancer treatment most tyrosine kinase inhibitors are applied in combination with conventional chemotherapeutic drugs, such as fluorouracil, taxanes, platin-based regimens, anthracylines and irinotecan or radiotherapy. 

Surgery followed by whole-brain radiotherapy (WBRT) is best indicated for patients with an accessible single brain lesion and controlled or limited systemic MM.62 Two randomized studies reported improved survival in patients treated with combination surgery and WBRT compared with WBRT alone.62,63 For those patients with multiple metastatic brain... 

Radiation therapy is the treatment of choice for chemotherapy-resistant tumors such as non-small cell lung cancer (NSCLC) or in chemotherapy-refractory patients with SVCS. Between 70% and 90% of patients will experience relief of symptoms. Radiation therapy also may be combined with chemotherapy for chemotherapy-sensitive tumors such as SCLC and lymphoma. In the rare emergency situations of airway obstruction or elevated intracranial pressure, empirical radiotherapy prior to tissue diagnosis should be used. In most patients, symptoms resolve within 1 to 3 weeks. 

Cytotoxic chemotherapy is the treatment of choice for chemotherapy-sensitive tumors such as SCLC and lymphoma. As indicated earlier, chemotherapy also may be combined with radiotherapy, especially in patients with lymphoma who have bulky mediastinal lymphadenopathy. 

An alternative anti-cancer strategy entails insertion of a copy of a tumour suppresser gene into cancer cells. For example, a dehciency in one such gene product, p53, has been directly implicated in the development of various human cancers. It has been shown in vitro that insertion of a p53 gene in some p53-dehcient tumour cell lines induces the death of such cells. A potential weakness of such an approach, however, is that 100 per cent of the transformed cells would have to be successfully treated to fully cure the cancer. Tumour suppressor-based gene therapy in combination with conventional approaches (chemotherapy or radiotherapy) may, therefore, prove most efficacious, and the sole gene-therapy-based medicine approved to date (in China only) is based upon this approach (Box 14.2). 

SCLC is very radiosensitive. Radiotherapy has been combined with chemotherapy to treat limited disease SCLC. This combined-modality therapy prevents local tumor recurrences but only modestly improves survival over chemotherapy alone. 

Radiotherapy followed by combination chemotherapy is recommended for patients with symptomatic brain metastases. Dexamethasone and anticonvulsants are also administered for symptom control and seizure prevention, respectively. 

Other possible improvements in ECT are the suggested benefits of combining ECT with other established treatments such as chemotherapy51 or radiotherapy 52 both these studies found the combination therapy more effective. Also, immunologically-related compounds such as TNF-a, IFN-a and IL-2 were observed to enhance the effect of ECT when used in combination with the latter.53,55 The studies have also been covered in a recent synoptic review.20 This combination therapy was also pioneered, it seems by Nordenstrom in Sweden 14,15 he also describes the details of the electrode wire electrodes, cannula and catheter etc. he used in his work.14... 

In other study,79 Samuelsson and coworkers (Sweden) investigated the efficacy of either ECT or radiotherapy or a combination of the two in destroying experimental colon carcinoma tumor in rats. The combined treatment resulted in tumor growth inhibition, and, total regression was obtained in 75% of the cases with radiotherapy alone, 75% of the tumors remained. As mentioned above78 with ECT alone, the regression rate was 50%, the same as surgery alone. 

Radiotherapy is the use of ionising radiation to damage and kill tumour cells. Radical radiotherapy involves using radiotherapy to cure the tumour. It may be combined with chemotherapy before, during or after radiotherapy. Adjuvant radiotherapy, for example following surgery to remove a tumour, is given to eradicate residual tumour... 

Steel GG, Peckham MJ. Exploitable mechanisms in combined radiotherapy-chemotherapy the concept of additivity. Int JRadiat Oncol Biol Phys 1979 Jan 5(1) 85—91. 

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. 

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