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Radiotherapy

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David H Johnson - One of the best experts on this subject based on the ideXlab platform.

  • a randomized trial of postoperative adjuvant therapy in patients with completely resected stage ii or iiia non small cell lung cancer
    The New England Journal of Medicine, 2000
    Co-Authors: Steven M Keller, Sudeshna Adak, Henry N Wagner, Arnold Herskovic, Ritsuko Komaki, B J Brooks, Michael C Perry, Robert B Livingston, David H Johnson
    Abstract:

    Background We conducted a randomized trial to determine whether combination chemotherapy plus thoracic Radiotherapy is superior to thoracic Radiotherapy alone in prolonging survival and preventing local recurrence in patients with completely resected stage II or IIIa non–small-cell lung cancer. Methods After surgical staging and resection of the tumor (usually by lobectomy or pneumonectomy), the patients were randomly assigned to receive either four 28-day cycles of cisplatin (60 mg per square meter of body-surface area intravenously on day 1) and etoposide (120 mg per square meter intravenously on days 1, 2, and 3) administered concurrently with Radiotherapy (a total of 50.4 Gy, given in 28 daily fractions) or Radiotherapy alone (a total of 50.4 Gy, given in 28 daily fractions). Results Of the 488 patients who were enrolled in the study, 242 were assigned to receive Radiotherapy alone and 246 were assigned to receive chemotherapy and Radiotherapy. The median duration of follow-up was 44 months. Treatment...

  • twice daily compared with once daily thoracic Radiotherapy in limited small cell lung cancer treated concurrently with cisplatin and etoposide
    The New England Journal of Medicine, 1999
    Co-Authors: Andrew T Turrisi, Henry N Wagner, Ritsuko Komaki, Robert B Livingston, Ronald H Blum, William T Sause, Seena C Aisner, David H Johnson
    Abstract:

    Background For small-cell lung cancer confined to one hemithorax (limited small-cell lung cancer), thoracic Radiotherapy improves survival, but the best ways of integrating chemotherapy and thoracic Radiotherapy remain unsettled. Twice-daily accelerated thoracic Radiotherapy has potential advantages over once-daily Radiotherapy. Methods We studied 417 patients with limited small-cell lung cancer. All the patients received four 21-day cycles of cisplatin plus etoposide. We randomly assigned these patients to receive a total of 45 Gy of concurrent thoracic Radiotherapy, given either twice daily over a three-week period or once daily over a period of five weeks. Results Twice-daily treatment beginning with the first cycle of chemotherapy significantly improved survival as compared with concurrent once-daily Radiotherapy (P=0.04 by the log-rank test). After a median follow-up of almost 8 years, the median survival was 19 months for the once-daily group and 23 months for the twice-daily group. The survival rat...

Samuele Massarut - One of the best experts on this subject based on the ideXlab platform.

  • targeted intraoperative Radiotherapy versus whole breast Radiotherapy for breast cancer targit a trial an international prospective randomised non inferiority phase 3 trial
    The Lancet, 2010
    Co-Authors: J S Vaidya, David Joseph, J S Tobias, Max Bulsara, Frederik Wenz, Christobel Saunders, Michael Alvarado, Henrik Flyger, Samuele Massarut
    Abstract:

    Findings 1113 patients were randomly allocated to targeted intraoperative Radiotherapy and 1119 were allocated to external beam Radiotherapy. Of 996 patients who received the allocated treatment in the targeted intraoperative Radiotherapy group, 854 (86%) received targeted intraoperative Radiotherapy only and 142 (14%) received targeted intraoperative Radiotherapy plus external beam Radiotherapy. 1025 (92%) patients in the external beam Radiotherapy group received the allocated treatment. At 4 years, there were six local recurrences in the intraoperative Radiotherapy group and five in the external beam Radiotherapy group. The Kaplan-Meier estimate of local recurrence in the conserved breast at 4 years was 1·20% (95% CI 0·53–2·71) in the targeted intraoperative Radiotherapy and 0·95% (0·39–2·31) in the external beam Radiotherapy group (difference between groups 0·25%, –1·04 to 1·54; p=0·41). The frequency of any complications and major toxicity was similar in the two groups (for major toxicity, targeted intraoperative Radiotherapy, 37 [3·3%] of 1113 vs external beam Radiotherapy, 44 [3·9%] of 1119; p=0·44). Radiotherapy toxicity (Radiation Therapy Oncology Group grade 3) was lower in the targeted intraoperative Radiotherapy group (six patients [0·5%]) than in the external beam Radiotherapy group (23 patients [2·1%]; p=0·002).

Christobel Saunders - One of the best experts on this subject based on the ideXlab platform.

  • targeted intraoperative Radiotherapy versus whole breast Radiotherapy for breast cancer targit a trial an international prospective randomised non inferiority phase 3 trial
    The Lancet, 2010
    Co-Authors: J S Vaidya, David Joseph, J S Tobias, Max Bulsara, Frederik Wenz, Christobel Saunders, Michael Alvarado, Henrik Flyger, Samuele Massarut
    Abstract:

    Findings 1113 patients were randomly allocated to targeted intraoperative Radiotherapy and 1119 were allocated to external beam Radiotherapy. Of 996 patients who received the allocated treatment in the targeted intraoperative Radiotherapy group, 854 (86%) received targeted intraoperative Radiotherapy only and 142 (14%) received targeted intraoperative Radiotherapy plus external beam Radiotherapy. 1025 (92%) patients in the external beam Radiotherapy group received the allocated treatment. At 4 years, there were six local recurrences in the intraoperative Radiotherapy group and five in the external beam Radiotherapy group. The Kaplan-Meier estimate of local recurrence in the conserved breast at 4 years was 1·20% (95% CI 0·53–2·71) in the targeted intraoperative Radiotherapy and 0·95% (0·39–2·31) in the external beam Radiotherapy group (difference between groups 0·25%, –1·04 to 1·54; p=0·41). The frequency of any complications and major toxicity was similar in the two groups (for major toxicity, targeted intraoperative Radiotherapy, 37 [3·3%] of 1113 vs external beam Radiotherapy, 44 [3·9%] of 1119; p=0·44). Radiotherapy toxicity (Radiation Therapy Oncology Group grade 3) was lower in the targeted intraoperative Radiotherapy group (six patients [0·5%]) than in the external beam Radiotherapy group (23 patients [2·1%]; p=0·002).

Christopher U Jones - One of the best experts on this subject based on the ideXlab platform.

  • Radiotherapy and short term androgen deprivation for localized prostate cancer
    The New England Journal of Medicine, 2011
    Co-Authors: Christopher U Jones, Daniel P Hunt, David G Mcgowan, Mahul B Amin, Michael Chetner, Deborah Watkins Bruner, Mark H Leibenhaut, S Husain, Marvin Rotman, Luis Souhami
    Abstract:

    Background It is not known whether short-term androgen-deprivation therapy (ADT) before and during Radiotherapy improves cancer control and overall survival among patients with early, localized prostate adenocarcinoma. Methods From 1994 through 2001, we randomly assigned 1979 eligible patients with stage T1b, T1c, T2a, or T2b prostate adenocarcinoma and a prostate-specific antigen (PSA) level of 20 ng per milliliter or less to Radiotherapy alone (992 patients) or Radiotherapy with 4 months of total androgen suppression starting 2 months before Radiotherapy (Radiotherapy plus short-term ADT, 987 patients). The primary end point was overall survival. Secondary end points included disease-specific mortality, distant metastases, biochemical failure (an increasing level of PSA), and the rate of positive findings on repeat prostate biopsy at 2 years. Results The median follow-up period was 9.1 years. The 10-year rate of overall survival was 62% among patients receiving Radiotherapy plus short-term ADT (the comb...

  • Radiotherapy plus cetuximab for squamous cell carcinoma of the head and neck
    The New England Journal of Medicine, 2006
    Co-Authors: James A Bonner, Paul M Harari, J Giralt, Nozar Azarnia, Dong M Shin, Roger B Cohen, Christopher U Jones, David Raben, Jacek Jassem, Merrill S Kies
    Abstract:

    BACKGROUND We conducted a multinational, randomized study to compare Radiotherapy alone with Radiotherapy plus cetuximab, a monoclonal antibody against the epidermal growth factor receptor, in the treatment of locoregionally advanced squamous-cell carcinoma of the head and neck. METHODS Patients with locoregionally advanced head and neck cancer were randomly assigned to treatment with high-dose Radiotherapy alone (213 patients) or high-dose Radiotherapy plus weekly cetuximab (211 patients) at an initial dose of 400 mg per square meter of body-surface area, followed by 250 mg per square meter weekly for the duration of Radiotherapy. The primary end point was the duration of control of locoregional disease; secondary end points were overall survival, progression-free survival, the response rate, and safety. RESULTS The median duration of locoregional control was 24.4 months among patients treated with cetuximab plus Radiotherapy and 14.9 months among those given Radiotherapy alone (hazard ratio for locoregional progression or death, 0.68; P = 0.005). With a median follow-up of 54.0 months, the median duration of overall survival was 49.0 months among patients treated with combined therapy and 29.3 months among those treated with Radiotherapy alone (hazard ratio for death, 0.74; P = 0.03). Radiotherapy plus cetuximab significantly prolonged progression-free survival (hazard ratio for disease progression or death, 0.70; P = 0.006). With the exception of acneiform rash and infusion reactions, the incidence of grade 3 or greater toxic effects, including mucositis, did not differ significantly between the two groups. CONCLUSIONS Treatment of locoregionally advanced head and neck cancer with concomitant highdose Radiotherapy plus cetuximab improves locoregional control and reduces mortality without increasing the common toxic effects associated with Radiotherapy to the head and neck. (ClinicalTrials.gov number, NCT00004227.)

Paolo Veronesi - One of the best experts on this subject based on the ideXlab platform.

  • intraoperative Radiotherapy versus external Radiotherapy for early breast cancer eliot a randomised controlled equivalence trial
    Lancet Oncology, 2013
    Co-Authors: Umberto Veronesi, Roberto Orecchia, Patrick Maisonneuve, Giuseppe Viale, Nicole Rotmensz, Claudia Sangalli, Alberto Luini, Paolo Veronesi
    Abstract:

    Methods This study was done at the European Institute of Oncology (Milan, Italy). Women aged 48–75 years with early breast cancer, a maximum tumour diameter of up to 2·5 cm, and suitable for breast-conserving surgery were randomly assigned in a 1:1 ratio (using a random permuted block design, stratifi ed for clinical tumour size [<1·0 cm vs 1·0–1·4 cm vs ≥1·5 cm]) to receive either whole-breast external Radiotherapy or intraoperative Radiotherapy with electrons. Study coordinators, clinicians, and patients were aware of the assignment. Patients in the intraoperative Radiotherapy group received one dose of 21 Gy to the tumour bed during surgery. Those in the external Radiotherapy group received 50 Gy in 25 fractions of 2 Gy, followed by a boost of 10 Gy in fi ve fractions. This was an equivalence trial; the prespecifi ed equivalence margin was local recurrence of 7·5% in the intraoperative Radiotherapy group. The primary endpoint was occurrence of ipsilateral breast tumour recurrences (IBTR); overall survival was a secondary outcome. The main analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01849133. Findings 1305 patients were randomised (654 to external Radiotherapy and 651 to intraoperative Radiotherapy) between Nov 20, 2000, and Dec 27, 2007. Af ter a medium follow-up of 5·8 years (IQR 4·1–7·7), 35 patients in the intraoperative Radiotherapy group and four patients in the external Radiotherapy group had had an IBTR (p<0·0001). The 5-year event rate for IBRT was 4·4% (95% CI 2·7–6·1) in the intraoperative Radiotherapy group and 0·4% (0·0–1·0) in the external Radiotherapy group (hazard ratio 9·3 [95% CI 3·3–26·3]). During the same period, 34 women allocated to intraoperative Radiotherapy and 31 to external Radiotherapy died (p=0·59). 5-year overall survival was 96·8% (95% CI 95·3–98·3) in the intraoperative Radiotherapy group and 96·9% (95·5–98·3) in the external Radiotherapy group. In patients with data available (n=464 for intraoperative Radiotherapy; n=412 for external Radiotherapy) we noted signifi cantly fewer skin side-eff ects in women in the intraoperative Radiotherapy group than in those in the external Radiotherapy group (p=0·0002). Interpretation Although the rate of IBTR in the intraoperative Radiotherapy group was within the prespecifi ed equivalence margin, the rate was signifi cantly greater than with external Radiotherapy , and overall survival did not diff er between groups. Improved selection of patients could reduce the rate of IBTR with intraoperative Radiotherapy with electrons.