RESUMEN
Background Pelvic recurrences from previously irradiated gynecological cancer lack solid evidence for recommendation on salvage. Methods A total of 58 patients were included in this clinical analysis. Salvage surgery was performed for locoregional relapse within previously irradiated pelvic area after initial surgery and adjuvant radiotherapy or radical external beam radiotherapy. The primary tumor diagnosis included cervical cancer (n = 47, 81%), uterine cancer (n = 4, 7%), and other types (n = 7, 12%). Thirty-three patients received adjuvant IOERT (19842000) at a median dose of 15 Gy (range 1020 Gy) and 25 patients received adjuvant PHDRB (20012016) at a median dose of 32 Gy (range 2440 Gy) in 6, 8, or 10 b.i.d. fractions. Results The median follow-up was 5.6 years (range 0.514.2 years). Twenty-nine (50.0%) patients had positive surgical margins. Grade ≥ 3 toxic events were recorded in 34 (58.6%) patients. The local control rate at 2 years was 51% and remained stable up to 14 years. Disease-free survival rates at 2, 5, and 10 years were 17.2, 15.5, and 15.5%, respectively. Overall survival rates at 2, 5, and 10 years were 58.1, 17.8, and 17.8%, respectively. Conclusions IOERT and PHDRB account for an effective salvage in oligorecurrent gynecological tumors. Patients with previous pelvic radiation suitable for salvage surgery and at risk of inadequate margins could benefit from adjuvant reirradiation in form of IOERT or PHDRB. However, the rate of severe grade ≥ 3 toxicity associated with the entire treatment program is relevant and needs to be closely counterbalanced against the expected therapeutic gain (AU)
Asunto(s)
Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano , Braquiterapia/efectos adversos , Electrones/uso terapéutico , Neoplasias de los Genitales Femeninos/radioterapia , Recurrencia Local de Neoplasia/radioterapia , Reirradiación/métodos , Terapia Recuperativa/métodos , Electrones/efectos adversos , Neoplasias de los Genitales Femeninos/mortalidad , Neoplasias de los Genitales Femeninos/cirugía , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/cirugía , Radioterapia Adyuvante , Reirradiación/efectos adversos , Terapia Recuperativa/efectos adversos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Pelvic recurrences from previously irradiated gynecological cancer lack solid evidence for recommendation on salvage. METHODS: A total of 58 patients were included in this clinical analysis. Salvage surgery was performed for locoregional relapse within previously irradiated pelvic area after initial surgery and adjuvant radiotherapy or radical external beam radiotherapy. The primary tumor diagnosis included cervical cancer (n = 47, 81%), uterine cancer (n = 4, 7%), and other types (n = 7, 12%). Thirty-three patients received adjuvant IOERT (1984-2000) at a median dose of 15 Gy (range 10-20 Gy) and 25 patients received adjuvant PHDRB (2001-2016) at a median dose of 32 Gy (range 24-40 Gy) in 6, 8, or 10 b.i.d. fractions. RESULTS: The median follow-up was 5.6 years (range 0.5-14.2 years). Twenty-nine (50.0%) patients had positive surgical margins. Grade ≥ 3 toxic events were recorded in 34 (58.6%) patients. The local control rate at 2 years was 51% and remained stable up to 14 years. Disease-free survival rates at 2, 5, and 10 years were 17.2, 15.5, and 15.5%, respectively. Overall survival rates at 2, 5, and 10 years were 58.1, 17.8, and 17.8%, respectively. CONCLUSIONS: IOERT and PHDRB account for an effective salvage in oligorecurrent gynecological tumors. Patients with previous pelvic radiation suitable for salvage surgery and at risk of inadequate margins could benefit from adjuvant reirradiation in form of IOERT or PHDRB. However, the rate of severe grade ≥ 3 toxicity associated with the entire treatment program is relevant and needs to be closely counterbalanced against the expected therapeutic gain.
Asunto(s)
Braquiterapia , Electrones/uso terapéutico , Neoplasias de los Genitales Femeninos/radioterapia , Recurrencia Local de Neoplasia/radioterapia , Reirradiación/métodos , Terapia Recuperativa/métodos , Adulto , Anciano , Braquiterapia/efectos adversos , Supervivencia sin Enfermedad , Electrones/efectos adversos , Femenino , Neoplasias de los Genitales Femeninos/mortalidad , Neoplasias de los Genitales Femeninos/cirugía , Humanos , Cuidados Intraoperatorios , Márgenes de Escisión , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/cirugía , Dosificación Radioterapéutica , Radioterapia Adyuvante/efectos adversos , Radioterapia Adyuvante/métodos , Reirradiación/efectos adversos , Terapia Recuperativa/efectos adversos , Tasa de Supervivencia , Resultado del TratamientoAsunto(s)
Antineoplásicos/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma/tratamiento farmacológico , Ensayos de Uso Compasivo , Neoplasias Endometriales/tratamiento farmacológico , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Sirolimus/análogos & derivados , Administración Intravenosa/métodos , Adulto , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/secundario , Carcinoma/mortalidad , Carcinoma/secundario , Ensayos de Uso Compasivo/métodos , Neoplasias Endometriales/mortalidad , Neoplasias Endometriales/secundario , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sirolimus/uso terapéutico , Análisis de Supervivencia , Resultado del TratamientoAsunto(s)
Antineoplásicos/efectos adversos , Carboplatino/efectos adversos , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad Tardía/diagnóstico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bevacizumab , Carboplatino/uso terapéutico , Hipersensibilidad a las Drogas/etiología , Femenino , Humanos , Hipersensibilidad Tardía/etiología , Persona de Mediana Edad , Neoplasias Ováricas/tratamiento farmacológico , Paclitaxel/uso terapéutico , Neoplasias Peritoneales/tratamiento farmacológico , Pruebas Cutáneas/métodosRESUMEN
Extensive prior treatment with cytotoxic agents is associated with impaired mobilization of hematopoietic cells. To assess the effect of a single course of standard-dose chemotherapy (CT), we compared the results of filgrastim-induced mobilization among two sequential groups of grade III-IV malignant glioma patients included in a hematopoietic transplantation program. The first group (21 patients) had never been treated with CT until 2 days after surgery, when they received a course of 100 mg/m2 BCNU (i.v.) and 100 mg intracarotid cisplatin for cytoreduction (not for mobilization). At 1 month after this CT, they were mobilized with 12 microg/kg filgrastim. The second group (22 patients) was mobilized with the same dose of filgrastim directly after the surgery, without having ever received any prior CT. The blood level of CD34+ cells was significantly lower in the CT-treated patients, both on the fourth day of filgrastim (15 vs 36 cells x 10(6)/l; P=0.01) and on the fifth (25 vs 58 cells x 10(6)/l; P=0.003), as it was the number of CD34+ cells collected per apheresis (1.3 vs 3.5 x 10(6)/l; P<0.0005). The toxic effect of a single course of BCNU-cisplatin CT led to significant impairment of the filgrastim-induced mobilization response.
Asunto(s)
Antineoplásicos Alquilantes/efectos adversos , Antineoplásicos/efectos adversos , Neoplasias Encefálicas/tratamiento farmacológico , Carmustina/administración & dosificación , Cisplatino/efectos adversos , Glioma/tratamiento farmacológico , Trasplante de Células Madre Hematopoyéticas , Adulto , Antígenos CD34/metabolismo , Antineoplásicos/administración & dosificación , Antineoplásicos Alquilantes/administración & dosificación , Cisplatino/administración & dosificación , Terapia Combinada , Movilización de Célula Madre Hematopoyética , Células Madre Hematopoyéticas/citología , Células Madre Hematopoyéticas/metabolismo , Humanos , Cinética , Persona de Mediana EdadRESUMEN
Surgery and radiotherapy provide the basis for local and regional control of cancer. The cancer patient has special characteristics that have implications for anesthesia. Tumors may involve the airways and affect ventilation, hemodynamics and intracranial pressure. Remote tumors can occur in endocrine cancer and in paraneoplastic syndromes. Other systemic complications of the cancer patient include hemostatic changes, immunosuppressant anemia and altered metabolism. Radiotherapy causes changes with anesthetic implications when treatment is directed at the head and neck, mediastinum, lung or surgical area. Chemotherapy is associated with non-specific toxic effects such as mucositis, aplasia and immunosuppression, alopecia and vascular injury; in addition, each chemical has other more specific toxic effects. Chemicals that are toxic for the heart and lungs have the greatest implications for anesthesia. Preoperative assessment should ascertain the effects caused by both the tumor and its treatment. Preparation for surgery includes improving nutrition and possibly inserting a venous port. Management during surgery depends on type of intervention and the patient's physical status, as they will determine the need for invasive monitoring and vessel access. The patient can be given antiemetic and antithrombotic prophylaxis. Important issues in postoperative care are the need for adequate analgesia; provision of early nutrition; antibiotic, antithrombotic and antiemetic prophylaxis; and prevention of ulcers caused by pressure.
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Anestesia/métodos , Neoplasias/complicaciones , Neoplasias/fisiopatología , Humanos , Neoplasias/terapia , Encuestas y CuestionariosRESUMEN
INTRODUCTION: 18FDG-PET was studied in the diagnosis of malignancy of the solitary pulmonary nodule and in the early staging of non-small-cell lung cancer. PET results were compared with thoracic-abdominal computed tomography (CT) and brain magnetic resonance (MR). PATIENTS AND METHODS: Fifty-five patients with a radiologically detected solitary pulmonary nodule (54 CT, 1 plain radiography), were studied following an intravenous injection of 370 MBq 18FDG. Attenuation corrected emission data were acquired and analyzed qualitatively and semi-quantitatively. 30 non-small-cell lung cancer underwent MR. Biopsies were obtained in 48 non-small-cell lung cancer and 7 were controlled by follow-up (18 months). The staging of 43 non-small-cell lung cancer was confirmed by surgery (n = 13), mediastinoscopy (n = 9) and follow-up (n = 21). RESULTS: PET correctly diagnosed 52 solitary pulmonary nodules with 3 false positives (100% sensitivity and 75% specificity). In the mediastinal staging (N), CT and PET demonstrated a sensitivity and specificity of 46% vs. 100%, and 59.3% vs. 93.3%, respectively. In 6 patients, some visceral metastases detected by PET were not detected by CT (including 3 adrenals), whereas 2 brain metastases in MR were not diagnosed by PET. PET was considered decisive in the treatment and follow-up of 17 patients (32.7%). CONCLUSIONS: Whole body PET imaging is a cost-effective diagnostic technique that simplifies the malignant characterization of solitary pulmonary nodule and improves the early staging of non-small-cell lung cancer. In combination with CT, PET makes an outstanding contribution to the correct assessment of therapeutical decisions in these patients.
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Carcinoma/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Neoplasias Pulmonares/diagnóstico por imagen , Radiofármacos , Tomografía Computarizada de Emisión , Carcinoma/cirugía , Análisis Costo-Beneficio , Estudios de Evaluación como Asunto , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/cirugía , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Estudios RetrospectivosRESUMEN
This study evaluated tolerance, local control, and short-term survival in patients with locally advanced non-small-cell lung carcinoma treated with induction chemotherapy followed by radical hyperfractionated radiotherapy with concurrent chemotherapy. Thirty-one patients with stage IIIa (N2) or IIIb tumors were treated with cis-platinum-based induction chemotherapy for 1 to 4 courses followed by radical hyperfractionated radiotherapy (69.6 Gy) with concurrent chemotherapy given at the beginning and end of radiotherapy. Induction chemotherapy produced no complete responses and 18 (58%) partial responses. After completion of radiotherapy, 4 patients had complete response (13%) and 23 patients (74%) partial response. The patterns of failure were as follows: intrathoracic, 6 patients (22%); intrathoracic + distant metastasis, 6 patients (22%); distant metastasis without thoracic failure, 5 patients (19%). Six patients of the 12 with intrathoracic failure experienced in-field radiotherapy pure local failure. At the time of this analysis, 10 patients were alive and well (4 complete and 6 partial responders). Actuarial survival projected at 39 months is 35%. No benefit was observed for those patients responding to induction chemotherapy. Toxicity was as follows: grade III neutropenic fever in 4 patients (13%), grade IV neutropenia in 13 patients (42%), pneumonia in 6 patients (19%), grade III esophagitis in 4 patients (13%) and severe clinical pneumonitis in 1 patient (3%). Induction chemotherapy followed by chemoradiotherapy is feasible, and the preliminary results are encouraging. Complete response after radiotherapy appeared to be related to short-term disease-free survival, and decisions based on the response to chemotherapy may be equivocal.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/terapia , Neoplasias Pulmonares/terapia , Adulto , Anciano , Carcinoma de Pulmón de Células no Pequeñas/patología , Cisplatino/administración & dosificación , Terapia Combinada , Femenino , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Dosificación Radioterapéutica , Análisis de Supervivencia , Insuficiencia del TratamientoRESUMEN
PURPOSE: Phase II study with intensive chemotherapy and autologous stem cells support in patients with metastatic breast cancer. METHODS: Forty-nine patients were treated with high-doses of two cytotoxic drugs and support with stem cells obtained from several leukapheresis without movilitation. The cells were reinfused forty-eight hours after finishing the administration of chemotherapy. RESULTS: Twenty-one patients (47%, CI-95%: 32.4-63.3%) achieved a complete remission. The objective responses rate was 73% (CI-95%: 57.2-85%). Overall and progression-free survival up to 4 years were 31% and 20%, respectively. Ten patients remain progression-free among 17 and 46 months. The most frequent extramedullary toxicity was hepatic and renal. Three patients (6%) died during the procedure. CONCLUSIONS: Intensive chemotherapy with hematopoietic support yields, with a moderate toxicity, a high objective response and complete remission rate. A small group of patients achieves a long progression-free survival.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma Ductal de Mama/tratamiento farmacológico , Carcinoma Ductal de Mama/secundario , Metástasis de la Neoplasia/tratamiento farmacológico , Terapia Recuperativa , Lesión Renal Aguda/inducido químicamente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Enfermedades de la Médula Ósea/inducido químicamente , Enfermedades de la Médula Ósea/terapia , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/terapia , Carboplatino/administración & dosificación , Carcinoma Ductal de Mama/mortalidad , Carcinoma Ductal de Mama/terapia , Terapia Combinada , Ciclofosfamida/administración & dosificación , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Etopósido/administración & dosificación , Femenino , Estudios de Seguimiento , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Enfermedad Veno-Oclusiva Hepática/inducido químicamente , Humanos , Tablas de Vida , Persona de Mediana Edad , Mitoxantrona/administración & dosificación , Metástasis de la Neoplasia/terapia , Neoplasias Hormono-Dependientes/tratamiento farmacológico , Neoplasias Hormono-Dependientes/mortalidad , Neoplasias Hormono-Dependientes/secundario , Neoplasias Hormono-Dependientes/terapia , Radioterapia Adyuvante , Inducción de Remisión , Sepsis/etiología , Choque Cardiogénico/etiología , Tasa de Supervivencia , Tiotepa/administración & dosificación , Resultado del TratamientoRESUMEN
Sixty-two patients with stage III non-small cell lung cancer (NSCLC) were treated with neoadjuvant chemotherapy consisting of cisplatin 120 mg/m2 day 1, mitomycin 8 mg/m2 day 1, and vindesine 3 mg/m2 days 1 and 14. Each cycle was repeated every 4 weeks for a total of 1 to 6 cycles (median, 3 cycles). Resection was attempted 4 to 5 weeks after the last course of chemotherapy. Intraoperative radiation therapy (IORT) (10-15 Gy) was delivered during surgery and postoperative external beam radiotherapy (EBRT) (46 Gy) was begun 4 weeks after surgery. Fifty-five patients (25 IIIA, 30 IIIB) were evaluable. Only partial responses occurred (64%), and 29 patients (53%) underwent resection. Complete resection rates were 85% (12/14) and 40% (6/15) in stage IIIA and IIIB, respectively (p = 0.01). In 3 of 29 patients (10%), no tumor was found in the resected specimen. There was one chemotherapy-related death and three postoperative-related deaths. The median survival time was 10 months, and the 5-year survival rate was 29 and 7% for stage IIIA and stage IIIB, respectively (p = 0.3). High complete resection rates and modest increase in 5-year survival have been observed in stage IIIA NSCLC. Although a number of stage IIIB patients can be made technically resectable, the low complete resectability rate reflects the lack of survival benefit in these patients.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/terapia , Neoplasias Pulmonares/terapia , Adulto , Anciano , Antibióticos Antineoplásicos/administración & dosificación , Antineoplásicos Fitogénicos/administración & dosificación , Quimioterapia Adyuvante , Cisplatino/administración & dosificación , Femenino , Humanos , Cuidados Intraoperatorios , Masculino , Persona de Mediana Edad , Mitomicinas/administración & dosificación , Estadificación de Neoplasias , Cuidados Posoperatorios , Radioterapia Adyuvante , Análisis de Supervivencia , Resultado del Tratamiento , Vindesina/administración & dosificaciónRESUMEN
A phase II study of postoperative high-dose carmustine (HDBCNU), intracarotid cisplatin (CDDP), and radical radiotherapy in patients with high-grade glioma was performed. Patients underwent 4-6 consecutive days of blood hematopoietic progenitor cell (HPC) apheresis without prior mobilization. Chemotherapy included intracarotid CDDP, 60 mg/m2, and BCNU, 900 mg/m2. HPC were infused 48 h after HDBCNU. Whole brain irradiation, up to 50 Gy, was started on the 8th day after HPC infusion. With a median follow-up time of 44 months, median overall survival was 15.5 months. Eight patients (23.5%) are alive free of disease 2-6 years after treatment (seven out of 25 patients with glioblastoma multiforme and one out of nine patients with anaplastic astrocytoma). Survival was influenced by young age, good performance and complete surgical resection. Two patients (5.8%) died of therapy-related complications. Acute hematological toxicity of HDBCNU was moderate, with a full recovery on day 26. No acute pulmonary or hepatic toxicity was found. Late severe neurological toxicity was observed in one third of patients surviving beyond 2 years. We conclude that HDBCNU, 900 mg/m2, intracarotid CDDP and radical radiotherapy appear to benefit some patients with high-grade gliomas, and phase III studies should preferentially select young patients with resectable tumors.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Encefálicas/terapia , Irradiación Craneana , Glioblastoma/terapia , Trasplante de Células Madre Hematopoyéticas , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Daño Encefálico Crónico/epidemiología , Daño Encefálico Crónico/etiología , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirugía , Carmustina/administración & dosificación , Carmustina/efectos adversos , Arterias Carótidas , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Terapia Combinada , Irradiación Craneana/efectos adversos , Supervivencia sin Enfermedad , Estudios de Seguimiento , Glioblastoma/tratamiento farmacológico , Glioblastoma/mortalidad , Glioblastoma/radioterapia , Glioblastoma/cirugía , Humanos , Inyecciones Intraarteriales , Tablas de Vida , Persona de Mediana Edad , Calidad de Vida , Traumatismos por Radiación/epidemiología , Traumatismos por Radiación/etiología , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
The results of two sequential trials, the first one with high dose interleukin 2 (IL2) by continuous intravenous infusion and the second one with subcutaneous IL2 and alpha-interferon (alpha IFN), performed in consecutive patients with metastatic melanoma and renal carcinoma at the Clinica Universitaria de Navarra are presented. In the high-dose continuous IL2 trial, recombinant IL2, 18 x 10(6) IU/m2, was administered daily by continuous infusion five days a week for two weeks, and the treatment cycle was repeated after a rest of 2 weeks. Twenty two patients were treated and objective responses were observed in 3 (13.3%). Toxicity was frequent and severe, and all but one required dose reduction. The mortality rate was 9% (2/22). In the subcutaneous IL2 and alpha IFN trial, subcutaneous IL2, 4.8 x 10(6) IU/m2, was administered daily, five days a week, for 3 consecutive weeks. IL2 dose was given every 8 hours on the first day and every 12 hours on the second day, as a loading induction dose. Concomitant alpha-IFN, 3 x 10(6) IU/m2 was given subcutaneously once a day on days 1, 3 and 5 weekly each week for the duration of IL2 therapy. Of the 24 patients treated with this combination, 3 partial responses were noticed (12.5%) and the toxicity was mild to moderate. These results suggest that both, IL2 alone or IL2 in combination with alpha-IFN are minimally active and that any improvement in tolerance might impair its antitumor activity.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Renales/terapia , Factores Inmunológicos/uso terapéutico , Interleucina-2/uso terapéutico , Neoplasias Renales/terapia , Melanoma/terapia , Neoplasias Cutáneas/terapia , Adolescente , Adulto , Anciano , Carcinoma de Células Renales/secundario , Esquema de Medicación , Femenino , Fiebre/inducido químicamente , Humanos , Hipotensión/inducido químicamente , Factores Inmunológicos/administración & dosificación , Factores Inmunológicos/efectos adversos , Infusiones Intravenosas , Inyecciones Subcutáneas , Interferón-alfa/administración & dosificación , Interleucina-2/administración & dosificación , Interleucina-2/efectos adversos , Neoplasias Renales/patología , Masculino , Melanoma/secundario , Persona de Mediana Edad , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/uso terapéutico , Neoplasias Cutáneas/patología , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
From January 1988 to August 1992, 18 patients (pts) with the established diagnosis of non-small cell lung cancer of the superior sulcus have been treated with a multidisciplinary approach, which includes 1-3 cycles of neoadjuvant chemotherapy (MVP or MCP regimens) followed by simultaneous preoperative chemotherapy and external beam irradiation. Radical surgery plus intraoperative radiotherapy (IORT) was planned 4-5 weeks after the end of the preoperative protocol. Tumor stages were IIIA (9 pts) and IIIB (9 pts). Tumor characteristics included rib and vertebral involvement in 15 and 4 pts, respectively. Fatal toxicity was present in 3 pts (16.6%). Resectability rate was 76.4%. Pathologic findings disclosed complete response (pT0) in 70.5% of the surgical specimens and viable tumor (pT+) in 29.5%. With a median follow-up of 24+ months (2-52+), 4-year actuarial local control, and overall survival rates are 91% and 56.2%, respectively. Four-year actuarial overall survival according to pathologic response was 87.5% for pT0 patients and 20% for pT+ patients. We conclude that this regimen promotes a high rate of pT0 as well as better than expected local control and survival rates. The presence of a pT0 specimen seems to correlate with the patient outcome.