Clinical trials of neutron radiotherapy in the United States
| Autor: | Paul S. Cho, M. Austin-Seymour, Thomas W. Griffin, George E. Laramore, K.L. Lindsley, Kenneth J. Russell, Wui Jin Koh, Keith J. Stelzer |
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| Rok vydání: | 1996 |
| Předmět: |
Male
Lung Neoplasms medicine.medical_treatment Fast Neutrons Radiotherapy High-Energy Prostate cancer Prostate Actuarial Analysis Neoplasms medicine Humans Radiology Nuclear Medicine and imaging Radiation treatment planning Lung cancer Survival analysis Neoplasm Staging Photons business.industry Cancer Prostatic Neoplasms Radiotherapy Dosage medicine.disease Clinical trial Radiation therapy medicine.anatomical_structure Oncology Head and Neck Neoplasms Female Nuclear medicine business |
| Zdroj: | Bulletin du cancer. Radiotherapie : journal de la Societe francaise du cancer : organe de la societe francaise de radiotherapie oncologique. |
| ISSN: | 0924-4212 |
| Popis: | Summary The development of clinical neutron facilities in the 1980s, capable of delivering high energy neutrons spurred full scale phase III testing of neutron beam radiotherapy in a number of tumors including salivary gland, head and neck, prostate, and non small-cell lung cancer. The Radiation Therapy Oncology Group (RTOG) and the Medical Research Council (MRC) jointly sponsored a randomized trial for the treatment of advanced stage salivary gland tumors comparing neutron to conventional photon and/or electron radiotherapy. Although no improvement in survival was seen, the study demonstrated a striking and statistically significant difference in the local-regional control of unresectable salivary gland tumors (56 vs 17%), favoring neutron beam irradiation. Subsequent clinical trials of neutron beam irradiation were initiated by the Neutron Therapy Collaborative Working Group (NTCWG) sponsored by the National Cancer Institute (NCI). A phase III trial comparing neutron to photon radiotherapy for inoperable regional non-small cell lung cancer showed no overall improvement in survival. However, a statistically significant improvement in survival was observed in the subset of patients with squamous cell histology. The NTCWG trial comparing fast-neutron therapy versus conventional photon irradiation in the treatment of advanced squamous cell carcinomas of the head and neck showed a statistically significant improvement in initial complete response (70 vs 52%) favoring neutrons. However, subsequent failures erased any difference in ultimate local-regional control rates and survival curves were essentially the same in both arms. The randomized study of the NTCWG for locally advanced prostate cancer demonstrated a significant decrease in local-regional failure (11 vs 32%) at 5 years, favoring the neutron arm. Furthermore, biochemical measures of disease control also favored the neutron arm with prostate specifie antigen (PSA) levels elevated in 17% of the neutron-treated patients compared to 45% of the photon-treated patients at 5 years. At the 5-year analysis, no significant difference in survival was observed between the two arms; however, longer follow-up is necessary to assess the ultimate impact of improved local-regional control on survival. An analysis of complications in this series revealed the importance of beam shaping and treatment planning capabilities in maintaining long-term sequelae following neutron irradiation at an acceptably low level. |
| Databáze: | OpenAIRE |
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