•Debates persist between the superiority of perioperative chemotherapy or adjuvant chemoradiotherapy in the management of gastric adenocarcinoma.•This review is to synthesize current knowledge about ...adjuvant chemoradiotherapy.•It will also present ongoing trials.
An estimated 990,000 new cases of gastric cancer are diagnosed worldwide each year. Surgical excision, the only chance for prolonged survival, is feasible in about 20% of cases. Even after surgery, the median survival is limited to 12 to 20 months due to the frequency of locoregional and/or metastatic recurrences. This led to clinical trials associating surgery with neoadjuvant or adjuvant treatments to improve tumor control and patient survival. The most studied modalities are perioperative chemotherapy and adjuvant chemoradiotherapy. To date, evidence has shown a survival benefit for postoperative chemoradiotherapy and for perioperative chemotherapy. Phase III trials are ongoing to compare these two modalities. The aim of this review is to synthesize current knowledge about adjuvant chemoradiotherapy in the management of gastric adenocarcinoma, and to consider its prospects by integrating modern radiotherapy techniques.
This study investigated the effectiveness of stereotactic body radiotherapy with helical TomoTherapy (T-SBRT) for treating medically inoperable primary and second-primary early stage non-small-cell ...lung neoplasm (SPLN) and evaluated whether the movement of organizing pneumonia (OP) within the irradiation field (IF) can be detected via analysis of radiological changes.
Patients (n = 16) treated for 1 year (2011-12) at our hospital by T-SBRT at a total dose of 60 Gy in five fractions were examined retrospectively. Outcome and toxicity were recorded and were separately described for SPLN. CT scans were reviewed by a single radiologist.
Of the 16 patients, 5 (31.3%) had primary lung malignancies, 10 (62.5%) had SPLN, and 1 case (6.3%) had isolated mediastinal metastasis of lung neoplasm. Pathological evidence was obtained for 72.2% of all lesions. The median radiological follow-up was 11 months (10.5 months for SPLN). For all cases, the 6- and 12-month survival rates were 100% and 77.7% (100% and 71.4%, respectively, for SPLN), and the 6- and 12-month locoregional control rates were 100% in all cases. 2 (12.5%) of 16 patients developed grade 3 late transient radiation pneumonitis following steroid therapy and 1 (6.3%) presented asymptomatic infiltrates comparable to OP opacities.
T-SBRT seems to be safe and effective.
Mild OP is likely associated with radiation-induced anomalies in the IF, identification of migrating opacities can help discern relapse of radiation-induced opacities.
Abstract In this retrospective study we evaluated the long-term results of 35 early-stage favourable T1-2 N0 M0 anal cancer patients treated with intensity-modulated radiotherapy techniques combining ...low dose prophylactic inguinal-pelvic irradiation with dose-escalated boost. Optimal locoregional control and good tolerance makes this treatment a valuable alternative to brachytherapy boost and involved-field radiotherapy plans.
Abstract Introduction This trial randomly assessed short-term adjuvant hormonal therapy added to radiotherapy (RT) for intermediate- and high-risk (UICC 1997 cT2a or cT1b-c with high PSA or Gleason ...score) localised prostate cancer. We report acute toxicity (CTCAE v2) assessed weekly during RT in relation to radiation parameters. Patients and methods Centres selected the RT dose (70, 74 or 78 Gy) and RT technique. Statistical significance is at 0.05. Results Of 791 patients, 652 received 3D-CRT (70 Gy: 195, 74 Gy: 376, 78 Gy: 81) and 139 received IMRT (74 Gy: 28, 78 Gy: 111). During RT, grade 3 gastrointestinal (GI) and genitourinary (GU) toxicities were reported by7 (0.8%) and 50 (6.3%) patients, respectively. No grade 4 was reported. The risk of grade ⩾2 GI toxicity increased significantly with increasing D50%-rectum ( p = 0.004) and that of grade ⩾2 GU toxicity correlated only to Dmax-bladder ( p = 0.051). 3D-RT technique, increasing total dose and V95% >400 cc increased D50% and Dmax. One month after RT, only 14 patients (1.8%) reported grade 3 toxicity. AST did not seem to influence the risk of GU or GI acute toxicity. Conclusion RT up to 78 Gy was well tolerated. Dmax-bladder and D50%-rectum influenced the risk of grade ⩾2 GU toxicity and GI toxicity, respectively. Both were lower with IMRT but remained high for an irradiated RT volume > 400 cc for 3D-RT and for a dose of 78 Gy. Hormonal treatment did not influence acute toxicity.
A diet rich in n-3 fatty acids (fish oils) is associated with reduced risks of cardiovascular and metabolic diseases, but the mechanisms remain incompletely understood. Sympathoadrenal activation is ...postulated to be involved in the pathogenesis of these diseases, and may be inhibited by n-3 fatty acids. We therefore evaluated the effects of a diet supplemented with n-3 fatty acids on the stimulation of the sympathetic nervous system and of stress hormones elicited by a mental stress.
Seven human volunteers were studied on two occasions, before and after 3 weeks of supplementation with 7.2 g/day fish oil. On each occasion, the concentrations of plasma cortisol, and catecholamines, energy expenditure (indirect calorimetry), and adipose tissue lipolysis (plasma non esterified fatty acid concentrations) were monitored in basal conditions followed by a 30 min mental stress (mental arithmetics and Stroop's test) and a 30 min recovery period.
In control conditions, mental stress significantly increased heart rate, mean blood pressure, and energy expenditure. It increased plasma epinephrine from 60.9 ± 6.2 to 89.3 ± 16.1 pg/ml (
p < 0.05), plasma cortisol from 291 ± 32 to 372 ± 37 μmol/l (
p < 0.05) and plasma non esterified fatty acids from 409 ± 113 to 544 ± 89 μmol/l (
p < 0.05). After 3 weeks of a diet supplemented with n-3 fatty acids, the stimulation by mental stress of plasma epinephrine, cortisol, energy expenditure, and plasma non esterified fatty acids concentrations, were all significantly blunted.
Supplementation with n-3 fatty acids inhibits the adrenal activation elicited by a mental stress, presumably through effects exerted at the level of the central nervous system.
Atténuation de l'activation de l'axe hypothalamo-hypophyso-surrénalien par une supplémentation en huiles de poisson chez l'homme
Une alimentation riche en acides gras de la série n-3 est associée à un risque réduit de maladies cardiovasculaires et métaboliques, mais la nature de cette association reste inconnue. Comme une stimulation de l'axe hypothalamo-hypophyso-surrénalien pourrait jouer un rôle dans la pathogenèse de ces maladies, il est possible que les acides gras de la série n-3 agissent en diminuant la sécrétion d'hormones de stress.
Sept volontaires sains ont été étudiés à deux reprises, avant et après 3 semaines de supplémentation par 7,2 g/jour d'huile de poisson. A chaque occasion, les concentrations plasmatiques de cortisol et catécholamines et des acides gras libres ainsi que les dépenses d'énergie ont été mesurées en conditions de repos après une nuit de jeûne pendant un stress mental de 30 minutes et pendant une période de récupération de 30 minutes.
Sous supplémentation, le stress mental a augmenté la fréquence cardiaque, la pression artérielle moyenne et les dépenses d'énergie. Les concentrations d'adrénaline ont augmenté de 60,9 ± 6,2 à 89,3 ± 16,1 pg/ml (p < 0,05), celles de cortisol de 291 ± 32 à 372 ± 37 μmol/l (p < 0,05) et celles d'acides gras libres de 409 ± 113 à 544 ± 89 μmol/l (p < 0,05). Après supplémentation en acides gras de la série n-3, les augmentations d'adrénaline, de cortisol, d'acides gras et des dépenses énergétiques étaient toutes significativement réduites.
Une supplémentation en acides gras de la série n-3 réduit la stimulation surrénalienne au cours d'un stress mental.
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