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Forty-seven patients with advanced larynx/hypopharynx, nasopharynx or oropharynx/oral cavity cancer were recorded before, and 10 weeks after concomitant chemoradiotherapy (CCRT), to investigate the effect of the tumor versus the effects of treatment. To evaluate voice functioning before and after treatment, voice quality and glottal behavior of sustained /a/ vowels were analyzed acoustically and compared with patient-based data on cigarette and alcohol usage. Acoustic measures of effort, nasality and regularity, such as periodicity or harmonics-to-noise ratio, differed significantly and progressed differently in dependence of the 3 distinct cancer/radiation sites. Baseline measures of voice stability correlated significantly with alcohol/smoking behavior.

Purpose Respiratory-gated radiotherapy allows for the reduction of the toxicity associated with concomitant chemoradiotherapy, but the smaller fields used could increase the risk of missing the target. A prospective study was performed to evaluate the dosimetric consequences of time-trend changes in patients with lung cancer who were treated with concomitant chemoradiotherapy. Methods and Materials A total of 24 lung cancer patients eligible for chemoradiotherapy and gated delivery underwent four-dimensional computed tomography (4D-CT) after 15 fractions. This scan was co-registered with the initial planning 4D-CT and a new planning target volume (PTV) was generated on the basis of the tumor visualized after 15 fractions. Coverage of the repeat PTV was evaluated by applying the original plan to the second scan and recalculating the dose. Plan modification was triggered by a 5% reduction in the PTV included within the 95% isodose volume or an unacceptable increase in the critical organ dose. Results Of the 21 evaluable patients, 15 had an average reduction in the PTV of 8% after 30 Gy. The PTV increased in the remaining 6 patients, but the increase was >20% in only 1 patient. In the latter patient, disease progression was observed, and repeat planning was required. The plans created using the new PTV were acceptable in all the other patients. Conclusion The role of adaptive radiotherapy appears limited when respiratory-gated radiotherapy is used to reduce the toxicity related to concomitant chemoradiotherapy. The use of more conformal treatment techniques might provide the rationale for repeat imaging as a method to identify patients at risk of dosimetric miss.

The main objectives of concomitant chemoradiotherapy are to increase local tumor control, decrease the incidence of distant metastases, and improve survival. In addition, concomitant therapy may reduce long-term cancer therapy morbidity either by reducing the need for radical surgery or by permitting the use of lower radiation doses. This article briefly summarizes the rationale for concomitant chemoradiotherapy and summarizes the most recent clinical experience for selected solid tumors. In addition, recent data that suggest additive or synergistic interaction between radiation and certain biologic response modifiers such as tumor necrosis factor and interferon are reviewed.

Mistletoe therapy, a cancer treatment suggested by Rudolf Steiner in 1920, is a typical and specific anthroposophic therapy, but could become more important today in the field of mainstream medicine. This article analyzes some of the most typical effects of mistletoe therapy based on the experience of more than 100 cases. A few patients were chosen who appear exemplary of the opportunities offered by mistletoe therapy. Their clinical history demonstrates an improvement in clinical condition and performance status, better quality of life, improved psychological status, reduction of infective events, better tolerance of concomitant chemoradiotherapy, and even a direct reduction of tumor size. The conclusion is that the patients may be indicative for future prospective clinical studies designed to confirm a real efficacy of mistletoe in cancer therapy.

In the majority of cases of malignant brain tumors surgical gross total resection is recommended to achieve long event-free survival and eventually the cure. In recent years neoadjuvant chemotherapy and adjuvant post surgical radiotherapy and chemotherapy have gained relevance in facilitating complete surgical removal and in achieving and consolidating complete remission of such tumors

Concomitant chemoradiotherapy can be used in order to increase both the local and systemic control of solid tumors. The rationale for its use and experimental data for selected chemotherapy drugs are reviewed. Clinical trials have focused on increasing complete response (CR) and survival rates; in addition, improved quality of life by decreasing the use of conventional surgical procedures is being pursued. Both of these goals may have been achieved for some tumors, most notably for anal cell carcinoma. Improved survival with concomitant chemoradiotherapy has also been shown for patients treated on randomized studies for pancreatic, colorectal, small-cell lung, head and neck, and cervical cancer. These results call for the continued investigation of this approach in the laboratory and in the clinic.

e17074 Background: Chemotherapy using TPF protocol has been showed efficacy in the neo-adjuvant setting for head and neck squamous cell carcinoma (SCC) so far. However, effectiveness of concomitant...

The combined effects of G-CSF (50 to 150μ g/one time) and erythropoietin (3, 000 IU/one time) on peripheral blood platelets were examined in 6 patients with oral and maxillary sinus carcinomas (2 were primary cases and 4 were secondary cases) who received concomitant chemoradiotherapy. In all patients who received both cytokines, blood platelets and white blood cells increased within a shorter period than in the control group.The results indicate that combined treatment with G-CSF and erythropoietin is useful in the management of thrombocytopenia induced by cancer therapy.

Current state-of-the-art of concomitant chemoradiation in cervical carcinomas. Vrdoljak E, Hamm W. Center of Oncology, University of Split School of Medicine, Clinical Hospital of Split, Croatia. Despite screening programs, cervical carcinoma remains a major health problem throughout the world. Until recently pelvic radiation has been the standard therapy for advanced disease with overall five-year survival rates of 50%. Recently, five randomized trials demonstrated a significant survival advantage for the concomitant administration of radiotherapy and cisplatin-based chemotherapy. Although the trials vary somewhat in terms of stage of disease, dose of radiation, and schedule of radiation and cisplatin, they all demonstrated a significant survival benefit for the combined approach. Congruent to these findings are results from a meta-analysis based on the data from 19 trials with 4, 580 randomized patients. The absolute increase in progression-free and overall survival was 16% and 12%, respectively. Contrary to these findings is the result of the National Cancer Institute of Canada (NCCI) trial. Despite that result cisplatin-based concomitant chemoradiotherapy has become the standard treatment of locally advanced cervical cancer.

Despite screening programs, cervical carcinoma remains a major health problem throughout the world. Until recently pelvic radiation has been the standard therapy for advanced disease with overall five-year survival rates of 50%. Recently, five randomized trials demonstrated a significant survival advantage for the concomitant administration of radiotherapy and cisplatin-based chemotherapy. Although the trials vary somewhat in terms of stage of disease, dose of radiation, and schedule of radiation and cisplatin, they all demonstrated a significant survival benefit for the combined approach. Congruent to these findings are results from a meta-analysis based on the data from 19 trials with 4, 580 randomized patients. The absolute increase in progression-free and overall survival was 16% and 12%, respectively. Contrary to these findings is the result of the National Cancer Institute of Canada (NCCI) trial. Despite that result cisplatin-based concomitant chemoradiotherapy has become the standard treatment of locally advanced cervical cancer.

Aim: Caregivers are of vital importance supporting LAHNC pts' during CRT. Since symptoms of pts with LAHNC are very visible and treatment is burdensome, this may impact caregivers as well. We therefore aimed to explore the course of caregivers’ burden and fatigue in relation to pts’ fatigue during and after CRT. Methods: Caregivers and pts completed a general questionnaire and the subscale "fatigue severity" of the Checklist Individual Strength (healthy controls M 17.3, SD 10.1). Additionally, caregivers completed the Self-Perceived Pressure from Informal Care questionnaire measuring burden (caregivers palliative phase M 6.0, SD 2.2). The severity of burden and fatigue was determined with validated cut-off scores. Measurements were conducted prior to CRT (T0), 1 week (T1) and 3 months after completing CRT (T2). The course of fatigue and burden was analyzed with general linear models. Results: 60 couples were included. 93% completed T0, 82% T1 and 75% T2. Caregivers’ and pts’ mean age was 54 (SD 14) and 56 years (SD 10), 75% and 34% were female, respectively. 70% of the caregivers were pts’ partner. At T0, caregivers’ burden was moderate (M 4.1, SD 2.4), as was burden at T1 (M 4.6, SD 2.4). At T2, a significant decrease in burden was observed (M 3.2, SD 2.4; p = .001). For caregivers’ fatigue, normal levels were found at T0 (M 24.3, SD 13), rising to moderate levels at T1 (M 27.5, SD 12.4), with a significant decrease to normal at T2 (M 22.4, SD 11.8; p = .019). Caregivers’ fatigue and burden were correlated at all time points (r = 0.43-0.54, p = .001). Comparing caregivers’ fatigue to pts’ fatigue over time, a peak in fatigue at T1 was found for both groups (p = .001). Pts were more fatigued over time (p = .025), with a lower level at baseline but a faster increase in fatigue than their caregivers (p = .003). Additionally, pts’ fatigue showed higher levels at T2 compared to T0 (p = .026). Conclusions: During and after LAHNC pts’ treatment, and regarding their severity of fatigue, caregivers seem resilient. When proactive support is considered for caregivers at risk for overstraining, intervention early during CRT is recommended. Disclosure: C. van Herpen: Dr. C.M.L. van Herpen received research funding from Novartis and Merck, and serves on a Merck advisory board W.T.A. van der Graaf: Prof. dr. W.T.A. van der Graaf received research funding from Novartis. All other authors have declared no conflicts of interest.

Purpose: Neighborhood Gray-level difference matrices (NGLDM) based texture parameters extracted from conventional (3D) 18F-FDG PET scans in patients with NSCLC have been previously shown to associate with response to chemoradiation and poorer patient outcome. However, the change in these parameters when utilizing respiratory-correlated (4D) FDG-PET scans has not yet been characterized for NSCLC. The Objectives: of this study was to assess the extent to which NGLDM-based texture parameters on 4D PET images vary with reference to values derived from 3D scans in NSCLC. Methods: Eight patients with newly diagnosed NSCLC treated with concomitant chemoradiotherapy were included in this study. 4D PET scans were reconstructed with OSEM-IR in 5 respiratory phase-binned images and corresponding CT data of each phase were employed for attenuation correction. NGLDM-based texture features, consisting of coarseness, contrast, busyness, complexity and strength, were evaluated for gross tumor volumes defined on 3D/4D PET scans by radiation oncologists. Variation of the obtained texture parameters over the respiratory cycle were examined with respect to values extracted from 3D scans. Results: Differences between texture parameters derived from 4D scans at different respiratory phases and those extracted from 3D scans ranged from −30% to 13% for coarseness, −12% to 40% for contrast, −5%more » to 50% for busyness, −7% to 38% for complexity, and −43% to 20% for strength. Furthermore, no evident correlations were observed between respiratory phase and 4D scan texture parameters. Conclusion: Results of the current study showed that NGLDM-based texture parameters varied considerably based on choice of 3D PET and 4D PET reconstruction of NSCLC patient images, indicating that standardized image acquisition and analysis protocols need to be established for clinical studies, especially multicenter clinical trials, intending to validate prognostic values of texture features for NSCLC.« less

e18535 Background: Concomitant chemoradiotherapy is the standard treatment of unresectable stage III non-small cell lung cancer (NSCLC). However, the optimal chemotherapy regimen is still controver...

e14546 Background: Locally advanced rectal cancer (LARC) represents a major therapeutic challenge. Preoperative chemoradiation has recently been approved as the new standard of care in the manageme...

Background There have been controversies in the treatment of elderly patients with glioblastoma. We introduce the outcome of the treatment of elderly patients with glioblastoma comparing with younger patients. Methods The author's hospital database was used to identify patients with histologically confirmed glioblastoma after surgery between January 2006 and December 2013. Forty-eight patients (control group) were under age 65 and 16 patients (elderly group) were aged 65 years or over at the time of surgery. Results The median age of the elderly group was 71 years and control group was 50 years. Mean number of medical comorbidities was 1.8 in the elderly group vs. 0.5 in the control group. The median progression free survival (PFS) was 5.6 months and the median overall survival (OS) was 19.9 months in all patients. The elderly group had a median PFS of 4.2 months vs. 8 months for the control group (log-rank test, p=0.762). Median OS was 8.2 months in the elderly group vs. 20.9 months in the control group (log-rank test, p=0.457). Major complications occurred in 5 cases (7.8%) for all patients. The ratio of completion of concomitant chemo-radiotherapy (CCRT) was 81.3% and was the same between the two groups. In multivariable analysis, extent of resection (p=0.034) and completion of CCRT (p=0.023) were statistically significant, independent prognostic factors only for PFS in all patients by Cox proportional hazards model. Age was not an independent prognostic factor. As for OS, there was no significant factor. Conclusion Surgical resection and CCRT were well tolerated in elderly patients with glioblastoma, and maximal safe resection followed by timely CCRT could improve clinic-oncologic outcomes.

Purpose: We conducted a phase II study of concomitant chemoradiotherapy with carboplatin for laryngeal carcinoma. Materials and Methods: Sixty-four patients with stage II–IV (stage II, 36; III, 19; IV 9) laryngeal carcinoma were treated with concomitant administration of carboplatin (CBDCA) during radiotherapy (CRT group) between 1991 and 1994. There were 36 supraglottic, 25 glottic, and 3 subglottic carcinomas. Patients with stage II and stage III–IV received intravenous CBDCA of 100 mg/m2 and 120 mg/m2 once a week, respectively. Tumor response was assessed at 40 Gy in 16 fractions to select the patients suitable for total laryngectomy or radical radiotherapy of 65 Gy in 26 fractions in 6.5 weeks. The treatment results were compared with the historical control consisting of 56 patients consecutively treated from 1988 to 1990 without chemotherapy (RT group). The two studies were comparable with regard to patient characteristics, including age distribution, gender, tumor location, size, and clinical stage. Results: The actuarial 5-year survival rate was 80.3% for the CRT group and 81.3% for the RT group. A favorable response (complete response or partial response) at 40 Gy was observed in 87.5% of the patients of the CRT group and in 62.5% of the patients of the RT group (χ2 = 7.566, p < 0.01). The actuarial 5-year larynx preservation rate for the CRT group (75%) was significantly higher than that for the RT group (57%) in patients with T2 supraglottic carcinoma (p < 0.05). There was no difference in the larynx preservation rate between the two treatment arms for any T stage of glottic carcinomas. Conclusion: CRT using carboplatin improved the tumor response at 40 Gy and consequently achieved a higher larynx preservation rate for T2 supraglottic carcinoma. A clinical randomized trial is indicated to certify the findings of this phase II study.

In this chapter, some of the basic radiobiological principles of DNA damage and repair and their potential application to clinical radiation oncology are reviewed. In addition, newer technologies to modify tumor cell killing that may have applications to radiotherapy are discussed.

e17030 Background: Patients undergoing concomitant chemoradiotherapy may or may not undergo prophylactic PEG placement, depending on baseline weight, medical status and presence of dysphagia. We examined quality of life, performance status and oral outcomes in patients with or without PEG at baseline and 3 months post-treatment. Methods: Thirty-three patients with head and neck cancer were treated with chemoradiotherapy. All were seen baseline and 3 months post-tx. Assessments included the Performance Status Scale (PSS), Karnofsky Performance Status Scale (KPSS), tongue strength, jaw opening, and saliva weight. Patient-rated QOL utilized the MD Anderson Dysphagia Inventory (MDADI) and Eating Assessment Tool (EAT-10) with significance at p

e18505 Background: Lung cancer remains the leading cause of cancer death in both men and women. One third of patients with NSCLC presents with localized unresectable disease. With the adavance in the diagnostic and therapeutic procedures, the median survival has shown substantial improvement. The aim of the study was to evaluate the efficacy of induction chemotherapy with docetaxel and carboplatin followed by chemo-radiotherapy in locally advanced NSCLC. Methods: A total of 30 patients (25 males and 5 females) aged between 49–60 years (mean age 51 years) with NSCLC stage III A (10 pts) stage III B (20 pts) were enrolled in the study. Patients received docetaxel 75 mg/m2 IV plus carboplatin AUC 5 on day 1 every 21 days for 4 cycles in combination with G-CSF. Patients then received radiotherapy (RT) at a dose 40-45 Gy depending on patients' tolerability combined with a low dose of carboplatin AUC 2 on the 1st day of each week during RT. Patients underwent CT chest and bronchoscopy before treatment and after completion of treatment to assess response and time to progression, patients with PR and SD received further 2 cycles of DC. Results: Of all patients received 4 cycles of IC were enrolled, 3 pts (10%) demonstrated CR, 9 pts (30%) had PR, 15 pts (50%) had SD and 3pts (10%) had PD. Twenty seven pts underwent CRT, 25 of these pts have completed CRT, five pts had CR, 15 pts had PR and 5pts had SD. No grade 4 toxicities were detected. The most common grade 3 toxicities were mucositis (6%), neutropenia (12%) and alopecia 50%. The median time to progression and median survival were 7 months and 9 months, respectively. Conclusions: IC with docetaxel and carboplatin followed by CRT with weekly carboplatin is feasible effective therapeutic strategy with manageable toxicity in patients with locally advanced NSCLC.

e17008 Background: The optimal treatment of pediatrics and young adolescents with nasopharyngeal carcinoma (NPC) is not clearly addressed in large clinical trials. Systemic failure remains the problem. Our aim is to analyze the profile and treatment outcome of NPC in this age group in Kuwait, and whether the change of practice from neoadjuvant to concomitant chemoradiotherapy (CRT) has an impact on outcome, particularly distant metastasis. Methods: Between 2002-2010, 7 NPC patients aged 10% weight loss. No G 4 acute toxicity was recorded. All patient developed delayed G 2 hypothyroidism, and most developed significant subcutaneous fibrosis. All patient achieved locoregional CR. The only patient that developed distant metastasis was the one who could not tolerate CTH even as adjuvant due to prolonged neutropenia. All patients were alive at time of analysis. Comparing these results to our previous report which included patients between 1991-2001, the general profile of the patients seems to be the same. However, in the former patient cohort, 50% died within the same follow-up period due to distant metastasis. Conclusions: It seems that adoption of concomitant rather than neoadjuvant CTH, and modern RT techniques rather than conventional methods may have an impact on reducing distant metastasis. However, large patient cohort is needed to validate such finding.

e16557 Background: In structure of cancer incidence among female population of Kyrgyzstan, cervical carcinoma takes the second place. incidence is 19.1 per 100 thousand of female population. growth of standardized cervical carcinoma index in Kyrgyzstan from 2002 to 2007 estimated as - 36.4% (from 14.0 to 19.1 per 100 thousand people). materials and methods. in the chemotherapy unit of the national center of oncology, ministry of health KR, from 2010 to 2012 were treated 51 patients with locally advanced cervical carcinoma IIb - stage IIIb with ftorafur as radiomodifier. all patients’ diagnosis were verified. histologically - squamous cell carcinoma. age of patients ranged from 29 to 74, median – 51 years. the main group consisted of patients with IIIb stage - 33 patients (64.7%), 18 patients with iib stage - 35.3%. all 51 patients with locally advanced cervical carcinoma received combined radiotherapy (external beam and intracavitary) on a radical program against ftorafur. ftorafur was taken orally dozed at 400 mg every 12 hours. absolute contraindications of use of ftorafur together with combined radiation therapy of patients with cervical carcinoma were not found. presence of severe comorbidity was one of the relative contraindication research results. evaluation of the effectiveness of the treatment was carried out according to WHO criteria, on the degree of regression of primary tumor. clinical results showed that complete regression occurred in 28 patients (54.9%), partial regression of the tumor in 16 patients (31.4%), stabilization of tumor in 7 (13.7%). objective response rates were 92.1%. side effects of the treatment were evaluated on a scale of toxicity (Common Toxicity Criteria NCIC). hematologic toxicity (anemia - 56.8%, leukopenia - 3,9%) I-II degree, gastrointestinal symptoms (nausea and vomiting - 3,9%) I-II toxicity. during the dynamical monitoring of patients, the III-IV toxicity stages were not found. conclusion. use of ftorafur as a radiomodifier together with concomitant radiation therapy on patients with locally advanced cervical carcinoma helped to accelerate the tumor regression. toxicity did not exceed I-II degrees. analysis of immediate results of treatment showed a high objective effect - 86.3% in the following category of patients.

6003 Background: This is the first phase III study directly comparing CRT vs CET/RT in LASCCHN. Primary endpoints of this study were to compare: 1) overall survival (OS) of induction vs. no induction arms; 2) Grade 3-4 in-field toxicity of CRT vs. CET/RT. Preliminary toxicity results of concomitant treatments (primary endpoint for this comparison) were reported at the 2012 ASCO meeting. Here we present response rate and survival data for the two concomitant treatments (CRT vs. CET/RT), irrespective of induction chemotherapy. Methods: Untreated patients with unresectable LASCCHN, stage III-IV, ECOG PS 0–1 were randomized to a 2x2 factorial design: Arm A1: CRT (2 cycles of cisplatin/5fluorouracil concomitant to RT); Arm A2: CET/RT; Arm B1: 3 cycles of TPF followed by the same CRT; Arm B2:3 cycles of TPF followed by CET/RT. Results: A total of421 patients were randomized: 261 received CRT (131 Arm A1+ 130 Arm B1) and 160 received CET/RT (80 Arm A2+ 80 Arm B2). 82% were male; median age was 60y; PS of 0 (79%) or 1 (21%). Stage was III (32%) or IV (68%). Sites of disease were: oral cavity 20%, oropharynx 57%, hypopharynx: 23%. No significant differences were observed in patients’ characteristics distribution. At a median follow-up of 32.9 months, a total of 174 deaths occurred (204 required for final OS analysis). Data on activity and efficacy of CRT and CET/RT are shown in the Table. Conclusions: No significant differences were observed in response rate, progression free survival and OS between CRT and CET/RT. Pts are still being followed-up to assess OS of induction vs. no induction arms. Clinical trial information: NCT01086826. [Table: see text]

e11501 Background: To demonstrate the compliance of radiotherapy and chemotherapy with concomitant taxanes by avoiding delays initiation of that treatment Methods: Retrospective, observational, and descriptive. We analyzed the medical records of 50 patients from June 2006 to December 2010 with an average follow up of 27.26 months (9 months to 56 months), in which all completed conservative surgery. The chemotherapy used was AC x 4 cycles (doxorubicin 60 mg/m2, Cyclophosphamide 600 mg/m2 on day 1 every 21 days) followed by weekly paclitaxel 80 mg/m2 for twelve weeks, concomitant with radiation in the affected breast. Standardized treatment was indicated to patients with positive hormone receptors. Results: Patients`s age averaged 53.58 years (33 years and 74 years) All patients received the planned chemotherapy, with a delay of 63.24 days, from the surgery to the first cycle of chemotherapy (20 days to 110 days. The radiation treatment was initiated in 143.4 days (90 to 205 days) on average after the surgical treatment.It was reported that 8% (n = 4) discontinued the treatment due to the toxicity of the radiation therapy: actinic dermatitis grade 3 and 4. The average number of days without radiation therapy due to toxicity was 6 days (3 to 9 days).With respect to chemotherapy, 22% (11) interrupted it because of hematologic toxicities (neutropenia, thrombocytopenia), constitutional toxicities (fatigue) and arthralgias. Regarding chemotherapy, the average time without treatment was 18 days (1 to 4 cycles).There were no cardiac or lung related adverse events. All other toxicities were well tolerated with concomitant medication. Conclusions: In our population, it is possible to carry out concomitant chemo-radiotherapy with acceptable early toxicities and compliance in patients with breast cancer.

e17527 Background: Concomitant chemoradiotherapy is the standard treatment of unresectable stage III non-small cell lung cancer (NSCLC). However, the optimal chemotherapy regimen is still controversial. We have conducted a phase II study to evaluate concomitant treatment using pemetrexed/carboplatin or paclitaxel/carboplatin in these patients. The purpose of this study is to compare the feasibility and activity, and also assess its impact on progression-free survival (PFS). Methods: A total of 37 patients were enrolled between January 2008 and May 2011. Patients received concomitant chemoradiotherapy [thoracic radiotherapy and pemetrexed 500mg/m2, carboplatin AUC 5 every 3 weeks for 2 cycles; or paclitaxel 50mg/m2, carboplatin AUC 2 weekly for 6 weeks. ] Objective response rate according to the RECIST criteria was recorded and toxicity was evaluated using the NCI Common Toxicity Criteria. The Kaplan–Meier method was used to evaluate patient survival. Univariate analysis of patient characteristics and tumor responses was conducted using the Chi-square and Fisher's exact test. Results: The overall response rate for pemetrexed/carboplatin was statistically superior to paclitaxel/carboplatin (P

e16020 Background: Chemotherapy using TPF protocol has been showed efficacy in the neo-adjuvant setting for head and neck squamous cell carcinoma (SCC) so far. However, effectiveness of concomitant chemoradiotherapy (CCRT) using TPF protocol has not yet been clearly distinguished. On the other hand, prognoses of the patients with advanced stage SCC of the ear invading extra-temporal bone were very poor. The aim of this study was to determine the safety and efficacy of newly developed CCRT using TPF protocol in patients with SCC of the temporal bone. Methods: Patients with previously untreated T4 disease were eligible for the study. Eleven patients were enrolled between December 2001 and August 2010. Treatment consisted of radiotherapy administered once daily to a total dose of 70 Gy, concomitant with 120 hour infusions of 5-FU (600 mg/m2/day), docetaxel (50 mg/m2, day 2) and cisplatin (60 mg/m2, day 2) given during first and fifth weeks of radiotherapy. These drug doses were determined from the results of our former phase I study to assess the dose limiting toxicity of this protocol. Median follow-up period was 33 months. Results: Nine patients completed this protocol. Bone marrow suppression was the most common adverse event observed through this study. Grade 4 leukopenia and neutropenia were observed in 1 (9%) and 3 (27%) of the patients and also those grade 3 events were observed in 3 (27%) and 1 (9%) of the patients. Grade 3 lymphopenia and hemoglobin were observed in 7 (64%) and 1(9%) patients. Although all patients showed dermatitis and alopecia at any grade, other grade 3 or 4 adverse events were obviously less than in patients with oropharyngeal or hypopharyngeal cancer using the same treatment protocol during the same period. Complete remission of primary tumor was obtained in all patients but one who rejected second course of TPF. Local recurrences were observed in three patients and one of them underwent salvage surgery. The disease-specific and over-all survival rates at 60 months of the patients were 77.8% and 70.7%, respectively. Conclusions: Our data suggested that CCRT using TPF protocol was feasible and very effective in patients with advanced stage SCC of the ear and temporal bone.

Concomitant chemoradiotherapy represents an investigational approach to the treatment of locoregionally advanced non-small cell lung cancer. The theoretical rationale, and clinical experience are reviewed in brief. Clinical trials conducted at the University of Chicago are summarized.

The treatment of locoregionally advanced solid tumors has been hampered by the inability of currently available therapy modalities to eradicate all tumors cells. This applies to surgery and radiation therapy, which frequently are able to control the bulk of locoregional disease but ultimately do not prevent locoregional recurrence. Similarly, chemotherapy can at times induce locoregional tumor shrinkage, but is unable to successfully eradicate macroscopic disease. On the other hand, chemotherapy can, at least in some tumor types, eradicate micrometastatic systemic disease. In addition, chemotherapy might be able to improve locoregional control rates of surgery and/or radiotherapy if given in sequence or concurrently. Based on this background, combined modality programs have been investigated intensively. For many years, research has focused predominantly on the sequential use of combined modality regimens, i.e., neoadjuvant or adjuvant chemotherapy. At present, concomitant chemoradiotherapy is increasingly being viewed as a potentially more successful combination of multiple treatment modalities.

Since the first publication in 1981 from the Wayne State University by Steiger and Franklin [1], the concomitant radio-chemotherapy has been used by many teams in the world for the treatment of œsophageal cancer.

2052 Background: Concomitant temozolomide (T) and radiotherapy (RT) is standard care in patients (pts) with newly diagnosed glioblastoma (GBM). Bevacizumab (B) and irinotecan (I) produces impressiv...

5542 Background: Aim of this study was the clinical evaluation of two different schemes of neoadjuvant chemotherapy (NACT) followed by two different concomitant chemoradiotherapy (CHRT) schedules i...

2092 Background: The use of radiotherapy plus TMZ administered concomitantly with and after radiotherapy (Stupp platform; SP) for HGG was shown to improve median and 5-year survival. To compare the...