one deck Flashcards
National Lung Screening Trial: P/D/R
P: age 55-74 with more than 30 pack yearsD: CXR vs. low dose CT every 3 yearsR: all cause mortality reduced by 7% with CT
LCSG 821 (Ginsberg): P/D/R
P: T1-2N0D: lobectomy vs. wedge resection (2cm margins)R: improved LC and DFS with lobectomy, trend toward improved OS
London metaanalysis: P/D/R
P: NSCLC who underwent CRTD: metaanalysis looking at pneumonitisR: V2040%: 36% grade 2 and 3.5% grade 5
Wash U lung pneumonitis: P/D/R
P: inoperable who underwent RT +/- chemoD: rates of grade 2 pneumonitisR: V20 < 22% - zero pneumonitis, V20 > 40% - 35% pneumonitis
PORT metaanalysis: P/D/R
P/D: all available clinical trials of PORT vs. surgery aloneR: inferior OS with PORT especially in early stage, but patients treated before 3DCRT
ANITA: P/D/R
P: resected stage IB-IIIAD: adjuvant chemo vs. observation, some received PORTR: N1 patients benefit from PORT if no chemo, N2 patients benefit from PORT regardless of chemo
What two main trials examined the utility of post-operative RT?
- PORT metaanalysis2. ANITA
CALGB 8433: P/D/R
P: locally advanced NSCLCD: RT 60Gy +/- induction cisplatin/vinblastineR: 5yr OS improved with induction chemo
RTOG 9804 (DCIS +/- RT) recurrence with and without RT
7yr LR 7% without RT and 1% with RT
WTF is palifermin
human keratinocyte growth factor used to reduce severity of mucositis during H&N RT
criteria for stage III multiple myeloma
hemoglobin < 8.5 orcalcium >12 orBence Jones >12g/24hr oradvanced lytic lesions
risk factors for CNS involvement in ALL
mature B-cell immunophenotypeT-cell immunophenotypehigh LOH
test for continuous independent variable and continuous dependent variable
regression
test for categorical independent variable and continuous dependent variable
T-test and ANOVA
test for categorical independent variable and categorical dependent variable
chi square
what was the benefit at 5 years with the addition of short term ADT in the D’Amico trial?
10% OS benefit with ADT (88% vs 78%)
what infection has an increased incidence during bortezomib treatment?
Herpes zoster
what criteria are used to define active/symptomatic myeloma?
CRABC - elevated calciumR - renal insufficiencyA - anemiaB - bone lesions
what was the local recurrence rate on RTOG 9704?
28% overall (25% with gem, 30% with 5FU)
what cytokine is associated with pneumonitis following lung RT?
TGFbeta1
what RT dose causes ovarian failure in a 30 year old?
14Gy for 30yo(18-20Gy from birth to 10yrs)
what is the CTV expansion and dose for APBI using EBRT?
1.5cm, 38.5Gy
what are the 5 sections of the male urethra?
glandular, penile, bulbous, membranous, prostatic(anterior urethra - glandular/penile/bulbous)(posterior urethra - membranous/prostatic)
Following RT for a solitary plasmacytoma, how often is skeletal survey obtained?
skeletal survey every 9-12 months
what is the dose per fraction when using 4 fractions of HDR brachytherapy alone for inoperable endometrial cancer (at 2cm from sources)?
8.5Gy per fraction at 2 cm
what percentage of patients with inflammatory breast cancer will present with metastatic disease?
25-30%
criteria for stage III Wilms
Positive marginPositive lymph nodesPeritoneal implantsPiecemeal resectionsPillagebioPsy
what dose rates define HDR and LDR brachytherapy?
LDR 0.4-2Gy/hrHDR >12Gy/hr
what histopathological finding and genetic abberation are associated with AT/RT?
negative INI-1 staining, 22q deletion
Burkitt lymphoma mutation
t(8;14)
what mutations portent a poor prognosis in neuroblastoma
n-myc amplificationLOH 1p + 11qdiploid DNAincreased telomerase activity
what chemotherapy was used in RTOG 9802?
PCV - procarbazine/lomustine/vincristine
median survival on Stupp trial for patients with MGMT methylation that received temozolomide and RT
23 months
factors included in IPI for non-Hodgkins
Age, Performance status, LDH, Extranodal sites, Stage
by what mechanism is EGFR expression level elevated in H and N SCCa?
gene amplification
what percentage of RT plans on Z11 utilized high tangents?
50%
On the WECARE study, what was the 10 year risk of contralateral breast cancer for BRCA1, BRCA2, and non-carrier?
BRCA1 - 20%BRCA2 - 16%non-carrier - 5%
what hormone has the lowest threshold for dysfunction after hypothalamic/pituitary RT?
Growth hormone (only requires 18Gy)
what molecular features are characteristic of pediatric anaplastic large cell lymphoma?
CD30 positive (100%), ALK rearrangement (90%)
Per QUANTEC, what is the risk of radiation pneumonitis with V20 of 30-35% and MLD of 20-23Gy?
20% risk of pneumonitis
indications for adjuvant RT following radical hysterectomy
two of the following:>1/3 stromal invasionLVSItumor >4cm
what percentage of solitary plasmacytomas arise in bone?
80% are osseous, 20% are extra-osseous
first line TKI for clear cell carcinoma of the kidney
sunitinib
reactivation of what virus occurs after liver SBRT?
hepatitis B (hence the reason they start antiviral treatment prior to RT)
what are the biomarker profiles for luminal B breast cancer?
ER/PR+, Her2+ER/PR+, Her2-, high Ki-67
which subtype of renal cell carcinoma is associated with deletion in chromosome 3p and Von Hippel Lindau disease?
clear cell
most common cancer in children <18 months of age?
neuroblastoma
what percentage of prostate cancer patients present with high risk disease?
25%
in RTOG 9111, what endpoints were improved with concurrent CRT as compared to sequential CRT?
concurrent CRT resulted in superior laryngeal preservation, local control, and locoregional control
for prostate SBRT, what rectal wall constraints are associated with risk of grade 3+ toxicity?
V50 < 3cc, less than 35% of the circumference receiving 39Gy
what was the path CR rate in NSABP R03 comparing preop vs. postop CRT for rectal cancer?
path CR rate 15% (obviously only in preop group)
on PORTEC-1, what was the 3 year OS after salvage radiation for patients who relapsed at the vaginal cuff following observation?
3yr OS 73%
what is the Siewert classification of a tumor mass centered in the gastric cardia with extension of the gastroesophageal junction?
Siewert type III
what constitutes T3 gallblader cancer?
invasion of visceral peritoneum, liver, or ONE adjacent organ
what is the N stage for anal cancer with unilateral pelvic side wall and inguinal lymph nodes?
N2
what is the recommended dose for ALL patients who have persistent testicular disease after induction chemo?
24Gy
what is the most common testicular cancer in men older than 50?
lymphoma
what are the 3 most common side effects of cetuximab?
acneiform rash, hypomagnesemia, infusion reaction
based on the EBCTCG meta-analysis, what is the 5 year local recurrence rate for stage I breast cancer treated with surgery and radiation?
5yr LR 7%
what percentage of craniopharyngioma patients will experience long-term diabetes insipidus?
60%
what are the most common breast cancer molecular subtypes associated with BRCA1 and BRCA2?
BRCA1 - triple negative / basal subtypeBRCA2 - luminal A/B
what 3 structures can be involved in stage II vulvar cancer?
lower urethra, vagina, anus
what structures comprise the CTV for IMRT for IB2 cervical cancer?
GTV, cervix, entire uterus, parametrium, upper half of vagina
What criteria makes a patient an ideal candidate for bladder preservation?
unifocal T2-3a tumor <5cm, no extensive CIS, no ureteral obstruction, good bladder capacity and renal function, visibly complete TURBT
what is the most likely diagnosis for a boy with a pineal mass and CSF with elevated bHCG and undetectable AFP?
pure germinoma, biopsy not required
following bladder preservation treatment, what percentage of long-term survivors will maintain an intact bladder?
80%
where do most ependymomas present in adults?
spine
what cell surface antigen is targeted by Zevalin (britumomab tiuxetan)?
CD20
what cell surface antigen is targeted by brentuximab?
CD30
On ECOG 5194 (DCIS +/- RT), what 2 factors indicated a higher risk of ipsilateral breast event?
nuclear grade, patient age
what is the appropriate adjuvant RT field and dose for a child with a 4th ventricular grade III non-metastatic ependymoma status post GTR?
RT to resection bed plus margin to 54-59.4Gy in 30-33fxs
what is the risk of conversion of solitary osseous plasmacytoma to multiple myeloma at 10 years? what about non-osseous plasmacytoma?
osseous - 54%non-osseous - 11%
what is the CSI dose for a child with persistent CSF involvement after chemotherapy for B-cell ALL?
24Gy
what are the indications for adjuvant CRT after radical hysterectomy for cervical cancer?
positive nodes, positive margins, parametrial involvement
for breast cancer, how many sentinel nodes are needed to give a 9% false negative rate?
3 nodes (false negative rate is 6% with 4 nodes)
what was the concurrent chemotherapy regimen utilized in NSABP R-03?
5-FU / leucovorin
what is the 10 year LRR with and without PMRT for patients with stage III breast cancer who have a pCR to neoadjuvant chemotherapy (MDACC)?
10yr LRR 33% without PMRT, 7% with PMRT
what gastric lymph node stations are removed with a D2 dissection?
left gastric, celiac, common hepatic, splenic hilum, splenic artery
what is the most common RT regimen for Graves ophthalmopathy?
20Gy/10fxs
what is the most common type of childhood leukemia?
B-cell ALL
what subtype is not a classical subtype of Hodgkin Lymphoma and what are the molecular markers for that subtype?
nodular lymphocyte predominant CD15/CD30 negative, CD20/CD45 positive
what are the 4 subtypes of classic Hodgkin Lymphoma and what are the characteristic molecular markers?
nodular sclerosing, lymphocyte rich, mixed cellularity, lymphocyte poor CD15/CD30 positive, CD20/CD45 negative
what were the inclusion criteria for SWOG 8794 (prostatectomy +/- adjuvant RT)?
SVI, ECE, positive margin
on PORTEC-2, what was the 5yr rate of isolated vaginal recurrence for high-intermediate risk patients treated with brachytherapy versus those treated with EBRT?
5yr vaginal recurrence 1.8% with brachy, 1.6% with EBRT
what is the 5 year pelvic control rate for stage I/II SCCa of the mid-vagina treated with RT alone? what about stage III/IV?
stage I/II - 85%stage III/IV - 71%
invasion of what structures constitute stage II urethral cancer?
corpus spongiosumprostateperiurethral muscle
on RTOG 9811, what was the 5yr OS for patients with T4N+ anal cancer?
5yr OS 40%
what was the complete resection rate and 5yr OS in the SWOG 9416 superior sulcus tumor trial?
complete resection rate 76%5yr OS 44%
on GOG 37, what was the 2yr local recurrence rate for patients randomized to RT?
2yr LRR 5%
on GOG 33, what was the risk of pelvic lymph node involvement for a grade 1 tumor involving inner 1/3 versus outer 1/3 of the myometrium?
inner 1/3 - 3% risk of nodal involvementouter 1/3 - 11% risk
on Slotman trial for ES-SCLC, what was the benefit in median survival for patients who received PCI?
median survival 6.7mo vs. 5.4mo1yr OS 27% vs. 13%
what is the TD 5/5 for whole kidney?
23Gy
what is the age cutoff used for staging thyroid cancer?
age 45
male breast cancer is most commonly associated with what mutation?
BRCA2
what is the preferred doublet chemotherapy for unresectable mesothelioma?
cisplatin / pemetrexed (40% response rate)
what factors constitute IPI for advanced Hodgkin lymphoma?
stage IVmale sexage > 45albumin < 4hemoglobin < 10.5lymphocyte count < 600
what are the indications for whole abdominal radiation with favorable histology Wilms?
SPAR:diffuse SpillagePeritoneal seedingAscitespreoperative Rupture
what percentage of patients with urothelial carcinoma of the renal pelvis will also have a urothelial carcinoma of the bladder?
50%
per NSABP analysis, what is the 10yr local recurrence rate for patients with T3N0 breast cancer treated with mastectomy and chemotherapy (without PMRT)?
10yr LRR 7%
what constitutes T2 cholangiocarcinoma of the distal bile duct?
invasion beyond the wall of the bile duct
what constitutes T4 cholangiocarcinoma of the distal bile duct?
involves celiac axis or SMA
what tumor marker is used to follow granulosa cell ovarian cancers if elevated at diagnosis?
inhibin
on subgroup analysis of intermediate risk patients on RTOG 9408, what was the 10yr OS improvement with addition of short term ADT?
10yr OS improved by 7% (61% vs. 54%)
what triad of symptoms are associated with classic radiation induced liver disease (RILD)?
anicteric hepatomegalyasciteselevated alk phos
for grade II astrocytoma, what is the rate of transformation to high grade glioma?
70%
what percentage of CNS germ cell tumors in males occur in the pineal area?
60%
what IHC stains help distinguish mesothelioma from adenocarcinoma NSCLC?
calretinin, thrombomodulin
at what site do most male urethral cancers occur?
bulbomembranous urethra (60%), penile urethra (35%), prostatic urethra (5%)
what constitutes FIGO III fallopian tube cancer?
peritoneal implants outside of the pelvis (there is no FIGO IV by the way)
what percentage of penile cancers are HPV positive?
80%
what percentage of women with BRCA1 mutation will develop breast cancer and/or ovarian cancer by age 70?
60% will develop breast cancer40% will develop ovarian cancer
what is the 2 year rate of pelvic insufficiency fracture after definitive radiation for early stage cervical cancer?
35%
what constitutes T3 female urethral cancer?
invasion of vagina or bladder neck
what percentage of patients with LS-SCLC by conventional imaging will be upstaged by FDG PET?
10%
what is the maximum dose constraint for the spinal cord with 3 fraction SBRT?
18Gy
for high risk endometrial cancer, what are the two main options for adjuvant WPRT with brachy boost?
WPRT 45Gy, HDR 6Gy x 3 to surfaceWPRT 50.4Gy, HDR 6Gy x 2 to surface
for postop endometrial cancer, what are the 3 main HDR regimens?
6Gy x 5 to surface4Gy x 6 to surface7Gy x 3 to 5mm depth
what constitutes T2 hepatocellular carcinoma?
solitary tumor with vascular invasion or multiple tumors <5cm
what constitutes S2 testicular cancer?
LDH 1.5 - 10x upper limit of normal rangebHCG 5,000 - 50,000AFP 1,000 - 10,000
Langerhans cell histiocytosis is associated with what marker?
CD1a
what is the histologic feature of ependymoma?
perivascular psuedorosettes
what is the histologic feature of retinoblastoma?
Flexner-Wintersteiner rosettes
what is the histologic feature of diffuse astrocytoma?
microcystic changes
what is the histologic feature of medulloblastoma?
Homer-Wright rosettes
what was the surgery and adjuvant chemotherapy used in the CLASSIC trial?
D2 gastrectomyadjuvant oxaliplatin/capecitabine
what is the RT dose for MALT (gastric and orbit)?
30Gy/15fxs
what is the treatment paradigm for osteosarcoma?
neoadjuvant chemo, surgical resection, adjuvant chemo for 4-6 months (results in long term survival of 60% vs. just 20% with surgery alone)
what are the dose constraints for the duodenum when treating the paraaortics in the setting of GYN cancer?
D2cc < 60GyV55 < 15cc
what anatomical portion of the penis is most commonly involved in penile cancer?
glans - 50% (next most common is prepuce/foreskin at 25%)
what was the rate of pCR and/or minimal residual disease on SWOG 9416 superior sulcus tumor trial?
56%
for pancreatic cancer, what are the classic superior and inferior borders for adjuvant RT?
superior T10/11 interspaceinferior L3/4 interspace(superior border of T11, inferior border of L3)
what vertebral bodies correspond with the approximate levels of the celiac axis, SMA, and IMA?
celiac - T12SMA - L1IMA - L3
what mutation is associated with favorable prognosis in B-cell ALL?
t(12;21) - TEL/AML1
criteria for N2 anal cancer?
unilateral internal iliac and/or unilateral inguinal
what are the adjuvant chemo options for patients with pN2 NSGCT?
BEP x 2 cycles or EP x 2 cycles
what were the two treatment arms in RTOG 9512 for T2 glottic cancer?
70Gy/35fxs qday vs. 79.2Gy/66fxs BIDno significant difference LC, DFS, or OS
sorry dude this is gonna suck…what were the 4 treatment arms in RTOG 9003?
standard frac: 70Gy/35fxshyperfrac: 81.6Gy/68fxs BIDaccelerated frac split course: 67.2Gy/42 BID with 2 week break in middleaccelerated frac concomitant boost: 72Gy/42fxs, BID during final 2 weeks
what were the 2 treatment arms in RTOG 8501 Herskovic trial for esophageal cancer?
64Gy/32fxs (RT alone) vs. 50Gy/25fxs with concurrent cis/5FU
what constitutes T2 pancreatic cancer?
> 2cm in size but confined to the pancreas
when treating stage I/II seminoma, what is the renal dose constraint?
D50 < 8Gy
per the new guidelines for APBI, what are the cautionary criteria for age, tumor size, and margin status?
age 40 - 49 (with no other risk factors)size 2.1 - 3.0cmmargin < 2mm
what was median survival on the CROSS trial?
50 vs 25 months (actually 49 vs 24 but lets not be ridiculous)
when should capecitabine be taken when used concurrently with radiation for rectal cancer?
1 hour before treatment
in treating with conventional fractionation for NSCLC, what is the appropriate CTV margin for adenocarcinoma and squamous histologies?
adeno - 8mmsquamous - 6mm
where is the motor cortex?
precentral gyrus
What is the 5-year overall survival for stage I, II, III, and IV oral cavity cancer?
I - 75%II - 55%III - 40%IV - 30%
What structures comprise the oral cavity?
lip, alveolar ridge, buccal mucosa, retromolar trigone, floor of mouth, oral tongue
What structures comprise the oropharynx?
palatine tonsils (fossa and pillars), soft palate, base of tongue, pharyngeal walls
What structures comprise the hypopharynx?
pyriform sinuses, postcricoid area, pharyngeal wall
GBM: RT fields and dose
CTV 46Gy - T2 + 2cmCTV 60Gy - T1 post / cavity + 2cm
GBM: temozolomide dosing during/after RT
during RT: 75mg/m2 dailyafter RT: 150-200mg/m2 days 1-5 on q28day cycle for 6 months
GBM: max dose constraints for chiasm, brainstem, optic nerves, retina, and lenses
chiasm 55Gybrainstem 60Gyoptic nerves 55Gyretina 50Gylenses 7Gy
GBM: follow up
MRI one month after RT then ever 3 months thereafter
GBM: simulation
supine, mask, fuse preop and postop MRIs
GBM: RT options for elderly or poor KPS
Roa - 40Gy/15fxs, age > 60 and KPS > 50Bauman - 30Gy/10fxs, age > 65 and KPS < 50(French trial showed improved MS with RT compared to observation)
WHO 3 glioma: RT fields and dose
CTV 5940 - GTV/cavity + T2 flair + 2cm
WHO 3 glioma: chemotherapy
PCV: procarbazine, lomustine, vincristinegiven either before or after course of RT, possibly omit if 1p 19q codeletion is present
WHO 3 glioma: max dose constraints for chiasm, brainstem, optic nerves, retina, and lenses
chiasm 55Gybrainstem 60Gyoptic nerves 55Gyretina 36Gylenses 5Gy
WHO 3 glioma: follow up
MRI one month after RT then ever 3 months thereafter
WHO 2 glioma: RT fields and dose
CTV 54Gy - GTV / T2 FLAIR + 2cm
Anal T2N0: RT fields and dose
CTV 42 - primary site, mesorectum, presacral, inguinal, external iliac, internal iliacCTV 50.4 - GTV + anal canal + 2.5cmPTV - 1cm margin
Anal T3-4N0: RT fields and dose
CTV 45 - primary site, mesorectum, presacral, inguinal, external iliac, internal iliacCTV 54 - GTV + anal canal + 2.5cm (consider 60Gy if T4)PTV - 1cm margin
Anal N+: doses
45Gy to elective nodal regions50.4Gy to nodal regions with nodes <3cm54Gy to primary and nodal regions with nodes >3cm
Anal: chemotherapy
two cycles at a 4 week interval:5FU 1000mg/m2 daily x 4 daysmitomycin 10mg/m2 x 1 day
Anal: workup
H&P: LN eval, DRE, anal sphincter tone, sexual history, HIV, HPV, IBD history, Gyn examLabs: CBC, HIV if risk factorsProctoscopy with bx. FNA of inguinal nodes. MRI or EUS.CT/MRI of A/P. CXR or CT chest
Rectal: criteria for WLE
T1, <3 cm, <30% circumference, margins >3mm, within 8 cm of anal verge, grade 1-2, no LVSI/PNI
Rectal: RT fields and dose (T3-4 or N+)
CTV 45 - mesorectum, presacrals, internal iliacs, obturatorsCTV 50.4 - tumor/mesorectum + 2cm sup/inf
Rectal: 2D fields
AP: L5/S1 down to bottom of obturator foramen or 3 cm below tumor, whichever is more inferior (anal verge for tumors close to anal verge), lat 2 cm on pelvic brimlat: want ant behind pubic symphysis and 3cm in front of sacral promontory, post 1cm behind sacrum If T4 with anterior structure invasion - move ant border in front of sacrum
Rectal: chemotherapy
preop with concurrent capecitabine 825mg bid M-Fadjuvant treatment for T3/4 or N+ is FOLFOX x 6 months
what are the components of FOLFOX
leucovorin (FOLinic acid)5FUOxaliplatin
what are the treatment options for early stage esophageal cancer (Tis, T1a, T1b, T2)?
Tis/T1a - endoscopic resection + ablationT1b - esophagectomyT2 - esophagectomy alone if noncervical, <2cm, well differentiated
definition of anal margin
area below anal verge encompassing 6cm of skin around anus, consists of keratinizing epithelum
definition of anal verge
area near end of anus where nonkeratinizing epithelium becomes keratinizing epithelium
What are the components of MAID chemotherapy?
MESNA, adriamycin, ifosfamide, dacarbazine
Pisters trial: P/D/R
P: 160 patients with extremity and superficial trunk sarcoma s/p WLED: adjuvant RT (brachy 45Gy) vs. observationR: RT improved local control for high grade lesions (90% vs. 65%) but not for low grade lesions (70%)
What were the local control rates for high grade sarcomas in the Pisters trial?
90% vs. 65%
NCI (Yang) trial, low grade portion: P/D/R
P: extremity sarcoma s/p WLED: adjuvant RT (63Gy total) vs. observationR: Local control improved with RT (95% vs. 60%)
NCI (Yang) trial, high grade portion: P/D/R
P: extremity sarcoma s/p WLED: adjuvant chemo vs. adjuvant chemo-RTR: Local control improved with RT (100% vs. 75%)
What was the chemotherapy regimen used in the NCI (Yang) trial?
doxorubicine, cyclophosphamide
NCI (Rosenberg) trial: P/D/R
P: 43 patients with high grade extremity sarcomaD: amputation vs. WLE + adjuvant RT (60-70Gy total)R: equivalent local control, DFS, and OS
NCIC (O’Sullivan) trial: P/D/R
P: 190 patients with extremity sarcomaD: neoadjuvant RT (50Gy) vs. adjuvant RT (66Gy)R: equivalent local control, DFS, and OS; more wound healing issues with neoadjuvant (35% vs. 15%); more late fibrosis with adjuvant (48% vs. 31%)
What were the rates of wound healing complications in the NCIC (O’Sullivan) trial?
35% vs. 15% (neoadjuvant vs. adjuvant)
What were the rates of late fibrosis in the NCIC (O’Sullivan) trial?
31% vs. 48% (neoadjuvant vs. adjuvant)
nasopharyngeal cancer CTV structures
nasopharynx, clivus, skull base, pterygoid fossa, parapharyngeal space, sphenoid sinus, posterior half of nasal cavity, posterior half of maxillary sinuses, inferior soft palate, retropharyngeal lymph nodes, retrostyloid space, bilateral nodal levels IB-V, cavernous sinus for T3/4
GBM volumes (RTOG)
CTV 46 is T2/FLAIR + 2cm, CTV 60 is contrast enhancing portion or surgical cavity + 2cm
RTOG GBM normal structure constraints (spinal cord, brain stem, optic chiasm 3mm PRV, optic nerve 3mm PRV)
spinal cord max 50, brainstem max 55 acceptable 60, optic chiasm 3mm PRV max 55 acceptable 60, optic nerve 3mm PRV max 55 acceptable 60
Nasopharyngeal carcinoma T1
tumor confined to nasopharynx or tumor extends to oropharynx and/or nasal cavity without parapharyngeal extension
Nasopharyngeal carcinoma T2
parapharyngeal extension
Nasopharyngeal carcinoma T3
skull base or paranasal sinuses
Nasopharyngeal carcinoma T4
intracranial extension, cranial nerves, hypopharynx, orbit, infratemporal fossa, or masticator space
Nasopharyngeal carcinoma N1
unilateral cervical nodes <6cm
Nasopharyngeal carcinoma N2
bilateral cervical nodes <6cm
Nasopharyngeal carcinoma N3
nodes >6cm or extension to supraclavicular fossa
NPC extending into nasal cavity and parapharyngeal space with unilateral node <6cm
T2N1, stage II (T1N1 or T2N0-1)
NPC extending to nasal cavity with cervical nodes <6cm
T1N2, stage III (T1-2N2 or T3N0-2)
NPC extending to paranasal sinus with no cervical nodes
T3N0, stage III (T1-2N2 or T3N0-2)
NPC with skull base invasion and no cervical nodes
T3N0, stage III (T1-2N2 or T3N0-2)
NPC with skull base invasion and bilateral cervical nodes <6cm
T3N2, stage III (T1-2N2 or T3N0-2)
NPC with cranial nerve involvement and no cervical nodes
T4N0, stage IVA (T4N0-2)
NPC confined to nasopharynx with supraclavicular node
T1N3, stage IVB (any T, N3)
NPC with distant metastases
stage IVC
Nasopharyngeal carcinoma T1
tumor confined to nasopharynx, or tumor extends to oropharynx and/or nasal cavity without parapharyngeal extension
Nasopharyngeal carcinoma T2
parapharyngeal extension
Nasopharyngeal carcinoma T3
invasion of skull base or paranasal sinuses
Nasopharyngeal carcinoma T4
intracranial extension, involvement of cranial nerves, hypopharynx, orbit, infratemporal fossa, or masticator space
Nasopharyngeal carcinoma N1
unilateral cervical nodes <6cm
Nasopharyngeal carcinoma N2
bilateral cervical nodes <6cm
Nasopharyngeal carcinoma N3
nodes >6cm or extension to supraclavicular fossa
Oropharynx T1
<2cm
Oropharynx T2
2-4cm
Oropharynx T3
> 4cm or extension to lingual surface of epiglottis
Oropharynx T4a
invading larynx, extrinsic tongue muscles, medial pterygoid, hard palate, or mandible
Oropharynx T4b
invading lateral pterygoid, pterygoid plates, lateral nasopharynx, skull base, or encasing carotid
Head & Neck N1
single ipsilateral node <3cm
Head & Neck N2a
single ipsilateral node 3-6cm
Head & Neck N2b
multiple ipsilateral nodes
Head & Neck N2c
bilateral or contralateral nodes
Head & Neck N3
> 6cm
Lip and oral cavity T1
<2cm
Lip and oral cavity T2
2-4cm
Lip and oral cavity T3
> 4cm
Lip and oral cavity T4a
Lip: invades bone, inferior alveolar nerve, floor of mouth, or skinOral cavity: invades bone, extrinsic tongue muscles, maxillary sinus, skin
Lip and oral cavity T4b
invades masticator space, pterygoid plates, skull base, or encasing carotid
Supraglottic larynx T1
limited to one subsite of supraglottis
Supraglottic larynx T2
invades more than one supraglottic subsite, glottis, or region outside the supraglottis (mucosa of base of tongue, vallecula, medial wall of pyriform sinus)
Supraglottic larynx T3
vocal cord fixation, invades postcricoid area, pre-epiglottic tissues, paraglottic space, or inner cortex of thyroid cartilage
Supraglottic larynx T4a
invades through thyroid cartilage, invades tissues beyond the larynx (trachea, deep tongue muscles, thyroid, esophagus)
Supraglottic larynx T4b
invades prevertebral space, mediastinal structures, or encasing carotid
Glottic larynx T1a
involves one vocal cord (normal mobility)
Glottic larynx T1b
involves both vocal cords (normal mobility)
Glottic larynx T2
impaired vocal cord mobility or involving supraglottic or subglottic larynx
Glottic larynx T3
vocal cord fixation, invasion of paraglottic space or inner cortex of thyroid cartilage
Glottic larynx T4a
invades outer cortex of thyroid cartilage or tissues beyond larynx
Glottic larynx T4b
invades prevertebral space, mediastinal structures, or encasing carotid
NSCLC T1a
<2cm
NSCLC T1b
2-3cm
NSCLC T2
3-7cm, involving main bronchus >2cm distal to carina, invades visceral pleura, atelectasis extending to hilar region but not involving entire lung
NSCLC T3
> 7cm, invades parietal pleura, diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium, involves main bronchus <2cm from carina, atelectasis of entire lung, separate nodules in same lobe
NSCLC T4
invades mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina, or nodules in separate ipsilateral lobes
NSCLC N1
ipsilsteral intrapulmonary, peribronchial, or hilar nodes
NSCLC N2
ipsilateral mediastinal or subcarinal nodes
NSCLC N3
contralateral mediastinal or hilar nodes, scalene or supraclavicular nodes
Breast T1mi
<1mm
Breast T1a
<0.5cm
Breast T1b
0.5-1cm
Breast T1c
1-2cm
Breast T2
2-5cm
Breast T3
> 5cm
Breast T4a
extension to chest wall not including pectorals muscle adherence/invasion
Breast T4b
ulceration, edema / peau d’orange
Breast T4c
both T4a and T4b
Breast T4d
inflammatory carcinoma
Breast cN1
mobile axillary nodes (levels 1-2)
Breast cN2a
fixed/matted axillary nodes (levels 1-2)
Breast cN2b
internal mammary nodes without axillary nodes
Breast cN3a
ipsilateral infraclavicular nodes
Breast cN3b
ipsilateral internal mammary AND axillary nodes
Breast cN3c
ipsilateral supraclavicular nodes
Breast pN1a
1-3 axillary nodes
Breast pN2a
4-9 axillary nodes
Breast pN3a
10 or more axillary nodes or infraclavicular node involvement (level 3)
Esophagus T1a
invades mucosa (lamina propria or muscularis mucosa)
Esophagus T1b
invades submucosa
Esophagus T2
invades muscularis propria
Esophagus T3
invades adventitia
Esophagus T4a
Resectable tumor that invades pleura, pericarcium, or diaphragm
Esophagus T4b
Unresectable tumor that invades adjacent structures
Esophagus N1
1-2 regional nodes
Esophagus N2
3-6 regional nodes
Esophagus N3
7 or more regional nodes
Rectum T1
invades submucosa
Rectum T2
invades muscularis propria
Rectum T3
invades through muscularis propria into pericolorectal tissue
Rectum T4
invades adjacent structures
Rectum N1
1-3 nodes
Rectum N2a
4-6 nodes
Rectum N2b
7 or more nodes
Anus T1
<2cm
Anus T2
2-5cm
Anus T3
> 5cm
Anus T4
invades adjacent organs
Anus N1
perirectal lymph nodes
Anus N2
unilateral internal iliac and/or inguinal nodes
Anus N3
perirectal AND inguinal nodes, bilateral internal iliac or inguinal nodes
Prostate T1a
incidental finding in less than 5% of tissue
Prostate T1b
incidental finding in more than 5% of tissue
Prostate T1c
tumor identified by needle biopsy (not palpable)
Prostate T2a
involves less than half of one lobe
Prostate T2b
involves more than half of one lobe
Prostate T2c
involves both lobes
Prostate T3a
extracapsular extension
Prostate T3b
seminal vesical invasion
Prostate T4
invasion of other organs/structures
Cervix FIGO IA1
depth of invasion <7mm
Cervix FIGO IA2
depth of invasion 3-5mm, horizontal spread <7mm
Cervix FIGO IB1
clinically visible lesion <4cm
Cervix FIGO IB2
clinically visible lesion >4cm
Cervix FIGO IIA1
<4cm and involves upper vagina
Cervix FIGO IIA2
> 4cm and involves upper vagina
Cervix FIGO IIB
parametrial invasion
Cervix FIGO IIIA
invades lower third of vagina
Cervix FIGO IIIB
extends to pelvic wall or causes hydronephrosis and/or nonfunctioning kidney
Cervix FIGO IVA
invades mucosa of bladder or rectum and/or extends beyond the true pelvis
Cervix: what FIGO stage is regional node involvement?
FIGO IIIB
Endometrium FIGO IA
invades less than half of the myometrium
Endometrium FIGO IB
invades more than half of the myometrium
Endometrium FIGO II
cervical stromal invasion
Endometrium FIGO IIIA
involves ovaries or uterine serosa
Endometrium FIGO IIIB
involves vagina or parametrium
Endometrium FIGO IVA
invades bladder or bowel mucosa
Endometrium: what FIGO stage is pelvic node involvement?
FIGO IIIC1
Endometrium: what FIGO stage is para-aortic node involvement?
FIGO IIIC2
Vulva FIGO IA
<1mm depth of invasion
Vulva FIGO IB
> 2cm in size OR >1mm depth of invasion
Vulva FIGO II
involves distal 1/3 urethra, distal 1/3 vagina, or anus
Vulva FIGO IVA
involves upper 2/3 urethra, upper 2/3 vagina, bladder, rectum, or is fixed to pelvic bone
Subsites of supraglottic larynx
false vocal cords, arytenoids, suprahyoid epiglottis, infrahyoid epiglottis, aryepiglottic folds
What are the 5 subsites of the oropharynx?
soft palate, palatine tonsils, tonsillar pillars, base of tongue (lingual tonsils), paryngeal wall
1cm BOT tumor with no cervical nodes
T1N0, stage I (T1N0)
2.5cm left tonsil tumor with no cervical nodes
T2N0, stage II (T2N0)
5cm tumor of soft palate with no cervical nodes
T3N0, stage III (T3 or N1)
3cm BOT tumor extending to lingual surface of epiglottis with single 2cm node
T3N1, stage III (T3 or N1)
BOT tumor invading the medial pterygoid with single 2cm node
T4aN1, stage IVA (T4a or N2)
2cm tumor of left tonsil with 4cm left cervical node
T1N2a, stage IVA (T4a or N2)
1cm left tonsil tumor with 1cm right cervical node
T1N2c, stage IVA (T4a or N2)
left tonsil tumor invading lateral pterygoid with no cervical nodes
T4bN0, stage IVB (T4b or N3)
BOT tumor extending to lingual surface of epiglottis with 7cm cervical node
T3N3, stage IVB (T4b or N3)
metastatic oropharyngeal cancer
stage IVC
Oropharynx T1
<2cm
Oropharynx T2
2-4cm
Oropharynx T3
> 4cm or extension to lingual surface of epiglottis
Oropharynx T4a
invading larynx, extrinsic tongue muscles, medial pterygoid, hard palate, or mandible
Oropharynx T4b
invading lateral pterygoid, pterygoid plates, lateral nasopharynx, skull base, or encasing carotid
Head & Neck N1
single ipsilateral node <3cm
Head & Neck N2a
single ipsilateral node 3-6cm
Head & Neck N2b
multiple ipsilateral nodes
Head & Neck N2c
bilateral or contralateral nodes
Head & Neck N3
> 6cm
Maxillary sinus T1
tumor limited to mucosa of maxillary sinus WITHOUT bone invasion
Maxillary sinus T2
bone invasion (excluding posterior wall)
Maxillary sinus T3
invasion of posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygod fossa, ethmoid sinuses
Maxillary sinus T4a
invasion of anterior orbit, skin of cheek, pterygoid plates, infratemporal fossa, cribriform plate, sphenoid sinus, frontal sinus
Maxillary sinus T4b
invasion of orbital apex, dura, brain, middle cranial fossa, cranial nerves (excluding V2), nasopharynx, or clivus
What are the 8 subsites of the oral cavity?
lips, gingiva, alveolus / alveolar ridge, buccal mucosa, retromolar trigone, hard palate, floor of mouth, oral tongue
criteria for stage III head and neck cancer
T3 or N1
criteria for stage IVA head and neck cancer
T4a or N2
criteria for stage IVB head and neck cancer
T4b or N3
Lip and oral cavity T1
<2cm
Lip and oral cavity T2
2-4cm
Lip and oral cavity T3
> 4cm
Lip and oral cavity T4a
Lip: invades bone, inferior alveolar nerve, floor of mouth, or skinOral cavity: invades bone, extrinsic tongue muscles, maxillary sinus, skin
Lip and oral cavity T4b
invades masticator space, pterygoid plates, skull base, or encasing carotid
5 subsites of supraglottic larynx
false vocal cords, arytenoids, suprahyoid epiglottis, infrahyoid epiglottis, aryepiglottic folds
Supraglottic larynx T1
limited to one subsite of supraglottis
Supraglottic larynx T2
invades more than one supraglottic subsite, glottis, or region outside the supraglottis (mucosa of base of tongue, vallecula, medial wall of pyriform sinus)
Supraglottic larynx T3
vocal cord fixation, invades postcricoid area, pre-epiglottic tissues, paraglottic space, or inner cortex of thyroid cartilage
Supraglottic larynx T4a
invades through thyroid cartilage, invades tissues beyond the larynx (trachea, deep tongue muscles, thyroid, esophagus)
Supraglottic larynx T4b
invades prevertebral space, mediastinal structures, or encasing carotid
Glottic larynx T1a
involves one vocal cord (normal mobility)
Glottic larynx T1b
involves both vocal cords (normal mobility)
Glottic larynx T2
impaired vocal cord mobility or involving supraglottic or subglottic larynx
Glottic larynx T3
vocal cord fixation, invasion of paraglottic space or inner cortex of thyroid cartilage
Glottic larynx T4a
invades outer cortex of thyroid cartilage or tissues beyond larynx
Glottic larynx T4b
invades prevertebral space, mediastinal structures, or encasing carotid
Subglottic larynx T1
limited to subglottis
Subglottic larynx T2
extends to vocal cords with normal or impaired vocal cord mobility
Subglottic larynx T3
vocal cord fixation
Subglottic larynx T4a
invades cricoid cartilage, thyroid cartilage, or tissues beyond larynx
Subglottic larynx T4b
invades prevertebral space, mediastinal structures, or encasing carotid
Hypopharynx T1
<2cm, limited to one subsite of hypopharynx
Hypopharynx T2
2-4cm, involves more than one subsite of hypopharynx
Hypopharynx T3
> 4cm, fixation of hemilarynx, invasion of esophagus
Hypopharynx T4a
invades thyroid cartilage, cricoid cartilage, hyoid bone, or thyroid gland
Hypopharynx T4b
invades prevertebral space, mediastinal structures, or encasing carotid
CROSS trial: P/D/R
P: 366 patients with resectable esophageal cancerD: surgery +/- neoadjuvant CRT (carboplatin, paclitaxel, 41.4Gy)R: improved OS with CRT (49mo vs. 24mo)
What percentage of patients on the CROSS trial had adeno vs. SCCa?
75% adenocarcinoma23% squamous cell carcinoma2% large cell undifferentiated carcinoma
Cross trial:overall path CRadeno path CRSCCa path CR
overall path CR: 29%adeno path CR: 23%SCCa path CR: 49%
RTOG 9405 / INT 0123 (Minsky trial): P/D/R
P: 236 patients with T1-4 N0-1 M0 esophageal cancerD: concurrent chemotherapy (cisplatin/5-FU) with radiation to 50.4Gy vs. 64.8GyR: no difference in OS or LRR with higher radiation dose, multiple deaths in dose escalation arm occurred early in treatment
RTOG 8501: P/D/R
P: 121 patients with esophageal cancerD: CRT (cisplatin/5-FU, 50Gy) vs. RT alone (64Gy)R: initial randomized portion closed early due to improved OS with CRT, 5yr OS 26% vs. 0%
What chemotherapy regimens were used for the following:RTOG 8501RTOG 9405CROSS trial
RTOG 8501: cisplatin/5-FURTOG 9405: cisplatin/5-FUCROSS trial: carboplatin/paclitaxel
What radiation doses were used in the following:RTOG 8501RTOG 9405CROSS trial
RTOG 8501: 50Gy with chemo, 64Gy aloneRTOG 9405: 50.4Gy, 64.8Gy (both with concurrent chemo)CROSS trial: 41.4Gy with chemo
What are the two main studies supporting RT for DCIS?
NSABP B-17, EBCTCG meta-analysis
What studies were included in the EBCTCG meta-analysis for DCIS?
SweDCIS, EORTC, UK/ANZ, NSABP B-17
What was the IBTR with and without RT in NSABP B-17?
32% vs. 16%
What was the IBTR with and without RT in the EBCTCG meta-analysis for DCIS?
28% vs. 13%
What are the two main studies supporting observation following lumpectomy for DCIS?
RTOG 9804, ECOG (Hughes)
RTOG 9804: entry criteria and difference in IBTR
low or intermediate grade 3mm, IBTR 6.7% vs. 0.9%
ECOG (Hughes): entry criteria
low or intermediate grade 3mm
ECOG (Hughes): IBTR by grade and age
low/int grade: 10.5% (7yrs)high grade: 15.3%high grade age 45: 10%
Rate of tamoxifen use in RTOG 9804 and ECOG (Hughes)
RTOG 9804 - 62%ECOG (Hughes) - 40%
What is the main study supporting the use of tamoxifen in DCIS?
NSABP B-24 (50Gy + TAM 5 years vs. 50Gy alone)
NSABP B-24: IBRT
15% vs. 11%
What are the two main studies supporting adjuvant RT for early stage breast cancer?
NSABP B-06, EBCTCG meta-analysis
NSABP B-06: design
mastectomy vs. lumpectomy vs. lumpectomy + 50Gy, all underwent axillary dissection
NSABP B-06: IBTR, OS
IBTR: 39% vs 14%OS: no difference
What were the major trials included in the EBCTCG meta-analysis for early stage breast cancer?
NSABP B-06, Milan I, EORTC, Danish, NCI, Gustave-Roussy
EBCTCG meta-analysis for early stage breast cancer: 10 year IBTR and BCM (N0 and N+)
IBTR: 35% vs. 19%BCM pN0: 21% vs. 17%BCM pN+: 51% vs. 43%
What is the main study supporting adjuvant RT and tamoxifen for early stage breast cancer?
NSABP B-21
NSABP B-21: design
TAM vs. TAM + 50Gy vs. placebo + 50Gy
NSABP B-21: IBTR
TAM alone: 17%RT alone: 9%TAM + RT: 3%
What are the two main studies evaluating boost for early stage breast cancer?
EORTC (Bartelink), Lyon
EORTC breast boost trial: design
T1-2, N0-1, s/p lumpectomy and axillary dissection, 50Gy +/- 16Gy boost
EORTC breast boost trial: IBTR by age
50yrs: 7% vs 4%
Canadian (Whelan) hypofrac trial: design
T1-2 N0 post-lumpectomy, 42.5Gy/16 vs 50Gy/25, no boost
START B: design
T1-3, N0-1 post lumpectomy, 40Gy/15 vs 50Gy/25, 61% received 10Gy boost
What is the main study support observation following lumpectomy for elderly patients with early stage breast cancer?
CALGB (Hughes)
CALGB (Hughes): design
> 70yrs, T1N0, ER+, TAM + RT (45Gy + 14Gy boost) vs TAM alone
CALGB (Hughes): IBTR 10yrs
IBTR: 10% vs 2%
NSABP B-04: design
cN0: radical mastectomy vs. total mastectomy vs. total mastectomy + axillary RTcN+: radical mastectomy vs. total mastectomy + axillary RT
NSABP 32: design
SLNBx (with ALND if positive) vs. upfront ALND
Z11: design
SLNBx positive: ALND + RT vs. RT alone
AMAROS: design
SLNBx positive: ALND vs. RT
DBCG 82b/c: high risk criteria
T3-4 or N+
DBCG 82b: design
premenopausal patients: CMF + RT vs. CMF alone(cyclophosphamide, methotrexate, 5-FU)
DBCG 82c: design
postmenopausal patients
EBCTCG meta-analysis PMRT: BCM by nodes (20yrs)
N0: no OS differenceN1: BCM 42% vs. 50%N2+: BCM 70% vs. 80%
Patchell I: design
surgery + WBRT vs. biopsy + WBRT
Patchell I: median OS
3mo vs. 9mo
Patchell I: what percentage of patients were found to not have metastases?
11%
Patchell II: design
surgery +/- WBRT (50.4Gy!)
Patchell II: brain recurrence
70% vs. 18%
RTOG 9508: design
1-3 brain mets, WBRT + SRS boost vs. WBRT alone
RTOG 9508: results
SRS boost improved median survival by 1-2 months for patients with single met
RTOG 9402: design
WHO grade III glioma, PCV + RT vs. RT alone(procarbazine, CCNU (lomustine), vincristine)
RTOG 9402: results
No difference in OS with RT, patients with 1p-19q codeletion MS 14.7 yrs vs. 7.3 yrs for patients without codeletion
RTOG 9802: design
WHO grade II glioma, observation for low risk (age
RTOG 9802: results
MS 13.3yrs vs. 7.8yrs - addition of PCV to radiation improves survival in high risk WHO grade II glioma
EORTC “believers trial”: design
WHO grade I-II, adjuvant RT 45Gy vs. 59.4Gy
EORTC “believers trial”: results
no difference in overall survival or progression free survival with dose escalation
EORTC “nonbelievers trial”: design
WHO grade I-II, adjuvant RT 54Gy vs. observation
EORTC “nonbelievers trial”: results
5yr PFS 55% vs. 35%, no difference in OS
EORTC, anal cancer (Bartelink): design
RT with concurrent 5FU/mitomycin vs. RT alone
EORTC, anal cancer (Bartelink): results
5yr LC 68% vs. 50%colostomy free survival 72% vs. 40%no difference in OS
UKCCCR ACT I: design
RT with concurrent 5FU/mitomycin vs. RT alone
UKCCCR ACT I: results
chemo improved LC and CFS but no improvement in OS
What are the two main studies supporting the addition of chemotherapy to RT for anal cancer?
EORTC (Bartelink), UKCCCR ACT I
What are the two main studies evaluating mitomycin vs cisplatin for anal cancer?
ACT II, RTOG 9811
ACT II: results
similar toxicity, no difference in LC, CFS, or OS
RTOG 9811: results
mitomycin improved 5yr OS (78% vs 71%) and CFS (725 vs 65%)
What was the clinical question/answer with RTOG 0529?
anal cancer, when compared to results from RTOG 9811, IMRT results in reduced skin, GI, and heme toxicity
CROSS trial: design
surgery alone vs. surgery with neoadjuvant CRT (41.4Gy, carboplatin/paclitaxel)
CROSS trial: 5yr OS results
5yr OS 47% vs 34%
CROSS trial: pCR rate(s)
pCR 29% (23% for adeno, 49% for SCCa)
RTOG 8501: design
esophageal cancer definitive treatment, 64Gy vs. 50Gy + cisplatin/5FU
RTOG 8501: 5yr OS
26% vs. 0%
RTOG 9405 (Minsky): design
50.4Gy + 5FU/cisplatin vs. 64.8Gy + 5FU/cisplatin
RTOG 9405 (Minsky): results
closed early, excess early deaths in dose escalation arm
MAGIC trial: design
gastric cancer, surgery alone vs. surgery + pre and post-op ECF chemotherapy(epirubicin, cisplatin, 5FU)
What chemo was used in the MAGIC trial?
ECF (epirubicin, cisplatin, 5FU)
MAGIC trial: 5yr OS results
5yr OS 36% vs. 23%
Intergroup / SWOG gastric cancer study: design
post-op observation vs. 45Gy + 5FU/leucovorin
Intergroup / SWOG gastric cancer study: 5yr OS and criticisms
5yr OS 44% vs. 26%, D1 resection in 50%, D2 resection in 10%
ARTIST trial: design
gastric cancer s/p surgery with D2 resection, adjuvant capecitabine/cisplatin vs. sequential chemo/RT/chemo
ARTIST trial: results
no difference in OS, possibly due to extensive surgical resection (D2)
CONKO: design
pancreas s/p resection, observation vs. gemcitabine
CONKO: MS results
MS 22mo vs 20mo
GITSG resectable pancreas: design
surgery alone vs. surgery + adjuvant RT + 5FU (40Gy split course)
GITSG resectable pancreas: MS results
MS 20mo vs. 11mo
EORTC resectable pancreas: design
adjuvant observation vs. CRT (40Gy split course, 5FU)
EORTC resectable pancreas: results
no difference in PFS or OS with adjuvant CRT, per Bill Regine there is a benefit if a one-sided t-test is used
ESPAC-1: design
2x2 factorial design, RT 40Gy, 5FU chemotherapy
ESPAC-1: results and criticisms
reduced survival with patients receiving RT, not really randomized, no RT quality assurance, wide range of RT doses used
RTOG 9704: design
adjuvant 5FU vs gemcitabine(5FU vs gem -> 50.4Gy with 5FU -> 5FU vs gem)
RTOG 9704: results
nonsignificant trend toward improved survival with gemcitabine
NEJM FOLFIRINOX vs. gemcitabine for metastatic pancreatic cancer: results
MS 11mo vs 7mo(leucovorin, 5FU, irinotecan, oxaliplatin)
Dutch rectal cancer study: design and results
design: preop RT (25Gy/5) + TME vs. TME alone,results: 10yr LR 5% vs 11%
Swedish rectal cancer study: design and results
design: preop RT (25Gy/5) + surgery vs. surgery alone (TME not used)results: 13yr OS 38% vs. 30%, LR 9% vs 27%
German rectal cancer study: design
preop CRT (50.4Gy, 5FU) vs postop CRT (50.4Gy, 5.4Gy boost, 5FU)
German rectal cancer study: results
5yr LR 6% vs. 13% favoring preop
Rectal cancer: what was the pCR rate on the German rectal cancer study and NSABP R-04?
German: pCR 8% (concurrent 5FU)NSABP R-04: pCR 21% (concurrent capecitabine)
BC2001: design
two randomizations:1. concurrent 5FU/mitomycin vs. no chemo2. standard volume RT vs. reduced high dose volume RT
BC2001: results
nonsignificant trend toward improved OS with chemotherapy (48% vs 35%)
RTOG meta-analysis for bladder preservation: pCR, 5yr intact bladder, 5yr OS
pCR 69%5yr intact bladder 80%5yr OS 57%
seminoma, MRC 18: design and results
PA field, adjuvant 30Gy vs 20Gy, no difference in local control
seminoma, MRC 10: design and results
30Gy, dogleg vs. para-aortic field, less toxicity with PA field but slightly increased risk of pelvic relapse
Bill-Axelson / Scandinavian study: entry criteria and design
age 10yrs, operable T1-2, PSA
Bill-Axelson / Scandinavian study: results
improved survival in men
What are the eight dose escalation studies in prostate cancer?
- MDACC (Pollack)2. Brazil meta-analysis3. GETUG4. Dutch5. MGH PROG6. MRC RT017. Ontario8. Fox Chase
MDACC prostate dose escalation: design and results
70Gy vs. 78Gy, failure free survival significantly improved with dose escalation
EORTC high risk prostate (Bolla): design
RT 70Gy +/- concurrent and adjuvant ADT (36mos)
EORTC high risk prostate (Bolla): 10yr OS results
10yr OS 58% vs 40%
RTOG 9202: design
mostly high risk patients, RT 65-70Gy and 4mos NCADT +/- 24mos adjuvant ADT
RTOG 9202: results
long term ADT improved LR and CSS; OS improvement in GS 8+ patients
GOG 122: population and design
stage III or IV endometrial cancer s/p resection, adjuvant chemo (doxorubicin/cisplatin) vs. WART (30Gy + 15Gy boost)
GOG 122: 5yr OS
5yr OS 53% vs 42%
GOG 37 (Homesley): population and design
vulvar cancer with positive groin nodes after vulvectomy and lymphadenectomy; pelvic node dissection vs. RT to bilateral pelvic and inguinal nodes
GOG 37 (Homesley): 6yr OS
6yr OS 41% vs. 51%
GOG 88: population and design
vulvar cancer, clinically N0; vulvectomy + groin dissection vs. vulvectomy + adjuvant inguinal RT (50Gy)
GOG 88: results and criticism
LR 19% vs. 0%; 20% received groin dissection and RT, OS 88% vs 63%, RT was prescribed to 3cm and often underdosed
GOG 92 (Sedlis): population and design
stage IB, two of 3 criteria (>1/3 stromal invasion, LVSI, >4cm tumor), all had radical hysterectomy and pelvic lymphadenectomy, randomized to adjuvant RT vs. observation
GOG 92 (Sedlis): 10yr LR and OS
10yr LR 21% vs 14%10yr OS 80% vs 71% (NS)
GOG 109 (Peters): population and design
stage IA2-IIA s/p radical hysterectomy with positive nodes, positive nodes, OR parametrial invasion; RT +/- chemo (cisplatin, 5FU)
GOG 109 (Peters): 4yr OS
4yr OS 71% vs 81%
GOG 123 (Keys): population and design
IB2 cervical cancer, RT -> hyst vs. CRT -> hyst
GOG 123 (Keys): 3yr OS
3yr OS 74% vs 83%
GOG 120: population and design
cervical cancer stage IIB-IVA, definitive CRT with cisplatin vs hydroxyurea vs both
GOG 120: results
OS better with weekly cisplatin; less toxicity with cisplatin vs. cisplatin + hydroxyurea
RTOG 9001: population and design
cervical cancer stage IIB-IVA, RT vs CRT (cisplatin, 5FU)
RTOG 9001: 8yr OS
8yr OS 41% vs 67%
RTOG 7920: population, design, results
cervical cancer IB-IIB, WPRT vs EFRT, improved OS with EFRT
