Articles related to RADIOTHERAPY

This is an 8-year follow-up to the author’s initial report of a randomized phase II study in patients with newly diagnosed primary CNS lymphoma treated with high-dose methotrexate-based induction chemotherapy followed by whole-brain radiotherapy (WBRT) or high-dose chemotherapy (thiotepa-busulfan-cyclophosphamide) with autologous stem-cell transplantation (ASCT). They conclude that 40 Gy WBRT should be avoided in first-line treatment in this population because of its neurotoxicity and suboptimal efficacy in reducing relapses, while ASCT appears to be highly efficient in preventing relapses.

The 18-month OS rates in this trial were: 66.7% for neoadjuvant mFOLFIRINOX 47.3% for neoadjuvant mFOLFIRINOX and hypofractionated radiotherapy 87.5% for mFOLFIRINOX followed by pancreatectomy 78.9% for mFOLFIRINOX plus radiotherapy followed by pancreatectomy The authors state these results “suggest that mFOLFIRINOX represents a reference neoadjuvant treatment regimen for borderline resectable pancreatic cancer; however, the role of radiotherapy in this setting remains undefined.”

The study was comprised of 17,913 men with a median age of 64 years with pT2-4N1M0 prostate cancer (PC) consecutively treated between 1995 and 2017, with postradical prostatectomy (RP) and pelvic lymph node (LN) assessment. The patients were then followed for possible treatment with adjuvant radiation therapy (aRT) or early salvage radiation therapy (sRT). It was determined that men with pN1 PC and 4 or more as compared with 1-3 positive pelvic LNs appear to benefit the most from the use of aRT.

The authors investigated the effect of adding radiotherapy to neoadjuvant chemotherapy on survival in patients with Stage III-N2 non-small cell lung cancer. Analysis included 1,175 patients diagnosed between 2004 and 2015; 799 (68.0%) underwent neoadjuvant CRT and 376 (32.0%) underwent neoadjuvant CT. Adding radiotherapy to chemotherapy showed a slightly higher median OS than chemotherapy alone (51 vs. 47 months, respectively), and a higher median CSS (75 vs. 59 months, respectively). However, these differences were not statistically significant.

Three-hundred-twenty-four (324) patients with stage II or III rectal adenocarcinoma were treated with induction chemotherapy followed by chemoradiotherapy (INCT-CRT) or chemoradiotherapy followed by consolidation chemotherapy (CRT-CNCT). Patients then underwent total mesorectal excision (TME) or were assigned to a watch-and-wait status on the basis of tumor response. Three-year TME-free survival was 41% in the INCT-CRT group and 53% in the CRT-CNCT group. Organ preservation is achievable in half of the patients with rectal cancer treated with total neoadjuvant therapy, without an apparent detriment in survival.

This editorial comments on Tilki and colleagues’ “Adjuvant Versus Early Salvage Radiation Therapy After Radical Prostatectomy for pN1 Prostate Cancer and the Risk of Death.” Those researchers found that adjuvant radiotherapy (RT) was associated with a lower all-cause mortality risk compared with early salvage RT. Yet in today’s practice environment, early salvage radiotherapy (sRT) is being broadly embraced over aRT despite a continuous lack of randomized data for certain high-risk groups. The editorialist recommends that “all patients with pN1 prostate cancer—and particularly those with increasing node positivity— should be counseled on the potential survival benefits of upfront adjuvant RT demonstrated in this study and the risk that early salvage RT may not be early enough.”