Irradiation of liver tumors from colorectal cancer: Additional local radiotherapy in addition to local chemotherapy gives significantly longer median survival time and disease-free period for treatment of unresectable liver tumors from colon cancer, galwegenkanker and primary liver cancer. Even a doubling in primary liver cancer.

December 14, 2005: Source: J Clin Oncol 2005, 23:8739-8747 and Medscape

Local radiotherapy - radiation in addition to arterial chemotherapy significantly increased the median lifespan of patients with unresectable liver tumors. Especially in cancer patients and patients with unresectable liver tumors galwegenkanker was remarkable and significant life extension. This translates literally as good as the results of the phase II study indicate that such Medscape.

NEW YORK (Reuters Health) in December 2005 - Additional custom high-dose radiotherapy / radiation (RT) to intra-arterial injected floxuridine (a chemotherapy) improves outcomes in patients with unresectable liver tumors significantly, according to a study published in the Dec. 1 edition of the Journal of Clinical Oncology.

"I want to alert physicians to the potential beneficial use of high dose targeted radiotherapy - radiotherapy for those patients who may no longer operative," said Dr.. Edgar Ben-Josef Universeit of Michigan. "There is currently wienig attention to the option of radiotherapy for this group of patients."

In a phase II trial, Dr.. Ben-Josef and colleagues studied the outcomes - effects in 128 patients with inoperable internal liver tumors from primary liver cancer or metastases from colorectal cancers simultaneously treated with three-dimensional custom high dose radiotherapy and in the liver by arterial approach contributed floxuridine (a chemo).

Current 3-year overall survival was 17%, rapproterden the authors, and the median survival was 15.8 months after the start of radiotherapy - radiotherapy. Median survival time was highest for metastatic colorectal cancer (17.2 months), slightly less but still better for primary liver cancer (15.2 months), and lowest, but still better than a standard treatment for galwegenkanker (13.3 months). All achieved survival rates are significantly higher than expected from cancer patients with these forms of cancer and stage of disease that generally no longer than about 8 to 9 months median survival time. Thus the researchers these figures based on previously published large phase III trials.

The used dose of local control - radiation therapy had a good and significant predictor of the likelihood of results, the researchers note. With doses of at least 75 Gy, the median survival time nearly doubled (23.9 months) as was seen at lower doses (14.9 months).

Bjna half of the patients with primary liver cancer were free from progression of their disease after three years, says the study, compared with only 15.1% of patients with colorectal cancer utigezaaide. 30 percent of patients had grade 1 / 2 adverse events, 30% suffered from grade 3 / 4 adverse events, and there was one treatment related death.
"For smaller tumors, this approach may work as well as other ablative techniques (ablative = surgical removal of eg radio waves, see RFA = Radio Frequency Ablation or laser, see LITT - Laser-induced Interstitial Thermal Therapy and patients not knadidat are operateive for a removal of this approach with RT would still benefit, "said Dr.. Benyosef.

"I stress that this approach is not an alternative for patients who are eligible for chemotherapy." explains Dr.. Ben-Josef from. "There is no reason why patients could not both get and we believe that these two complementary forms of treatment may be ibij metastatic colorectal cancer: aggressive systemic chemotherapy plus aggressive local treatment."

"We are working on a larger phase II trial to establish intensive modulated radiotherapy and floxuridine," said Dr.. Ben-Josef. "Our preclinical research even suggests that we can use higher doses than used in this study with similar or even fewer side effects and toxicity"

J Clin Oncol 2005, 23:8739-8747.

Radiation Therapy Improves Outcome of Unresectable Hepatic Cancer

By Will Boggs, MD

NEW YORK (Reuters Health) Dec 05 - Adding high-dose conformal radiation therapy (RT) to intra-arterial floxuridine improves outcomes in patient with unresectable intrahepatic malignancies, According To a report in the December 1st Journal of Clinical Oncology.

"I would like physicians to be aware of the potential Useful ness or high-dose focal radiotherapy patiënten For Those who do not have Surgical options," Dr. Edgar Ben-Josef from University of Michigan, Ann Arbor, Told Reuters Health. "Currently There is little awareness or radiotherapy as an option for thesispatiënten. "

In a phase II trial, Dr.. Ben-Josef and colleagues Investigated the outcomes of 128 patients with unresectable intrahepatic primary hepatic Biliary cancers or liver metastases from colorectal cancer Treated concurrently with three-dimensional conformal radiation therapy and high-dose hepatic arterial floxuridine.

Actuarial 3-year overall survival was 17%, the authors report, and the median survival was 15.8 months after the start of radiotherapy. Median survival was for meta-static colorectal cancer Highest (17.2 months), intermediate for hepatocellular carcinoma (15.2 months), and lowest for cholangiocarcinoma (13.3 months). All of prosthesis survival times Were Longer Than the eight-to nine-months expected median survival for theses diseases, Indicating the results.

Radiotherapy dose was a significant predictor of survival, the researchers note, with doses of at least 75 Gy Bringing an overall survival Nearly Twice as high (23.9 months) That as seen with lower doses (14.9 months).

Nearly half the patiënten with primary hepatic cancers Were free from extrahepatic progression at 3 years, the report indicates, compared with only 15.1% of the Patients with meta-static colorectal cancer. Thirty percent of the Patients Developed grade 1 / 2 toxicity, 30% Developed grade 3 / 4 toxicity, and there was one treatment-related death.
"In smaller lesions, Probably Could this work just as well as Other nonablative methods, and patients who are not Candidates for nonsurgical ablation could-still benefit from RT," Dr. Ben-Josef said.

"That I'd like to emphasize this is not an alternative to chemotherapy in Those Who Are Candidates for chemotherapy." Dr. Ben-Josef Explained. "There is no reason why patiënten Could not have both, and we believe That thesis are two forms of complementary therapy in meta-static colorectal cancer: aggressive systemic therapy plus aggressive local therapy."

"We are about to Initiate a Phase II trial of intensity-modulated radiotherapy with floxuridine competitor," Dr.. Ben-Josef added. "Our preliminary work HAS Suggested That we can deliver an even higher dose Than we did in the trial Reported With The Same Reduced or expected level of toxicity."

J Clin Oncol 2005, 23:8739-8747.

Here is a study phase, the results of internal radiation after surgical removal of liver tumors which also gave a better result in the median survival time, 512% got the five year survival and disease-free time.

J Clin Oncol. 2005 in September 1920, 23 (27) :6763-70.

Phase II trial of carcinoembryonic antigen radioimmunoassay therapy with 131I-labetuzumab after salvage resection of colorectal metastases in the liver: five-year safety and efficacy results.

Liersch T, Meller J, Kulle B, Behr TM, Markus P, Langer C, Ghadimi BM, Wegener WA, Kovacs J, Horak ID, Becker H, Goldenberg DM.
Department of General Surgery, University of Gottingen, Germany. tliersc@gwdg.de

PURPOSE: Although complete resection (R0) or liver metastases (LM) Remains the treatment of choice for colorectal cancer (CRC) patient amen-able to Curative therapy, only approximately one third survive for 5 years. The Objective of this phase II study was to Evaluate the safety and efficacy of radio-immunotherapy (Rait) after salvage resection of LM.

PATIENT AND METHODS: Twenty-three Patients who under went surgery for LM of CRC Received a dose of 40 to 60 mCi/m2 or 131I-labetuzumab, a humanized monoclonal antibody Which is against carcinoembryonic antigen. Safety (n = 23), disease-free survival (DFS, n = 19), and overall survival (OS, n = 19) Were Determined.

RESULTS: With a median follow-up of 64 months, the median OS time from the first liver resection for Rait patient was 68.0 months (95% CI, 46.0 months to infinity), and the median DFS time was 18.0 months (95% CI , 11.0 to 31.0 months). The 5-year survival rate was 51.3%. Rait benefited patiënten Independently or bilobar involvement, size and number of LM, and resection margins. The major adverse effect was transient myelosuppression, mostly tion results in grade <or = 3 neutropenia and / or thrombocytopenia.

CONCLUSION: Because Both the median OS and 5-year survival rates Seem to be improved with adjuvant Rait after complete LM resection in CRC, compared with historical and contemporaneous controls not receiving Rait, theses results justify Further evaluation of this modality in a multicenter, randomized trial.

Publication Types:
Clinical Trial
Clinical Trial, Phase II

PMID: 16170184 [PubMed - indexed for MEDLINE]