- 作者：Patrick Kelly ; M.D. ; Ph.D.&lowast ; ; Prajnan Das ; M.D. ; M.S. ; M.P.H.&lowast ; ; Gauri R. Varadhachary ; M.D.&dagger ; ; Hiral P. Fontanilla ; M.D.&lowast ; ; Sunil Krishnan ; M.D.&lowast ; ; Marc E. Delclos ; M.D.&lowast ; ; Anuja Jhingran ; M.D.&lowast ; ; Patricia J. Eifel ; M.D.&lowast ; ; Christopher H. Crane ; M.D.&lowast ; ; ccrane@mdanderson.org
- 关键词：Carcinoma of unknown primary ; Chemoradiation ; Conformal radiation therapy ; Intensity-modulated radiation therapy ; Lymph node metastasis
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 出版时间：1 April, 2012
- 年：2012
- 卷：82
- 期：5
- 页码：2012-2017
- 全文大小：285 K
Objectives
Carcinoma of unknown primary (CUP) in the abdomen and pelvis is a heterogeneous group of cancers with no standard treatment. Considered by many to be incurable, these patients are often treated with chemotherapy alone. In this study, we determined the effectiveness of radiation therapy in combination with chemotherapy in patients with CUP in the abdomen and pelvis.Patients and Methods
Medical records were reviewed for 37 patients with CUP treated with radiation therapy for disease located in the soft tissues and/or nodal basins of the abdomen and pelvis at the University of Texas M.D. Anderson Cancer between 2002 and 2009. All patients underwent chemotherapy, either before or concurrent with radiation therapy. Patients were selected for radiation therapy on the basis of histologic type, disease extent, and prior therapy response. Twenty patients underwent definitive radiation therapy (defined as radiation therapy targeting all known disease sites with at least 45 Gy) and 17 patients underwent palliative radiation therapy. Only 6 patients had surgical resection of their disease. Patient and treatment characteristics were extracted and the endpoints of local disease control, progression-free survival (PFS), overall survival (OS), and treatment-related toxicity incidence were analyzed.
Results
The 2-year PFS and OS rates for the entire cohort were 32 % and 57 % , respectively. However, in patients treated with definitive radiation therapy, the rates were 48 % and 76 % , and 7 patients lived more than 3 years after treatment with no evidence of disease progression. Nevertheless, radiation-associated toxicity was significant in this cohort, as 40 % experienced Grade 2 or higher late toxicities.
Conclusions
The use of definitive radiation therapy should be considered in selected patients with CUP in the soft tissues or nodal basins of the abdomen and pelvis.