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      Concurrent paclitaxel and radiation therapy for the treatment of cutaneous angiosarcoma

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          Highlights

          • Cutaneous angiosarcoma has poor outcomes with no standardized treatment regimen.

          • Paclitaxel-based chemoRT (CRT) was compared to other therapies at two US institutions.

          • Similar oncologic outcomes and improved survival with paclitaxel CRT.

          • Paclitaxel CRT + surgery provided best oncologic outcomes and survival.

          • Paclitaxel CRT + surgery regimen now being studied in a prospective phase II trial.

          Abstract

          Introduction

          We compared clinical outcomes in patients with cutaneous angiosarcoma receiving concurrent paclitaxel-based chemoradiotherapy (CRT) vs. other modalities (Non-CRT).

          Materials and methods

          Patients with non-metastatic cutaneous angiosarcoma diagnosed from 1998 to 2018 at two institutions were identified. In the CRT cohort, paclitaxel 80 mg/m 2 weekly was given for up to 12 weeks and patients received radiotherapy (RT) during the final 6 weeks of chemotherapy. The RT dose was 50–50.4 Gy delivered in 1.8–2 Gy per fraction with an optional post-operative boost of 10–16 Gy. Kaplan-Meier and log-rank statistics were used to compare the outcomes between the two groups. P < 0.05 was considered statistically significant.

          Results

          Fifty-seven patients were included: 22 CRT and 35 Non-CRT. The CRT cohort had more patients > 60 years (100% vs. 60%, p < 0.001) and tumors >5 cm (68.2% vs 54.3%, p = 0.023). The median follow-up was 25.8 (1.5–155.2) months. There was no significant difference in 2-year local control (LC), distant control (DC), or progression-free survival (PFS) between the two groups. The 2-year overall survival (OS) was significantly higher for the CRT cohort (94.1% vs. 71.6%, p = 0.033). Amongst the subset of patients in the CRT cohort who received trimodality therapy, the 2-year LC, DC, PFS, and OS was 68.6%, 100%, 68.6%, and 100%, respectively.

          Conclusion

          The use of concurrent paclitaxel CRT demonstrates promising outcomes. Given these results, we are currently evaluating the safety and efficacy of this regimen in prospective, phase 2 trial (NCT 03921008).

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          Most cited references 20

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          Phase II trial of weekly paclitaxel for unresectable angiosarcoma: the ANGIOTAX Study.

          The objective of this phase II trial was to assess the efficacy and toxicity of weekly paclitaxel for patients with metastatic or unresectable angiosarcoma. Thirty patients were entered onto the study from April 2005 through October 2006. Paclitaxel was administered intravenously as a 60-minute infusion at a dose of 80 mg/m(2) on days 1, 8, and 15 of a 4-week cycle. The primary end point was the nonprogression rate after two cycles. The progression-free survival rates after 2 and 4 months were 74% and 45%, respectively. With a median follow-up of 8 months, the median time to progression was 4 months and the median overall survival was 8 months. The progression-free survival rate was similar in patients pretreated with chemotherapy and in chemotherapy-naïve patients (77% v 71%). Three patients with locally advanced breast angiosarcoma presented partial response, which enabled a secondary curative-intent surgery with complete histologic response in two cases. One toxic death occurred as a result of a thrombocytopenia episode. Six patients presented with grade 3 toxicities and one patient presented with a grade 4 toxicity. Anemia and fatigue were the most frequently reported toxicities. Weekly paclitaxel at the dose schedule used in the current study was well tolerated and demonstrated clinical benefit.
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            Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial.

            Initial results of the ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) comparing neoadjuvant chemoradiotherapy plus surgery versus surgery alone in patients with squamous cell carcinoma and adenocarcinoma of the oesophagus or oesophagogastric junction showed a significant increase in 5-year overall survival in favour of the neoadjuvant chemoradiotherapy plus surgery group after a median of 45 months' follow-up. In this Article, we report the long-term results after a minimum follow-up of 5 years.
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              • Article: not found

              Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial phase 3 study

              The Lancet Oncology, 16(2), 187-199
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                Author and article information

                Contributors
                Journal
                Clin Transl Radiat Oncol
                Clin Transl Radiat Oncol
                Clinical and Translational Radiation Oncology
                Elsevier
                2405-6308
                28 January 2021
                March 2021
                28 January 2021
                : 27
                : 114-120
                Affiliations
                [a ]Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, St. Louis, MO 63110, United States
                [b ]Baylor Scott and White Health Cancer Center, 300 University Blvd., Bldg. A, Round Rock, TX 78665, United States
                [c ]Department of Hematology and Oncology, Vanderbilt University School of Medicine, 1161 21st Ave S # D3300, Nashville, TN 37232, United States
                [d ]Division of Medical Oncology, Washington University School of Medicine, 4921 Parkview Place, St. Louis, MO 63110, United States
                [e ]Department of Human Oncology, University of Wisconsin School of Medicine, 600 Highland Ave, Madison, WI 53792, United States
                [f ]Department of Pathology and Immunology, Washington University School of Medicine, 4921 Parkview Place, St. Louis, MO 63110, United States
                Author notes
                [* ]Corresponding author at: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, LL, Campus Box 8224, St. Louis, MO 63110, United States. mspraker@ 123456wustl.edu
                [1]

                These authors contributed equally to the manuscript and are co-first authors.

                Article
                S2405-6308(21)00009-4
                10.1016/j.ctro.2021.01.009
                7876514
                © 2021 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                Categories
                Original Research Article

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