Download open "500182_ASTRO_hirowatari"

www.***.com
PHASE I TRIAL OF CONCURRENT
CHEMORADIOTHERAPY
USING DOXIFLURIDINE AND
PACLITAXEL IN ADVANCED BREAST
CANCER
H.Hirowatari1, K. Karasawa1,2, K. Ito1,2, T. Takada1, H. Izawa1, T. Furuya1,2,
S.Ozawa 1,2,C.Kurokawa 1,2
１Department
of Radiology, School of Medicine Juntendo University,
2Department of Medical Physics for Advanced Radiotherapy, Graduate School of Medicine, Juntendo
University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421 Japan
Backgrounds
• Radiotherapy with concurrent chemotherapy
has been used to increase local control in
patients with advanced tumor.
• A variety of anti-cancer agents have been
used, the optimal drug combinations, doses,
and schedules have not yet been established.
• Concurrent chemoradiotherapy for breast
cancer has been not popular.
2
Purpose
We conducted phase I trial of concurrent
chemoradiotherapy using Doxifluridine (5'DFUR) and Paclitaxel (TAL) for advanced or
recurrent breast cancer, which could admit the
induction of d-ThdPase peculiarly only in the
tumor for a radiation sensitizer.
3
Patients Eligibility
•Histologically documented cancer of the breast.
• Locally advanced inoperable breast tumor or a recurrent
tumor requiring localized radiotherapy.
• Bone marrow function tolerance: WBC >4000/µL and
<10000/µL , Plt>100000,Hb>9.5g/dl
• Expected prognosis:who will live more than 3 months.
• No infections.
• No severe respiratory complications.
•Pretreatment staging:CT or MRI of head, neck,chest
abdomen and bone scintigraphy.
Treatment Methods
Radiotherapy 60Gy/30f/6week
(4-MV photon beam)
5’-DFUR
TAL
600mg/body five days/week
20-35mg/m2 twice/week
Mon
Tue
Wed
Thu
Fri
Radiation
5’-DFUR
TAL
Adjuvant therapy
TAL
60mg/m2/week
5
Patients Characteristics of the16 cases
(2002.11-2005.5)
Age
Menopausal status Pre
Post
Pathology
37-74y.o.(median 57)
3
13
IDC
ILC
15
1
Untreated fresh
Pervious chemotherapy
13
3
6
Patients Status of the 16 cases
(2002.11-2005.5)
Unresectable advance primary tumor
with axillary lymph nodes
(Bilateral tumor
Local recurrence
Regional lymph node recurrence
Chest wall recurrence
13
1)
3
2
1
The Dosage Level of TAL
TAL
Cases
Level 1
20mg/m2
6
Level 2
25mg/m2
4
Level 3
30mg/m2
3
Level 4
35mg/m2
3
8
Adverse effects
NCI CTCAEv3.0
Hematological
Leukocytes
Neutrophils
Lymphopenia
Hb
Platelets
Others
Dermatitis
Hair loss
Neuropathy
grade
0
1
2
3
4
4
7
5
3
16
5
4
1
1
0
6
4
7
0
0
1
1
3
0
0
0
0
0
0
0
0
8
10
0
5
0
8
1
5
8
2
1
0
0
0
9
Case:55y.o. T4cN1M0
CR
Pretherapy
4 months after treatment
TAL level:20mg/m2
She died after 58 months because of metastatic disease from other primary,
otherwise breast tumor had been controled.
10
Treatment Responses
Follow up period :10 to 53 months. (median 24)
Irradiated site
CR
PR
10
6
Overall
CR
PR
PD
6
9
1
11
Local Control Rate
provability
61%
50%
years
Overall Survival Rate
provability
69%
60%
years
Summary
• Sixteen cases of inoperable advanced breast cancer had
been treated with concurrent chemoradiotherapy.
• The treatment regimen consisting of TAL, 5’-DFUR
and local radiotherapy.
• The dose of TAL 35mg/m2 twice a week and 5'-DFUR
of 600mg/body five times a week was tolerable.
• The treatment response of irradiated site, CR and PR
were 10 and 6 case, respectively.
• Local control rates at 2 and 3 years after treatment were
61% and 50%, overall survival rates at 2 and 3 years
after treatment were 69% and 60%, respectively.
14
Conclusions
The regimen consisting of concurrent dose of
600 mg of 5'-DFUR and doses of 35mg/m2
twice a week of TAL was tolerable and
effective in the local control of advanced or
recurrent breast cancer.
15