演題抄録

シンポジウム

開催概要
開催回
第52回・2014年・横浜
 

Advances in local treatment with combined modalities improve cancer survival

演題番号 : S2-6

[筆頭演者]
Cox James D.:1 

1:Clinical Professor of Radiation Oncology, The University of Texas MD Anderson Cancer Center, U.S.A.

 

The necessity for systemic treatment to improve survival for most types of cancer is widely accepted. It is less widely accepted that improved local control with radiation therapy also contributes to survival. Very recently, there are strong suggestions that avoidance of unwanted effects on normal tissues with local radiation therapy further improve survival.

Early evidence of the importance of local control came from the Netherlands Cancer Institute. Investigators there showed that the addition of cisplatin daily or weekly with thoracic radiation therapy improved survival in cancer of the lung an improvement that was entirely due to increased local control. Subsequently, the Radiation Therapy Oncology Group showed improved survival with concurrent chemotherapy and radiation therapy for carcinomas of the esophagus, lung, head and neck, and cervix. In each of these sites, chemotherapy alone would not be expected to provide control of the disease.

The toxicity of concurrent chemotherapy cannot be dismissed. Treatment related pneumonitis is a serious problem in treatment of non-small cell carcinoma of the lung. Even subclinical pneumonitis can decrease survival.

It was found that intensity modulated radiation therapy with motion management decreased the risk and improved survival with NSCLC. To go further, proton therapy, which irradiates less normal lung, further diminishes the risk of TRT and improves survival.

Concurrent chemotherapy and radiation therapy improves local control and survival in patients with carcinoma of the oropharynx. Further improvement in survival can be achieved with IMRT but it is associated with many side effects occurring in the beam paths. These adversely affect the patients' quality of life and perhaps survival. Recently developed intensity modulated proton therapy relying upon spot scanning whereby the proton beam is painted through the tumor and avoids normal structures, can obviate much of this toxicity. Survival data are not yet available.

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