BACKGROUNDFew studies were reported on the comparison of clinical outcomes between intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) in the treatment of glioblastoma multiforme (GBM). This study aimed to determine whether IMRT improves clinical outcomes compared with 3D-CRT in patients with GBM.

METHODSThe records of 54 patients with newly-diagnosed GBM from July 2009 to December 2010 were reviewed. The patients underwent postoperative IMRT or 3D-CRT with concurrent and adjuvant temozolomide. Kaplan-Meier method and log rank test were used to estimate differences of patients' survival.

RESULTSThe median follow-up was 13 months. Of the 54 patients, fifty (92.6%) completed the combined modality treatment. The 1-year overall survival rate (OS) was 79.6%. The pattern of failure was predominantly local. A comparative analysis revealed that no statistical difference was observed between the IMRT group (n = 21) and the 3D-CRT group (n = 33) for 1-year OS (89.6% vs. 75.8%, P = 0.795), or 1-year progression-free survival (PFS) (61.0% vs. 45.5%, P = 0.867). In dosimetric comparison, IMRT seemed to allow better sparing of organs at risk than 3D-CRT did (P = 0.050, P = 0.055). However, there was no significant difference for toxicities of irradiation between the IMRT group and the 3D-CRT group.

CONCLUSIONSOur preliminary results suggested that delivering standard radiation doses by IMRT is unlikely to improve local control or overall survival for GBM compared with 3D-CRT. Given this lack of survival benefit and increased costs of IMRT, the utilization of IMRT treatment for GBM needs to be carefully rationalized.

Adult ; Aged ; Brain Neoplasms ; mortality ; radiotherapy ; Female ; Glioblastoma ; mortality ; radiotherapy ; Humans ; Male ; Middle Aged ; Radiotherapy, Conformal ; adverse effects ; Radiotherapy, Intensity-Modulated ; adverse effects ; Treatment Outcome

This is to report the results of 3-dimensional (3D) high dose re-irradiation (re-RT) for patients with locally recurrent nasopharyngeal cancer. Between May 1995 and Dec. 2000, 21 patients with locally recurrent cancer of the nasopharynx received high dose 3D re-RT at Samsung Medical Center. The median 55 (45 - 70) Gy was applied by daily fractions of 2.5 Gy or 3.0 Gy. The median survival period, the rates of local control, overall survival and disease-free survival at 5 years, of all patients, were 21 months, 71.8%, 32.3%, and 21.2% respectively. The number of patients who experienced treatment failures at any site was 14 (67.0%) : eight patients (38.1%) experienced distant hematogenous metastases; five patients (23.8%) experienced recurrences within the current re-RT treatment volume; and seven patients (33.0%) had recurrences outside this volume. Five patients (23.8%) experienced severe late radiation-induced complications of RTOG grade IV or V, and these were brainstem necrosis (2), temporal lobe necrosis (1), mucosal necrosis (1), and massive epistaxis (1). For locally recurrent nasopharyngeal cancer patients, high dose 3D re-RT could lead to improved results when compared with the historic data by conventional re-RT techniques. Further treatment refinements, that would be necessary, may include optimization in patient selection, improvement in target localization and patient immobilization, and the addition of systemic agents, either as a radiation sensitizer or a radiation protector.
Adult ; Aged ; Carcinoma, Squamous Cell/mortality/*radiotherapy/secondary ; Disease-Free Survival ; Female ; Follow-Up Studies ; Human ; Male ; Middle Aged ; Nasopharyngeal Neoplasms/mortality/pathology/*radiotherapy ; Neoplasm Recurrence, Local/mortality/*radiotherapy ; Radiation Dosage ; *Radiotherapy, Conformal ; Survival Analysis

BACKGROUND AND AIMS: We investigated the five-year survival outcomes of a large cohort of hepatocellular carcinoma (HCC) patients who were treated at a single institute, and this is a follow-up study of a previous report. METHODS: Nine hundred four HCC patients who were treated at the National Cancer Center Korea were enrolled and they were followed till February 2007. RESULTS: The mean age of the patients was 56.0 years and 731 patients were male. Six hundred seventy-seven (74.9%) patients died and the overall 5-year survival rate (5-YSR) was 23.9%. The 5-YSRs of the patients with modified UICC stage I, II and III were 61.2%, 54.4% and 18.4%, respectively, and the median survival time was 4.3 and 3.7 months for the stage IVa and IVb patients, respectively. For the analysis of the treatment modality, surgical resection showed significantly better outcomes for the five-year survival as compared with transcatheter arterial chemoembolization (TACE) for Child-Pugh A patients with modified UICC stage I or II disease (80.1% vs 52.8%, respectively, P<.001), or stage III disease (60.7% vs 17.0%, respectively, P<.001). For patients with advanced stage IVb disease, TACE, systemic chemotherapy and radiotherapy increased the median survival period more than conservative management for the Child-Pugh class A patients. The serum alpha-fetoprotein level, portal vein tumor thrombosis, the Child-Pugh class, the tumor stage, the tumor type and symptoms were related to the prognosis. CONCLUSIONS: This study presented, for the first time, the 5-YSRs of a cohort of HCC patients.
Aged ; Carcinoma, Hepatocellular/etiology/*mortality/surgery ; Chemoembolization, Therapeutic ; Cohort Studies ; Combined Modality Therapy ; Female ; Humans ; Korea ; Liver Neoplasms/etiology/*mortality/surgery ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Radiotherapy, Conformal ; Severity of Illness Index ; Survival Rate

OBJECTIVETo evaluate the effects of 3-dimensional conformal radiation therapy combined with chemotherapy for rectal cancer of postoperative local recurrence.

METHODSFifty-six rectal cancer patients of postoperative local recurrence were treated with 3-dimensional conformal radiotherapy (66 approximately 68 Gy in 2 Gy daily fraction) combined with chemotherapy (5-Fu 0.75, Days 1 - 5 and Days 29 - 33; Cisplatin 40 mg, Days 1 - 3 and Days 29 - 31). Acute and late radioreactions and survival rates were observed. Kaplan-Meier method was used for survival analysis.

RESULTSThe 1, 2, 3 years local control rate was 87.5%, 66.1%, 38.2%, respectively. The 1, 2, 3 years disease-free survival and overall were 82.7%, 56.6%, 30.1% and 88.3%, 66.8%, 44.2%, respectively. The median survival was 25.3 months. Acute small enteritis were the most common but acceptable radioreactions Grade 1 approximately 2. No late radioreactions occurred.

CONCLUSIONS3-dimensional conformal radiotherapy combined with chemotherapy can be considered as an effective and feasible approach to cancer patients of postoperative local recurrence.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cisplatin ; administration & dosage ; Combined Modality Therapy ; Female ; Fluorouracil ; administration & dosage ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; drug therapy ; mortality ; radiotherapy ; therapy ; Postoperative Period ; Radiotherapy Dosage ; Radiotherapy, Conformal ; adverse effects ; methods ; Rectal Neoplasms ; drug therapy ; mortality ; radiotherapy ; therapy ; Retrospective Studies ; Survival Rate

This study was performed to validate the effectiveness and safety of concurrent chemoradiotherapy and adjuvant therapy with temozolomide for newly diagnosed glioblastoma multiforme as a standard treatment protocol. Between 2004 and 2011, patients newly diagnosed with glioblastoma who were treated with temozolomide during concurrent chemoradiotherapy and adjuvant chemotherapy were included from a single institution and analyzed retrospectively. The primary endpoint was overall survival, and the secondary endpoints were progression-free survival, response, and safety. A total of 71 patients were enrolled in this study. The response rate was 41% (29/71), and the tumor control rate was 80% (57/71). In the 67 patients who completed the concurrent chemoradiotherapy with temozolomide, the median overall survival was 19 months and the 1- and 2-yr overall survival rates were 78.3% and 41.7%, respectively. The median progression free survival was 9 months, and the 1- and 2-yr progression free survival rates were 33.8% and 14.3%, respectively. The mean duration of survival after progression of disease in salvage treatment group was 11.9 (1.3-53.2) months. Concurrent chemoradiotherapy with temozolomide resulted in grade 3 or 4 hematologic toxic effects in 2.8% of the patients. The current protocol of temozolomide during and after radiation therapy is both effective and safe and is still appropriate as the standard protocol for treatment of glioblastoma. An active salvage treatment might be required for a better prognosis.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents, Alkylating/administration & dosage ; Brain Neoplasms/diagnosis/*mortality/*therapy ; Chemoradiotherapy, Adjuvant/methods/mortality ; Comorbidity ; Dacarbazine/administration & dosage/*analogs & derivatives ; Female ; Glioblastoma/diagnosis/*mortality/*therapy ; Hematologic Diseases/*mortality ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Prevalence ; Radiotherapy, Conformal/mortality ; Republic of Korea/epidemiology ; Risk Factors ; Survival Rate ; Treatment Outcome ; Young Adult

PURPOSE: For locally unresectable hepatocellular carcinoma (HCC) patients, concurrent chemoradiotherapy (CCRT) has been applied as a loco-regional treatment. After shrinkage of tumors in selected patients, surgical resection is performed. The aim of this study was to evaluate prognostic factors and long-term survivors in such patients. MATERIALS AND METHODS: From January 2000 to January 2009, 264 patients with HCC were treated with CCRT (45 Gy with fractional dose of 1.8 Gy), and intra-arterial chemotherapy was administered during radiotherapy. Eighteen of these patients (6.8%) underwent hepatic resection after showing a response to CCRT. Cases were considered resectable when tumor-free margins and sufficient remnant volumes were obtained without extrahepatic metastasis. Prior to operation, there were six patients with complete remission, 11 with partial remission, and six with stable disease according to modified Response Evaluation Criteria in Solid Tumors. RESULTS: In pathologic review, four patients (22.2%) showed total necrosis and seven patients (38.9%) showed 70-99% necrosis. A high level of necrosis (> or =80%) was correlated with low risk for extrahepatic metastasis and long-term survival. In univariate analyses, vessel invasion and capsular infiltration were significantly correlated with disease free survival (DFS) (p=0.017 and 0.013, respectively), and vessel invasion was significantly correlated with overall survival (OS) (p=0.013). In multivariate analyses, capsule infiltration was a significant factor for DFS (p=0.016) and vessel invasion was significant for OS (p=0.015). CONCLUSION: CCRT showed favorable responses and locally advanced HCC converted into resectable tumor after CCRT in selected patients. Long-term survivors showed the pathological features of near total necrosis, as well as negative capsule and vessel invasion.
Adult ; Aged ; Antimetabolites, Antineoplastic/administration & dosage ; Antineoplastic Agents/administration & dosage ; Carcinoma, Hepatocellular/mortality/pathology/*therapy ; Chemoradiotherapy/*methods ; Cisplatin/administration & dosage ; Disease-Free Survival ; Female ; Fluorouracil/administration & dosage ; Humans ; Liver Neoplasms/mortality/pathology/*therapy ; Male ; Middle Aged ; Prognosis ; Radiotherapy, Conformal ; Remission Induction ; Republic of Korea/epidemiology ; *Salvage Therapy ; Survival Rate ; Treatment Outcome ; Tumor Burden

OBJECTIVETo evaluate the efficacy of late accelerated hyperfractionated conformal radiotherapy (LACF) combined with capecitabine on esophageal carcinoma.

METHODSOne hundred and sixty eight patients of esophageal cancer were randomly divided into 3 groups, including the radiotherapy alone group (CF) which received conventional conformal radiotherapy to a total of 60 - 66 Gy, LCAF group which received conventional fractionated conformal radiotherapy during the first two-thirds of the treatment to a dose about 40 Gy/20F/4W, then followed by late accelerated hyperfractionated conformal radiotherapy, twice daily radiotherapy at 1.3 Gy per fraction to a total dose about 64 - 69 Gy, and LCAF + C group (late accelerated hyperfractionated radiotherapy combined with capecitabine), in which patients were treated as the same as the LCAF group, except that they were treated with capecitabine (1.5 g po bid) from beginning of the radiotherapy to the end.

RESULTSThe short-term results of the 3 groups were 74.0%, 85.5% and 95.2%, respectively (P = 0.006). The local control rates at 1, 3 and 5 years were 64.0%, 30.0%, 24.0% in the CF group, 81.8%, 65.5%, 58.2% in the LCAF group and 90.1%, 77.8%, 74.6% in the LCAF+C group, respectively. The 1-, 3- and 5-year survival rates of the 3 groups were 58.0%, 20.0%, 8.0%; 78.2%, 36.4%, 17.0% and 85.7%, 55.6%, 30.2%, respectively. The effect of LCAF+C group was better than that of LCAF group and CF group. The incidence of acute tracheitis and acute esophagitis in the LCAF+C group and LCAF group was higher than that in the CF group, but there was no stastistically significant difference between the 2 groups. There was no statistically significant difference in distant metastasis in the 3 groups.

CONCLUSIONSCapecitabine, as an effective chemosensitizater combined with late accelerate hyperfractionated radiotherapy can improve the short-term results of treatment of esophageal cancer. The value of this combined treatment in distant metastasis reqires further study in the clinic.

Antimetabolites, Antineoplastic ; therapeutic use ; Capecitabine ; Carcinoma, Squamous Cell ; mortality ; pathology ; therapy ; Chemoradiotherapy ; Deoxycytidine ; analogs & derivatives ; therapeutic use ; Dose Fractionation ; Esophageal Neoplasms ; mortality ; pathology ; therapy ; Esophagitis ; etiology ; Fluorouracil ; analogs & derivatives ; therapeutic use ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Radiation Pneumonitis ; etiology ; Radiotherapy, Conformal ; adverse effects ; methods ; Remission Induction ; Survival Rate