Chemo-Radiation in Advanced Stage Carcinoma Cervix
|
|
|
- Laura Curtis
- 7 years ago
- Views:
Transcription
1 Chemo-Radiation in Advanced Stage Carcinoma Cervix Green Meta-analysis Update Cochrane Database Syst Rev 05 Lukka Meta-analysis, Clin Oncol 02 Cochrane Review: Green et al, The Lancet 01 Green Meta-analysis, The Lancet 01 Canadian Meta-analysis analysis : Lukka et al, Clin Oncol 02 Pearcey, Proc ASCO 00 [abst] NCI Clinical Announcement 1999 Tseng, Rose, Keys, Morris, Peters, Whitney Wong, Gynecol Oncol 89 Green et al meta-analysis analysis on concurrent chemoradiation: Update Cochrane Database Syst Rev, 2005;Jul 20: (3)
2 Critical Review of 5 trials AUTHOR ARMS RESULTS COMMENTS CRITICISMS Whitney et al (GOG-85) IIB-IIIB RT+Cisplatin / 5FU RT+HU OS-55% 43% Better PFS and OS than HU with manageable toxicity 1. Comparison of two CTRT regimens 2. No RT alone arm 3. Sub optimal (81Gy to pt A) 4. protracted RT (median duration 63 days) Morris et al (RTOG 9001) IB- IVA RT+Cisplatin 5FU + RT OS-73% 58% CT had a survival advantage with decrease in both LR and distant failure 1. RT optimal, 89Gy to pt A, 58 days 2. Survival benefit in IB-IIB, not in adv stage Keys et al (GOG-123) Bulky IB RT+Cisplatin+ SX RT+ SX OS-83% 74% Significant differences in PFS and OS favoring CTRT 1. Suboptimal RT dose 2. Trial for pre op regimen IB only 4/6/2010 2
3 AUTHOR ARMS RESULTS COMMENTS CRITICISMS Peters et al IA2-IIA SX+RT+Cisplatin/5 FU SX+RT OS-80% 63% Survival favored the chemoradiotherapy arm 1. Post op RT, no brachy 2. Early stage Rose et al (GOG 120) IIB-III- IVA RT+Cisplatin RT+Cisplatin/5FU/H U RT+HU PFS 67% 64% 47% Superiority of concomitant CTRT regimen with cis alone was less toxic then 3 drug regimen 1. No RT alone arm 2. Comparison of 3 ctrt regimens 3. Low total RT dose & protracted Rx time 4/6/2010 3
4 BACKGROUND AND RATIONALE NATIONAL CANCER INSTITUTE CLINICAL ANNOUNCEMENT CONCURRENT CHEMORADIATION FOR CERVICAL CANCER in February 1999 Five major randomized phase III trials show that platinum based chemo when given concurrently with RT prolongs survival in women with locally advanced cervical cancer stages Ib2 - IVa as well as in women with stage I / IIa found to have metastatic pelvic lymph nodes, positive parametrial disease and positive surgical margins at the time of primary surgery
5 Cochrane Collaborative Group (19 Trials) Meta - analysis Green JA et al Lancet 358;781 (Sept. 2001) 19 RCTs between 1981 and 2000 : 4580 pts Increase in OAS by 12% & RFS by 16% (absolute benefit) (p=0.0001) Greater benefit in patients in stages IB2 and IIB Decrease in local and systemic recurrence (p=0.0001) Update in July 2005: 21 trials and 4921 pts Similar findings (absolute benefit: 10%) Test for Heterogeneity : Positive No data on late toxicities Cochrane Database Syst Rev Jul 20;(3):CD
6 Canadian Group (9 Trials) - 4 year survival data Meta-analysis Cisplatin based Concomitant Chemo-radiation Significant improvement in Overall Survival - Advanced Stages (Only 30% tumors) - Bulky IB tumors (prior to surgery) - High risk early disease (post-surgery) Toxicities Acute Grade 3/4 Hematological and G.I significantly higher : all short lived 2 deaths due to the toxicities No significant late toxicities seen Lukka et al, Clinical Oncology 14;203(June 2002)
7 Critical Review of Trials Chemo-radiation in Carcinoma Cervix Heterogenous patient data Suboptimal Radiotherapy Schedules Used Non-uniform use of CT drugs and Sequencing QOL issues : Unknown Cost effectiveness? Hence Concomitant chemo-radiation needs to be tested optimally in our setting Sparse literature form Developing Countries
8 Chemo-Radiation in Advanced Stage Carcinoma Cervix (FIGO IIIB): A Phase III Randomized Trial (CRACx Trial) HSRC / HEC Project No: 114/2003 Clinicaltrials.gov ID : NCT Protocol ID : TMH/114/2003/CRACx TRIAL TMC Cervix Working Group
9 Chemo-Radiation in Advanced Carcinoma Cervix (CRACx Trial ): 2003 Carcinoma Cervix Stage FIGO IIIB 425 patients Radical Radiotherapy Ext RT+ICA 50 Gy(MLB at 40)/5wks + LDR/HDR LDR: 30Gy or HDR: 7Gyx3# 425 patients Concomitant chemotherapy weekly Cisplatin and Radiotherapy Hypothesis: Improvement in OAS by 10% (35% to 45%) Power of detection: 80% (alpha error: 0.05) Intent to treat basis Accrual Period: 5-6 years Interim analysis : Twice One at 50 % and another at 75 % event rates
10 Chemo-Radiation in Advanced Carcinoma Cervix (CRACx Trial ) Primary Aims & Objectives 1. To compare the overall and disease free survivals 2. To compare acute toxicities 3. To evaluate single agent chemotherapy Cisplatin Secondary 1. To compare distant metastasis rate. 2. To compare late toxicities in both groups.
11 Chemo-Radiation in Advanced Carcinoma Cervix (CRACx Trial ) Pre-treatment Evaluation Pelvic Examination / EUA (sos( sos) ) / Gynae Joint Clinic Complete Blood Profile Serum Biochemistry (Liver+Renal( functions+ Electrolytes) Chest X-RayX USG (A + P) / CT Scan (A+P) : Optional ECG Cystoscopy: : if indicated.
12 Chemo-Radiation in Advanced Carcinoma Cervix (CRACx Trial ) Inclusion Criteria Squamous carcinoma Performance index WHO Grade 0 or 1 Age < 65 years FIGO stage IIIB Normal ECG and Cardiovascular systems Normal hematological parameters. Normal renal & liver function test. Exclusion Criteria Co-morbid conditions like medical renal disease. Medical or psychological condition that would preclude Rx. History of previous treatment. Patient unreliable for treatment completion & follow-up.
13 Chemo-Radiation in Advanced Carcinoma Cervix (CRACx Trial ) External RT : Whole Pelvis with AP/PA or four field box technique Dose : 50 Gy / 25 # / 5 Weeks (40 Gy open + 10 Gy with MLB) Brachytherapy : LDR : 30 Gy X 1 # to pt A Or HDR : 7 Gy X 3 # to pt A Treatment Protocol Chemotherapy Patient randomised to CT+ RT receive Inj. Cisplatin 40 mg/m2 wkly
14 Chemo-Radiation in Advanced Carcinoma Cervix (CRACx Trial ) Evaluation of Response & Toxicity Response : WHO Criteria Toxicity Scoring Acute toxicities : CTC version 2.0 Late toxicities : RTOG / LENT-SOMA scoring criteria. Follow Up : Clinical examination, Assessment of tumor response, late complications & relevant investigations / Rx will be done accordingly 1 st follow-up: 6-10 weeks Subsequently every 3-4 mths for the first 2 years. 6 monthly thereafter
15 Chemo-Radiation in Advanced Carcinoma Cervix (CRACx Trial ) ACCRUAL DETAILS Study Started : August 2003 Pts randomised till Nov Audit of pts till Dec : 627 pts : 528 pts Planned Accrual Completion : Dec 2009 Interim Analysis : Jan 2010 Final Analysis : Dec 2011
16 Chemo-Radiation in Advanced Carcinoma Cervix (CRACx Trial ) AUDIT Audit of pts till Dec RT Alone CT + RT Randomization Analysis : 528 pts : 255 pts : 263 pts : Computerized (open label) : ITT
17 Chemo-Radiation in Advanced Carcinoma Cervix (CRACx Trial ) Cisplatin Chemotherapy Compliance No of Cycles No of pts (263 pts) 6# # 226 (4#: 43 pts) 3# 17 2# 7 (1pt had single kidney) 0-1# 10 (Incomplete Rx)
18 Chemo-Radiation in Advanced Carcinoma Cervix (CRACx Trial ) RESPONSE RATES (6-10 weeks Post Rx) RT Alone 255 pts CT + RT 263 pts CR PR Prog.. Disease Not assessed* * 6-10 weeks Post Rx not completed
19 Chemo-Radiation in Advanced Carcinoma Cervix (CRACx Trial ) GI GU Skin Anemia Neutropenia Thrombocytopenia ACUTE TOXICITIES RT Alone 255 pts Gr II Gr III (4.7%) Gr II 15 Gr III 10 (4%) Gr II 63 Gr III 29 Gr II 24 Gr III 5 (2%) Gr II 06 Gr III 02 (0.7%) Gr II 01 Gr III 02 (0.7%) CT + RT* 263 pts (7%) (5.7%) (5.7%) (3.5%) (3.5%) * 1 pt Dyselectrolytemia and death & 2 pt Gr IV Oto-toxicity (Irreversible)
20 Chemo-Radiation in Advanced Carcinoma Cervix (FIGO IIIB) (CRACx Trial ) N= 486 pts: Follow-up: Median: 24 months (3-48 months) RT ALONE (255 pts) CT + RT (263 pts) Recurrences Progressive Disease Loco-regional Recurrence LR + Distant Recurrence Distant Mets Died due to Rx Complications 01 (Unknown) 01 Lost to follow-up (after FU) * Acute Gr II/III Genitourinary/hematological toxicities higher in CT+ RT arm * Grade II / III Procitiits seen in 7 pts in each arm so far Ongoing
21 Chemo-Radiation in Advanced Carcinoma Cervix (CRACx Trial ) AUDIT SUMMARY Acute Grade III GI and Hematological toxicities : Higher with CT+ RT Recurrence event rates comparable so far Late toxicities yet to evaluated Cost benefit analysis most critical in our setting Completion of accrual and outcome analysis Report on 1 st Interim Analysis : Jan 2010
22 Thank You
Carcinoma of the Cervix. Kathleen M. Schmeler, MD Associate Professor Department of Gynecologic Oncology
Carcinoma of the Cervix Kathleen M. Schmeler, MD Associate Professor Department of Gynecologic Oncology Cervical Cancer Treatment Treatment Microinvasive (Stage IA1): Simple (extrafascial) hysterectomy/cone
Stomach (Gastric) Cancer. Prof. M K Mahajan ACDT & RC Bathinda
Stomach (Gastric) Cancer Prof. M K Mahajan ACDT & RC Bathinda Gastric Cancer Role of Radiation Layers of the Stomach Mucosa Submucosa Muscularis Serosa Stomach and Regional Lymph Nodes Stomach and Regional
Cervical Cancer: Definitive Chemoradiation
Cervical Cancer: Definitive Chemoradiation Huma Chaudhry Jordan Kharofa Faculty: Dr. Beth Erickson, MD Medical College of Wisconsin Department of Radiation Oncology July 14, 2013 Clinical Presentation
Radiotherapy in locally advanced & metastatic NSC lung cancer
Radiotherapy in locally advanced & metastatic NSC lung cancer Dr Raj Hegde. MD. FRANZCR Consultant Radiation Oncologist. William Buckland Radiotherapy Centre. Latrobe Regional Hospital. Locally advanced
Invasive Cervical Cancer. Kathleen M. Schmeler, MD Associate Professor Department of Gynecologic Oncology
Invasive Cervical Cancer Kathleen M. Schmeler, MD Associate Professor Department of Gynecologic Oncology Cervical Cancer Etiology Human Papilloma Virus (HPV): Detected in 99.7% of cervical cancers Cancer
Controversies in Management of. Inoperable NSCLC. Inoperable NSCLC. Introduction:
Inoperable NSCLC Controversies in Management of Inoperable NSCLC Introduction: It is difficult to overemphasize the magnitude of lung cancer as Public Health Problem in our society. - In US, Lung cancer
Concurrent Chemotherapy and Radiotherapy for Head and Neck Cancer
Concurrent Chemotherapy and Radiotherapy for Head and Neck Cancer Ryan J. Burri; Nancy Y. Lee Published: 03/23/2009 Abstract and Introduction Abstract Head and neck cancer is best managed in a multidisciplinary
Management of low grade glioma s: update on recent trials
Management of low grade glioma s: update on recent trials M.J. van den Bent The Brain Tumor Center at Erasmus MC Cancer Center Rotterdam, the Netherlands Low grades Female, born 1976 1 st seizure 2005,
Chemotherapy in Ovarian Cancer. Dr R Jones Consultant Medical Oncologist South Wales Gynaecological Oncology Group
Chemotherapy in Ovarian Cancer Dr R Jones Consultant Medical Oncologist South Wales Gynaecological Oncology Group Adjuvant chemotherapy for early stage EOC Fewer than 30% women present with FIGO stage
Monthly palliative pelvic radiotherapy in advanced carcinoma of uterine cervix
Original Article Free full text available from www.cancerjournal.net Monthly palliative pelvic radiotherapy in advanced carcinoma of uterine cervix Mishra Sanjib K, Laskar Siddhartha, Muckaden Mary Ann,
U.S. Food and Drug Administration
U.S. Food and Drug Administration Notice: Archived Document The content in this document is provided on the FDA s website for reference purposes only. It was current when produced, but is no longer maintained
How To Compare The Effects Of A Hysterectomy And A Hysterectomy
A RANDOMIZED TRIAL COMPARING RADICAL HYSTERECTOMY AND PELVIC NODE DISSECTION VS SIMPLE HYSTERECTOMY AND PELVIC NODE DISSECTION IN PATIENTS WITH LOW RISK EARLY STAGE CERVICAL CANCER A Gynecologic Cancer
Re irradiation Using HDR Interstitial Brachytherapy for Locally Recurrent. Disclosure
Re irradiation Using HDR Interstitial Brachytherapy for Locally Recurrent Cervical lcancer Yasuo Yoshioka, MD Department of Radiation Oncology Osaka University Graduate School of Medicine Osaka, Japan
Integrating Chemotherapy and Liver Surgery for the Management of Colorectal Metastases
I Congresso de Oncologia D Or July 5-6, 2013 Integrating Chemotherapy and Liver Surgery for the Management of Colorectal Metastases Michael A. Choti, MD, MBA, FACS Department of Surgery Johns Hopkins University
the standard of care 2009 5/1/2009 Mesothelioma: The standard of care take home messages PILC 2006 Jan.vanmeerbeeck@ugent.be Brussels, March 7, 2009
Mesothelioma: The standard of care Jan.vanmeerbeeck@ugent.be Brussels, March 7, 2009 take home messages PILC 2006 All patients should receive adequate palliation of dyspnea and pain before starting chemotherapy
Maintenance therapy in in Metastatic NSCLC. Dr Amit Joshi Associate Professor Dept. Of Medical Oncology Tata Memorial Centre Mumbai
Maintenance therapy in in Metastatic NSCLC Dr Amit Joshi Associate Professor Dept. Of Medical Oncology Tata Memorial Centre Mumbai Definition of Maintenance therapy The U.S. National Cancer Institute s
SMALL CELL LUNG CANCER
Protocol for Planning and Treatment The process to be followed in the management of: SMALL CELL LUNG CANCER Patient information given at each stage following agreed information pathway 1. DIAGNOSIS New
NCCN Non-Small Cell Lung Cancer V.1.2011 Update Meeting 07/09/10
Guideline Page and Request NSCL-3 Stage IA, margins positive delete the recommendation for chemoradiation. Stage IB, IIA, margins positive delete the recommendation for chemoradiation + Stage IIA, Stage
PRIMARY GLIOMA (oligodendroglioma, astrocytoma, oligodendroglioma, oligoastrocytoma, including anaplastic, gliosarcoma and glioblastoma multiforme)
Protocol for Planning and Treatment The process to be followed when a course of chemotherapy is required to treat: PRIMARY GLIOMA (oligodendroglioma, astrocytoma, oligodendroglioma, oligoastrocytoma, including
Van Cutsem E et al. Proc ASCO 2009;Abstract LBA4509.
Efficacy Results from the ToGA Trial: A Phase III Study of Trastuzumab Added to Standard Chemotherapy in First-Line HER2- Positive Advanced Gastric Cancer Van Cutsem E et al. Proc ASCO 2009;Abstract LBA4509.
How TARGIT Intra-operative Radiotherapy can help Older Patients with Breast cancer
How TARGIT Intra-operative Radiotherapy can help Older Patients with Breast cancer Jeffrey S Tobias, Jayant S Vaidya, Frederik Wenz and Michael Baum, University College Hospital, London, UK - on behalf
Corso Integrato di Clinica Medica ONCOLOGIA MEDICA AA 2010-2011 LUNG CANCER. VIII. THERAPY. V. SMALL CELL LUNG CANCER Prof.
Corso Integrato di Clinica Medica ONCOLOGIA MEDICA AA 2010-2011 LUNG CANCER. VIII. THERAPY. V. SMALL CELL LUNG CANCER Prof. Alberto Riccardi SMALL CELL LUNG CARCINOMA Summary of treatment approach * limited
Adjuvant Therapy Non Small Cell Lung Cancer. Sunil Nagpal MD Director, Thoracic Oncology Jan 30, 2015
Adjuvant Therapy Non Small Cell Lung Cancer Sunil Nagpal MD Director, Thoracic Oncology Jan 30, 2015 No Disclosures Number of studies Studies Per Month 12 10 8 6 4 2 0 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3
Approccio multidisciplinare nei tumori del retto
Approccio multidisciplinare nei tumori del retto F. Muñoz Radiation Oncology Department University of Torino, Italy RECENT CHANGES IN RECTAL CANCER DIAGNOSIS AND THERAPY Optimal staging by EUS and MRI
Neoadjuvant therapy are we doing it right? Short course and chemoradiation
Neoadjuvant therapy are we doing it right? Short course and chemoradiation Rob Glynne-Jones Mount Vernon Cancer Centre Relevant Endpoints in rectal cancer Local recurrence Disease-free survival Overall
ROLE OF RADIATION THERAPY FOR RESECTABLE LUNG CANCER
AFA 08958 From Bench to Bedside From KK DT1 10/27/2015 12:04 PM 01 ROLE OF RADIATION THERAPY FOR RESECTABLE LUNG CANCER Hak Choy, MD University of Texas Southwestern Medical Center Dallas, Texas, USA Orchestrating
SAKK Lung Cancer Group. Current activities and future projects
SAKK Lung Cancer Group Current activities and future projects SAKK Lung Cancer Group Open group of physicians interested in lung cancer Mostly Medical Oncologists, but also Thoracic Surgeons Radiation
Management of stage III A-B of NSCLC. Hamed ALHusaini Medical Oncologist
Management of stage III A-B of NSCLC Hamed ALHusaini Medical Oncologist Global incidence, CA cancer J Clin 2011;61:69-90 Stage III NSCLC Includes heterogeneous group of patients with differences in the
GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER
GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER BY Ali Shamseddine, MD (Coordinator); as04@aub.edu.lb Fady Geara, MD Bassem Shabb, MD Ghassan Jamaleddine, MD CLINICAL PRACTICE GUIDELINES FOR THE TREATMENT
Implementation Date: April 2015 Clinical Operations
National Imaging Associates, Inc. Clinical guideline PROSTATE CANCER Original Date: March 2011 Page 1 of 5 Radiation Oncology Last Review Date: March 2015 Guideline Number: NIA_CG_124 Last Revised Date:
Prior Authorization Guideline
Prior Authorization Guideline Guideline: PS Inj - Alimta Therapeutic Class: Antineoplastic Agents Therapeutic Sub-Class: Antifolates Client: PS Inj Approval Date: 8/2/2004 Revision Date: 12/5/2006 I. BENEFIT
Overview of Gynaecologic Cancer
Overview of Gynaecologic Cancer Stuart Salfinger Gynaecologic Oncologist St John of God Hospital King Edward Memorial Hospital Cervical Cancer Cervical Cancer Risk HPV Smoking?OCP Cervical Cancer Symptoms
Principles of Radiation Therapy A Bapsi Chakravarthy, MD Associate e P rofessor Professor Radiation Oncology
Principles of Radiation Therapy A Bapsi Chakravarthy, MD Associate Professor Radiation Oncology Disclosure Information I have no financial relationships to disclose relevant to the conten of this presentation.
La Chemioterapia Adiuvante Dose-Dense. Lo studio GIM 2. Alessandra Fabi
La Chemioterapia Adiuvante Dose-Dense Lo studio GIM 2 Alessandra Fabi San Antonio Breast Cancer Symposium -December 10-14, 2013 GIM 2 study Epirubicin and Cyclophosphamide (EC) followed by Paclitaxel (T)
Hodgkin Lymphoma Disease Specific Biology and Treatment Options. John Kuruvilla
Hodgkin Lymphoma Disease Specific Biology and Treatment Options John Kuruvilla My Disclaimer This is where I work Objectives Pathobiology what makes HL different Diagnosis Staging Treatment Philosophy
BASED ON THE RESULTS of the Radiation Therapy
INT 0123 (Radiation Therapy Oncology Group 94-05) Phase III Trial of Combined-Modality Therapy for Esophageal Cancer: High-Dose Versus Standard-Dose Radiation Therapy By Bruce D. Minsky, Thomas F. Pajak,
The evolution of rectal cancer therapy. Objectives
The evolution of rectal cancer therapy Hagen Kennecke MD MHA FRCPC Western Canada Consensus Conference September 5, 2014 Objectives Identify standard therapy: stage II/III rectal cancer Update recent adjuvant
Nursing Care of the Patient Receiving Brachytherapy for Gynecologic Cancer
Nursing Care of the Patient Receiving Brachytherapy for Gynecologic Cancer Una Randall, RN, BSN, OCN Dana Farber / Brigham and Women s Cancer Center Department of Radiation Oncology Una Randall is not
How To Treat A Uterine Sarcoma
EVERYONE S GUIDE FOR CANCER THERAPY Malin Dollinger, MD, Ernest H. Rosenbaum, MD, Margaret Tempero, MD, and Sean Mulvihill, MD 4 th Edition 2001 Uterus: Uterine Sarcomas Jeffrey L. Stern, MD Uterine sarcomas
Should we use Docetaxel in hormone- naïve prostate cancer? Karim Fizazi, MD, PhD Institut Gustave Roussy Villejuif, France
Should we use Docetaxel in hormone- naïve prostate cancer? Karim Fizazi, MD, PhD Institut Gustave Roussy Villejuif, France Disclosure Participation to advisory boards/honorarium from: Amgen, Astellas,
SCAN Gynaecological Group. Clinical Management Protocols: Cancer of the Cervix. www.scan.scot.nhs.uk
SE Scotland Cancer Network SCAN Gynaecological Group Clinical Management Protocols: Cancer of the Cervix www.scan.scot.nhs.uk Table of contents 3 Introduction 4 Diagnosis 5-6 Staging and spread of disease
Carcinoma of the vagina is a relatively uncommon disease, affecting only about 2,000 women in
EVERYONE S GUIDE FOR CANCER THERAPY Malin Dollinger, MD, Ernest H. Rosenbaum, MD, Margaret Tempero, MD, and Sean Mulvihill, MD 4 th Edition, 2001 Vagina Jeffrey L. Stern, MD Carcinoma of the vagina is
Rectal Cancer. To Radiate or not to radiate? Q: Should rectal cancer RT/CRT decisions be based solely on stage? 11/09/2014
Rectal Cancer To Radiate or not to radiate?? Dr. Corinne Doll Radiation Oncologist Tom Baker Cancer Centre Calgary, Alberta Q: Should rectal cancer RT/CRT decisions be based solely on stage? 1 Q: Can RT/CRT
PRIMARY TREATMENT CLINICAL PRESENTATION INITIAL EVALUATION. Conclude procedure with/without lymph node dissection
INITIAL EVALUATION History and Physical CXR Pathology review 1 Labs Consider CA125, and pre-operative imaging of abdomen and pelvis Screen for Lynch Syndrome by family history or molecular testing CLINICAL
Pancreatic Cancer: FDA Approved Treatments and Clinical Trials
Pancreatic Cancer: FDA Approved Treatments and Clinical Trials Vincent J Picozzi MD MMM Virginia Mason Medical Center Seattle WA 1 Pancreatic cancer is the hardest cancer of all to treat 2 Pancreatic cancer:
Stage IIIB disease includes patients with T4 tumors,
Guidelines on Treatment of Stage IIIB Non-small Cell Lung Cancer* James R. Jett, MD, FCCP; Walter J. Scott, MD, FCCP; M. Patricia Rivera MD, FCCP; and William T. Sause, MD, FACR Stage IIIB includes patients
Small Cell Lung Cancer
Small Cell Lung Cancer Types of Lung Cancer Non-small cell carcinoma (NSCC) (87%) Adenocarcinoma (38%) Squamous cell (20%) Large cell (5%) Small cell carcinoma (13%) Small cell lung cancer is virtually
Lung Cancer and Mesothelioma
Lung Cancer and Mesothelioma Robert Kratzke, M.D. John C. Skoglund Professor of Lung Cancer Research Section of Heme/Onc/Transplant Department of Medicine University of Minnesota Medical School Malignant
Treatment Volume and Technique
RADIATION THERAPY The standard of care for early lesions is surgical resection; however, selected patients with small central lesions may be considered for definitive radiation, particularly when the lesions
Issues Concerning Development of Products for Treatment of Non-Metastatic Castration- Resistant Prostate Cancer (NM-CRPC)
Issues Concerning Development of Products for Treatment of Non-Metastatic Castration- Resistant Prostate Cancer (NM-CRPC) FDA Presentation ODAC Meeting September 14, 2011 1 Review Team Paul G. Kluetz,
Adiuwantowe i neoadiuwantowe leczenie chorych na zaawansowanego raka żołądka
Adiuwantowe i neoadiuwantowe leczenie chorych na zaawansowanego raka żołądka Neoadiuvant and adiuvant therapy for advanced gastric cancer Franco Roviello, IT Neoadjuvant and adjuvant therapy for advanced
Radiation Therapy in the Treatment of
Lung Cancer Radiation Therapy in the Treatment of Lung Cancer JMAJ 46(12): 537 541, 2003 Kazushige HAYAKAWA Professor and Chairman, Department of Radiology, Kitasato University School of Medicine Abstract:
Management of Postmenopausal Women with T1 ER+ Tumors: Options and Tradeoffs. Case Study. Surgery. Lumpectomy and Radiation
Management of Postmenopausal Women with T1 ER+ Tumors: Options and Tradeoffs Michael Alvarado, MD Associate Professor of Surgery University of California San Francisco Case Study 59 yo woman with new palpable
Intervention(s) Results primary outcome Results secondary and other outcomes
Uitgangsvraag 1: evidence tables Systematic reviews Study ID Method Patient Critical appraisal of review quality Fiorica SR and MA 2004 1 Supported by Universities and a cancer centre Search date until
Moving forward, where are we with Clinical Trials?
Moving forward, where are we with Clinical Trials? Dennis A. Wigle Division of Thoracic Surgery Mayo Clinic AATS/STS General Thoracic Surgery Symposium Sunday, April 27 th 2014 2012 MFMER slide-1 Where
REPORT ASCO 1998 LOS ANGELES : LUNG CANCER Johan F. Vansteenkiste, MD, PhD, Univ. Hospital and Leuven Lung Cancer Group
REPORT ASCO 1998 LOS ANGELES : LUNG CANCER Johan F. Vansteenkiste, MD, PhD, Univ. Hospital and Leuven Lung Cancer Group Educational session Treatment of stage III non-small cell lung cancer (NSCLC) in
INTERVENTIONAL PROCEDURES PROGRAMME
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of radical laparoscopic hysterectomy for early stage cervical cancer Introduction This overview
Preliminary Results from a Phase 2 Study of ARQ 197 in Patients with Microphthalmia Transcription Factor Family (MiT) Associated Tumors
Preliminary Results from a Phase 2 Study of ARQ 197 in Patients with Microphthalmia Transcription Factor Family (MiT) Associated Tumors John Goldberg 1 *, George Demetri 2, Edwin Choy 3, Lee Rosen 4, Alberto
January 2013 LONDON CANCER NEW DRUGS GROUP RAPID REVIEW. Summary. Contents
LONDON CANCER NEW DRUGS GROUP RAPID REVIEW Paclitaxel albumin (Abraxane ) as a substitute for docetaxel/paclitaxel for cancer Paclitaxel albumin (Abraxane ) as a substitute for docetaxel/ paclitaxel for
What is neuroendocrine cervical cancer?
Key Points: 1. Neuroendocrine cancer of the uterine cervix is a rare and aggressive disease. 2. Treatment for neuroendocrine cervical cancer is usually more intensive than that for most other types of
EVALUATION/PRIORITIZATION CRITERIA: C, L, R, S *to meet requirement 1
COMPENDIA TRANSPARENCY TRACKING FORM DATE: MAY 2015 PACKET: 111 DRUG: INDICATION: Vinorelbine Tartrate Malignant pleural mesothelioma COMPENDIA TRANSPARENCY REQUIREMENTS 1 Provide criteria used to evaluate/prioritize
Role of taxanes in the treatment of advanced NHL patients: A randomized study of 87 cases
Role of taxanes in the treatment of advanced NHL patients: A randomized study of 87 cases R. Shraddha, P.N. Pandit Radium Institute, Patna Medical College and Hospital, Patna, India Abstract NHL is a highly
Treatment of Small Cell Lung Cancer: American Society of Clinical Oncology. Endorsement of the American College of Chest Physicians (ACCP) Guideline
Treatment of Small Cell Lung Cancer: American Society of Clinical Oncology Endorsement of the American College of Chest Physicians (ACCP) Guideline Table of Contents Data Supplement 1: Summary of included
GYNECOLOGIC CANCERS Facts to Help Patients Make an Informed Decision
RADIATION THERAPY FOR GYNECOLOGIC CANCERS Facts to Help Patients Make an Informed Decision TARGETING CANCER CARE AMERICAN SOCIETY FOR RADIATION ONCOLOGY FACTS ABOUT GYNECOLOGIC CANCERS Gynecologic cancers
Lung Cancer Treatment Guidelines
Updated June 2014 Derived and updated by consensus of members of the Providence Thoracic Oncology Program with the aid of evidence-based National Comprehensive Cancer Network (NCCN) national guidelines,
Transition from 2D to 3D Brachytherapy in Cervical Cancers: The Vienna Experience. Richard Pötter MD. BrachyNext, Miami, 2014.
Transition from 2D to 3D Brachytherapy in Cervical Cancers: The Vienna Experience Richard Pötter MD BrachyNext, Miami, 2014 Disclosures Richard Pötter, MD, does not have any financial relationships or
CHEMOTHERAPY FOR ADVANCED UROTHELIAL CANCER OF THE BLADDER. Walter Stadler, MD University of Chicago
CHEMOTHERAPY FOR ADVANCED UROTHELIAL CANCER OF THE BLADDER Walter Stadler, MD University of Chicago Chemotherapy Doctor Terms Drugs used to treat cancer Will attack cancer no matter where it is located
GUIDELINES ADJUVANT SYSTEMIC BREAST CANCER
GUIDELINES ADJUVANT SYSTEMIC BREAST CANCER Author: Dr Susan O Reilly On behalf of the Breast CNG Written: December 2008 Agreed at CNG: June 2009 & June 2010 Review due: June 2011 Guidelines Adjuvant Systemic
CYBERKNIFE RADIOSURGERY FOR EARLY PROSTATE CANCER Rationale and Results. Alan Katz MD JD Flushing, NY USA
CYBERKNIFE RADIOSURGERY FOR EARLY PROSTATE CANCER Rationale and Results Alan Katz MD JD Flushing, NY USA Prostate Ablative Therapy Over the last 10 years our therapy has improved bned rates for LDR/HDR
THE SECRETS OF OUR SUCCESS
THE SECRETS OF OUR SUCCESS QUALITY OF LIFE STUDIES OF THE NCIC Andrea Bezjak, MDCM, MSc,, FRCPC Chair, NCIC CTG QOL Committee Outline of the Presentation Can we consider NCIC CTG QOL activities a success?
Advances In Chemotherapy For Hormone Refractory Prostate Cancer. TAX 327 study results & SWOG 99-16 study results presented at ASCO 2004
Ronald de Wit Rotterdam Cancer Institute The Netherlands Advances In Chemotherapy For Hormone Refractory Prostate Cancer TAX 327 study results & SWOG 99-16 study results presented at Slide 1 Prostate Cancer
Prostatectomy, pelvic lymphadenect. Med age 63 years Mean followup 53 months No other cancer related therapy before recurrence. Negative.
Adjuvante und Salvage Radiotherapie Ludwig Plasswilm Klinik für Radio-Onkologie, KSSG CANCER CONTROL WITH RADICAL PROSTATECTOMY ALONE IN 1,000 CONSECUTIVE PATIENTS 1983 1998 Clinical stage T1 and T2 Mean
Chapter 14 Cancer of the Cervix Uteri
Carol L. Kosary Introduction Despite the existence of effective screening through the use of Pap smears since the 195 s, there were 9,71 estimated cases of invasive cervical cancer and 3,7 deaths in 26
The Need for Accurate Lung Cancer Staging
The Need for Accurate Lung Cancer Staging Peter Baik, DO Thoracic Surgery Cancer Treatment Centers of America Oklahoma Osteopathic Association 115th Annual Convention Financial Disclosures: None 2 Objectives
Goals and Objectives: Breast Cancer Service Department of Radiation Oncology
Goals and Objectives: Breast Cancer Service Department of Radiation Oncology The breast cancer service provides training in the diagnosis, management, treatment, and follow-up of breast malignancies, including
Original Date: June 2013 CERVICAL CANCER
National Imaging Associates, Inc. Clinical guideline Original Date: June 2013 CERVICAL CANCER Page 1 of 6 Radiation Oncology Last Review Date: September 2015 Guideline Number: NIA_CG_223 Last Revised Date:
Non-small cell lung cancer, advanced or metastatic, switch-therapy after gemcitabine/carboplatin
COMPENDIA TRANSPARENCY TRACKING FORM DRUG: Docetaxel INDICATION: Non-small cell lung cancer, advanced or metastatic, switch-therapy after gemcitabine/carboplatin COMPENDIA TRANSPARENCY REQUIREMENTS 1 Provide
How To Treat A Cancer With A Radical
Management of mesothelioma Jan.vanmeerbeeck@ugent.be Amsterdam, March 6, 2010 1 management Palliation Symptomatic care Pain Breathlessness Radiotherapy Chemotherapy Surgery Radical (intention to cure)
Epidemiology, Staging and Treatment of Lung Cancer. Mark A. Socinski, MD
Epidemiology, Staging and Treatment of Lung Cancer Mark A. Socinski, MD Associate Professor of Medicine Multidisciplinary Thoracic Oncology Program Lineberger Comprehensive Cancer Center University of
Table of Contents. Data Supplement 1: Summary of ASTRO Guideline Statements. Data Supplement 2: Definition of Terms
Definitive and Adjuvant Radiotherapy in Locally Advanced Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation
Activity of pemetrexed in thoracic malignancies
Activity of pemetrexed in thoracic malignancies Results of phase III clinical studies of pemetrexed in malignant pleural mesothelioma and non-small cell lung cancer show benefit P emetrexed (Alimta) is
Radioterapia panencefalica. Umberto Ricardi
Radioterapia panencefalica Umberto Ricardi Background Systemic disease to the brain is unfortunately a quite common event Radiotherapy, especially with the great technical development during the past decades,
Kanıt: Klinik çalışmalarda ZYTIGA
mkdpk de Sonunda Gerçek İlerleme! Kanıt: Klinik çalışmalarda ZYTIGA Dr. Sevil Bavbek 5. Türk Tıbbi Onkoloji Kongresi Mart 214, Antalya Endocrine therapies Adrenals Testis Abiraterone Orteronel Androgen
Efficacy analysis and graphical representation in Oncology trials - A case study
Efficacy analysis and graphical representation in Oncology trials - A case study Anindita Bhattacharjee Vijayalakshmi Indana Cytel, Pune The views expressed in this presentation are our own and do not
intensity_modulated_radiation_therapy_imrt_of_abdomen_and_pelvis 11/2009 5/2016 5/2017 5/2016
Corporate Medical Policy Intensity Modulated Radiation Therapy (IMRT) of Abdomen File Name: Origination: Last CAP Review: Next CAP Review: Last Review: intensity_modulated_radiation_therapy_imrt_of_abdomen_and_pelvis
COMMISSIONING. for ULTRA-RADICAL SURGERY ADVANCED OVARIAN CANCER
COMMISSIONING for ULTRA-RADICAL SURGERY in ADVANCED OVARIAN CANCER WHY THIS MUST HAPPEN PERSPECTIVE COMMISSIONING FOR WHO, FOR WHAT? Biological Basis Surgical Basis International and national standards
NATIONAL CANCER DRUG FUND PRIORITISATION SCORES
NATIONAL CANCER DRUG FUND PRIORITISATION SCORES Drug Indication Regimen (where appropriate) BORTEZOMIB In combination with dexamethasone (VD), or with dexamethasone and thalidomide (VTD), is indicated
Non-Small Cell Lung Cancer Treatment Comparison to NCCN Guidelines
Non-Small Cell Lung Cancer Treatment Comparison to NCCN Guidelines April 2008 (presented at 6/12/08 cancer committee meeting) By Shelly Smits, RHIT, CCS, CTR Conclusions by Dr. Ian Thompson, MD Dr. James
Luis D. Carcorze Soto, MD PGY-3
Luis D. Carcorze Soto, MD PGY-3 Peritoneal Surface Malignancies Peritoneum Patient Selection Operative Technique HIPEC EPIC Primary: Primary Peritoneal Carcinoma Malignant Peritoneal Mesothelioma Metastatic:
Gemcitabine, Paclitaxel, and Trastuzumab in Metastatic Breast Cancer
Gemcitabine, Paclitaxel, and Trastuzumab in Metastatic Breast Cancer Review Article [1] December 01, 2003 By George W. Sledge, Jr, MD [2] Gemcitabine (Gemzar) and paclitaxel show good activity as single
Acute Myeloid Leukemia
Acute Myeloid Leukemia Upfront Therapy in Newly Diagnosed Elderly AML Patients: Is Decitabine (DAC) the new standard? Raoul Tibes, MD, PhD Senior Associate Consultant, Mayo Clinic Arizona Associate Director,
Sentinel Lymph Node Mapping for Endometrial Cancer. Locke Uppendahl, MD Grand Rounds
Sentinel Lymph Node Mapping for Endometrial Cancer Locke Uppendahl, MD Grand Rounds Endometrial Cancer Most common gynecologic malignancy in US estimated 52,630 new cases in 2014 estimated 8,590 deaths
Clinical Trial Design. Sponsored by Center for Cancer Research National Cancer Institute
Clinical Trial Design Sponsored by Center for Cancer Research National Cancer Institute Overview Clinical research is research conducted on human beings (or on material of human origin such as tissues,
Metastatic Breast Cancer 201. Carolyn B. Hendricks, MD October 29, 2011
Metastatic Breast Cancer 201 Carolyn B. Hendricks, MD October 29, 2011 Overview Is rebiopsy necessary at the time of recurrence or progression of disease? How dose a very aggressive treatment upfront compare
Current Status and Perspectives of Radiation Therapy for Breast Cancer
Breast Cancer Current Status and Perspectives of Radiation Therapy for Breast Cancer JMAJ 45(10): 434 439, 2002 Masahiro HIRAOKA, Masaki KOKUBO, Chikako YAMAMOTO and Michihide MITSUMORI Department of Therapeutic
Metastatic Cervical Cancer s/p Radiation Therapy, Radical Hysterectomy and Attempted Modified Internal Hemipelvectomy
Metastatic Cervical Cancer s/p Radiation Therapy, Radical Hysterectomy and Attempted Modified Internal Hemipelvectomy Sarah Hutto,, MSIV Marc Underhill, M.D. January 27, 2009 Past History 45 yo female
Historical Basis for Concern
Androgens After : Are We Ready? Mohit Khera, MD, MBA Assistant Professor of Urology Division of Male Reproductive Medicine and Surgery Scott Department of Urology Baylor College of Medicine Historical
Corporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: hematopoietic_stem-cell_transplantation_for_epithelial_ovarian_cancer 2/2001 11/2015 11/2016 11/2015 Description
Endometrial Cancer. Measurability of Quality Performance Indicators Version 2.0
Endometrial Cancer Measurability of Quality Performance Indicators Version 2.0 To be read in conjunction with: Endometrial Cancer QPIs Final Publication v2 Endometrial QPI Dataset (latest published version)
New Trends & Current Research in the Treatment of Lung Cancer, Pt. II
New Trends & Current esearch in the Treatment of Lung Cancer, Pt. II Howard (Jack) West, MD President & CEO, GACE Medical Director, Thoracic Oncology Program Swedish Cancer Institute Seattle, WA Cancer