Radiochemotherapy with cisplatin and oral tegafur in advanced head and neck cancer: long-term results of a phase II study.

AIMS AND BACKGROUND: To evaluate the tolerance and efficacy of an original concurrent radiochemotherapy regimen in locally advanced head and neck cancer. METHODS: Sixty-four patients with stage III or IV squamous cell carcinoma arising from a head and neck mucosal site were eligible. Simultaneous radiochemotherapy consisted of two courses of continuous infusional cisplatin (20 mg/m2/d, days 1-4 and 29-32) and oral tegafur (1200 mg/d, days 1-14 and 29-43), together with conventional radiation therapy up to a total dose of 70-75 Gy over nine weeks. RESULTS: All the patients were evaluated for toxicity and response. Acute mucositis was the most prevalent complication. Grade 3 toxicities were mucositis (44%), skin toxicity (10%), leukopenia (8%), and thrombocytopenia (1%). No toxic death was observed. Complete response to treatment was observed in 72% of patients. With a median follow-up of 48.5 months (range, 27-84), 5-year actuarial rate of local-regional control, disease-free survival, overall survival and disease-specific survival were 60% (95% confidence interval [CI], 40-70%), 55% (95% CI, 45-65%), 51% (95% CI, 43-59%) and 61% (95% CI, 53-69%), respectively. CONCLUSIONS: Response, local-regional control and survival rates are equivalent to those reported from other concomitant radiochemotherapy combinations. However, the regimen offers the advantage of its tolerance and toxicity profile.

[Fractionated stereotactic-guided radiotherapy in the treatment of pituitary adenomas]. / Radioterapia estereotáxica fraccionada en adenomas de hipófisis: resultados y factores pronósticos.

AIMS: To evaluate the survival rates, prognostic factors and adverse events in patients with pituitary adenomas following fractionated stereotactic-guided radiotherapy (FSRT). MATERIAL AND METHODS: Fifty-six patients with pituitary adenomas were treated with FSRT; 23 patients (41.1%) had primary adenomas, 33 had recurrent disease; 24 (42.9%) with non-functional and 32 (57.1%) with functional adenomas. Using conventional fractionation, median total dose administered was 54 Gy (range: 24-56 Gy). RESULTS: The median follow-up was 51 months (range: 9-102) and, at the time of analysis, 49 patients were alive and disease-free, 1 patient was alive with reduced visual acuity and biochemical indications of recurrence, 2 patients had died from the disease and 1 patient had died from unrelated causes. Overall survival was 94% (50/53) and overall local tumour control was 92% (49/53). Univariate analysis indicated hormonal secretion (ACTH) and previous radiotherapy as being statistically significant. Fourteen patients (25%) had minor side-effects during treatment and 3 patients (5.4%) had late-onset events; 2 with optical neuropathy (both patients had other relevant co-existing diseases) and 1 patient had brain necrosis (re-irradiation). CONCLUSION: Fractionated stereotactic-guided radiotherapy is an effective modality for the treatment of pituitary adenomas. Care is required in patients with co-morbidities and/or previously-irradiated recurrent tumour so as to minimise late-onset secondary effects.

Radioterapia estereotáxica fraccionada en adenomas de hipófisis: resultados y factores pronósticos / Fractionated stereotactic-guided radiotherapy in the treatment of pituitary adenomas

Introducción. Se analizan retrospectivamente la supervivencia global (SG), control local, factores pronóstico y toxicidad, de pacientes con adenoma de hipófisis tratados con radioterapia estereotáxica fraccionada (REF). Material y métodos. Entre mayo de 1994 y junio de 2001 se trataron 56 pacientes con adenomas de hipófisis, 23 (41,1%) primarios y 33 recidivas. Veinticuatro (42,9%) casos fueron adenomas no funcionantes, y 32 (57,1%) funcionantes. La mediana de dosis administrada fue 54 Gy (rango 24-56 Gy), 2 Gy/día, 5 días/semana. Resultados. Con un seguimiento de 51 meses (9-102 meses), al cierre del estudio, 49 pacientes están vivos sin evidencia de enfermedad, una paciente viva, con pérdida de visión y progresión hormonal, 2 pacientes han fallecido con progresión y uno falleció por otra causa. La supervivencia global fue de 94% (50/53), con una supervivencia libre de fallo del 92% (49/53). En análisis univariado sólo el tipo de hormona secretada (ACTH) y la irradiación previa resultaron de mal pronóstico. Catorce pacientes (25%) presentaron síntomas leves de toxicidad aguda durante la radioterapia estereotáxica fraccionada y 3 (5,4%) desarrollaron toxicidad tardía, neuropatía óptica (2 pacientes, multipatología asociada) y radionecrosis (1 paciente, reirradiación). Conclusiones. La radioterapia estereotáxica fraccionada es eficaz para adenomas de hipófisis, aunque es preciso valorar individualmente a aquellos pacientes con patologías concomitantes, o con tratamientos de radioterapia previa, con objeto de minimizar la aparición de efectos adversos a largo plazo

Aims. To evaluate the survival rates, prognostic factors and adverse events in patients with pituitary adenomas following fractionated stereotactic-guided radiotherapy (FSRT). Material and methods. Fifty-six patients with pituitary adenomas were treated with FSRT; 23 patients (41.1%) had primary adenomas, 33 had recurrent disease; 24 (42.9%) with non-functional and 32 (57.1%) with functional adenomas. Using conventional fractionation, median total dose administered was 54 Gy (range: 24-56 Gy). Results. The median follow-up was 51 months (range: 9-102) and, at the time of analysis, 49 patients were alive and disease-free, 1 patient was alive with reduced visual acuity and biochemical indications of recurrence, 2 patients had died from the disease and 1 patient had died from unrelated causes. Overall survival was 94% (50/53) and overall local tumour control was 92% (49/53). Univariate analysis indicated hormonal secretion (ACTH) and previous radiotherapy as being statistically significant. Fourteen patients (25%) had minor side-effects during treatment and 3 patients (5.4%) had late-onset events; 2 with optical neuropathy (both patients had other relevant co-existing diseases) and 1 patient had brain necrosis (re-irradiation). Conclusion. Fractionated stereotactic-guided radiotherapy is an effective modality for the treatment of pituitary adenomas. Care is required in patients with co-morbidities and/or previously-irradiated recurrent tumour so as to minimise late-onset secondary effects