Radiosensitizing Chemotherapy (Irinotecan) with Stereotactic Body Radiation Therapy for the Treatment of Inoperable Liver and/or Lung Metastases of Colorectal Cancer

Background: Stereotactic body radiotherapy (SBRT) is a recognized treatment for colorectal cancer (CRC) metastases. We postulated that local responses could be improved by SBRT with a concomitant radiosensitizing agent (irinotecan). Methods: RADIOSTEREO-CAMPTO was a prospective multi-center phase 2 trial investigating SBRT (40–48 Gy in 4 fractions) for liver and/or lung inoperable CRC oligometastases (≤3), combined with two weekly intravenous infusions of 40 mg/m2 Irinotecan. Primary outcome was the objective local response rate as per RECIST. Secondary outcomes were early and late toxicities, EORTC QLQ-C30 quality of life, local control and overall survival. Results: Forty-four patients with 51 lesions (liver = 39, lungs = 12) were included. Median age was 69 years (46–84); 37 patients (84%) had received at least two prior chemotherapy treatments. Median follow-up was 48.9 months. One patient with two lung lesions was lost during follow-up. Assuming maximum bias hypothesis, the objective local response rate in ITT was 86.3% (44/51—95% CI: [76.8–95.7]) or 82.4% (42/51—95% CI: [71.9–92.8]). The observed local response rate was 85.7% (42/49—95% CI: [75.9–95.5]). The 1 and 2-year local (distant) progression-free survivals were 84.2% (38.4%) and 67.4% (21.3%), respectively. The 1 and 2-year overall survivals were 97.5% and 75.5%. There were no severe acute or late reactions. The EORTC questionnaire scores did not significantly worsen during or after treatment. Conclusions: SBRT with irinotecan was well tolerated with promising results despite heavily pretreated patients.

Photodynamic therapy (PDT) pada penderita karsinoma nasofaring: kajian angka harapan hidup

Latar belakang: Terapi karsinoma nasofaring (KNF) yang adekuat dan efektif tidak selalu tercapaidi negara berkembang. Ketersediaan alat radioterapi yang tidak seimbang dengan jumlah penderita KNFmenyebabkan keterlambatan jadwal terapi, sehingga berakibat pada buruknya hasil terapi. Alternatifterapi lain perlu dikembangkan untuk mengatasi permasalahan tersebut. Photodynamic therapy (PDT)telah digunakan untuk terapi tambahan pada berbagai kanker, termasuk KNF residu maupun rekuren.Tujuan: Mengetahui respon terapi lokal dan angka harapan hidup 5 tahun penderita KNF residu ataurekuren yang mendapatkan PDT.Metode: Kohort retrospektif dengan data rekam medis penderita KNFresidu atau rekuren yang mendapatkan PDT di Departemen THT-KL RSUP Dr. Sardjito Yogyakarta tahun2005–2011.Hasil: Local response rate sebesar 83,9% dan angka harapan hidup 5 tahun penderita sebesar60,7%. Angka harapan hidup 5 tahun penderita laki-laki lebih tinggi (73,5%) dibandingkan penderitaperempuan (42,2%), perbedaan ini bermakna secara statistik (p=0,045). Angka harapan hidup 5 tahunpenderita berusia <40 tahun lebih tinggi (76,2%) dibandingkan penderita berusia > 40 tahun (53,0%),meskipun tidak signifikan (p=0,417). Angka harapan hidup penderita yang masih terdapat tumor padanasofaring lebih baik (80%) dibandingkan penderita dengan hasil biopsi nasofaring negatif (57,8%),namun tidak signifikan (p=0,638). Angka harapan hidup penderita berdasarkan stadium saat ditegakkandiagnosis KNF, penderita stadium awal mempunyai angka harapan hidup lebih kecil (53,3%) dibandingkanpenderita stadium lanjut (62,1%), meskipun tidak signifikan (p=0,521).Kesimpulan: Local responserate PDT 83,9% dan angka harapan hidup 5 tahun sebesar 60,7%. PDT merupakan modalitas terapi yangefektif untuk KNF residu maupun rekuren. Kata kunci: Karsinoma nasofaring, photodynamic therapy, angka harapan hidup ABSTRACTBackground: Adequate and effective nasopharyngeal carcinoma (NPC) treatment cannot bereached in developing countries. The lack of radiotherapy apparatus cause delayed treatment thatbring about bad treatment results. An alternative treatment modality should be created to overcome theproblem. Photodynamic therapy (PDT) has been conducted for many malignancies including recurrentor residual NPC. Purpose: To find out the local response rate and 5-year overall survival amongrecurrent or residual NPC patients who got PDT. Method: Retrospective cohort, data was taken frommedical records of patients with PDT in ENT-H&N Surgery Department Sardjito Hospital since 2005until 2011. Results: Local response rate was 83.9%. Five-year overall survival was 6.7%. The 5-yearoverall survival among men was significantly higher than women (73.5%:42.2%) p=0.045. The 5-yearoverall survival among patients <40 years old was higher than patients > 40 years old (76.2%:53.0%)even though it was not significant (p=0.417). The 5-year overall survival among patients with tumor washigher than patients without tumor (80%:57.8%) although it was not significant (p=0.638). The 5-yearoverall survival among patients with previous early stage NPC was lower than previous advanced stage (53.3%:62.1%) although it was not significant (p=0.521). Conclusion: Local response rate of PDT was83.9% and the 5-year overall survival was 60.7%. PDT was found as an effective treatment modalityfor recurrent or residual NPC. Keywords: Nasopharyngeal carcinoma, photodynamic therapy, 5-year overall survival

Results of invasive cervical cancer patients undergoing inadvertent hysterectomy followed by salvage radiotherapy

15034 Background: Ca cervix is the leading gynecologic malignancy in India. Conventional treatment consists of radical hysterectomy or primary radiotherapy. Due to inadequate preop workup, invasive ca cervix has been incidentally found in surgical specimens after simple hysterectomy. Extrafascial hysterectomy is not curative as paracervical, paravaginal soft tissues & vaginal cuff are not removed. It is technically difficult to perform adequate radical surgery after a previous simple hysterectomy. It is critical that these patients receive postop RT immediately after surgery; otherwise the prognosis is much worse. Methods: Retrospective analyses of 68 patients of ca cervix referred to our Institute after simple hysterectomy for presumed benign or preinvasive cervical disease was done. The median age was 44 yrs (35–65). 18 pts (26.5%) were pre menopausal while 50 (73.5%) were post menopausal. Exact postop staging was not possible; however 40 pts (59%) had residual growth at vault, 4 had involvement of vagina and in 18 cases parametrial infiltration was evident. Postop USG showed median tumor size of 4.4 cm, hydronephrosis in 17.6% & bladder infiltration in 5.8% pts. Histopathology was squamous cell carcinoma in 97% cases. Results: All patients were treated with EBRT to whole pelvis (dose 50 Gy/25 Fr to 50.4 Gy/28 Fr) over 5-weeks, followed by central vaginal surface HDR brachytherapy (Dose 21 Gy/3 Fr). At an average follow up of 18 to 24 months post RT residual disease was present in 2 (2.9%), local recurrence in 6 (8.6%), scar recurrence in 2 (2.9%) and distant failures in 4 patients (5.8%). Radiation proctitis developed in 2, SAIO in 2, RVF in one and VVF in one patient. All local and distant failures were seen in patients with residual disease before starting RT. Poor response to RT was seen in patients elder than 40 years and when OTT was more than 75 days. No significant correlation was seen between local response rate and type or grade of tumor. Conclusion: Survival for patients with no residual cancer after simple hysterectomy is favorable; & poor for those with gross disease at the start of post hysterectomy treatment. EBRT combined with one or two fractions of intravaginal brachytherapy in the immediate postop period can achieve satisfactory disease control. No significant financial relationships to disclose.

Neoadjuvant Chemotherapy with Vincristine, Bleomycin and Methotrexate Combined with Radiotherapy in Advanced Head and neck Squamous Cell Carcinoma

From September 1980 to August 1981, 25 patients with advanced head and neck squamous cell carcinoma were treated at the Centro Oncologico, Trento, by a chemo-radiotherapeutic combination. The treatment protocol consisted of 4–6 courses of VBM (vincristine, bleomycin and methotrexate) followed by conventional radiotherapy (65 Gy). Only to VBM responders (15 patients) were administered 10 cycles of vincristine-methotrexate. At the end of induction chemotherapy an overall response of 60 % (12 % complete, 48 % partial) was obtained. At the end of radiotherapy the responses were 52.5 % complete and 35.5 % partial, for an overall response of 88 %. The overall survival at 60 months was 8 %. This combined approach, in spite of the satisfactory immediate local response rate, does not offer advantages for survival in comparison to conventional treatment modalities.