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Tutorial Inkscape Bahasa Indonesia Pdf Viewer. Original Article Concurrent Chemotherapy and Radiotherapy for Organ Preservation in Advanced Laryngeal Cancer Arlene A. Forastiere, M.D., Helmuth Goepfert, M.D., Moshe Maor, M.D., Thomas F.
Pajak, Ph.D., Randal Weber, M.D., William Morrison, M.D., Bonnie Glisson, M.D., Andy Trotti, M.D., John A. Ridge, M.D., Ph.D., Clifford Chao, M.D., Glen Peters, M.D., Ding-Jen Lee, M.D., Ph.D., Andrea Leaf, M.D., John Ensley, M.D., and Jay Cooper, M.D. N Engl J Med 2003; 349:2091-2098 DOI: 10.1056/NEJMoa031317. Results A total of 547 patients were randomly assigned to one of the three study groups. The median follow-up period was 3.8 years. At two years, the proportion of patients who had an intact larynx after radiotherapy with concurrent cisplatin (88 percent) differed significantly from the proportions in the groups given induction chemotherapy followed by radiotherapy (75 percent, P=0.005) or radiotherapy alone (70 percent, P. Figure 1 Rates of Laryngeal Preservation According to the Treatment Group.
Toshiba Function Key Driver Windows 7 Download here. Figure 2 Rates of Locoregional Control According to the Treatment Group. Each year, approximately 9500 persons in the United States receive the diagnosis of cancer of the larynx. Until the early 1990s, the standard treatment for locally advanced disease was total laryngectomy. This practice changed, however, after the landmark trial conducted by the Department of Veterans Affairs Laryngeal Cancer Study Group, in which induction chemotherapy (cisplatin plus fluorouracil) followed by radiotherapy was compared with surgery plus adjuvant radiotherapy.
The larynx was preserved in 64 percent of the patients who received the nonsurgical treatment, and the two-year survival rate was 68 percent in both groups. Download Video Melahirkan Anak Kembar. No significant difference in survival has been reported after more than 10 years of follow-up. The ability to preserve the larynx without jeopardizing survival established the use of induction chemotherapy followed by radiotherapy as an alternative to laryngectomy for locally advanced laryngeal cancer. To determine the contributions of chemotherapy and radiotherapy to larynx-preserving treatment, the Radiation Therapy Oncology Group and the Head and Neck Intergroup conducted a randomized trial (RTOG 91-11) to investigate three radiation-based treatments: induction cisplatin plus fluorouracil followed by radiotherapy if there was a response to the chemotherapy (a regimen identical to that given the “experimental” group in the Department of Veterans Affairs Laryngeal Cancer Study Group trial), radiotherapy with concurrent administration of cisplatin, and radiotherapy alone. The rationale for the second group was based on the enhancement of radiation effects on tumor cells by concurrent treatment with cisplatin. The primary objective of the trial was to compare the rates of laryngeal preservation associated with the three treatments.