Concomitant radiochemotherapy in XXXX : methodology and indications.

@entity1 @entity137 @entity5 @entity18437 @entity158
Concomitant radiochemotherapy (CRC) is based on the administration of chemotherapeutic agents concurrently with radiation therapy. It is aimed at the spatial cooperation of radiotherapy ( @entity18437 ) and chemotherapy and the enhancement of the local action of radiotherapy. In this study the role of @entity18437 enhancement in the treatment of @entity5 , is analyzed. 5FU is the commonly used drug. Clinical and experimental evidence indicates radiotherapy to be enhanced when the drug is administered in continuous infusion after radiation and for a suitable dose of 5FU. In these conditions, @entity137 is usually mild. In contrast, when the drug is administered as bolus, the experimental evidence seems to indicate only additivity. However the clinical experience has shown an improvement in local control and survival at the expense of a higher @entity137 . In @entity1 with resectable lesions at high risk for local recurrence, randomized CRC studies have shown a high rate of local control between 85% and 90%, a 5-year survival between 55% and 60%, significantly better as compared to control arms: exclusive surgery (GITSG7 175), exclusive @entity18437 (NCCTG), bolus CRC (Intergroup). Acute @entity137 is mostly hematological and gastrointestinal. In @entity1 with lesions unresectable for cure, CRC allows high surgical radicality (85-90%). Complete pathologic response is 4 to 20%. Local control is high (80-90%) and 3-year survival is 70 to 90%. Grade 3-4 acute gastrointestinal @entity137 was shown to be higher in combinations with bolus 5FU. In recurrence CRC has been used for palliation. Control of @entity158 to the pelvis was similar to that achieved with radiotherapy alone. In a single experience was CRC used preoperatively and results seem encouraging.
