In this poorly powered study, there were no statistically significant differences in survival or local control among the arms. Median disease-free survival was also similar among treatment groups: 3.7 months with neutron irradiation, 3.4 months with mixed radiation beams and 3.7 months with pure photon irradiation. However, three neutron-irradiated patients suffered moderate to life-threatening gastrointestinal toxicity compared with one patient treated with photons.
Adverse effects of chemoradiotherapy: Chemoradiotherapy can be associated with cytopenia, nausea, vomiting and diarrhea (Table 2). However, these adverse effects are generally tolerable, and treatment-related deaths are unusual. Combination 5-FU and radiation is also well tolerated. Although not superior to 5-FU in efficacy, other chemotherapeutic regimens appear to be more toxic.
TABLE 2 Adverse effects of treatment
|Reference||Treatment Arm||Nausea or vomiting (%)||Adverse effects – all grades Diarrhea (%) Leucopenia (%) Thrombocytopenia (%)||Treatment-related deaths|
|A) Chemoradiotherapy versus radiotherapy alone|
|Moertel et al,||RTCT (5-FU)||76||13||100||52||NR|
|GITSG 9273,||RTCT (60 Gy + 5-FU)||86||7||78||37||NR*|
|1981||RTCT (40 Gy + 5-FU)||77||6||62||45||1|
|RT alone (60 Gy)||64||0||52||8||NR*|
|B) Chemoradiotherapy versus chemotherapy alone|
|GITSG 9283,||RTCT (5-FU+SMF)||78||46||100||100||NR|
|C) Chemoradiotherapy with comparison of different chemotherapy regimens|
|SWOG,||RTCT (mCCNU+5-FU)||Did not report adverse effects separated by treatment arm (%)|
|1980||RTCT (mCCNU+5-FU) CT (testalactone).|
|GITSG 9277,||RTCT (5-FU)||36||0|
|Earle et al,||RTCT (5-FU)||90||0||50||NR||0|
|1994||RTCT (hycanthone)||90||2Grade 3+||0<2000 mm3||NR||1|
|D) Comparison of different types of radiation beams|
|Neutrons||6Grade 3+||6Grade 3+||0(all adverse hematological effects)||NR|
*Two other patient deaths noted in report, treatment arm unspecified. 5-FU Bolus 5-fluorouracil; CT Chemotherapy; ECOG Eastern Cooperative Oncology Group; GITSG Gastrointestinal Tumor Study Group; Gy Gray; mCCNU Methyl lomustine; NR Not reported; RT Radiotherapy; RTCT Chemoradiotherapy; RTOG Radiation Therapy Oncology Group; SMF Streptozocin, mitomycin, 5-FU; SWOG Southwest Oncology Group
Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.