Concurrent Chemotherapy

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Assuming that the biological characteristics of squamous cell carcinoma of the trachea and carina and their response to radiation and chemotherapy are very similar to those of primary carcinoma of the bronchus and lung, it is recommended that radiation therapy be combined with chemotherapy for patients with unresectable or gross residual squamous cell carcinoma.

Dillman and colleagues compared radiation therapy alone (60 Gy/30 fractions/6 weeks) with sequential chemoradiotherapy, in which two cycles of induction chemotherapy (cisplatin 100 mg/m2 IV on days 1 and 29, and vinblastine 5 mg/m2 IV on days 1, 8, 15, 22, and 29 ) were administered first, and radiation therapy (60 Gy/30 fractions/6 weeks) was administered subsequently starting on day 50.34 The 5-year survival rates were 7% with radiation therapy alone as compared to 16% with chemoradiotherapy. Arriagada and colleagues also compared radiation therapy alone with chemoradiotherapy, in which 3-monthly cycles of VCPC (vindesine 1.5 mg/m2 on days 1 and 2; cyclophosphamide 200 mg/m2 on days 2 to 4; cisplatin 100 mg/m2 on day 2; lomustine 50 mg/m2 on day 2 and 25 mg/m2 on day 3) were administered before and after radiation therapy (65 Gy/26 fractions/6.5 weeks) for patients with stage IIIA and IIIB nonsmall cell lung carcinoma.35 The eligibility criteria were less restrictive in this study than those of Dillman and colleagues.34 The locoregional failure that was assessed by bronchoscopy and biopsy at 3 months after the completion of the therapies was found to be in the order of 80% for both chemoradiotherapy and radiation therapy alone groups. However,

Rpo Radioactive

figure 41-2 An axial view of the thorax with a composite isodose plan of three-dimensional conformal radiotherapy using 6 portals (AP-PA, RAO-LPO, LAO-RPO). The planning target volume (PTV) is covered with 95% of the isodose line. AP = anteroposteriorly; LAO = left anterior oblique; LPO = left posterior ablique; PA = posteroanteriorly; RAO = right anterior oblique; RPO = right posterior oblique.

figure 41-2 An axial view of the thorax with a composite isodose plan of three-dimensional conformal radiotherapy using 6 portals (AP-PA, RAO-LPO, LAO-RPO). The planning target volume (PTV) is covered with 95% of the isodose line. AP = anteroposteriorly; LAO = left anterior oblique; LPO = left posterior ablique; PA = posteroanteriorly; RAO = right anterior oblique; RPO = right posterior oblique.

the distant failure rate at 5 years was reduced from 70% with radiation therapy alone to 49% by addition of chemotherapy. Thus, a combination of radiotherapy and chemotherapy seems most appropriate for unresectable squamous cell carcinoma of the trachea and/or carina. Chemotherapy for adenoid cystic carcinoma has not been studied extensively, and its role in curative therapy remains to be determined.

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