The treatment of XXXX using high dose conformal radiotherapy.

@entity1 @entity137 @entity7279 @entity55 @entity5 @entity957 @entity1149 @entity891
PURPOSE: To review our experience using conformal treatment planning and high-dose radiotherapy for Stage IIIa and IIIb @entity1149 ( @entity1149 ), and to identify a subset of @entity1 best suited for this approach by analyzing multiple pretreatment @entity1 and @entity5 characteristics. METHODS AND MATERIALS: Between December 1987 and June 1992, 37 @entity1 with @entity5 treated with high-dose radiotherapy using conformal radiotherapy were reviewed. The @entity1 characteristics were as follows: Stage IIIa (18 @entity1 ), IIIb [19]; @entity7279 [13], T3-4 [24]; N0-1 [8], N2-3 [29]; and median age 63. All @entity1 were treated with 1.8-2.0 Gy fractions to a median dose of 66 Gy (range 60-70 Gy). Outcome was analyzed by multiple pretreatment variables including age, sex, Karnofsky performance score, pretreatment symptoms, stage group, T and N stage, @entity5 volume (calculated from computed tomography (CT) contours), presence of @entity891 , and @entity5 histology. Outcome was also analyzed by total radiotherapy dose. RESULTS: The median, 1-year and 2-year survival rates for the entire group were 19.5 months, 75 and 37%, respectively. The median, 1-year, and 2-year local progression-free survival rates are 15.6 months, 62 and 23%. There was no difference in survival by stage group (IIIa vs. IIIb) or by T or N stage. @entity5 volumes ranged from 47-511 cc in the @entity1 without @entity891 and were not a significant prognostic factor. Histology was found to be a significant prognostic factor, with @entity957 having a better overall survival and local progression-free survival than other histologies. No other @entity1 characteristic was found to be significant by either univariate or multivariate analysis. When outcome was analyzed by radiotherapy dose, no dose response was evident in the narrow dose range studied (60-70 Gy). @entity137 included two cases of @entity55 , which resolved with conservative therapy. CONCLUSION: High-dose conformal radiotherapy, in our experience, results in overall survival rates that compare favorably with trials of chemoradiotherapy or conventional radiotherapy with a low treatment-associated morbidity. However, local progression remains a significant problem despite median radiotherapy doses of 66 Gy. Future trials using escalating radiotherapy doses with conformal radiotherapy are therefore, indicated.
