Motexafin Gadolinium Combined With Prompt Whole Brain Radiotherapy Prolongs Time to Neurologic Progression in Non–Small-Cell Lung Cancer Patients With Brain Metastases: Results of a Phase III TrialPage 1069
M. P. Mehta, W. R. Shapiro, S. C. Phan, R. Gervais, C. Carrie, P. Chabot, R. A. Patchell, M. J. Glantz, L. Recht, C. Langer, R. K. Sur, W. H. Roa, M. A. Mahe, A. Fortin, C. Nieder, C. A. Meyers, J. A. Smith, R. A. Miller, and M. F. Renschler
This article, which reports the results from a randomized comparison of whole-brain radiotherapy with or without the enhancer Motexafin Gadolinium (MGd), presents the results from a large, multicenter, international Phase III trial, using a unique endpoint. Survival improvement has never conclusively been demonstrated in patients with multiple brain metastases, primarily due to competing systemic disease progression and consequential mortality. The therapeutic objective in these patients has therefore primarily been on neurologic and neurocognitive stabilization and improvement, and whole brain radiotherapy is considered the “standard.” In this trial, a unique endpoint, time to neurologic progression, was utilized and was scored by an Events Review Committee, blinded to treatment assignment. In patients receiving prompt therapy, a significant benefit was identified with the enhancer, MGd, whereas in those patients whose treatment was delayed by 4 or more weeks, the benefit in delaying neurologic progression was lost, implying the significance of prompt therapeutic intervention in this cohort of patients. This endpoint is a very useful tool to evaluate the benefit of therapies directed at intracranial disease control.
Impact of Adding Concomitant Chemotherapy to Hyperfractionated Accelerated Radiotherapy for Advanced Head-and-Neck Squamous Cell CarcinomaPage 1088
S. Nuyts, P. Dirix, P. M. J. Clement, V. V. Poorten, P. Delaere, J.Schoenaers, R. Hermans, and W.Van den Bogaert
Treatment of locally advanced head and neck cancer still remains a challenge to radiation oncologists. One important question that currently remains unanswered is whether altered fractionation is still necessary in the setting of concomitant chemoradiotherapy. The intention of the authors was to establish a chemoradiotherapy protocol based on hyperfractionated accelerated radiotherapy. In comparison with the previous cohort of patients treated with the same fractionation schedule, the addition of chemotherapy resulted in a 15% increase in locoregional control and survival at 2 years, with acceptable acute and late toxicity.
Hyperparathyroidism After Irradiation for Childhood MalignancyPage 1164
T. McMullen, G. Bodie, A. Gill, C. Ihre-Lundgren, A. Shun, M. Bergin, G. Stevens, and L. Delbridge
This study revealed a significant risk of hyperparathyroidism in patients previously treated with head-and-neck irradiation for childhood malignancy. The timeframe for the development of hyperparathyroidism is much shorter than that seen for individuals who have undergone irradiation for benign disease. We believe that both radiation dose and age of exposure are factors in determining the future risk of disease. In light of the proven benefits of surgery in hyperparathyroidism and the relatively high risk of disease in patients treated for childhood malignancy, new protocols should be developed that will provide lifelong screening for serum calcium and PTH levels in this group.
Using Fluorodeoxyglucose Positron Emission Tomography to Assess Tumor Volume During Radiotherapy for Non–Small-Cell Lung Cancer and Its Potential Impact on Adaptive Dose Escalation and Normal Tissue SparingPage 1228
M. Feng, F.-M. Kong, M. Gross, S. Fernando, J. A. Hayman, and R. K. Ten Haken
This article examines the potential use of FDG-PET in adaptive radiotherapy for lung cancer. Imaging after 40–50 Gy of radiation detects changes in tumor metabolic activity and volume. These residual volumes can be included in boost plans aimed at tumor dose escalation or normal tissue sparing. In their study of a limited number of patients, the authors were able to escalate the dose by 30–102 Gy or to decrease the normal tissue complication probability by 0.4–3%.
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