Radiation Oncology In-service exam review: GI cancers
German Rectal Cancer Trial (NEJM 2004)
Dutch Colorectal Cancer Group (NEJM 2001)
Swedish Rectal Cancer Trial (NEJM 1997)
GITSG 7175
Low dose RT alone
Chemotherapy alone
Antibiotics directed at H. pylori
Surgical resection followed by chemoradiation
Superior rectal vein
Inferior rectal vein
Middle rectal vein
Inferior mesenteric vein
50.4 Gy with concurrent Xeloda
50.4 Gy with a 5.4 Gy boost with concurrent 5-FU
54 Gy with concurrent 5-FU
50.4 Gy with concurrent 5-FU
25 Gy in 5 fractions with concurrent 5-FU
L2-L3
L5-S1
L4-L5
Top of obturator foramen
L3-L4
225 mg/m2 over 24 hours, 7 days per week during RT
150 mg/m2 over 24 hours, 7 days per week during RT
250 mg/m2 over 6 hours, 7 days per week during RT
250 mg/m2 over 12 hours, 5 days per week during RT
225 mg/m2 over 12 hours, 5 days per week during RT
Chemoradation with 5-FU and mitomycin improved 3 year OS from 35 to 48% as compared to RT alone
Chemoradiation with cisplatin and 5-FU improved LC from 36% to 59% as compared to RT alone
Addition of post-op RT after surgery improved OS at 3 years from 35 to 48%
Dose escalation from 45 Gy with 50.4 Gy improved LC from 36% to 59%
Chemoradation with 5-FU and mitomycin improved 3 year LC from 36% to 59% as compared to RT alone
Palpable tumor nodule at the umbilicus
Palpable gallbladder
Migratory thrombophlebitis
Palpable axillary lymphadenopathy
Surgery alone vs surgery followed by chemoradiation with 54 Gy and concurrent 5-FU
Definitive RT to 54 Gy versus Definitive CRT wtih 54 Gy and concurrent 5-FU
Surgery alone vs surgery followed by chemoradiation with a 40 Gy split course followed by adjuvent gemcitabine
Surgery alone vs surgery followed by chemoradiation with a 40 Gy split course and concurrent 5-FU
Surgery alone vs surgery followed by radiation with a 40 Gy split course
Addition of adjuvent CRT with 5-FU and 40 Gy split course to surgery improved 5 yr OS from 5% to 14% in resectable pancreatic cancer
Addition of adjuvent CRT with 5-FU and 40 Gy split course to surgery improved 5 yr LC but had no effect on OS.
Addition of adjuvent RT with a 40 Gy split course to surgery improved LC at 2 years from 22% to 43%
Addition of adjuvent gemcitabine to defintive RT for pancreatic cancer improved 1 year LC from 18% to 32%
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