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Clemens F. Hess - One of the best experts on this subject based on the ideXlab platform.
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Preoperative versus Postoperative Chemoradiotherapy for Rectal Cancer
The New England journal of medicine, 2004Co-Authors: Rolf Sauer, Heinz Becker, Werner Hohenberger, Claus Rödel, Christian Wittekind, Rainer Fietkau, Peter Martus, Jörg Tschmelitsch, Eva Hager, Clemens F. HessAbstract:Postoperative Chemoradiotherapy is the recommended standard therapy for patients with locally advanced rectal cancer. In recent years, encouraging results with preoperative radiotherapy have been reported. We compared preoperative Chemoradiotherapy with postoperative Chemoradiotherapy for locally advanced rectal cancer. We randomly assigned patients with clinical stage T3 or T4 or node-positive disease to receive either preoperative or postoperative Chemoradiotherapy. The preoperative treatment consisted of 5040 cGy delivered in fractions of 180 cGy per day, five days per week, and fluorouracil, given in a 120-hour continuous intravenous infusion at a dose of 1000 mg per square meter of body-surface area per day during the first and fifth weeks of radiotherapy. Surgery was performed six weeks after the completion of Chemoradiotherapy. One month after surgery, four five-day cycles of fluorouracil (500 mg per square meter per day) were given. Chemoradiotherapy was identical in the postoperative-treatment group, except for the delivery of a boost of 540 cGy. The primary end point was overall survival. Four hundred twenty-one patients were randomly assigned to receive preoperative Chemoradiotherapy and 402 patients to receive postoperative Chemoradiotherapy. The overall five-year survival rates were 76 percent and 74 percent, respectively (P=0.80). The five-year cumulative incidence of local relapse was 6 percent for patients assigned to preoperative Chemoradiotherapy and 13 percent in the postoperative-treatment group (P=0.006). Grade 3 or 4 acute toxic effects occurred in 27 percent of the patients in the preoperative-treatment group, as compared with 40 percent of the patients in the postoperative-treatment group (P=0.001); the corresponding rates of long-term toxic effects were 14 percent and 24 percent, respectively (P=0.01). Preoperative Chemoradiotherapy, as compared with postoperative Chemoradiotherapy, improved local control and was associated with reduced toxicity but did not improve overall survival. Copyright 2004 Massachusetts Medical Society.
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preoperative versus postoperative Chemoradiotherapy for rectal cancer
The New England Journal of Medicine, 2004Co-Authors: Rolf Sauer, Heinz Becker, Werner Hohenberger, Claus Rödel, Christian Wittekind, Rainer Fietkau, Peter Martus, Jörg Tschmelitsch, Eva Hager, Clemens F. HessAbstract:background Postoperative Chemoradiotherapy is the recommended standard therapy for patients with locally advanced rectal cancer. In recent years, encouraging results with preoperative radiotherapy have been reported. We compared preoperative Chemoradiotherapy with postoperative Chemoradiotherapy for locally advanced rectal cancer. methods We randomly assigned patients with clinical stage T3 or T4 or node-positive disease to receive either preoperative or postoperative Chemoradiotherapy. The preoperative treatment consisted of 5040 cGy delivered in fractions of 180 cGy per day, five days per week, and fluorouracil, given in a 120-hour continuous intravenous infusion at a dose of 1000 mg per square meter of body-surface area per day during the first and fifth weeks of radiotherapy. Surgery was performed six weeks after the completion of Chemoradiotherapy. One month after surgery, four five-day cycles of fluorouracil (500 mg per square meter per day) were given. Chemoradiotherapy was identical in the postoperative-treatment group, except for the delivery of a boost of 540 cGy. The primary end point was overall survival. results Four hundred twenty-one patients were randomly assigned to receive preoperative Chemoradiotherapy and 402 patients to receive postoperative Chemoradiotherapy. The overall five-year survival rates were 76 percent and 74 percent, respectively (P=0.80). The five-year cumulative incidence of local relapse was 6 percent for patients assigned to preoperative Chemoradiotherapy and 13 percent in the postoperative-treatment group (P=0.006). Grade 3 or 4 acute toxic effects occurred in 27 percent of the patients in the preoperative-treatment group, as compared with 40 percent of the patients in the postoperative-treatment group (P=0.001); the corresponding rates of long-term toxic effects were 14 percent and 24 percent, respectively (P=0.01). conclusions Preoperative Chemoradiotherapy, as compared with postoperative Chemoradiotherapy, improved local control and was associated with reduced toxicity but did not improve overall survival.
Yue Zhao - One of the best experts on this subject based on the ideXlab platform.
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Induction chemotherapy with concurrent Chemoradiotherapy versus concurrent Chemoradiotherapy for locally advanced squamous cell carcinoma of head and neck: a meta-analysis
Scientific reports, 2015Co-Authors: Li-juan Zhang, Nan Jiang, Yuexian Shi, Peiguo Wang, Yue ZhaoAbstract:Induction chemotherapy with concurrent Chemoradiotherapy versus concurrent Chemoradiotherapy for locally advanced squamous cell carcinoma of head and neck: a meta-analysis
N P O'rourke - One of the best experts on this subject based on the ideXlab platform.
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Concurrent Chemoradiotherapy in non-small cell lung cancer.
The Cochrane database of systematic reviews, 2004Co-Authors: N P Rowell, N P O'rourkeAbstract:In a previous meta-analysis of adjuvant chemotherapy in NSCLC there was a 13% reduction in the risk of death in patients receiving radical radiotherapy. This overview specifically excluded trials in which chemotherapy and radiotherapy were given concurrently (NSCLCCG 1995). The use of concurrent chemotherapy and radiotherapy might be seen as a way of increasing the effectiveness of radiotherapy at the same time as reducing the risks of metastatic disease by using chemotherapy. To determine the effectiveness of concurrent Chemoradiotherapy as compared to radiotherapy alone with regard to local control and overall survival; and to determine whether the addition of concurrent chemotherapy results in an altered risk of treatment-related morbidity. To compare concurrent with sequential Chemoradiotherapy. Electronic search of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE with identification of further studies from references cited in the initial identified studies. Randomised trials of patients with stage I-III non-small cell lung cancer (NSCLC) undergoing radical radiotherapy and randomised to receive concurrent Chemoradiotherapy versus radiotherapy alone, or concurrent versus sequential Chemoradiotherapy. Identified trials were reviewed independently by both reviewers. Relative risks (calculated according to a random-effects model) were determined with respect to overall survival, progression-free survival and treatment morbidity. Fourteen randomised studies (including 2393 patients) of concurrent Chemoradiotherapy versus radiotherapy alone met the inclusion criteria. In a meta-analysis there was a reduction in risk of death at two years (relative risk (RR) 0.93; 95% CI 0.88 to 0.98; P = 0.01). Similar improvements in two-year locoregional progression-free survival (RR 0.84; 95% CI 0.72 to 0.98; P = 0.03) and progression-free survival at any site (RR 0.90; 95% CI 0.84 to 0.97; P = 0.005) were also seen in those receiving concurrent Chemoradiotherapy. Subgroup analysis suggested the possibility of a greater benefit from regimens which incorporated once daily fractionation of radiotherapy or a higher total chemotherapy dose. The incidence of acute oesophagitis, neutropenia and anaemia were significantly increased by concurrent Chemoradiotherapy. In a meta-analysis of three trials of concurrent versus sequential Chemoradiotherapy there was a significant reduction in the risk of death at two years with concurrent treatment (RR 0.86; 95% CI 0.78 to 0.95; P = 0.003) but potentially at the expense of toxicity, although data was incomplete. With concurrent Chemoradiotherapy there was a 14% reduction in risk of death at two years compared to sequential Chemoradiotherapy, and a 7% reduction compared to radiotherapy alone. In both cases there was some increase in acute oesophagitis. Caution is advised in adopting concurrent Chemoradiotherapy as the standard of care because of uncertainties about the true magnitude of benefit in comparison with sequential Chemoradiotherapy. With short follow up and uncertainties about toxicity in the identified studies, the optimal chemotherapy regimen remains uncertain. The confounding effects of treatment-related anaemia and gaps in treatment due to toxicity require further investigation.
Claus Rödel - One of the best experts on this subject based on the ideXlab platform.
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Radiotherapy: Preoperative Chemoradiotherapy for rectal cancer
Nature reviews. Clinical oncology, 2010Co-Authors: Claus RödelAbstract:Chemoradiotherapy and surgical resection are important elements of multimodality treatment for patients with locally advanced rectal cancer. The optimum sequence of these modalities has been addressed in several randomized trials and preoperative Chemoradiotherapy has been shown to be superior to postoperative treatment for a variety of end points.
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Preoperative versus Postoperative Chemoradiotherapy for Rectal Cancer
The New England journal of medicine, 2004Co-Authors: Rolf Sauer, Heinz Becker, Werner Hohenberger, Claus Rödel, Christian Wittekind, Rainer Fietkau, Peter Martus, Jörg Tschmelitsch, Eva Hager, Clemens F. HessAbstract:Postoperative Chemoradiotherapy is the recommended standard therapy for patients with locally advanced rectal cancer. In recent years, encouraging results with preoperative radiotherapy have been reported. We compared preoperative Chemoradiotherapy with postoperative Chemoradiotherapy for locally advanced rectal cancer. We randomly assigned patients with clinical stage T3 or T4 or node-positive disease to receive either preoperative or postoperative Chemoradiotherapy. The preoperative treatment consisted of 5040 cGy delivered in fractions of 180 cGy per day, five days per week, and fluorouracil, given in a 120-hour continuous intravenous infusion at a dose of 1000 mg per square meter of body-surface area per day during the first and fifth weeks of radiotherapy. Surgery was performed six weeks after the completion of Chemoradiotherapy. One month after surgery, four five-day cycles of fluorouracil (500 mg per square meter per day) were given. Chemoradiotherapy was identical in the postoperative-treatment group, except for the delivery of a boost of 540 cGy. The primary end point was overall survival. Four hundred twenty-one patients were randomly assigned to receive preoperative Chemoradiotherapy and 402 patients to receive postoperative Chemoradiotherapy. The overall five-year survival rates were 76 percent and 74 percent, respectively (P=0.80). The five-year cumulative incidence of local relapse was 6 percent for patients assigned to preoperative Chemoradiotherapy and 13 percent in the postoperative-treatment group (P=0.006). Grade 3 or 4 acute toxic effects occurred in 27 percent of the patients in the preoperative-treatment group, as compared with 40 percent of the patients in the postoperative-treatment group (P=0.001); the corresponding rates of long-term toxic effects were 14 percent and 24 percent, respectively (P=0.01). Preoperative Chemoradiotherapy, as compared with postoperative Chemoradiotherapy, improved local control and was associated with reduced toxicity but did not improve overall survival. Copyright 2004 Massachusetts Medical Society.
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preoperative versus postoperative Chemoradiotherapy for rectal cancer
The New England Journal of Medicine, 2004Co-Authors: Rolf Sauer, Heinz Becker, Werner Hohenberger, Claus Rödel, Christian Wittekind, Rainer Fietkau, Peter Martus, Jörg Tschmelitsch, Eva Hager, Clemens F. HessAbstract:background Postoperative Chemoradiotherapy is the recommended standard therapy for patients with locally advanced rectal cancer. In recent years, encouraging results with preoperative radiotherapy have been reported. We compared preoperative Chemoradiotherapy with postoperative Chemoradiotherapy for locally advanced rectal cancer. methods We randomly assigned patients with clinical stage T3 or T4 or node-positive disease to receive either preoperative or postoperative Chemoradiotherapy. The preoperative treatment consisted of 5040 cGy delivered in fractions of 180 cGy per day, five days per week, and fluorouracil, given in a 120-hour continuous intravenous infusion at a dose of 1000 mg per square meter of body-surface area per day during the first and fifth weeks of radiotherapy. Surgery was performed six weeks after the completion of Chemoradiotherapy. One month after surgery, four five-day cycles of fluorouracil (500 mg per square meter per day) were given. Chemoradiotherapy was identical in the postoperative-treatment group, except for the delivery of a boost of 540 cGy. The primary end point was overall survival. results Four hundred twenty-one patients were randomly assigned to receive preoperative Chemoradiotherapy and 402 patients to receive postoperative Chemoradiotherapy. The overall five-year survival rates were 76 percent and 74 percent, respectively (P=0.80). The five-year cumulative incidence of local relapse was 6 percent for patients assigned to preoperative Chemoradiotherapy and 13 percent in the postoperative-treatment group (P=0.006). Grade 3 or 4 acute toxic effects occurred in 27 percent of the patients in the preoperative-treatment group, as compared with 40 percent of the patients in the postoperative-treatment group (P=0.001); the corresponding rates of long-term toxic effects were 14 percent and 24 percent, respectively (P=0.01). conclusions Preoperative Chemoradiotherapy, as compared with postoperative Chemoradiotherapy, improved local control and was associated with reduced toxicity but did not improve overall survival.
M Kimmich - One of the best experts on this subject based on the ideXlab platform.
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phase iii study of surgery versus definitive concurrent Chemoradiotherapy boost in patients with resectable stage iiia n2 and selected iiib non small cell lung cancer after induction chemotherapy and concurrent Chemoradiotherapy espatue
Journal of Clinical Oncology, 2015Co-Authors: W Eberhardt, Christoph Pottgen, Thomas Gauler, Godehard Friedel, Stefanie Veit, Vanessa Heinrich, Stefan Welter, Wilfried Budach, Werner Spengler, M KimmichAbstract:Purpose Concurrent Chemoradiotherapy with or without surgery are options for stage IIIA(N2) non–small-cell lung cancer. Our previous phase II study had shown the efficacy of induction chemotherapy followed by Chemoradiotherapy and surgery in patients with IIIA(N2) disease and with selected IIIB disease. Here, we compared surgery with definitive Chemoradiotherapy in resectable stage III disease after induction. Patients and Methods Patients with pathologically proven IIIA(N2) and selected patients with IIIB disease that had medical/functional operability received induction chemotherapy, which consisted of three cycles of cisplatin 50 mg/m2 on days 1 and 8 and paclitaxel 175 mg/m2 on day 1 every 21 days, as well as concurrent Chemoradiotherapy to 45 Gy given as 1.5 Gy twice daily, concurrent cisplatin 50 mg/m2 on days 2 and 9, and concurrent vinorelbine 20 mg/m2 on days 2 and 9. Those patients whose tumors were reevaluated and deemed resectable in the last week of radiotherapy were randomly assigned to rece...