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12 Cards in this Set

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Intergroup 0099: Null hypothesis
Intergroup 0099: Null hypothesis

In patients with stage III and IV nasopharyngeal cancer, there is no difference in survival with radiotherapy versus chemoradiotherapy.
Intergroup 0099: Who was included?
Intergroup 0099: Who was included?

Patients with biopsy-proven stage III and IV nasopharyngeal carcinoma without evidence of systemic mets (M0) or prior RT and no plan for resection other than persistent neck nodes after completion of therapy.
Intergroup 0099: Treatment volume
Intergroup 0099: Treatment volume

Primary tumor site and neck nodes to the clavicle
Upper neck field: nasopharynx and upper neck
- Two opposed laterals
- Included base of skull and sphenoid sinus
- Post: 2 cm beyond mastoid process with 1.5 cm beyond palpable nodal disease
- Ant: posterior third of maxillary sinus and nasal cavity
- Inf: thyroid notch
Intergroup 0099: Dose
Intergroup 0099: Dose

Primary + 2cm margin: 70 Gy
Nodes > 2cm: 70 Gy
Nodes < 2cm: 66 Gy
N0: 50 Gy
Intergroup 0099: Randomization
Intergroup 0099: Randomization

Radiotherapy alone

Chemoradiotherapy --> more chemo
Intergroup 0099: Chemotherapy
Intergroup 0099: Chemotherapy

Concurrent with RT
- Cisplatin 100 mg/m2 on days 1, 22, and 43
Post-RT
- Cisplatin 80 mg/m2 days 71, 99, and 127
- 5FU 1000 mg/m2/d CI x 96h days 71-74, 99-102, and 127-130 starting four weeks after RT
Intergroup 0099: Primary endpoints
Intergroup 0099: Primary endpoints

PFS

OS
Intergroup 0099: Results
Intergroup 0099: Results

PFS
- RT: 15m
- CCRT: Not reached
- 3yr PFS: RT 24% CCRT 69%

OS
- Mean OS RT: 34m
- CCRT: Not reached
- 3yr survival: RT 47% CCRT 78%
Intergroup 0099: Reported overall 5-year survival for nasopharyngeal carcinoma
Intergroup 0099: Previously reported overall 5-year survival for nasopharyngeal carcinoma

41%
Intergroup 0099: Why was the survival rate for patients in the radiotherapy arm higher than expected?
Intergroup 0099: Why was the survival rate for patients in the radiotherapy arm higher than expected?

May be due to salvage rate of these patients after disease progression or recurrence.
Do women with node-negative breast cancers 5 cm and larger require postmastectomy RT?
Floyd IJROBP 2006 66 358
- Retrospective 70 patients
- Mastectomy without RT
- 5-year LRF 7.6%
- 5-year OS 83% and DFS 86%
- LVI increased risk so RT
Taghian JCO 2006 24 3927
- 313 NSABP mastectomy patients
- 10-year LRF 7.1%
- With or without chemotherapy
In young women with DCIS status post lumpectomy, is a boost necessary?
Omlin Lancet Oncol 2006 7 652
- 373 women with TisN0
- Age <= 45 years with BCT
- 57 no RT, 166 no boost, 150 with boost
- Medial follow-up 72 months
- 10-year LRF survival (p < 0.0001)
-- No RT: 46%
-- RT no boost: 72%
-- RT with boost: 86%
- 10-year OS 97% (no diff)
For women <= 45 years with DCIS, boost improves local control.