1
|
Bujko K, Wyrwicz L, Rutkowski A, Malinowska M, Pietrzak L, Kryński J, Michalski W, Olędzki J, Kuśnierz J, Zając L, Bednarczyk M, Szczepkowski M, Tarnowski W, Kosakowska E, Zwoliński J, Winiarek M, Wiśniowska K, Partycki M, Bęczkowska K, Polkowski W, Styliński R, Wierzbicki R, Bury P, Jankiewicz M, Paprota K, Lewicka M, Ciseł B, Skórzewska M, Mielko J, Bębenek M, Maciejczyk A, Kapturkiewicz B, Dybko A, Hajac Ł, Wojnar A, Leśniak T, Zygulska J, Jantner D, Chudyba E, Zegarski W, Las-Jankowska M, Jankowski M, Kołodziejski L, Radkowski A, Żelazowska-Omiotek U, Czeremszyńska B, Kępka L, Kolb-Sielecki J, Toczko Z, Fedorowicz Z, Dziki A, Danek A, Nawrocki G, Sopyło R, Markiewicz W, Kędzierawski P, Wydmański J. Long-course oxaliplatin-based preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for cT4 or fixed cT3 rectal cancer: results of a randomized phase III study. Ann Oncol 2016; 27:834-42. [PMID: 26884592 DOI: 10.1093/annonc/mdw062] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/08/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Improvements in local control are required when using preoperative chemoradiation for cT4 or advanced cT3 rectal cancer. There is therefore a need to explore more effective schedules. PATIENTS AND METHODS Patients with fixed cT3 or cT4 cancer were randomized either to 5 × 5 Gy and three cycles of FOLFOX4 (group A) or to 50.4 Gy in 28 fractions combined with two 5-day cycles of bolus 5-Fu 325 mg/m(2)/day and leucovorin 20 mg/m(2)/day during the first and fifth week of irradiation along with five infusions of oxaliplatin 50 mg/m(2) once weekly (group B). The protocol was amended in 2012 to allow oxaliplatin to be then foregone in both groups. RESULTS Of 541 entered patients, 515 were eligible for analysis; 261 in group A and 254 in group B. Preoperative treatment acute toxicity was lower in group A than group B, P = 0.006; any toxicity being, respectively, 75% versus 83%, grade III-IV 23% versus 21% and toxic deaths 1% versus 3%. R0 resection rates (primary end point) and pathological complete response rates in groups A and B were, respectively, 77% versus 71%, P = 0.07, and 16% versus 12%, P = 0.17. The median follow-up was 35 months. At 3 years, the rates of overall survival and disease-free survival in groups A and B were, respectively, 73% versus 65%, P = 0.046, and 53% versus 52%, P = 0.85, together with the cumulative incidence of local failure and distant metastases being, respectively, 22% versus 21%, P = 0.82, and 30% versus 27%, P = 0.26. Postoperative and late complications rates in group A and group B were, respectively, 29% versus 25%, P = 0.18, and 20% versus 22%, P = 0.54. CONCLUSIONS No differences were observed in local efficacy between 5 × 5 Gy with consolidation chemotherapy and long-course chemoradiation. Nevertheless, an improved overall survival and lower acute toxicity favours the 5 × 5 Gy schedule with consolidation chemotherapy. CLINICAL TRIAL NUMBER The trial is registered as ClinicalTrials.gov number NCT00833131.
Collapse
Affiliation(s)
| | - L Wyrwicz
- Department of Gastroenterological Oncology
| | | | | | | | - J Kryński
- Department of Gastroenterological Oncology
| | - W Michalski
- Department of Bioinformatics and Biostatistics Unit, M. Skłodowska-Curie Memorial Cancer Centre, Warsaw
| | - J Olędzki
- Department of Colorectal Surgery, Medical University, Warsaw
| | - J Kuśnierz
- Department of Gynecology, M. Skłodowska-Curie Memorial Cancer Centre, Warsaw
| | - L Zając
- Department of Gastroenterological Oncology
| | | | - M Szczepkowski
- Department of Rehabilitation, Jozef Piłsudski University of Physical Education, Warsaw Clinical Department of General and Colorectal Surgery, Bielański Hospital, Warsaw
| | - W Tarnowski
- Department of General, Oncologic and Digestive Tract Surgery, Medical Centre of Postgraduate Education, Orłowski Hospital, Warsaw
| | | | | | - M Winiarek
- Department of Gastroenterological Oncology
| | | | | | | | - W Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Lublin
| | - R Styliński
- First Department of General Surgery, Transplantology and Nutritional Therapy, Medical University of Lublin, Lublin
| | | | - P Bury
- II Chair and Department of General and Gastrointestinal Surgery and Surgical Oncology of the Alimentary Tract, Medical University, Lublin
| | - M Jankiewicz
- Department of Surgical Oncology, Medical University of Lublin, Lublin Department of Radiotherapy, St John's Cancer Center, Lublin
| | - K Paprota
- Department of Radiotherapy, St John's Cancer Center, Lublin
| | - M Lewicka
- Department of Surgical Oncology, Medical University of Lublin, Lublin
| | - B Ciseł
- Department of Surgical Oncology, Medical University of Lublin, Lublin
| | - M Skórzewska
- Department of Surgical Oncology, Medical University of Lublin, Lublin
| | - J Mielko
- Department of Surgical Oncology, Medical University of Lublin, Lublin
| | | | | | | | | | | | - A Wojnar
- Pathology, Silesian Oncological Centre, Wroclaw
| | - T Leśniak
- Department of Surgery, Beskid Centre of Oncology, Bielsko-Biala
| | - J Zygulska
- Department of Radiotherapy, Beskid Centre of Oncology, Bielsko-Biala
| | - D Jantner
- Department of Surgery, Beskid Centre of Oncology, Bielsko-Biala
| | - E Chudyba
- Department of Radiotherapy, Beskid Centre of Oncology, Bielsko-Biala
| | - W Zegarski
- Department of Oncological Surgery, Collegium Medicum Nicolaus Copernicus University and Oncology Centre, Bydgoszcz
| | - M Las-Jankowska
- Department of Oncological Surgery, Collegium Medicum Nicolaus Copernicus University and Oncology Centre, Bydgoszcz
| | - M Jankowski
- Department of Oncological Surgery, Collegium Medicum Nicolaus Copernicus University and Oncology Centre, Bydgoszcz
| | | | - A Radkowski
- Department of Radiotherapy, Regional Cancer Centre, Tarnów
| | | | - B Czeremszyńska
- Department Radiotherapy, Independent Public Health Care Facility of the Ministry of the Interior and Warmian-Masurian Oncology Centre, Olsztyn
| | - L Kępka
- Department Radiotherapy, Independent Public Health Care Facility of the Ministry of the Interior and Warmian-Masurian Oncology Centre, Olsztyn
| | - J Kolb-Sielecki
- Department Radiotherapy, Independent Public Health Care Facility of the Ministry of the Interior and Warmian-Masurian Oncology Centre, Olsztyn
| | - Z Toczko
- Department of Surgery, Regional Hospital, Elbląg
| | - Z Fedorowicz
- Department of Surgery, Regional Hospital, Elbląg
| | - A Dziki
- Department of Surgery, Medical University, Lódź
| | | | - G Nawrocki
- Department of Surgery, M. Skłodowska-Curie Memorial Cancer Centre, Warsaw
| | - R Sopyło
- Department of Surgery, M. Skłodowska-Curie Memorial Cancer Centre, Warsaw
| | - W Markiewicz
- Department of Surgery, Regional Cancer Centre, Białystok
| | - P Kędzierawski
- Department of Radiotherapy, Regional Oncological Centre, Kielce
| | - J Wydmański
- Department of Radiotherapy, M. Skłodowska-Curie Memorial Cancer Centre, Gliwice, Poland
| | | |
Collapse
|
2
|
Hliniak A, Gwiazdowska B, Szutkowski Z, Kraszewska E, Kukolowicz P, Jarzabski A, Sochacka B, Mazurkiewicz M, Paprota K, Oliskiewicz W, Zadrozna O, Milecki P, Kubiak M, Czopkiewicz L, Jagas M, Góźdź S, Wieczorek A, Woytowicz A, Cisowska B, Magdziarz H, Nowakowski S, Kośniewski W, Laskosz I, Serafin A, Gradoń E. A multicentre randomized/controlled trial of a conventional versus modestly accelerated radiotherapy in the laryngeal cancer: influence of a 1 week shortening overall time. Radiother Oncol 2002; 62:1-10. [PMID: 11830307 DOI: 10.1016/s0167-8140(01)00494-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE To compare in a phase III study the loco-regional control, disease-free survival and overall survival induced by an accelerated regimen (AF) as compared with conventional regimen (CF) and to analyze the early and late post-radiation morbidity in both arms. MATERIALS AND METHODS Patients with age < or = 75, WHO 0-1, suitable for a radical course of radiotherapy T1-T3, N0, M0, stage of glottic and supraglottic laryngeal cancer were randomized to either CF: 66Gy given in 33 fractions over 45 days or AF: 66Gy given in 33 fractions over 38 days (2 fractions every Thursday). A total of 395 patients were included from 05.1995 to 12.1998. RESULTS Early toxicity: At the end of radiotherapy patients treated with AF complained for more severe reactions than patients treated with CF. In 8 weeks after treatment completion patients treated with AF complained only for more severe pain on swallowing (P=0.027). In 4 months after treatment completion all types of toxicity except for skin teleangiectasia (P=0.001) were similar in the two groups. Loco-regional control: comparison between CF and AF showed no difference in terms of loco-regional control (P=0.37). CONCLUSIONS The improvement in AF in terms of loco-regional control is estimated to be 3-5% in comparison with conventional regimen and is not significant. The intensity of reactions after 4 months was similar in both arms, what suggests the possibility of further shortening of the overall time by few days or enhancing the total dose within the limits of acceptable morbidity.
Collapse
Affiliation(s)
- A Hliniak
- Center of Oncology-Institute, Warsaw, Poland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|