Faculty of Medicine
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Item type:Publication, Adjuvant chemotherapy plus concurrent chemoradiotherapy (CCRT) in advanced gastric adenocarcinoma treatment as standard of care(2020); ; ; Berat, MeriIntroduction. Despite a worldwide decline in incidence based on GLOBOCAN 2018 data, stomach cancer is the 5th most common neoplasm and the 3rd most deadly cancer. In 90% of cases, its histology is adenocarcinoma, either of the intestinal type or of diffuse. Helicobacter pylori infection, smoking, salt and nitrate-rich foods are the most important factors of risk. The interactions between dietary factors, environmental factors and the development of gastric cancer are well described with clearly identified dietary exposures strongly associated with gastric cancer induction and prevention. Postoperative fluoropyrimidine-based CCRT and chemotherapy is standard adjuvant treatment of resected gastric adenocarcinoma. Materials and methods. Patients with subtotal gastrectomy and D1 lymph node dissection were treated with 2 cycles of Capecitabine (DD 2500 mg/m2 po bid/21day cycle) followed by chemoradiotherapy and another of 2 cycles chemotherapy with Capecitabine (DD 2500 mg/m2 po bid/21d cycle). CT simulation with oral contrast application was performed followed by delineation of target volumes and organs at risk according to CRITICS protocol. 3D conformal postoperative chemoirradiation was delivered with standard fractionation (TTD 50.4 Gy/1.8 Gy) with concurrent application of Capecitabine 1650mg/m2/bid/d1-5. Adjuvant treatment was delivered in postoperative period of 6 months. Results. Adjuvant chemotherapy and chemoradiotherapy prolongs disease free survival (DFS) and improves quality of life. CT-based 3D conformal treatment planning and delivery of postoperative chemoirradiation is minimum standard of care of gastric cancer treatment. Conclusion. Multidisciplinary decision making team approach is preferred. Primary treatment option for patients with potentially resectable locoregional gastric tumors is surgery. The guidelines have included postoperative chemo/chemoradiotherapy treatment depending of tumor stage, nodal status, extent of lymph node dissection and other risk factors (differentiation, lymphovascular invasion, neural invasion, surgical margins). Adjuvant chemotherapy and chemoradiotherapy prolongs disease free survival (DFS) and improves quality of life. Keywords: Gastric cancer, chemoirradiation, CCRT, DFS, 3D conformal, postoperative - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Acute toxicity in standard treatment of cervical cancer(Seventh international conference on radiation in various fields of research, RAD 2019, 2019-06-10); ; Purpose: Prospective evaluation of the acute toxicity caused by standard definitive treatment of cervical cancer – concurrent weekly cisplatin and External Beam Radiotherapy (EBRT) followed by high dose rate intracavitary brachytherapy (HDR BT). Methods and materials In this analysis were included 50 patients treated at one institution between June 2017 and June 2018. All patients were treated with 3D conformal chemo-radiation, with weekly Cisplatin 30 mg/m2 for a maximum of 5 cycles. They received 50.4 Gy/28 fractions, 5 fractions per week of external beam radiation. In these patients dose optimization was done in order to achieve a tumor maximum dose (Dmax) around 105%. Various techniques were used for dose optimization which included the use of sub fields, adjusting the weight-ages, using wedges and the use of mixed energies. EBRT was followed by three fractions of HDR BT of 7 Gy each. Acute RTOG toxicity was assessed weekly during the treatment and 2 weeks post treatment. Results The median age of the patients was 51±11.3 years. All the patients (100%) completed EBRT; 42 patients (85%) of the patients received all 5 cycles of chemotherapy while 8 patients (15%) of the patients received 4 cycles of chemotherapy. The most predominant toxicity seen was gastrointestinal toxicity (radiation proctitis), diarrhea being the most common GI toxicity followed by vomiting. Neutropenia was the most common hematological toxicity: most patients had grade 0 and grade 1 toxicity. None of the patients had grade 4 toxicity while few had grade 2 and 3 toxicity. Radiation cystitis was observed in the majority of cases with a grade 0 and grade 1 toxicity, without the need for symptomatic therapy, only 2 patients have grade 3 toxicity with the need for therapy. Conclusion Acute toxicity appears as a result of the standard definite treatment of cervical cancer, but it is usually of low grade, easy to manage and does not disturb the general condition of the patient.