1
|
Huang HT, Brand DH, Fenwick JD, Hawkins MA. ImmunoChemoradiation for Non-Small Cell Lung Cancer: A Meta-Analysis of Factors Influencing Survival Benefit in Combination Trials. Int J Radiat Oncol Biol Phys 2024; 120:409-421. [PMID: 38570169 DOI: 10.1016/j.ijrobp.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Adding immune checkpoint blockade (ICB) to concurrent chemoradiotherapy (cCRT) has improved overall survival (OS) for inoperable locally advanced non-small cell lung cancer. Trials of cCRT-ICB are heterogeneous for factors such as tumor stage and histology, programmed cell death ligand-1 (PDL-1) status, and cCRT-ICB schedules. We therefore aimed to determine the ICB contribution to survival across studies and identify factors associated with survival gain. METHODS AND MATERIALS Data were collated from cCRT-ICB clinical studies published 2018 to 2022 that treated 2196 patients with non-small cell lung cancer (99% stage 3). Associations between 2-year OS and ICB, CRT, patient and tumor factors were investigated using metaregression. A published model of survival after radiation therapy (RT) or CRT was extended to include ICB effects. The model was fitted simultaneously to the cCRT-ICB data and data previously compiled for RT/CRT treatments alone. The net ICB contribution (OS gain) and its associations with factors were described by fitted values of ICB terms added to the model. Statistical significance was determined by likelihood-ratio testing. RESULTS The gain in 2-year OS from ICB was 9.9% overall (95% CI, 7.6%, 12.2%; P = .018). Both OS gain and 2-year OS itself rose with increasing planned ICB duration (P = .008, .002, respectively) and with tumor PDL-1 ≥ 1% (P = .034, .023). Fitted OS gains were also greater for patients with stage 3B/C disease (P = .021). OS gain was not associated with tumor histology, patient performance status, radiation therapy dose, ICB drug type (anti-PDL-1 vs anti-programmed cell death-1), or whether ICB began concurrently with or after cCRT. CONCLUSIONS Fitted gains in 2-year OS due to ICB were higher in cohorts with greater fractions of stage 3B/C patients and patients with tumor PDL-1 ≥ 1%. OS gain was also significantly higher in a single cohort with a planned ICB duration of 2 years rather than 1, but was not associated with whether ICB treatment began during versus after CRT.
Collapse
Affiliation(s)
- Huei-Tyng Huang
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Douglas H Brand
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom; University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - John D Fenwick
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.
| | - Maria A Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom; University College London Hospital NHS Foundation Trust, London, United Kingdom.
| |
Collapse
|
2
|
Hessels AC, Visser S, Both S, Korevaar EW, Langendijk JA, Wijsman R. A planning study of proton therapy dose escalation for non-small cell lung cancer. Phys Imaging Radiat Oncol 2024; 31:100616. [PMID: 39157295 PMCID: PMC11327929 DOI: 10.1016/j.phro.2024.100616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 07/19/2024] [Accepted: 07/24/2024] [Indexed: 08/20/2024] Open
Abstract
In non-small-cell lung cancer (NSCLC), improving local control through radiotherapy dose escalation might improve survival. However, a photon-based RCT showed increased organ at risk dose exposure and worse overall survival in the dose escalation arm. In this study, intensity-modulated proton therapy plans with dose escalation to the primary tumour were created for 20 NSCLC patients. The mediastinal envelope was delineated to spare structures around the heart. It was possible to increase primary tumour dose up to 74.0 Gy without a significant increase in organ at risk doses and predicted toxicity.
Collapse
Affiliation(s)
- Arno C Hessels
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sabine Visser
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stefan Both
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik W Korevaar
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robin Wijsman
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
3
|
Possenti L, Vitullo P, Cicchetti A, Zunino P, Rancati T. Modeling hypoxia-induced radiation resistance and the impact of radiation sources. Comput Biol Med 2024; 173:108334. [PMID: 38520919 DOI: 10.1016/j.compbiomed.2024.108334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/29/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
Hypoxia contributes significantly to resistance in radiotherapy. Our research rigorously examines the influence of microvascular morphology on radiotherapy outcome, specifically focusing on how microvasculature shapes hypoxia within the microenvironment and affects resistance to a standard treatment regimen (30×2GyRBE). Our computational modeling extends to the effects of different radiation sources. For photons and protons, our analysis establishes a clear correlation between hypoxic volume distribution and treatment effectiveness, with vascular density and regularity playing a crucial role in treatment success. On the contrary, carbon ions exhibit distinct effectiveness, even in areas of intense hypoxia and poor vascularization. This finding points to the potential of carbon-based hadron therapy in overcoming hypoxia-induced resistance to RT. Considering that the spatial scale analyzed in this study is closely aligned with that of imaging data voxels, we also address the implications of these findings in a clinical context envisioning the possibility of detecting subvoxel hypoxia.
Collapse
Affiliation(s)
- Luca Possenti
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy.
| | - Piermario Vitullo
- MOX, Department of Mathematics, Politecnico di Milano, P.zza Da Vinci 32, Milan, 20133, Italy
| | - Alessandro Cicchetti
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy
| | - Paolo Zunino
- MOX, Department of Mathematics, Politecnico di Milano, P.zza Da Vinci 32, Milan, 20133, Italy
| | - Tiziana Rancati
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy
| |
Collapse
|
4
|
Slama Y, Arcambal A, Septembre-Malaterre A, Morel AL, Pesnel S, Gasque P. Evaluation of core-shell Fe 3O 4@Au nanoparticles as radioenhancer in A549 cell lung cancer model. Heliyon 2024; 10:e29297. [PMID: 38644868 PMCID: PMC11033100 DOI: 10.1016/j.heliyon.2024.e29297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/23/2024] Open
Abstract
In radiotherapy, metallic nanoparticles are of high interest in the fight against cancer for their radiosensitizing effects. This study aimed to evaluate the ability of core-shell Fe3O4@Au nanoparticles to potentiate the irradiation effects on redox-, pro-inflammatory markers, and cell death of A549 human pulmonary cancer cells. The hybrid Fe3O4@Au nanoparticles were synthesized using green chemistry principles by the sonochemistry method. Their characterization by transmission electron microscopy demonstrated an average size of 8 nm and a homogeneous distribution of gold. The decreased hydrodynamic size of these hybrid nanoparticles compared to magnetite (Fe3O4) nanoparticles showed that gold coating significantly reduced the aggregation of Fe3O4 particles. The internalization and accumulation of the Fe3O4@Au nanoparticles within the cells were demonstrated by Prussian Blue staining. The reactive oxygen species (ROS) levels measured by the fluorescent probe DCFH-DA were up-regulated, as well as mRNA expression of SOD, catalase, GPx antioxidant enzymes, redox-dependent transcription factor Nrf2, and ROS-producing enzymes (Nox2 and Nox4), quantified by RT-qPCR. Furthermore, irradiation coupled with Fe3O4@Au nanoparticles increased the expression of canonical pro-inflammatory cytokines and chemokines (TNF-α, IL-1β, IL-6, CXCL8, and CCL5) assessed by RT-qPCR and ELISA. Hybrid nanoparticles did not potentiate the increased DNA damage detected by immunofluorescence following the irradiation. Nevertheless, Fe3O4@Au caused cellular damage, leading to apoptosis through activation of caspase 3/7, secondary necrosis quantified by LDH release, and cell growth arrest evaluated by clonogenic-like assay. This study demonstrated the potential of Fe3O4@Au nanoparticles to potentiate the radiosensitivity of cancerous cells.
Collapse
Affiliation(s)
- Youssef Slama
- Université de La Réunion, Unité de Recherche Etudes Pharmaco-Immunologiques (EPI), CHU de La Réunion, Site Felix Guyon, Allée des Topazes, SC11021, 97400, Saint-Denis, La Réunion, France
- Clinique Sainte-Clotilde, Groupe Clinifutur, 127 Route de Bois de Nèfles, 97400, Saint-Denis, La Réunion, France
| | - Angelique Arcambal
- Université de La Réunion, Unité de Recherche Etudes Pharmaco-Immunologiques (EPI), CHU de La Réunion, Site Felix Guyon, Allée des Topazes, SC11021, 97400, Saint-Denis, La Réunion, France
| | - Axelle Septembre-Malaterre
- Université de La Réunion, Unité de Recherche Etudes Pharmaco-Immunologiques (EPI), CHU de La Réunion, Site Felix Guyon, Allée des Topazes, SC11021, 97400, Saint-Denis, La Réunion, France
| | - Anne-Laure Morel
- Torskal, Nanosciences, 2 Rue Maxime Rivière, 97490 Sainte-Clotilde, La Réunion, France
| | - Sabrina Pesnel
- Torskal, Nanosciences, 2 Rue Maxime Rivière, 97490 Sainte-Clotilde, La Réunion, France
| | - Philippe Gasque
- Université de La Réunion, Unité de Recherche Etudes Pharmaco-Immunologiques (EPI), CHU de La Réunion, Site Felix Guyon, Allée des Topazes, SC11021, 97400, Saint-Denis, La Réunion, France
| |
Collapse
|
5
|
Wu L, Zhang Z, Bai M, Yan Y, Yu J, Xu Y. Radiation combined with immune checkpoint inhibitors for unresectable locally advanced non-small cell lung cancer: synergistic mechanisms, current state, challenges, and orientations. Cell Commun Signal 2023; 21:119. [PMID: 37221584 PMCID: PMC10207766 DOI: 10.1186/s12964-023-01139-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
Until the advent of immune checkpoint inhibitors (ICIs), definitive radiotherapy (RT) concurrently with chemotherapy was recommended for unresectable, locally advanced non-small cell lung cancer (LA-NSCLC). The trimodality paradigm with consolidation ICIs following definitive concurrent chemoradiotherapy has been the standard of care since the PACIFIC trial. Preclinical evidence has demonstrated the role of RT in the cancer-immune cycle and the synergistic effect of RT combined with ICIs (iRT). However, RT exerts a double-edged effect on immunity and the combination strategy still could be optimized in many areas. In the context of LA-NSCLC, optimized RT modality, choice, timing, and duration of ICIs, care for oncogenic addicted tumors, patient selection, and novel combination strategies require further investigation. Targeting these blind spots, novel approaches are being investigated to cross the borders of PACIFIC. We discussed the development history of iRT and summarized the updated rationale for the synergistic effect. We then summarized the available research data on the efficacy and toxicity of iRT in LA-NSCLC for cross-trial comparisons to eliminate barriers. Progression during and after ICIs consolidation therapy has been regarded as a distinct resistance scenario from primary or secondary resistance to ICIs, the subsequent management of which has also been discussed. Finally, based on unmet needs, we probed into the challenges, strategies, and auspicious orientations to optimize iRT in LA-NSCLC. In this review, we focus on the underlying mechanisms and recent advances of iRT with an emphasis on future challenges and directions that warrant further investigation. Taken together, iRT is a proven and potential strategy in LA-NSCLC, with multiple promising approaches to further improve the efficacy. Video Abstract.
Collapse
Affiliation(s)
- Leilei Wu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Zhenshan Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Menglin Bai
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yujie Yan
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jinming Yu
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
| | - Yaping Xu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
| |
Collapse
|
6
|
Allignet B, De Ruysscher D, Martel-Lafay I, Waissi W. Stereotactic body radiation therapy in unresectable stage III non-small cell lung cancer: A systematic review. Cancer Treat Rev 2023; 118:102573. [PMID: 37210766 DOI: 10.1016/j.ctrv.2023.102573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/29/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023]
Abstract
In unresectable stage III non-small cell lung cancer (NSCLC), the standard of care for most fit patients is concurrent chemotherapy with normofractionated radiotherapy (NFRT), followed by durvalumab consolidation. Nevertheless, almost half of patients will present locoregional or metastatic intrathoracic relapse. Improving locoregional control thus remains an important objective. For this purpose, stereotactic body radiotherapy (SBRT) may be a relevant treatment modality. We performed a systematic review of the literature that evaluate the efficacy and safety of SBRT in this situation, either instead of or in addition to NFRT. Among 1788 unique reports, 18 met the inclusion criteria. They included 447 patients and were mainly prospective (n = 10, including 5 phase 2 trials). In none, maintenance durvalumab was administered. Most reported SBRT boost after NFRT (n = 8), or definitive tumor and nodal SBRT (n = 7). Median OS varied from 10 to 52 months, due to the heterogeneity of the included populations and according to treatment regimen. The rate of severe side effects was low, with <5 % grade 5 toxicity, and mainly observed when mediastinal SBRT was performed without dose constraints to the proximal bronchovascular tree. It was suggested that a biologically effective dose higher than 112.3 Gy may increase locoregional control. SBRT for selected stage III NSCLC bears potential to improve loco-regional tumor control, but at present, this should only be done in prospective clinical trials.
Collapse
Affiliation(s)
- Benoît Allignet
- Department of Radiation Oncology, Centre Léon Bérard, 28 rue Laennec, 69673 Lyon, France; Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294 Lyon, France.
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro), Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, The Netherlands; Department of Radiotherapy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Isabelle Martel-Lafay
- Department of Radiation Oncology, Centre Léon Bérard, 28 rue Laennec, 69673 Lyon, France
| | - Waisse Waissi
- Department of Radiation Oncology, Centre Léon Bérard, 28 rue Laennec, 69673 Lyon, France
| |
Collapse
|
7
|
Martinez-Zubiaurre I, Hellevik T. Cancer-associated fibroblasts in radiotherapy: Bystanders or protagonists? Cell Commun Signal 2023; 21:108. [PMID: 37170098 PMCID: PMC10173661 DOI: 10.1186/s12964-023-01093-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/26/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND The primary goal of radiotherapy (RT) is to induce cellular damage on malignant cells; however, it is becoming increasingly recognized the important role played by the tumor microenvironment (TME) in therapy outcomes. Therapeutic irradiation of tumor lesions provokes profound cellular and biological reconfigurations within the TME that ultimately may influence the fate of the therapy. MAIN CONTENT Cancer-associated fibroblasts (CAFs) are known to participate in all stages of cancer progression and are increasingly acknowledged to contribute to therapy resistance. Accumulated evidence suggests that, upon radiation, fibroblasts/CAFs avoid cell death but instead enter a permanent senescent state, which in turn may influence the behavior of tumor cells and other components of the TME. Despite the proposed participation of senescent fibroblasts on tumor radioprotection, it is still incompletely understood the impact that RT has on CAFs and the ultimate role that irradiated CAFs have on therapy outcomes. Some of the current controversies may emerge from generalizing observations obtained using normal fibroblasts and CAFs, which are different cell entities that may respond differently to radiation exposure. CONCLUSION In this review we present current knowledge on the field of CAFs role in radiotherapy; we discuss the potential tumorigenic functions of radiation-induced senescent fibroblasts and CAFs and we make an effort to integrate the knowledge emerging from preclinical experimentation with observations from the clinics. Video Abstract.
Collapse
Affiliation(s)
- Inigo Martinez-Zubiaurre
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postbox 6050, 9037, Langnes, Tromsö, Norway.
| | - Turid Hellevik
- Department of Radiation Oncology, University Hospital of North Norway, Postbox 100, 9038, Tromsö, Norway
| |
Collapse
|
8
|
Randomized, Multicenter, Phase 3 Study of Accelerated Fraction Radiation Therapy With Concomitant Boost to the Gross Tumor Volume Compared With Conventional Fractionation in Concurrent Chemoradiation in Patients With Unresectable Stage III Non-Small Cell Lung Cancer: The Korean Radiation Oncology Group 09-03 Trial. Int J Radiat Oncol Biol Phys 2023; 115:873-885. [PMID: 36280151 DOI: 10.1016/j.ijrobp.2022.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE We designed the Korean Radiation Oncology Group 09-03 phase III clinical trial to compare accelerated hypofractionated radiation therapy (RT) using a concomitant boost to the gross tumor volume (GTV) with conventionally fractionated 60-Gy RT in patients with stage III unresectable non-small cell lung cancer (NSCLC). METHODS AND MATERIALS A conventionally fractionated RT group (arm 1; 124 patients) received a 2-Gy daily dose to a total cumulative dose of 44 Gy to the planning target volume (PTV) in 22 fractions and 60 Gy to the GTV in 30 fractions over 6 weeks. A hypofractionated RT group (arm 2; 142 patients) received a 1.8-Gy daily dose to the PTV with a synchronous boost of 0.6 Gy to the GTV, for total cumulative doses of 45 Gy to the PTV and 60 Gy to the GTV in 25 fractions over 5 weeks. All patients received concurrent weekly chemotherapy consisting of paclitaxel and cisplatin. RESULTS The objective response rate of all patients was 86.5% (arm 1, 84.6%; arm 2, 88.1%; P = .612). The median overall survival was 26 months (arm 1, 26 months; arm 2, 27 months; P = .508). The median progression-free survival was 11 months (arm 1, 10 months; arm 2, 13 months; P = .295). The local tumor control rates at 2 and 5 years were 58.3% and 50.7%, respectively (arm 1, 62.4% and 51.0%, respectively; arm 2, 54.0% and 48.6%, respectively; P = .615). There were no significant between-group differences in the cumulative incidence of grade ≥3 radiation pneumonitis (P = .134) or radiation esophagitis (P = .539). CONCLUSIONS This clinical trial did not confirm the superiority of accelerated 2.4-Gy hypofractionated RT compared with conventional 2-Gy fractionation in patients with unresectable stage III NSCLC undergoing concurrent chemoradiation therapy.
Collapse
|
9
|
Hoppen L, Sarria GR, Kwok CS, Boda-Heggemann J, Buergy D, Ehmann M, Giordano FA, Fleckenstein J. Dosimetric benefits of adaptive radiation therapy for patients with stage III non-small cell lung cancer. Radiat Oncol 2023; 18:34. [PMID: 36814271 PMCID: PMC9945670 DOI: 10.1186/s13014-023-02222-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Daily adaptive radiation therapy (ART) of patients with non-small cell lung cancer (NSCLC) lowers organs at risk exposure while maintaining the planning target volume (PTV) coverage. Thus, ART allows an isotoxic approach with increased doses to the PTV that could improve local tumor control. Herein we evaluate daily online ART strategies regarding their impact on relevant dose-volume metrics. METHODS Daily cone-beam CTs (1 × n = 28, 1 × n = 29, 11 × n = 30) of 13 stage III NSCLC patients were converted into synthetic CTs (sCTs). Treatment plans (TPs) were created retrospectively on the first-fraction sCTs (sCT1) and subsequently transferred unaltered to the sCTs of the remaining fractions of each patient (sCT2-n) (IGRT scenario). Two additional TPs were generated on sCT2-n: one minimizing the lung-dose while preserving the D95%(PTV) (isoeffective scenario), the other escalating the D95%(PTV) with a constant V20Gy(lungipsilateral) (isotoxic scenario). RESULTS Compared to the original TPs predicted dose, the median D95%(PTV) in the IGRT scenario decreased by 1.6 Gy ± 4.2 Gy while the V20Gy(lungipsilateral) increased in median by 1.1% ± 4.4%. The isoeffective scenario preserved the PTV coverage and reduced the median V20Gy(lungipsilateral) by 3.1% ± 3.6%. Furthermore, the median V5%(heart) decreased by 2.9% ± 6.4%. With an isotoxic prescription, a median dose-escalation to the gross target volume of 10.0 Gy ± 8.1 Gy without increasing the V20Gy(lungipsilateral) and V5%(heart) was feasible. CONCLUSIONS We demonstrated that even without reducing safety margins, ART can reduce lung-doses, while still reaching adequate target coverage or escalate target doses without increasing ipsilateral lung exposure. Clinical benefits by means of toxicity and local control of both strategies should be evaluated in prospective clinical trials.
Collapse
Affiliation(s)
- Lea Hoppen
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Gustavo R. Sarria
- grid.10388.320000 0001 2240 3300Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Chung S. Kwok
- grid.7700.00000 0001 2190 4373Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Judit Boda-Heggemann
- grid.7700.00000 0001 2190 4373Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Daniel Buergy
- grid.7700.00000 0001 2190 4373Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Michael Ehmann
- grid.7700.00000 0001 2190 4373Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Frank A. Giordano
- grid.7700.00000 0001 2190 4373Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Jens Fleckenstein
- grid.7700.00000 0001 2190 4373Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| |
Collapse
|
10
|
Colori A, Hiley C. The Interaction of Preexisting Cardiac Dysfunction and Heart Dose From Radical Radiotherapy on All-Cause Mortality in Locally Advanced NSCLC. J Thorac Oncol 2023; 18:14-16. [PMID: 36543430 DOI: 10.1016/j.jtho.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Amy Colori
- Department of Clinical Oncology, University College London Hospital, London, United Kingdom
| | - Crispin Hiley
- Department of Clinical Oncology, University College London Hospital, London, United Kingdom; Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, United Kingdom.
| |
Collapse
|
11
|
Russ E, Davis CM, Slaven JE, Bradfield DT, Selwyn RG, Day RM. Comparison of the Medical Uses and Cellular Effects of High and Low Linear Energy Transfer Radiation. TOXICS 2022; 10:toxics10100628. [PMID: 36287908 PMCID: PMC9609561 DOI: 10.3390/toxics10100628] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 05/14/2023]
Abstract
Exposure to ionizing radiation can occur during medical treatments, from naturally occurring sources in the environment, or as the result of a nuclear accident or thermonuclear war. The severity of cellular damage from ionizing radiation exposure is dependent upon a number of factors including the absorbed radiation dose of the exposure (energy absorbed per unit mass of the exposure), dose rate, area and volume of tissue exposed, type of radiation (e.g., X-rays, high-energy gamma rays, protons, or neutrons) and linear energy transfer. While the dose, the dose rate, and dose distribution in tissue are aspects of a radiation exposure that can be varied experimentally or in medical treatments, the LET and eV are inherent characteristics of the type of radiation. High-LET radiation deposits a higher concentration of energy in a shorter distance when traversing tissue compared with low-LET radiation. The different biological effects of high and low LET with similar energies have been documented in vivo in animal models and in cultured cells. High-LET results in intense macromolecular damage and more cell death. Findings indicate that while both low- and high-LET radiation activate non-homologous end-joining DNA repair activity, efficient repair of high-LET radiation requires the homologous recombination repair pathway. Low- and high-LET radiation activate p53 transcription factor activity in most cells, but high LET activates NF-kB transcription factor at lower radiation doses than low-LET radiation. Here we review the development, uses, and current understanding of the cellular effects of low- and high-LET radiation exposure.
Collapse
Affiliation(s)
- Eric Russ
- Graduate Program of Cellular and Molecular Biology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Catherine M. Davis
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - John E. Slaven
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Dmitry T. Bradfield
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Reed G. Selwyn
- Department of Radiology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Regina M. Day
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Correspondence:
| |
Collapse
|
12
|
Huang HT, Nix MG, Brand DH, Cobben D, Hiley CT, Fenwick JD, Hawkins MA. Dose-Response Analysis Describes Particularly Rapid Repopulation of Non-Small Cell Lung Cancer during Concurrent Chemoradiotherapy. Cancers (Basel) 2022; 14:4869. [PMID: 36230791 PMCID: PMC9563948 DOI: 10.3390/cancers14194869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Purpose: We analysed overall survival (OS) rates following radiotherapy (RT) and chemo-RT of locally-advanced non-small cell lung cancer (LA-NSCLC) to investigate whether tumour repopulation varies with treatment-type, and to further characterise the low α/β ratio found in a previous study. (2) Materials and methods: Our dataset comprised 2-year OS rates for 4866 NSCLC patients (90.5% stage IIIA/B) belonging to 51 cohorts treated with definitive RT, sequential chemo-RT (sCRT) or concurrent chemo-RT (cCRT) given in doses-per-fraction ≤3 Gy over 16-60 days. Progressively more detailed dose-response models were fitted, beginning with a probit model, adding chemotherapy effects and survival-limiting toxicity, and allowing tumour repopulation and α/β to vary with treatment-type and stage. Models were fitted using the maximum-likelihood technique, then assessed via the Akaike information criterion and cross-validation. (3) Results: The most detailed model performed best, with repopulation offsetting 1.47 Gy/day (95% confidence interval, CI: 0.36, 2.57 Gy/day) for cCRT but only 0.30 Gy/day (95% CI: 0.18, 0.47 Gy/day) for RT/sCRT. The overall fitted tumour α/β ratio was 3.0 Gy (95% CI: 1.6, 5.6 Gy). (4) Conclusion: The fitted repopulation rates indicate that cCRT schedule durations should be shortened to the minimum in which prescribed doses can be tolerated. The low α/β ratio suggests hypofractionation should be efficacious.
Collapse
Affiliation(s)
- Huei-Tyng Huang
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
| | - Michael G. Nix
- Department of Medical Physics and Engineering, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Foundation Trust, Leeds LS9 7TF, UK
| | - Douglas H. Brand
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
- University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
| | - David Cobben
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool CH63 4JY, UK
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool L69 3GF, UK
| | - Crispin T. Hiley
- University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London WC1E 6AG, UK
| | - John D. Fenwick
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool CH63 4JY, UK
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool L69 7BE, UK
| | - Maria A. Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
- University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
| |
Collapse
|
13
|
Wurstbauer K, Kazil M, Meinschad M, Pinter R, De Vries C, Clemens P, Kreuter C, Hernler T, Hitzl W, Cerkl P, Künzler T, De Vries A. Locally advanced NSCLC: a plea for sparing the ipsilateral normal lung-prospective, clinical trial with DART-bid (dose-differentiated accelerated radiation therapy, 1.8 Gy twice daily) by VMAT. Radiat Oncol 2022; 17:120. [PMID: 35799182 PMCID: PMC9264580 DOI: 10.1186/s13014-022-02083-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background In radiation treatment of locally advanced non-small cell lung cancer (LA-NSCLC), ‘margins’ from internal target volumes to planning target volumes in the range of 12 to 23 mm are reported, and avoiding exposure of the contralateral lung is common practice. We investigated prospectively an approach with tight margins (7 mm) and maximal sparing of the ipsilateral normal lung. Mature results for the first endpoint (pneumonitis) and further toxicities are reported. Methods Primary tumors were treated by VMAT with 73.8–90.0 Gy in positive correlation to tumor volumes, nodes with 61.2 Gy, a restricted volume of nodes electively with 45 Gy. Fractional doses of 1.8 Gy bid, interval 8 h. Before radiotherapy, two cycles platin-based chemotherapy were given. 12 patients finished maintenance therapy with Durvalumab. Median follow up time for all patients is 19.4 months, for patients alive 27.0 months (3.4–66.5 months). Results 100 consecutive, unselected patients with LA-NSCLC in stages II through IVA were enrolled (UICC/AJCC, 8th edition). No acute grade 4/5 toxicity occurred. Pneumonitis grade 2 and 3 was observed in 12% and 2% of patients, respectively; lowering the risk of pneumonitis grade ≥ 2 in comparison to the largest study in the literature investigating pneumonitis in LA-NSCLC, is significant (p < 0.0006). Acute esophageal toxicity grade 1, 2 and 3 occurred in 12%, 57% and 3% of patients, respectively. Two patients showed late bronchial stricture/atelectasis grade 2. In two patients with lethal pulmonary haemorrhages a treatment correlation cannot be excluded. Median overall survival for all stage III patients, and for those with ‘RTOG 0617 inclusion criteria’ is 46.6 and 50.0 months, respectively. Conclusions Overall toxicity is low. In comparison to results in the literature, maximal sparing the ipsilateral normal lung lowers the risk for pneumonitis significantly. Trial registration Ethics committee of Vorarlberg, Austria; EK-0.04-105, Registered 04/09/2017—Retrospectively registered. http://www.ethikkommission-vorarlberg.at
Collapse
Affiliation(s)
- Karl Wurstbauer
- Department for Radiation Oncology, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria.
| | - Margit Kazil
- Department for Radiation Oncology, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
| | - Marco Meinschad
- Academic Teaching Hospital, Institute of Medical Physics, Feldkirch, Austria
| | - Raoul Pinter
- Department for Radiation Oncology, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
| | - Catharina De Vries
- Department for Radiation Oncology, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
| | - Patrick Clemens
- Department for Radiation Oncology, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
| | - Christof Kreuter
- Department for Radiation Oncology, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
| | - Tamara Hernler
- Department for Pneumology, Academic Teaching Hospital, Hohenems, Austria
| | - Wolfgang Hitzl
- Team Biostatistics and Publication of Clincial Studies, FM&TT, Paracelsus Medical University, Salzburg, Austria
| | - Peter Cerkl
- Department for Pneumology, Academic Teaching Hospital, Hohenems, Austria
| | - Thomas Künzler
- Academic Teaching Hospital, Institute of Medical Physics, Feldkirch, Austria
| | - Alexander De Vries
- Department for Radiation Oncology, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
| |
Collapse
|
14
|
Tambe NS, Pires IM, Moore CS, Wieczorek A, Upadhyay S, Beavis AW. Predicting personalised and progressive adaptive dose escalation to gross tumour volume using knowledge-based planning models for inoperable advanced-stage non-small cell lung cancer patients treated with volumetric modulated arc therapy. Biomed Phys Eng Express 2022; 8. [PMID: 35189613 DOI: 10.1088/2057-1976/ac56eb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/21/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Increased radiation doses could improve local control and overall survival of lung cancer patients, however, this could be challenging without exceeding organs at risk (OAR) dose constraints especially for patients with advanced-stage disease. Increasing OAR doses could reduce the therapeutic ratio and quality of life. It is therefore important to investigate methods to increase the dose to target volume without exceeding OAR dose constraints. METHODS Gross tumour volume (GTV) was contoured on synthetic computerised tomography (sCT) datasets produced using the Velocity adaptive radiotherapy software for eleven patients. The fractions where GTV volume decreased compared to that prior to radiotherapy (reference plan) were considered for personalised progressive dose escalation. The dose to the adapted GTV (GTVAdaptive) was increased until OAR doses were affected (as compared to the original clinical plan). Planning target volume (PTV) coverage was maintained for all plans. Doses were also escalated to the reference plan (GTVClinical) using the same method. Adapted, dose-escalated, plans were combined to estimate accumulated dose, D99 (dose to 99%) of GTVAdapted, PTV D99 and OAR doses and compared with those in the original clinical plans. Knowledge-based planning (KBP) model was developed to predict D99 of the adapted GTV with OAR doses and PTV coverage kept similar to the original clinical plans; prediction accuracy and model verification were performed using further data sets. RESULTS Compared to the original clinical plan, dose to GTV was significantly increased without exceeding OAR doses. Adaptive dose-escalation increased the average D99 to GTVAdaptive by 15.1Gy and 8.7Gy compared to the clinical plans. The KBP models were verified and demonstrated prediction accuracy of 0.4% and 0.7% respectively. CONCLUSION Progressive adaptive dose escalation can significantly increase the dose to GTV without increasing OAR doses or compromising dose to microscopic disease. This may increase overall survival without increasing toxicities.
Collapse
Affiliation(s)
- Nilesh S Tambe
- Radiation Physics Department, Hull University Teaching Hospitals NHS Trust, Queens Centre For Oncology And Haematology, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Isabel M Pires
- Biomedical Sciences, University of Hull, Cottingham Road,, Hardy Building,, Hull, Kingston upon Hull, HU6 7RX, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Craig Steven Moore
- Medical Physics, Hull University Teaching Hospitals NHS Trust, Queens Centre, Castle Hill Hospital, Cottingham, Hull, HU16 5LH, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Andrzej Wieczorek
- Hull University Teaching Hospitals NHS Trust, Department of Clinical Oncology, The Queen's Centre, Cottingham, Hull, Kingston upon Hull, HU3 2JZ, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Sunil Upadhyay
- Clinical Oncology Department, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital,, Queen's Centre for Oncology and Hematology, Castle Road, Cottingham, Kingston upon Hull, HU16 5JQ, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Andrew W Beavis
- Department of Radiotherapy Physics, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, Kingston upon Hull, HU3 2JZ, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| |
Collapse
|
15
|
Daly ME, Singh N, Ismaila N, Antonoff MB, Arenberg DA, Bradley J, David E, Detterbeck F, Früh M, Gubens MA, Moore AC, Padda SK, Patel JD, Phillips T, Qin A, Robinson C, Simone CB. Management of Stage III Non-Small-Cell Lung Cancer: ASCO Guideline. J Clin Oncol 2021; 40:1356-1384. [PMID: 34936470 DOI: 10.1200/jco.21.02528] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations to practicing clinicians on management of patients with stage III non-small-cell lung cancer (NSCLC). METHODS An Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary oncology, community oncology, research methodology, and advocacy experts was convened to conduct a literature search, which included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included survival, disease-free or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 127 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations were developed to address evaluation and staging workup of patients with suspected stage III NSCLC, surgical management, neoadjuvant and adjuvant approaches, and management of patients with unresectable stage III NSCLC.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
Collapse
Affiliation(s)
| | - Navneet Singh
- Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Nofisat Ismaila
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | | | | | | | | | | | - Martin Früh
- Department of Medical Oncology Cantonal Hospital of St Gallen, St Gallen, Switzerland.,University of Bern, Bern, Switzerland
| | | | | | - Sukhmani K Padda
- Department of Medicine, Division of Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jyoti D Patel
- Northwestern University-Feinberg School of Medicine, Chicago, IL
| | | | - Angel Qin
- University of Michigan, Ann Arbor, MI
| | | | - Charles B Simone
- New York Proton Center and Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
16
|
Zandi A, Rafizadeh‐Tafti S, Shojaeian F, Ali Khayamian M, Abbasvandi F, Faranoush M, Anbiaee R, Najafikhoshnoo S, Hoseinpour P, Assadi S, Katebi P, Davari sh. Z, Shalileh S, Salemizadeh Parizi M, Vanaei S, Ghaderinia M, Abadijoo H, Taheri P, Reza Esmailinejad M, Sanati H, Reza Rostami M, Sadeghian R, Kordehlachin Y, Sadegh Mousavi‐kiasary SM, Mamdouh A, Hossein Miraghaie S, Baharvand H, Abdolahad M. Positive electrostatic therapy of metastatic tumors: selective induction of apoptosis in cancer cells by pure charges. Cancer Med 2021; 10:7475-7491. [PMID: 34626092 PMCID: PMC8559484 DOI: 10.1002/cam4.4267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND We discovered that pure positive electrostatic charges (PECs) have an intrinsic suppressive effect on the proliferation and metabolism of invasive cancer cells (cell lines and animal models) without affecting normal tissues. METHODS We interacted normal and cancer cell lines and animal tumors with PECs by connecting a charged patch to cancer cells and animal tumors. many biochemical, molecular and radiological assays were carried out on PEC treated and control samples. RESULTS Correlative interactions between electrostatic charges and cancer cells contain critical unknown factors that influence cancer diagnosis and treatment. Different types of cell analyses prove PEC-based apoptosis induction in malignant cell lines. Flowcytometry and viability assay depict selective destructive effects of PEC on malignant breast cancer cells. Additionally, strong patterns of pyknotic apoptosis, as well as downregulation of proliferative-associated proteins (Ki67, CD31, and HIF-1α), were observed in histopathological and immunohistochemical patterns of treated mouse malignant tumors, respectively. Quantitative real-time polymerase chain reaction results demonstrate up/down-regulated apoptotic/proliferative transcriptomes (P21, P27, P53/CD34, integrin α5, vascular endothelial growth factor, and vascular endothelial growth factor receptor) in treated animal tumors. Expression of propidium iodide in confocal microscopy images of treated malignant tissues was another indication of the destructive effects of PECs on such cells. Significant tumor size reduction and prognosis improvement were seen in over 95% of treated mouse models with no adverse effects on normal tissues. CONCLUSION We discovered that pure positive electrostatic charges (PECs) have an intrinsic suppressive effect on the proliferation and metabolism of invasive cancer cells (cell lines and animal models) without affecting normal tissues. The findings were statistically and observationally significant when compared to radio/chemotherapy-treated mouse models. As a result, this nonionizing radiation may be used as a practical complementary approach with no discernible side effects after passing future human model studies.
Collapse
Affiliation(s)
- Ashkan Zandi
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of ExcellenceNanoelectronics and Thin Film Lab.School of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | - Saeid Rafizadeh‐Tafti
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | - Fatemeh Shojaeian
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
- School of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Ali Khayamian
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | - Fereshteh Abbasvandi
- ATMP DepartmentBreast Cancer Research CenterMotamed Cancer InstituteACECRTehranIran
| | - Mohammad Faranoush
- Pediatric Growth and Development Research CenterInstitute of Endocrinology and MetabolismIran University of Medical SciencesTehranIran
- Cardio‐Oncology Research CenterRajaie Cardiovascuar Medical & Research CenterIran University of Medical SciencesTehranIran
| | - Robab Anbiaee
- Department of Radiation OncologyImam Hossein HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Sahar Najafikhoshnoo
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | | | - Sepanta Assadi
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | - Pouyan Katebi
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | - Zahra Davari sh.
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | - Shahriar Shalileh
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | - Mohammad Salemizadeh Parizi
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | - Shohreh Vanaei
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | - Mohammadreza Ghaderinia
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | - Hamed Abadijoo
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | - Payam Taheri
- Department of Stem Cells and Developmental BiologyCell Science Research CenterRoyan Institute for Stem Cell Biology and TechnologyACECRTehranIran
| | | | - Hassan Sanati
- ATMP DepartmentBreast Cancer Research CenterMotamed Cancer InstituteACECRTehranIran
| | - Mohammad Reza Rostami
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | - Reza Sadeghian
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | - Yasin Kordehlachin
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | - S. M. Sadegh Mousavi‐kiasary
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | - Amir Mamdouh
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | - Seyyed Hossein Miraghaie
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
| | - Hossein Baharvand
- Department of Stem Cells and Developmental BiologyCell Science Research CenterRoyan Institute for Stem Cell Biology and TechnologyACECRTehranIran
- Department of Developmental BiologyUniversity of Science and CultureTehranIran
| | - Mohammad Abdolahad
- Nanobioelectronic Devices Lab.Cancer Electronics Research GroupSchool of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of ExcellenceNanoelectronics and Thin Film Lab.School of Electrical and Computer EngineeringFaculty of EngineeringUniversity of TehranTehranIran
- Cancer InstituteImam Khomeini HospitalTehran University of Medical SciencesTehranIran
- UT&TUMS Cancer electronic Research CenterTehran University of Medical SciencesTehranIran
| |
Collapse
|
17
|
Ghaderi N, Jung JH, Odde DJ, Peacock J. Clinically validated model predicts the effect of intratumoral heterogeneity on overall survival for non-small cell lung cancer (NSCLC) patients. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 212:106455. [PMID: 34736167 DOI: 10.1016/j.cmpb.2021.106455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Radiation therapy is used in nearly 50% of cancer treatments in the developed world. Currently, radiation treatments are homogenous and fail to take into consideration intratumoral heterogeneity. We demonstrate the importance of considering intratumoral heterogeneity and the development of resistance during fractionated radiotherapy when the same dose of radiation is delivered for all fractions (Fractional Equivalent Dosing FED). METHODS A mathematical model was developed with the following parameters: a starting population of 1011 non-small cell lung cancer (NSCLC) tumor cells, 48 h doubling time, and cell death per the linear-quadratic (LQ) model with α and β values derived from RSIα/β, in a previously described gene expression based model that estimates α and β. To incorporate both inter- and intratumor radiation sensitivity, RSIα/β output for each patient sample is assumed to represent an average value in a gamma distribution with the bounds set to -50% and +50% of RSIα/b. Therefore, we assume that within a given tumor there are subpopulations that have varying radiation sensitivity parameters that are distinct from other tumor samples with a different mean RSIα/β. A simulation cohort (SC) comprised of 100 lung cancer patients with available RSIα/β (patient specific α and β values) was used to investigate 60 Gy in 30 fractions with fractionally equivalent dosing (FED). A separate validation cohort (VC) of 57 lung cancer patients treated with radiation with available local control (LC), overall survival (OS), and tumor gene expression was used to clinically validate the model. Cox regression was used to test for significance to predict clinical outcomes as a continuous variable in multivariate analysis (MVA). Finally, the VC was used to compare FED schedules with various altered fractionation schema utilizing a Kruskal-Wallis test. This was examined using the end points of end of treatment log cell count (LCC) and by a parameter described as mean log kill efficiency (LKE) defined as: LCC = log10(tumorcellcount) [Formula: see text] RESULTS: Cox regression analysis on LCC for the VC demonstrates that, after incorporation of intratumoral heterogeneity, LCC has a linear correlation with local control (p = 0.002) and overall survival (p = < 0.001). Other suggested treatment schedules labeled as High Intensity Treatment (HIT) with a total 60 Gy delivered over 6 weeks have a lower mean LCC and an increased LKE compared to standard of care 60 Gy delivered in FED in the VC. CONCLUSION We find that LCC is a clinically relevant metric that is correlated with local control and overall survival in NSCLC. We conclude that 60 Gy delivered over 6 weeks with altered HIT fractionation leads to an enhancement in tumor control compared to FED when intratumoral heterogeneity is considered.
Collapse
Affiliation(s)
- Nima Ghaderi
- Department of Mechanical Engineering, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Joseph H Jung
- Department of Biomedical Engineering, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - David J Odde
- Department of Biomedical Engineering, University of Minnesota Twin Cities, Minneapolis, MN, USA.
| | - Jeffrey Peacock
- Department of Radiation Oncology, University of Alabama Birmingham, Birmingham, AL, USA.
| |
Collapse
|
18
|
Socha J, Wasilewska-Teśluk E, Stando R, Kuncman L, Kepka L. Duration of acute esophageal toxicity in concomitant radio-chemotherapy for non-small cell lung cancer with different fractionation schedules. Br J Radiol 2021; 94:20210776. [PMID: 34538071 DOI: 10.1259/bjr.20210776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES In our previous prospective trial on accelerated hypofractionated concomitant radiochemotherapy (AHRT-CHT) for non-small-cell lung cancer (NSCLC), the incidence of grade ≥3 acute esophageal toxicity (AET) was similar to that reported for conventionally fractionated concomitant radiochemotherapy (CFRT-CHT), but its duration was prolonged. Thus, we aimed to compare the duration of grade ≥3 AET between AHRT-CHT and CFRT-CHT. METHODS Clinical data of 76 NSCLC patients treated with CFRT-CHT (60-66 Gy/2 Gy) during 2015-2020 were retrospectively compared with the data of 92 patients treated with AHRT-CHT (58.8 Gy/2.8 Gy) in the prospective trial. The maximum grade of AET, incidence, and duration of grade ≥3 AET were the end points. Univariate and multivariate analyses were applied to correlate clinical and treatment variables with these end points. RESULTS Neither the maximum grade of AET (p = 0.71), nor the incidence of grade ≥3 AET (p = 0.87) differed between the two groups. The number of CHT cycles delivered (2 vs 1, p = 0.005) and higher esophagus mean BED (p = 0.009) were significant predictors for a higher maximum grade of AET; older age was a significant predictor for higher incidence of grade ≥3 AET (p = 0.03). The median duration of grade ≥3 AET in AHRT-CHT and CFRT-CHT group was 30 days (range 5-150) vs 7 days (range 3-20), respectively, p = 0.0005. In multivariate analysis, only the AHRT-CHT schedule (p=0.003) was a significant predictor for a longer duration of grade ≥3 AET. CONCLUSION Despite similar incidence of grade ≥3 AET, its duration is significantly prolonged in NSCLC patients treated with AHRT-CHT compared to CFRT-CHT. ADVANCES IN KNOWLEDGE Reporting only the rate of grade ≥3 AET in clinical trials may underestimate the real extent of the esophageal toxicity; its duration should also be routinely reported.
Collapse
Affiliation(s)
- Joanna Socha
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland.,Department of Radiotherapy, Regional Oncology Centre, Czestochowa, Poland
| | - Ewa Wasilewska-Teśluk
- Independent Public Health Care Facility of the Ministry of the Interior and Warmian & Mazurian Oncology Centre, Olsztyn, Poland.,Department of Oncology, Faculty of Medicine, University of Warmia & Mazury, Olsztyn, Poland
| | - Rafal Stando
- Department of Radiotherapy, Holy Cross Cancer Center, Kielce, Poland
| | - Lukasz Kuncman
- Department of Radiotherapy, Medical University of Lodz, Lodz, Poland
| | - Lucyna Kepka
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland
| |
Collapse
|
19
|
Jin H, Park SB, Yoon JH, Lee JY, Kim EH, Yoon SW. Traditional herbal medicine combined with first-line platinum-based chemotherapy for advanced non-small-cell lung cancer: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27163. [PMID: 34664842 PMCID: PMC8448030 DOI: 10.1097/md.0000000000027163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Non-small-cell lung cancer (NSCLC) is a major health burden in many countries. This review aimed to evaluate the efficacy of traditional herbal medicine (THM) combined with first-line platinum-based chemotherapy (PBCT) for the treatment of advanced NSCLC. METHODS From inception to April 2021, relevant studies were retrieved from 9 electronic databases. Randomized controlled trials (RCTs) comparing survival outcomes of THM + PBCT treatment with PBCT treatment in patients with advanced NSCLC were reviewed. The risk of bias was evaluated using the Cochrane Risk of Bias Tool. Overall survival, 1-year survival, progression-free survival or time to progression, tumor response rate, and adverse effects were analyzed. RESULTS Sixteen RCTs comprising 1445 patients were included. The meta-analysis indicated that THM + PBCT treatment, compared to PBCT alone, could improve overall survival (median survival ratio = 1.24, 95% confidence intervals [CI] [1.11, 1.39], P < .001), progression-free survival/time to progression (median survival ratio = 1.22, 95% CI [1.09, 1.37], P < .001), and the 1-year survival rate (risk ratio [RR] = 1.56, 95% CI [1.31, 1.86], P < .001). THM + PBCT also led to a higher tumor response rate (RR = 1.39, 95% CI [1.22, 1.59], P < .001) and lower incidence of thrombocytopenia (RR = 0.72, 95% CI [0.56, 0.92], P = .009) and nausea/vomiting (RR = 0.35, 95% CI [0.21, 0.57], P < .001), while there was no significant effect observed on leukopenia (RR = 0.68, 95% CI [0.34, 1.36], P = .27). CONCLUSION THM, when used in combination with PBCT, might increase survival and the tumor response rate while decreasing the side effects caused by chemotherapy in patients with advanced NSCLC. However, considering the limited methodological qualities of the included trials, more rigorous RCTs are needed.
Collapse
Affiliation(s)
- Hayun Jin
- College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Su Bin Park
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jee-Hyun Yoon
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jee Young Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Eun Hye Kim
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Seong Woo Yoon
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| |
Collapse
|
20
|
Gu X, Wang Z, Sun Y, Yang L, Wu J, Ju Z, Wang R. Intensity‐modulated radiotherapy combined with intensity‐modulated radiotherapy CT–guided iodine 125 seed brachytherapy for non‐small cell lung cancer: A case report. PRECISION RADIATION ONCOLOGY 2021. [DOI: 10.1002/pro6.1121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Xinyi Gu
- Department of Medical Oncology Chengdu Fifth People's Hospital
| | - Zhe Wang
- Department of Medical Oncology Affiliated Zhongshan Hospital of Dalian University
| | - Yingming Sun
- Department of Radiation and Medical Oncology Affiliated Sanming First Hospital of Fujian Medical University
| | - Liang Yang
- Department of Medical Oncology Affiliated Zhongshan Hospital of Dalian University
| | - Jinyu Wu
- Department of Medical Oncology Affiliated Zhongshan Hospital of Dalian University
| | - Zaishuang Ju
- Department of Medical Oncology Affiliated Zhongshan Hospital of Dalian University
| | - Ruoyu Wang
- Department of Medical Oncology Affiliated Zhongshan Hospital of Dalian University
| |
Collapse
|
21
|
Turtle L, Bhalla N, Willett A, Biggar R, Leadbetter J, Georgiou G, Wilson JM, Vivekanandan S, Hawkins MA, Brada M, Fenwick JD. Cardiac-sparing radiotherapy for locally advanced non-small cell lung cancer. Radiat Oncol 2021; 16:95. [PMID: 34082782 PMCID: PMC8176693 DOI: 10.1186/s13014-021-01824-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/25/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We have carried out a study to determine the scope for reducing heart doses in photon beam radiotherapy of locally advanced non-small cell lung cancer (LA-NSCLC). MATERIALS AND METHODS Baseline VMAT plans were created for 20 LA-NSCLC patients following the IDEAL-CRT isotoxic protocol, and were re-optimized after adding an objective limiting heart mean dose (MDHeart). Reductions in MDHeart achievable without breaching limits on target coverage or normal tissue irradiation were determined. The process was repeated for objectives limiting the heart volume receiving ≥ 50 Gy (VHeart-50-Gy) and left atrial wall volume receiving ≥ 63 Gy (VLAwall-63-Gy). RESULTS Following re-optimization, mean MDHeart, VHeart-50-Gy and VLAwall-63-Gy values fell by 4.8 Gy and 2.2% and 2.4% absolute respectively. On the basis of associations observed between survival and cardiac irradiation in an independent dataset, the purposefully-achieved reduction in MDHeart is expected to lead to the largest improvement in overall survival. It also led to useful knock-on reductions in many measures of cardiac irradiation including VHeart-50-Gy and VLAwall-63-Gy, providing some insurance against survival being more strongly related to these measures than to MDHeart. The predicted hazard ratio (HR) for death corresponding to the purposefully-achieved mean reduction in MDHeart was 0.806, according to which a randomized trial would require 1140 patients to test improved survival with 0.05 significance and 80% power. In patients whose baseline MDHeart values exceeded the median value in a published series, the average MDHeart reduction was particularly large, 8.8 Gy. The corresponding predicted HR is potentially testable in trials recruiting 359 patients enriched for greater MDHeart values. CONCLUSIONS Cardiac irradiation in RT of LA-NSCLC can be reduced substantially. Of the measures studied, reduction of MDHeart led to the greatest predicted increase in survival, and to useful knock-on reductions in other cardiac irradiation measures reported to be associated with survival. Potential improvements in survival can be trialled more efficiently in a population enriched for patients with greater baseline MDHeart levels, for whom larger reductions in heart doses can be achieved.
Collapse
Affiliation(s)
- Louise Turtle
- Department of Radiotherapy, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, CH63 4JY, Wirral, UK.
| | - Neeraj Bhalla
- Department of Radiotherapy, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, CH63 4JY, Wirral, UK
| | - Andrew Willett
- Department of Radiotherapy, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, CH63 4JY, Wirral, UK
| | - Robert Biggar
- Medical Physics, Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - Jonathan Leadbetter
- Department of Radiotherapy, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, CH63 4JY, Wirral, UK
| | - Georgios Georgiou
- Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Royal Liverpool University Hospital, Liverpool, L69 3GA, UK
| | - James M Wilson
- Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT, UK
- University College London Hospital NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK
| | - Sindu Vivekanandan
- Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Maria A Hawkins
- Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT, UK
- University College London Hospital NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK
| | - Michael Brada
- Department of Radiotherapy, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, CH63 4JY, Wirral, UK
| | - John D Fenwick
- Department of Radiotherapy, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, CH63 4JY, Wirral, UK
- Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Royal Liverpool University Hospital, Liverpool, L69 3GA, UK
| |
Collapse
|
22
|
Luna J, Sotoca A, Fernández P, Miralles C, Rodríguez A. Recent advances in early stage lung cancer. J Clin Transl Res 2021; 7:163-174. [PMID: 34104819 PMCID: PMC8177843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/19/2020] [Accepted: 02/28/2021] [Indexed: 12/04/2022] Open
Abstract
Treatment of early-stage non-small cell lung cancer has undergone considerable change in recent years. Areas of great interest to researchers include less invasive surgical methods with lower associated morbidity, indications for adjuvant chemotherapy and radiotherapy, the emergence of stereotactic body radiotherapy (SBRT) for peripheral and central or ultracentral tumors, and the probable role of adjuvant immunotherapy following surgery and SBRT, all of which may influence the management of these patients. RELEVANCE FOR PATIENTS At present, the treatment of early stage non-small cell lung cancer is undergoing changes associated with the evolution of existing treatments and the advent of new treatments.
Collapse
Affiliation(s)
- Javier Luna
- Department of Radiation Oncology, Fundación Jiménez Díaz, Madrid, Spain
| | - Amalia Sotoca
- Department of Radiation Oncology, Ruber International, Madrid, Spain
| | - Pablo Fernández
- Department of Thoracic Surgery, Fundación Jiménez Díaz, Madrid, Spain
| | - Celia Miralles
- Department of Medical Oncology, Ruber Clinic, Madrid, Spain
| | - Aurora Rodríguez
- Department of Radiation Oncology, Ruber International, Madrid, Spain
| |
Collapse
|
23
|
Rico M, Martínez M, Rodríguez M, Rosas L, Barco A, Martínez E. Hypofractionation and Stereotactic Body Radiation Therapy in Inoperable Locally Advanced Non-small Cell Lung Cancer. J Clin Transl Res 2021; 7:199-208. [PMID: 34104822 PMCID: PMC8177839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/24/2021] [Accepted: 03/29/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND AND AIM Radiotherapy (RT) plays a key role in the control of locally advanced non-small cell lung cancer (LA-NSCLC). Throughout the years, different doses and fractionations of RT have been used in an attempt to optimize the results. Recently, special interest has been given to hypofractionation (hypoRT) and stereotactic body radiation therapy (SBRT). HypoRT is a relatively widespread treatment, although the accompanying level of evidence is limited. For its part, SBRT has been used specially to overdose specific areas of the disease as a boost after radiochemotherapy. In both cases, the study of how to integrate these RT tools with chemotherapy and immunotherapy is fundamental. In addition, the 2020 COVID-19 pandemic situation has sparked increased interest in hypofractionated treatments. In this review, we analyze the role of SBRT and hypoRT in the management of LA-NSCLC in accordance with current scientific evidence. RELEVANCE FOR PATIENTS The objective of this article is to introduce professionals to the role that hypoRT and SBRT can play in the treatment of LA-NSCLC to offer the best treatment to their patients.
Collapse
Affiliation(s)
- Mikel Rico
- 1Department of Radiation Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Navarra, Spain,2Health Research Institute of Navarre (IdiSNA), Navarra Biomed, Pamplona 31008, Navarra, Spain,
Corresponding author Mikel Rico Department of Radiation Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Navarra, Spain/Health Research Institute of Navarre (IdiSNA), Navarra Biomed, Pamplona 31008, Navarra, Spain E-mail:
| | - Maribel Martínez
- 1Department of Radiation Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Navarra, Spain
| | - Maitane Rodríguez
- 1Department of Radiation Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Navarra, Spain
| | - Lombardo Rosas
- 1Department of Radiation Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Navarra, Spain
| | - Andrea Barco
- 1Department of Radiation Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Navarra, Spain
| | - Enrique Martínez
- 1Department of Radiation Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Navarra, Spain
| |
Collapse
|
24
|
Kepka L, Socha J. Dose and fractionation schedules in radiotherapy for non-small cell lung cancer. Transl Lung Cancer Res 2021; 10:1969-1982. [PMID: 34012807 PMCID: PMC8107746 DOI: 10.21037/tlcr-20-253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In the field of radiotherapy (RT), the issues of total dose, fractionation, and overall treatment time for non-small cell lung cancer (NSCLC) have been extensively investigated. There is some evidence to suggest that higher treatment intensity of RT, when given alone or sequentially with chemotherapy (CHT), is associated with improved survival. However, there is no evidence that the outcome is improved by RT at a higher dose and/or higher intensity when it is used concurrently with CHT. Moreover, some reports on the combination of full dose CHT with a higher biological dose of RT warn of the significant risk posed by such intensification. Stereotactic body radiotherapy (SBRT) provides a high rate of local control in the management of early-stage NSCLC through the use of high ablative doses. However, in centrally located tumors the use of SBRT may carry a risk of serious damage to the great vessels, bronchi, and esophagus, owing to the high ablative doses needed for optimal tumor control. There is a similar problem with moderate hypofractionation in radical RT for locally advanced NSCLC, and more evidence needs to be gathered regarding the safety of such schedules, especially when used in combination with CHT. In this article, we review the current evidence and questions related to RT dose/fractionation in NSCLC.
Collapse
Affiliation(s)
- Lucyna Kepka
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland
| | - Joanna Socha
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland
| |
Collapse
|
25
|
Chemoradiotherapy by intensity-modulated radiation therapy with simultaneous integrated boost in locally advanced or oligometastatic non-small-cell lung cancer-a two center experience. Strahlenther Onkol 2021; 197:405-415. [PMID: 33725133 PMCID: PMC8062353 DOI: 10.1007/s00066-021-01756-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/15/2021] [Indexed: 11/24/2022]
Abstract
Purpose Integrating moderate hypofractionation to the macroscopic tumor with elective nodal irradiation while sparing the organs at risk (OAR) in chemoradiotherapy of locally advanced non-small-cell lung cancer. Methods From 2010–2018, treatment, patient and tumor characteristics of 138 patients from two radiation therapy centers were assessed. Chemoradiotherapy by intensity-modulated radiation therapy (IMRT) with a simultaneous integrated boost (SIB) to the primary tumor and macroscopic lymph node metastases was used. Results A total of 124 (90%) patients received concurrent chemotherapy. 106 (76%) patients had UICC (Union for International Cancer Control) stage ≥IIIB and 21 (15%) patients had an oligometastatic disease (UICC stage IV). Median SIB and elective total dose was 61.6 and 50.4 Gy in 28 fractions, respectively. Furthermore, 64 patients (46%) had an additional sequential boost to the primary tumor after the SIB-IMRT main series: median 6.6 Gy in median 3 fractions. The median cumulative mean lung dose was 15.6 Gy (range 6.2–29.5 Gy). Median follow-up and radiological follow-up for all patients was 18.0 months (range 0.6–86.9) and 16.0 months (range 0.2–86.9), respectively. Actuarial local control rates at 1, 2 and 3 years were 80.4, 68.4 and 57.8%. Median overall survival and progression-free survival was 30.0 months (95% confidence interval [CI] 23.5–36.4) and 12.1 months (95% CI 8.2–16.0), respectively. Treatment-related toxicity was moderate. Radiation-induced pneumonitis grade 2 and grade 3 occurred in 13 (9.8%) and 3 (2.3%) patients. Conclusions Chemoradiotherapy using SIB-IMRT showed promising local tumor control rates and acceptable toxicity in patients with locally advanced and in part oligometastatic lung cancer. The SIB concept, resulting in a relatively low mean lung dose, was associated with low numbers of clinically relevant pneumonitis. The overall survival appears promising in the presence of a majority of patients with UICC stage ≥IIIB disease.
Collapse
|
26
|
Yang Y, Xu X, Zhou X, Bao W, Zhang D, Gu F, Du X, Chen Q, Qiu G. Impact of Radiation Dose on Survival for Esophageal Squamous Cell Carcinoma Treated With Neoadjuvant Chemoradiotherapy. Front Oncol 2020; 10:1431. [PMID: 32974158 PMCID: PMC7468494 DOI: 10.3389/fonc.2020.01431] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 07/06/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: Radiation dose used in the neoadjuvant chemoradiotherapy (NCRT) for patients with locally advanced esophageal squamous cell carcinoma (ESCC) varies in different trials and clinical practice. Methods and Materials: Data from patients diagnosed with ESCC receiving NCRT followed by esophagectomy were retrospectively collected from February 2013 to December 2017. Lower dose (LD) radiotherapy was defined as ≤45 Gy, and >45 Gy was considered as higher dose (HD). Survival rates were calculated by the Kaplan-Meier method and compared with long-rank test. Multivariate Cox regression analyses were performed to identify variables associated with survival. Results: A total of 118 patients treated with NCRT were included in our analysis: 62 patients received LD radiotherapy, and 56 patients received HD radiotherapy. The median follow-up time was 24.3 months (0.67-65.3 m). Two-years overall survival (OS) rates were 75.0 and 79.0% in HD and LD group, respectively (P = 0.360), and complete pathological remission (pCR) rates in two groups were 42.9 and 30.6%, respectively (P = 0.17). The incidences of toxic effects including post-operative complications were not significantly different between two groups. Multivariate analysis showed that tumor T stage, M1a disease, smoking history, and pCR rate were significantly associated with OS. Conclusions: In ESCC patients treated with NCRT followed by surgery, higher radiation dose was not significantly associated with a higher pCR rate and longer survival. Lower radiation dose might be a preferable time-dose fraction scheme. Our finding needs to be further validated by randomized trials.
Collapse
Affiliation(s)
- Yang Yang
- Department of Thoracic Radiotherapy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Xiaofang Xu
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
| | - Xia Zhou
- Department of Thoracic Radiotherapy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Wuan Bao
- Department of Thoracic Radiotherapy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Danhong Zhang
- Department of Thoracic Radiotherapy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Feiying Gu
- Department of Thoracic Radiotherapy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Xianghui Du
- Department of Thoracic Radiotherapy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Qixun Chen
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
| | - Guoqin Qiu
- Department of Thoracic Radiotherapy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| |
Collapse
|
27
|
Glinski K, Socha J, Wasilewska-Tesluk E, Komosinska K, Kepka L. Accelerated hypofractionated radiotherapy with concurrent full dose chemotherapy for locally advanced non-small cell lung cancer: A phase I/II study. Radiother Oncol 2020; 148:174-180. [PMID: 32388152 DOI: 10.1016/j.radonc.2020.04.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/25/2020] [Accepted: 04/21/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION We report the results of toxicity and survival in stage III NSCLC patients treated with concurrent accelerated hypofractionated AHRT-CHT within a prospective study. METHODS 92 patients received 3D-CRT or IMRT-planned RT: 58.8 Gy /21 fractions (2.8 Gy/fraction, 4 weeks) with 2 cycles of CHT (Cisplatin 80 mg/m2 D1 and D22; and Vinorelbine 25 mg/m2, D1, D8, D22, and D29) started with D1 of RT. Non-hematological toxicity was evaluated using RTOG-EORTC criteria, every week during treatment, one month after treatment completion, and every three months thereafter. RESULTS Two patients did not receive the prescribed RT dose; 22 (24%) received only one CHT cycle. Median follow-up was 21.5 months (range: 1-65) for all patients and 32 months (range: 8-65) for living patients. There were: 13 (14%) cases of grade ≥III acute esophageal toxicity; 3 grade III acute pneumonitis, and 2 grade III late pulmonary toxicities. Two toxic deaths occurred within 3 months after treatment: fatal hemoptysis (1) and complications of esophageal toxicity (1). Five other deaths that occurred within one year after treatment were probably treatment-related: lung abscess (1), fatal hemoptysis (2), death from undetermined cause (2). Median overall survival was 38 months (95%CI:27-49), median progression free survival was 25 months (95%CI:14-36). CONCLUSIONS Survival rates are encouraging, but the observed rate of toxic and probably toxic deaths is of potential concern. We proceed with the use of AHRT with concomitant full dose CHT, but patients with large PTV and major vascular abutment are excluded due to potentially increased risk of toxic death.
Collapse
Affiliation(s)
- Krzysztof Glinski
- Independent Public Health Care Facility of the Ministry of the Interior and Warmian & Mazurian Oncology Centre, Olsztyn, Poland
| | - Joanna Socha
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland
| | - Ewa Wasilewska-Tesluk
- Independent Public Health Care Facility of the Ministry of the Interior and Warmian & Mazurian Oncology Centre, Olsztyn, Poland; Department of Oncology, University of Warmia & Mazury, Olsztyn, Poland
| | | | - Lucyna Kepka
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland.
| |
Collapse
|
28
|
Chemo-radiotherapy integration in unresectable locally advanced non-small-cell lung cancer: a review. Clin Transl Oncol 2020; 22:1681-1686. [PMID: 32128671 DOI: 10.1007/s12094-020-02326-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/18/2020] [Indexed: 12/25/2022]
Abstract
Approximately one-third of all non-small-cell lung cancer (NSCLC) are locally-advanced at diagnosis, and 15-17% of these tumors are unresectable at presentation. Definitive chemo-radiotherapy (CRT) represents the standard therapeutic approach. However, the literature has shown that only 15% of patients are alive at 5 years and this percentage has remained unchanged despite various attempts of improvement. The recent introduction of immunotherapy has not only strongly changed the clinical scenario but has also drawn attention to a stage of disease apparently forgotten for decades. Stage III NSCLC can represent an interesting setting for the combined use of chemo-radiation and immunotherapy, due to the potential synergistic effect between radiation and immune checkpoint inhibitors. We reviewed the available literature in order to report the state of art of stage III NSCLC, by focusing on trials that evaluate different combinations of CRT and new drugs of PD-1/PD-L1 axis, and anti-CTLA-4. The future goal in the management of unresectable stage III NSCLC will be the optimal patients' selection combined with the use of individualized immuno/chemotherapies that could potentially improve clinical outcomes.
Collapse
|
29
|
Gao S, Zhang W, Wang R, Hopkins SP, Spagnoli JC, Racin M, Bai L, Li L, Jiang W, Yang X, Lee C, Nagata K, Howerth EW, Handa H, Xie J, Ma Q, Kumar A. Nanoparticles Encapsulating Nitrosylated Maytansine To Enhance Radiation Therapy. ACS NANO 2020; 14:1468-1481. [PMID: 31939662 DOI: 10.1021/acsnano.9b05976] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Radiotherapy remains a major treatment modality for cancer types such as non-small cell lung carcinoma (or NSCLC). To enhance treatment efficacy at a given radiation dose, radiosensitizers are often used during radiotherapy. Herein, we report a nanoparticle agent that can selectively sensitize cancer cells to radiotherapy. Specifically, we nitrosylated maytansinoid DM1 and then loaded the resulting prodrug, DM1-NO, onto poly(lactide-co-glycolic)-block-poly(ethylene glycol) (PLGA-b-PEG) nanoparticles. The toxicity of DM1 is suppressed by nanoparticle encapsulation and nitrosylation, allowing the drug to be delivered to tumors through the enhanced permeability and retention effect. Under irradiation to tumors, the oxidative stress is elevated, leading to the cleavage of the S-N bond and the release of DM1 and nitric oxide (NO). DM1 inhibits microtubule polymerization and enriches cells at the G2/M phase, which is more radiosensitive. NO under irradiation forms highly toxic radicals such as peroxynitrites, which also contribute to tumor suppression. The two components work synergistically to enhance radiotherapy outcomes, which was confirmed in vitro by clonogenic assays and in vivo with H1299 tumor-bearing mice. Our studies suggest the great promise of DM1-NO PLGA nanoparticles in enhancing radiotherapy against NSCLC and potentially other tumor types.
Collapse
MESH Headings
- Animals
- Antineoplastic Agents, Phytogenic/chemistry
- Antineoplastic Agents, Phytogenic/pharmacology
- Capsules/chemistry
- Carcinoma, Non-Small-Cell Lung/metabolism
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/therapy
- Cell Cycle Checkpoints/drug effects
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Drug Screening Assays, Antitumor
- Female
- Lung Neoplasms/metabolism
- Lung Neoplasms/pathology
- Lung Neoplasms/therapy
- Maytansine/chemistry
- Maytansine/pharmacology
- Mice
- Mice, Nude
- Nanoparticles/chemistry
- Neoplasms, Experimental/metabolism
- Neoplasms, Experimental/pathology
- Neoplasms, Experimental/therapy
- Oxidative Stress/drug effects
- Particle Size
- Surface Properties
- Tumor Cells, Cultured
Collapse
Affiliation(s)
- Shi Gao
- Department of Nuclear Medicine , China-Japan Union Hospital of Jilin University , Changchun , Jilin 130033 , China
| | - Weizhong Zhang
- Department of Chemistry , University of Georgia , Athens , Georgia 30602 , United States
| | - Renjie Wang
- Department of Nuclear Medicine , China-Japan Union Hospital of Jilin University , Changchun , Jilin 130033 , China
| | - Sean P Hopkins
- College of Engineering , University of Georgia , Athens , Georgia 30602 , United States
| | - Jonathan C Spagnoli
- Department of Chemistry , University of Georgia , Athens , Georgia 30602 , United States
| | - Mohammed Racin
- Department of Chemistry , University of Georgia , Athens , Georgia 30602 , United States
| | - Lin Bai
- Department of Nuclear Medicine , China-Japan Union Hospital of Jilin University , Changchun , Jilin 130033 , China
| | - Lu Li
- Department of Nuclear Medicine , China-Japan Union Hospital of Jilin University , Changchun , Jilin 130033 , China
| | - Wen Jiang
- Department of Chemistry , University of Georgia , Athens , Georgia 30602 , United States
| | - Xueyuan Yang
- Department of Chemistry , University of Georgia , Athens , Georgia 30602 , United States
| | - Chaebin Lee
- Department of Chemistry , University of Georgia , Athens , Georgia 30602 , United States
| | - Koichi Nagata
- Veterinary Biosciences & Diagnostic Imaging, College of Veterinary Medicine , University of Georgia , Athens , Georgia 30602 , United States
| | - Elizabeth W Howerth
- Department of Pathology, College of Veterinary Medicine , University of Georgia , Athens , Georgia 30602 , United States
| | - Hitesh Handa
- College of Engineering , University of Georgia , Athens , Georgia 30602 , United States
| | - Jin Xie
- Department of Chemistry , University of Georgia , Athens , Georgia 30602 , United States
| | - Qingjie Ma
- Department of Nuclear Medicine , China-Japan Union Hospital of Jilin University , Changchun , Jilin 130033 , China
| | - Anil Kumar
- Department of Chemistry , University of Georgia , Athens , Georgia 30602 , United States
| |
Collapse
|
30
|
Zhao Q, Liu M, Wang Z, Huang W, Allen Li X, Zhou T, Zhang J, Zhang Z, Wang Q, Yu S, Han D, Sun H, Li H, Lin H, Li B. High dose radiation therapy based on normal tissue constraints with concurrent chemotherapy achieves promising survival of patients with unresectable stage III non-small cell lung cancer. Radiother Oncol 2019; 145:7-12. [PMID: 31869678 DOI: 10.1016/j.radonc.2019.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to investigate the potential of individual isotoxic dose escalation based on normal tissue constraints (NTC), hypothesizing that high dose radiation therapy would be superior to standard-dose in concurrent chemoradiotherapy for unresectable stage III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Individually prescribed radiation doses were calculated based on NTC. Patients with total tumour radiation doses ≥66 Gy were assigned to the high dose (HD, ≥66 Gy) group, and all other patients were assigned to the standard-dose (SD, <66 Gy) group. Each patient was retrospectively assigned an Eighth edition of American Joint Committee on Cancer disease stage based on the imaging data of initial diagnosis to avoid over- and under-staging. Intensity modulated radiation therapy plans were optimized to minimize the volumes of organs at risk exposed to radiation. The primary endpoint was overall survival. RESULTS From March 2006 to September 2012, 140 patients were enrolled and assigned to two groups: 71 patients into the HD group and 69 patients into the SD group. The median survival time (MST) was significantly higher in the HD group (33.5 months) than in the SD group (21 months), (p < 0.0001). Overall 5-year survival rates were significantly higher in the HD group than in the SD group (37.8% vs 16.7%). Median progression-free survival was 19 months in the HD group and 11 months in the SD group (p < 0.0001). No difference in severe (grade 3-5) toxic effects was noted between the two groups. CONCLUSIONS The significant positive association observed between prescribed dose and survival suggests that individualized isotoxic dose-escalated radiation based on NTC might improve survival in this cohort of stage III NSCLC Chinese patients.
Collapse
Affiliation(s)
- Qian Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Ming Liu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China
| | - Zhongtang Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Wei Huang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, USA
| | - Tao Zhou
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jian Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zicheng Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qiang Wang
- Department of Radiation Oncology, People's Hospital of Linzi District, Zibo, China
| | - Shuzeng Yu
- Department of Radiation Oncology, LiaoCheng People's Hospital, Liaocheng, China
| | - Dan Han
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Hongfu Sun
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Hongsheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Haiqun Lin
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China.
| |
Collapse
|
31
|
Fenwick JD, Landau DB, Baker AT, Bates AT, Eswar C, Garcia-Alonso A, Harden SV, Illsley MC, Laurence V, Malik Z, Mayles WPM, Miles E, Mohammed N, Spicer J, Wells P, Vivekanandan S, Mullin AM, Hughes L, Farrelly L, Ngai Y, Counsell N. Long-Term Results from the IDEAL-CRT Phase 1/2 Trial of Isotoxically Dose-Escalated Radiation Therapy and Concurrent Chemotherapy for Stage II/III Non-small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2019; 106:733-742. [PMID: 31809876 PMCID: PMC7049901 DOI: 10.1016/j.ijrobp.2019.11.397] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/30/2019] [Accepted: 11/17/2019] [Indexed: 12/25/2022]
Abstract
Purpose The IDEAL-CRT phase 1/2 multicenter trial of isotoxically dose-escalated concurrent chemoradiation for stage II/III non-small cell lung cancer investigated two 30-fraction schedules of 5 and 6 weeks’ duration. We report toxicity, tumor response, progression-free survival (PFS), and overall survival (OS) for both schedules, with long-term follow-up for the 6-week schedule. Methods and Materials Patients received isotoxically individualized tumor radiation doses of 63 to 71 Gy in 5 weeks or 63 to 73 Gy in 6 weeks, delivered concurrently with 2 cycles of cisplatin and vinorelbine. Eligibility criteria were the same for both schedules. Results One-hundred twenty patients (6% stage IIB, 68% IIIA, 26% IIIB, 1% IV) were recruited from 9 UK centers, 118 starting treatment. Median prescribed doses were 64.5 and 67.6 Gy for the 36 and 82 patients treated using the 5- and 6-week schedules. Grade ≥3 pneumonitis and early esophagitis rates were 3.4% and 5.9% overall and similar for each schedule individually. Late grade 2 esophageal toxicity occurred in 11.1% and 17.1% of 5- and 6-week patients. Grade ≥4 adverse events occurred in 17 (20.7%) 6-week patients but no 5-week patients. Four adverse events were grade 5, with 2 considered radiation therapy related. After median follow-up of 51.8 and 26.4 months for the 6- and 5-week schedules, median OS was 41.2 and 22.1 months, respectively, and median PFS was 21.1 and 8.0 months. In exploratory analyses, OS was significantly associated with schedule (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.32-0.98; P = .04) and fractional clinical/internal target volume receiving ≥95% of the prescribed dose (HR, 0.88; 95% CI, 0.77-1.00; P = .05). PFS was also significantly associated with schedule (HR, 0.53; 95% CI, 0.33-0.86; P = .01). Conclusions Toxicity in IDEAL-CRT was acceptable. Survival was promising for 6-week patients and significantly longer than for 5-week patients. Survival might be further lengthened by following the 6-week schedule with an immune agent, motivating further study of such combined optimized treatments.
Collapse
Affiliation(s)
- John D Fenwick
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - David B Landau
- Guy's & St. Thomas' NHS Foundation Trust, London, United Kingdom.
| | | | - Andrew T Bates
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Chinnamani Eswar
- The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, United Kingdom
| | | | | | - Marianne C Illsley
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, United Kingdom
| | | | - Zafar Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, United Kingdom
| | | | - Elizabeth Miles
- Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Middlesex, United Kingdom
| | - Nazia Mohammed
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - James Spicer
- Guy's & St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Paula Wells
- Barts Health NHS Trust, London, United Kingdom
| | | | - Anne-Marie Mullin
- Cancer Research UK & University College London Cancer Trials Centre, London, United Kingdom
| | - Laura Hughes
- Cancer Research UK & University College London Cancer Trials Centre, London, United Kingdom
| | - Laura Farrelly
- Cancer Research UK & University College London Cancer Trials Centre, London, United Kingdom
| | - Yenting Ngai
- Cancer Research UK & University College London Cancer Trials Centre, London, United Kingdom
| | - Nicholas Counsell
- Cancer Research UK & University College London Cancer Trials Centre, London, United Kingdom
| |
Collapse
|
32
|
Brown S, Banfill K, Aznar MC, Whitehurst P, Faivre Finn C. The evolving role of radiotherapy in non-small cell lung cancer. Br J Radiol 2019; 92:20190524. [PMID: 31535580 PMCID: PMC6913359 DOI: 10.1259/bjr.20190524] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/06/2019] [Accepted: 08/30/2019] [Indexed: 12/12/2022] Open
Abstract
Lung cancer is the most commonly diagnosed cancer and biggest cause of cancer mortality worldwide with non-small cell lung cancer (NSCLC) accounting for most cases. Radiotherapy (RT) plays a key role in its management and is used at least once in over half of patients in both curative and palliative treatments. This narrative review will demonstrate how the evolution of RT for NSCLC has been underpinned by improvements in RT technology. These improvements have facilitated geometric individualization, increasingly accurate treatment and now offer the ability to deliver truly individualized RT. In this review, we summarize and discuss recent developments in the field of advanced RT in early stage, locally advanced and metastatic NSCLC. We highlight limitations in current approaches and discuss future potential treatment strategies for patients with NSCLC.
Collapse
Affiliation(s)
- Sean Brown
- The Christie NHS Foundation Trust, Manchester, UK, Manchester, UK
| | | | | | - Philip Whitehurst
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | | |
Collapse
|
33
|
Wang S, Liu Y, Feng Y, Zhang J, Swinnen J, Li Y, Ni Y. A Review on Curability of Cancers: More Efforts for Novel Therapeutic Options Are Needed. Cancers (Basel) 2019; 11:E1782. [PMID: 31766180 PMCID: PMC6896199 DOI: 10.3390/cancers11111782] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 02/07/2023] Open
Abstract
Cancer remains a major cause of death globally. Given its relapsing and fatal features, curing cancer seems to be something hardly possible for the majority of patients. In view of the development in cancer therapies, this article summarizes currently available cancer therapeutics and cure potential by cancer type and stage at diagnosis, based on literature and database reviews. Currently common cancer therapeutics include surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy. However, treatment with curative intent by these methods are mainly eligible for patients with localized disease or treatment-sensitive cancers and therefore their contributions to cancer curability are relatively limited. The prognosis for cancer patients varies among different cancer types with a five-year relative survival rate (RSR) of more than 80% in thyroid cancer, melanoma, breast cancer, and Hodgkin's lymphoma. The most dismal prognosis is observed in patients with small-cell lung cancer, pancreatic cancer, hepatocellular carcinoma, oesophagal cancer, acute myeloid leukemia, non-small cell lung cancer, and gastric cancer with a five-year RSR ranging between 7% and 28%. The current review is intended to provide a general view about how much we have achieved in curing cancer as regards to different therapies and cancer types. Finally, we propose a small molecule dual-targeting broad-spectrum anticancer strategy called OncoCiDia, in combination with emerging highly sensitive liquid biopsy, with theoretical curative potential for the management of solid malignancies, especially at the micro-cancer stage.
Collapse
Affiliation(s)
- Shuncong Wang
- KU Leuven, Campus Gasthuisberg, Faculty of Medicine, 3000 Leuven, Belgium; (S.W.); (Y.L.); (Y.F.); (J.S.)
| | - Yewei Liu
- KU Leuven, Campus Gasthuisberg, Faculty of Medicine, 3000 Leuven, Belgium; (S.W.); (Y.L.); (Y.F.); (J.S.)
| | - Yuanbo Feng
- KU Leuven, Campus Gasthuisberg, Faculty of Medicine, 3000 Leuven, Belgium; (S.W.); (Y.L.); (Y.F.); (J.S.)
| | - Jian Zhang
- Laboratories of Translational Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210028, China;
| | - Johan Swinnen
- KU Leuven, Campus Gasthuisberg, Faculty of Medicine, 3000 Leuven, Belgium; (S.W.); (Y.L.); (Y.F.); (J.S.)
| | - Yue Li
- Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China
| | - Yicheng Ni
- KU Leuven, Campus Gasthuisberg, Faculty of Medicine, 3000 Leuven, Belgium; (S.W.); (Y.L.); (Y.F.); (J.S.)
| |
Collapse
|
34
|
Image-guided interstitial high-dose-rate brachytherapy for dose escalation in the radiotherapy treatment of locally advanced lung cancer: A single-institute experience. Brachytherapy 2019; 18:829-834. [DOI: 10.1016/j.brachy.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/02/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022]
|
35
|
Robinson SD, Tahir BA, Absalom KAR, Lankathilake A, Das T, Lee C, Fisher PM, Bates E, Hatton MQF. Radical accelerated radiotherapy for non-small cell lung cancer (NSCLC): A 5-year retrospective review of two dose fractionation schedules. Radiother Oncol 2019; 143:37-43. [PMID: 31563408 DOI: 10.1016/j.radonc.2019.08.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/22/2019] [Accepted: 08/29/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Numerous fractionation regimes are used for inoperable NSCLC patients not suitable for stereotactic ablative radiotherapy. Continuous hyperfractionated accelerated radiotherapy (CHART, 54 Gy, 36 fractions over 12 days) and hypofractionated accelerated radiotherapy (55 Gy, 20 fractions over 4 weeks) are recommended UK schedules. In this single-centre retrospective analysis, we compare both fractionation schemes for patients treated at our institution from 2010 to 15. MATERIALS AND METHODS Clinical demographic, tumour and survival data were collected alongside radiotherapy dosimetric data from the Varian Eclipse Scripting application programming interface. Differences were assessed using independent samples t-tests. Multivariate survival analysis was performed using Cox regression. RESULTS We identified 563 eligible patients; 43% received CHART and 57% hypofractionated radiotherapy. Median age was 71 years, 56% were male, 95% PET staged with 53% WHO performance status 0-1. 30%, 14%, 50% and 6% were stage I, II, III and IV, respectively. 38% of patients underwent induction chemotherapy. 99% completed their prescribed radiotherapy treatment. Overall response rate was 50% with a 6.5% 90-day mortality rate. Median disease-free survival was 19 months, 50% recurred locally. Median overall survival was 22.5 months with 48% alive at 2 years. Multivariate analysis identified histology, stage, performance status, chemotherapy and radiotherapy response as independent predictors of survival; no significant differences between radiotherapy regimes were observed. CONCLUSION In our centre, CHART and hypofractionated accelerated radiotherapy produce similar outcomes. Dose escalation studies are in progress to develop these schedules to match outcomes reported in concurrent chemo-radiation studies.
Collapse
Affiliation(s)
- Stephen D Robinson
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Bilal A Tahir
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Katherine A R Absalom
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Amila Lankathilake
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Tathagata Das
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Caroline Lee
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Patricia M Fisher
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Emma Bates
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Matthew Q F Hatton
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom.
| |
Collapse
|
36
|
[Lung cancer and elective nodal irradiation: A solved issue?]. Cancer Radiother 2019; 23:701-707. [PMID: 31501024 DOI: 10.1016/j.canrad.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/27/2019] [Indexed: 12/25/2022]
Abstract
Lung cancer treatment is a heavy workload for radiation oncologist and that field showed many evolutions over the last two decades. The issue about target volume was raised when treatment delivery became more precise with the development of three-dimensional conformal radiotherapy. Initially based upon surgical series, numerous retrospective and prospective studies aimed to evaluate the risk of elective nodal failure of involved-field radiotherapy compared to standard large field elective nodal irradiation. In every setting, locally advanced non-small cell lung cancer, localized non-small cell lung cancer, localized small cell lung cancer, exclusive chemoradiation or postoperative radiotherapy, most of the studies showed no significant difference between involved-field radiotherapy or elective nodal irradiation with elective nodal failure rate under 5% at 2 years, provided staging had been done with modern imaging and diagnostic techniques (positron emission tomography scan, endoscopy, etc.). Moreover, if reducing irradiated volumes are safe regarding recurrences, involved-field radiotherapy allowed dose escalation while reducing acute and late oesophageal, cardiac and pulmonary toxicities. Consequently, major clinical trials involving radiotherapy initiated in the last two decades and international clinical guidelines recommended omission of elective nodal irradiation in favour of in-field radiotherapy.
Collapse
|
37
|
Nix MG, Rowbottom CG, Vivekanandan S, Hawkins MA, Fenwick JD. Chemoradiotherapy of locally-advanced non-small cell lung cancer: Analysis of radiation dose-response, chemotherapy and survival-limiting toxicity effects indicates a low α/β ratio. Radiother Oncol 2019; 143:58-65. [PMID: 31439448 DOI: 10.1016/j.radonc.2019.07.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/21/2019] [Accepted: 07/22/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To analyse changes in 2-year overall survival (OS2yr) with radiotherapy (RT) dose, dose-per-fraction, treatment duration and chemotherapy use, in data compiled from prospective trials of RT and chemo-RT (CRT) for locally-advanced non-small cell lung cancer (LA-NSCLC). MATERIAL AND METHODS OS2yr data was analysed for 6957 patients treated on 68 trial arms (21 RT-only, 27 sequential CRT, 20 concurrent CRT) delivering doses-per-fraction ≤4.0 Gy. An initial model considering dose, dose-per-fraction and RT duration was fitted using maximum-likelihood techniques. Model extensions describing chemotherapy effects and survival-limiting toxicity at high doses were assessed using likelihood-ratio testing, the Akaike Information Criterion (AIC) and cross-validation. RESULTS A model including chemotherapy effects and survival-limiting toxicity described the data significantly better than simpler models (p < 10-14), and had better AIC and cross-validation scores. The fitted α/β ratio for LA-NSCLC was 4.0 Gy (95%CI: 2.8-6.0 Gy), repopulation negated 0.38 (95%CI: 0.31-0.47) Gy EQD2/day beyond day 12 of RT, and concurrent CRT increased the effective tumour EQD2 by 23% (95%CI: 16-31%). For schedules delivered in 2 Gy fractions over 40 days, maximum modelled OS2yr for RT was 52% and 38% for stages IIIA and IIIB NSCLC respectively, rising to 59% and 42% for CRT. These survival rates required 80 and 87 Gy (RT or sequential CRT) and 67 and 73 Gy (concurrent CRT). Modelled OS2yr rates fell at higher doses. CONCLUSIONS Fitted dose-response curves indicate that gains of ~10% in OS2yr can be made by escalating RT and sequential CRT beyond 64 Gy, with smaller gains for concurrent CRT. Schedule acceleration achieved via hypofractionation potentially offers an additional 5-10% improvement in OS2yr. Further 10-20% OS2yr gains might be made, according to the model fit, if critical normal structures in which survival-limiting toxicities arise can be identified and selectively spared.
Collapse
Affiliation(s)
- Michael G Nix
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, United Kingdom.
| | - Carl G Rowbottom
- Department of Physics, Clatterbridge Cancer Centre, Wirral, United Kingdom; Department of Physics, University of Liverpool, Oliver Lodge Laboratory, Liverpool, United Kingdom
| | - Sindu Vivekanandan
- Guy's Hospital Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Maria A Hawkins
- Department of Oncology, University of Oxford, United Kingdom
| | - John D Fenwick
- Department of Physics, Clatterbridge Cancer Centre, Wirral, United Kingdom; Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, United Kingdom
| |
Collapse
|
38
|
Tsolou A, Lamprou I, Fortosi AO, Liousia M, Giatromanolaki A, Koukourakis MI. 'Stemness' and 'senescence' related escape pathways are dose dependent in lung cancer cells surviving post irradiation. Life Sci 2019; 232:116562. [PMID: 31201845 DOI: 10.1016/j.lfs.2019.116562] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/01/2019] [Accepted: 06/11/2019] [Indexed: 12/26/2022]
Abstract
AIMS Lung cancer is one of the main causes of cancer-related deaths worldwide and radiotherapy is a major treatment of choice. However, radioresistance is a main reason for radiotherapy failure or tumor relapse. Here, we investigated possible mechanisms associated with cancer cell radioresistance. MATERIALS AND METHODS We compared two newly derived cell lines, namely A549-IR3 and A549-IR6, which survived repeated (3 or 6 times) 4 Gy exposure of parental A549 lung cancer cell line. DNA repair ability, stemness and senescence were comparatively studied. KEY FINDINGS A549-IR3 exhibited higher proliferation ability and radioresistance compared to parental and A549-IR6 cells. Enhanced radioresistance was not accompanied by chemoresistance to cisplatin or docetaxel. DNA repair kinetics (γΗ2ΑΧ expression) were similar in all cell lines. A549-IR3 cells exhibited a significant rise in stem cell markers (CD44, CD133, OCT4, SOX2 and NANOG) whereas A549-IR6 displayed an increased senescent population. SIGNIFICANCE Cancer cells surviving after radiotherapy may follow two different escape pathways: selection for radioresistance resulting in regrowth, and in clinical terms relapse, or above an irradiation threshold, stem-cells die and cancer cells become senescent, leading the tumor to a state of dormancy.
Collapse
Affiliation(s)
- Avgi Tsolou
- Department of Radiotherapy/Oncology, Democritus University of Thrace and University General Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Ioannis Lamprou
- Department of Radiotherapy/Oncology, Democritus University of Thrace and University General Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Alexandra-Ourania Fortosi
- Department of Radiotherapy/Oncology, Democritus University of Thrace and University General Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Maria Liousia
- Department of Radiotherapy/Oncology, Democritus University of Thrace and University General Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Alexandra Giatromanolaki
- Department of Pathology, Democritus University of Thrace and University General Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Michael I Koukourakis
- Department of Radiotherapy/Oncology, Democritus University of Thrace and University General Hospital of Alexandroupolis, Alexandroupolis 68100, Greece.
| |
Collapse
|
39
|
Association of single nucleotide polymorphisms at HSPB1 rs7459185 and TGFB1 rs11466353 with radiation esophagitis in lung cancer. Radiother Oncol 2019; 135:161-169. [DOI: 10.1016/j.radonc.2019.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 01/10/2019] [Accepted: 03/07/2019] [Indexed: 12/25/2022]
|
40
|
Li F, Li Z, Jin X, Liu Y, Zhang P, Li P, Shen Z, Wu A, Chen W, Li Q. Ultra-small gadolinium oxide nanocrystal sensitization of non-small-cell lung cancer cells toward X-ray irradiation by promoting cytostatic autophagy. Int J Nanomedicine 2019; 14:2415-2431. [PMID: 31040665 PMCID: PMC6455003 DOI: 10.2147/ijn.s193676] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Gadolinium-based nanoparticles (GdNPs) have been used as theranostic sensitizers in clinical radiotherapy studies; however, the biomechanisms underlying the radio-sensitizing effects of GdNPs have yet to be determined. In this study, ultra-small gadolinium oxide nanocrystals (GONs) were employed to investigate their radiosensitizing effects and biological mechanisms in non-small-cell lung cancer (NSCLC) cells under X-ray irradiation. METHOD AND MATERIALS GONs were synthesized using polyol method. Hydroxyl radical production, oxidative stress, and clonogenic survival after X-ray irradiation were used to evaluate the radiosensitizing effects of GONs. DNA double-strand breakage, cell cycle phase, and apoptosis and autophagy incidences were investigated in vitro to determine the radiosensitizing biomechanism of GONs under X-ray irradiation. RESULTS GONs induced hydroxyl radical production and oxidative stress in a dose- and concentration-dependent manner in NSCLC cells after X-ray irradiation. The sensitizer enhancement ratios of GONs ranged between 19.3% and 26.3% for the NSCLC cells under investigation with a 10% survival rate compared with that of the cells treated with irradiation alone. Addition of 3-methyladenine to the cell medium decreased the incidence rate of autophagy and increased cell survival, supporting the idea that the GONs promoted cytostatic autophagy in NSCLC cells under X-ray irradiation. CONCLUSION This study examined the biological mechanisms underlying the radiosensitizing effects of GONs on NSCLC cells and presented the first evidence for the radiosensitizing effects of GONs via activation of cytostatic autophagy pathway following X-ray irradiation.
Collapse
Affiliation(s)
- Feifei Li
- Institute of Modern Physics, Chinese Academy of Sciences, Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou 730000, China, ;
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zihou Li
- University of Chinese Academy of Sciences, Beijing 100049, China
- Key Laboratory of Magnetic Materials and Devices, Chinese Academy of Sciences, Division of Functional Materials and Nano Devices, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, Zhejiang 315201, China
| | - Xiaodong Jin
- Institute of Modern Physics, Chinese Academy of Sciences, Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou 730000, China, ;
| | - Yan Liu
- Institute of Modern Physics, Chinese Academy of Sciences, Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou 730000, China, ;
| | - Pengcheng Zhang
- Institute of Modern Physics, Chinese Academy of Sciences, Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou 730000, China, ;
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Ping Li
- Institute of Modern Physics, Chinese Academy of Sciences, Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou 730000, China, ;
| | - Zheyu Shen
- Key Laboratory of Magnetic Materials and Devices, Chinese Academy of Sciences, Division of Functional Materials and Nano Devices, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, Zhejiang 315201, China
| | - Aiguo Wu
- Key Laboratory of Magnetic Materials and Devices, Chinese Academy of Sciences, Division of Functional Materials and Nano Devices, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, Zhejiang 315201, China
| | - Weiqiang Chen
- Institute of Modern Physics, Chinese Academy of Sciences, Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou 730000, China, ;
| | - Qiang Li
- Institute of Modern Physics, Chinese Academy of Sciences, Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou 730000, China, ;
| |
Collapse
|
41
|
Ma L, Men Y, Feng L, Kang J, Sun X, Yuan M, Jiang W, Hui Z. A current review of dose-escalated radiotherapy in locally advanced non-small cell lung cancer. Radiol Oncol 2019; 53:6-14. [PMID: 30840594 PMCID: PMC6411023 DOI: 10.2478/raon-2019-0006] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/05/2019] [Indexed: 12/14/2022] Open
Abstract
Background The mainstay therapy for locally advanced non-small cell lung cancer is concurrent chemoradiotherapy. Loco-regional recurrence constitutes the predominant failure patterns. Previous studies confirmed the relationship between increased biological equivalent doses and improved overall survival. However, the large randomized phase III study, RTOG 0617, failed to demonstrate the benefit of dose-escalation to 74 Gy compared with 60 Gy by simply increasing fraction numbers. Conclusions Though effective dose-escalation methods have been explored, including altered fractionation, adapting individualized increments for different patients, and adopting new technologies and new equipment such as new radiation therapy, no consensus has been achieved yet.
Collapse
Affiliation(s)
- Li Ma
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Yu Men
- Department of VIP Medical Services, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing100021, China
| | - Lingling Feng
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Jingjing Kang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing100021, China
| | - Xin Sun
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing100021, China
| | - Meng Yuan
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing100021, China
| | - Wei Jiang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Zhouguang Hui
- Department of VIP Medical Services, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing100021, China
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing100021, China
- Zhouguang Hui, M.D., Department of VIP Medical Services & Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Panjiayuan Nanli 17, Chaoyang District, Beijing 100021, China. Phone: + 861087787656
| |
Collapse
|
42
|
Abel S, Hasan S, Horne ZD, Colonias A, Wegner RE. Stereotactic body radiation therapy in early-stage NSCLC: historical review, contemporary evidence and future implications. Lung Cancer Manag 2019; 8:LMT09. [PMID: 31044018 PMCID: PMC6488937 DOI: 10.2217/lmt-2018-0013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/22/2018] [Indexed: 12/17/2022] Open
Abstract
Clinical use of stereotactic body radiation therapy (SBRT) has increased dramatically over the last 2 decades and is the current standard-of-care in cases of inoperable early stage non-small-cell lung cancer. While surgical resection remains the standard-of-care for operable patients, several ongoing clinical trials are investigating the role of SBRT in these operative candidates as well. Taking into consideration the expanding role and utility of SBRT, this paper will: review the historical basis of SBRT; examine landmark trials establishing the framework for the current body of evidence; discuss areas of active and future research; and identify epidemiological trends that are likely to further increase the use of SBRT.
Collapse
Affiliation(s)
- Stephen Abel
- Allegheny Health Network Cancer Institute, Division of Radiation Oncology, Pittsburgh, PA, 15212, USA
| | - Shaakir Hasan
- Allegheny Health Network Cancer Institute, Division of Radiation Oncology, Pittsburgh, PA, 15212, USA
| | - Zachary D Horne
- Allegheny Health Network Cancer Institute, Division of Radiation Oncology, Pittsburgh, PA, 15212, USA
| | - Athanasios Colonias
- Allegheny Health Network Cancer Institute, Division of Radiation Oncology, Pittsburgh, PA, 15212, USA
| | - Rodney E Wegner
- Allegheny Health Network Cancer Institute, Division of Radiation Oncology, Pittsburgh, PA, 15212, USA
| |
Collapse
|
43
|
Shrimali RK, Nallathambi C, Saha A, Das A, Prasath S, Mahata A, Arun B, Mallick I, Achari R, Dabkara D, Thambudorai R, Chatterjee S. Radical radiotherapy or chemoradiotherapy for inoperable, locally advanced, non-small cell lung cancer: Analysis of patient profile, treatment approaches, and outcomes for 213 patients at a tertiary cancer center. Indian J Cancer 2019; 55:125-133. [PMID: 30604722 DOI: 10.4103/ijc.ijc_469_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Radical radiotherapy (RT) with curative intent, with or without chemotherapy, is the standard treatment for inoperable, locally advanced nonsmall cell lung cancer (NSCLC). MATERIALS AND METHODS We retrospectively reviewed the data for all 288 patients who presented with inoperable, locally advanced NSCLC at our institution, between May 2011 and December 2016. RESULTS RT alone or sequential chemoradiotherapy (SCRT) or concurrent chemoradiotherapy (CCRT) was used for 213 patients. Median age was 64 years (range: 27-88 years). Stage-III was the biggest stage group with 189 (88.7%) patients. Most patients with performance status (PS) 0 or 1 received CCRT, whereas most patients with PS 2 received RT alone (P < 0.001). CCRT, SCRT, and RT alone were used for 120 (56.3%), 24 (11.3%), and 69 (32.4%) patients, respectively. A third of all patients (32.4%) required either volumetric-modulated arc radiotherapy (VMAT) or tomotherapy. Median follow-up was 16 months. The median progression-free survival and median overall survival (OS) were 11 and 20 months, respectively. One-year OS and 2-year OS were 67.9% and 40.7%, respectively. Patients treated using CCRT lived significantly longer with a median survival of 28 months, compared with 13 months using SCRT and RT alone (P < 0.001). On multivariate analysis, OS was significantly affected by age, stage group, treatment approach, and response to treatment. CONCLUSION RT including CCRT is feasible, safe, and well tolerated in our patient population and results in survival benefits comparable with published literature. CCRT should be considered for all patients with inoperable, locally advanced NSCLC, who are fit and have good PS.
Collapse
Affiliation(s)
- Raj Kumar Shrimali
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Chandran Nallathambi
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Animesh Saha
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Avipsa Das
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sriram Prasath
- Department of Radiotherapy Physics, Tata Medical Center, Kolkata, West Bengal, India
| | - Anurupa Mahata
- Department of Radiotherapy Physics, Tata Medical Center, Kolkata, West Bengal, India
| | - B Arun
- Department of Radiotherapy Physics, Tata Medical Center, Kolkata, West Bengal, India
| | - Indranil Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Rimpa Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Robin Thambudorai
- Department of Thoracic Surgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Sanjoy Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| |
Collapse
|
44
|
Radiation Therapy in Non-small-Cell Lung Cancer. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-52619-5_34-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
45
|
Healy GEA, Marsh SH, Cousins AT. The dosimetric effect of electron density overrides in 3DCRT Lung SBRT for a range of lung tumor dimensions. J Appl Clin Med Phys 2018; 19:79-87. [PMID: 30199127 PMCID: PMC6236830 DOI: 10.1002/acm2.12446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 07/24/2018] [Accepted: 08/04/2018] [Indexed: 11/25/2022] Open
Abstract
The combined effects of lung tumor motion and limitations of treatment planning system dose calculations in lung regions increases uncertainty in dose delivered to the tumor and surrounding normal tissues in lung stereotactic body radiotherapy (SBRT). This study investigated the effect on plan quality and accuracy when overriding treatment volume electron density values. The QUASAR phantom with modified cork cylindrical inserts, each containing a simulated spherical tumor of 15‐mm, 22‐mm, or 30‐mm diameter, was used to simulate lung tumor motion. Using Monaco 5.1 treatment planning software, two standard plans (50% central phase (50%) and average intensity projection (AIP)) were compared to eight electron density overridden plans that focused on different target volumes (internal target volume (ITV), planning target volume (PTV), and a hybrid plan (HPTV)). The target volumes were set to a variety of electron densities between lung and water equivalence. Minimal differences were seen in the 30‐mm tumor in terms of target coverage, plan conformity, and improved dosimetric accuracy. For the smaller tumors, a PTV override showed improved target coverage as well as better plan conformity compared to the baseline plans. The ITV plans showed the highest gamma pass rate agreement between treatment planning system (TPS) and measured dose (P < 0.040). However, the low electron density PTV and HPTV plans also showed improved gamma pass rates (P < 0.035, P < 0.011). Low‐density PTV overrides improved the plan quality and accuracy for tumor diameters less than 22 mm only. Although an ITV override generated the most significant increase in accuracy, the low‐density PTV plans had the additional benefit of plan quality improvement. Although this study and others agreed that density overrides improve the treatment of SBRT, the optimal density override and the conditions under which it should be applied were found to be department specific, due to variations in commissioning and calculation methods.
Collapse
Affiliation(s)
- Grace E A Healy
- University of Canterbury, Canterbury, New Zealand.,Department of Medical Physics and Bioengineering, Christchurch Hospital, Canterbury, New Zealand
| | | | - Andrew T Cousins
- Department of Medical Physics and Bioengineering, Christchurch Hospital, Canterbury, New Zealand
| |
Collapse
|
46
|
Meijer TWH, Wijsman R, Usmanij EA, Schuurbiers OCJ, Kollenburg PV, Bouwmans L, Bussink J, Geus-Oei LFD. Stereotactic radiotherapy boost after definite chemoradiation for non-responding locally advanced NSCLC based on early response monitoring 18F-FDG-PET/CT. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2018; 7:16-22. [PMID: 33458400 PMCID: PMC7807537 DOI: 10.1016/j.phro.2018.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/04/2018] [Accepted: 08/17/2018] [Indexed: 12/25/2022]
Abstract
Background and purpose Prognosis of locally advanced non-small cell lung cancer remains poor despite chemoradiation. This planning study evaluated a stereotactic boost after concurrent chemoradiotherapy (30 × 2 Gy) to improve local control. The maximum achievable boost directed to radioresistant primary tumor subvolumes based on pre-treatment fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) (pre-treatment-PET) and on early response monitoring 18F-FDG-PET/CT (ERM-PET) was compared. Materials and methods For ten patients, a stereotactic boost (VMAT) was planned on ERM-PET (PTVboost;ERM) and on pre-treatment-PET (PTVboost;pre-treatment), using a 70% SUVmax threshold with 7 mm margin to segmentate radioresistant subvolumes. Dose was escalated till organ at risk (OAR) constraints were met, aiming to plan at least 18 Gy in 3 fractions (EQD2 84 Gy/BED 100.8 Gy). Results In five patients, PTVboost;ERM was 9-40% smaller relative to PTVboost;pre-treatment. Overlap of PTVboost;ERM with OARs decreased also compared to overlap of PTVboost;pre-treatment with OARs. However, any overlap with OAR remained in 4/5 patients resulting in minimal differences between planned dose before and during treatment. Median dose (EQD2) covering 99% and 95% of PTVboost;ERM were 15 Gy and 18 Gy respectively. Median boost volume receiving a physical dose of ≥ 18 Gy (V18) was 88%. V18 was ≥ 80% for PTVboost in six patients. Conclusions A significant stereotactic boost to volumes with high initial or persistent 18F-FDG-uptake could be planned above 60 Gy chemoradiation. Differences between planned dose before and during treatment were minimal. However, as an ERM-PET also monitors changes in tumor position, we recommend to plan the boost on the ERM-PET.
Collapse
Affiliation(s)
- Tineke W H Meijer
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robin Wijsman
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Edwin A Usmanij
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga C J Schuurbiers
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter van Kollenburg
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Liza Bouwmans
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johan Bussink
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, The Netherlands
| |
Collapse
|
47
|
Barrett S, Hanna GG, Marignol L. An overview on personalisation of radiotherapy prescriptions in locally advanced non-small cell lung cancer: Are we there yet? Radiother Oncol 2018; 128:520-533. [PMID: 29908871 DOI: 10.1016/j.radonc.2018.05.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/21/2018] [Accepted: 05/28/2018] [Indexed: 12/25/2022]
Abstract
Standard of care radiotherapy in LA-NSCLC is 60-66 Gy in 30-33 fractions. However outcomes for these patients are poor with 5-year survival in the range of 10-20%. Randomised controlled trials have shown that dose escalation in a linear fashion does not improve outcomes for all patients, thus there is a need to tailor the prescription to the individual patient. This review assesses the strategies published to personalise the radiation therapy dose prescription in LA-NSCLC. A systematic and scoping search of the literature was performed to identify studies that met the inclusion criteria. 19 relevant studies were identified ranging from prospective clinical trials to mathematically modelled concept studies. Heterogeneity existed between all clinical studies. Nine heterogeneous publications proposed methodology to adapt the dose prescription to the individual patient. A number of encouraging strategies have been identified but fall short of the evidence level required to influence clinical practice.
Collapse
Affiliation(s)
- Sarah Barrett
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Dublin, Ireland.
| | - Gerard G Hanna
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, United Kingdom.
| | - Laure Marignol
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Dublin, Ireland.
| |
Collapse
|
48
|
Ferris MJ, Jiang R, Behera M, Ramalingam SS, Curran WJ, Higgins KA. Radiation Therapy Is Associated With an Increased Incidence of Cardiac Events in Patients with Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2018; 102:383-390. [PMID: 30191870 DOI: 10.1016/j.ijrobp.2018.05.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/17/2018] [Accepted: 05/25/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Cardiac radiation dose was a predictor of inferior overall survival in the Radiation Therapy Oncology Group 0617 non-small cell lung cancer trial. We examined the association between radiation therapy (RT) and cardiac events (CE) for patients with small cell lung cancer (SCLC). METHODS AND MATERIALS The US population-based Surveillance, Epidemiology, and End Results Program and Medicare claims databases were queried for rates of CE among patients with SCLC treated with chemotherapy (CTX) ± RT. Propensity score matching (PSM) and multivariate analysis were conducted. Patients were matched for actual/theoretical RT start date (to prevent immortal time bias) and then full PSM balanced clinical characteristics. Cumulative incidence function curves were generated. RESULTS From 2000 to 2011, 7060 patients were included: 2892 limited-stage SCLC (LS-SCLC) and 4168 extensive-stage SCLC. Grouping LS-SCLC and extensive-stage SCLC together, the incidence of CE for the CTX + RT and CTX-only groups was 44.1% versus 39% at 60 months (P = .008). After PSM (5286 patients), the incidence of CE for the CTX + RT and CTX-only groups was 43% versus 38.6% at 60 months (P = .033). Analysis of only LS-SCLC (2016 patients) demonstrated that the incidence of CE for CTX + RT versus CTX-only groups was 50.3% versus 42% at 60 months (P = .0231). Multivariate analysis again demonstrated an association between CE and RT (hazard ratio 1.20; 95% confidence interval 1.06-1.37; P = .005). After PSM (1614 patients), the incidence of CE for CTX + RT versus CTX-only groups was 51.7% versus 41.6% at 60 months (P = .0042). CONCLUSIONS Patients with SCLC are at significant risk of developing CE posttreatment; RT is associated with an absolute increase in the rate of CE at 5 years of approximately 5% for all patients with SCLC and up to 10% for patients with LS-SCLC. Cardiac risk management and cardiac-sparing RT techniques should be further evaluated for patients with SCLC.
Collapse
Affiliation(s)
- Matthew J Ferris
- Department of Radiation Oncology and Winship Cancer Institute at Emory University, Atlanta, Georgia.
| | - Renjian Jiang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Madhusmita Behera
- Department of Hematology and Medical Oncology, and Winship Cancer Institute at Emory University, Atlanta, Georgia
| | - Suresh S Ramalingam
- Department of Hematology and Medical Oncology, and Winship Cancer Institute at Emory University, Atlanta, Georgia
| | - Walter J Curran
- Department of Radiation Oncology and Winship Cancer Institute at Emory University, Atlanta, Georgia
| | - Kristin A Higgins
- Department of Radiation Oncology and Winship Cancer Institute at Emory University, Atlanta, Georgia
| |
Collapse
|
49
|
|
50
|
Fleckenstein J, Boda-Heggemann J, Siebenlist K, Gudzheva T, Prakofyeva N, Lohr F, Wenz F, Simeonova-Chergou A. Non-coplanar VMAT combined with non-uniform dose prescription markedly reduces lung dose in breath-hold lung SBRT. Strahlenther Onkol 2018; 194:815-823. [PMID: 29802434 DOI: 10.1007/s00066-018-1316-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/08/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE In this retrospective treatment planning study, the effect of a uniform and non-uniform planning target volume (PTV) dose coverage as well as a coplanar and non-coplanar volumetric modulated arc therapy (VMAT) delivery approach for lung stereotactic body radiation therapy (SBRT) in deep inspiration breath-hold (DIBH) were compared. MATERIALS AND METHODS For 46 patients with lesions in the peripheral lungs, three different treatment plans were generated: First, a coplanar 220° VMAT sequence with a uniform PTV dose prescription (UC). Second, a coplanar 220° VMAT treatment plan with a non-uniform dose distribution in the PTV (nUC). Third, a non-coplanar VMAT dose delivery with four couch angles (0°, ±35°, 90°) and a non-uniform prescription (nUnC) was used. All treatment plans were optimized for pareto-optimality with respect to PTV coverage and ipsilateral lung dose. Treatment sequences were delivered on a flattening-filter-free linear accelerator and beam-on times were recorded. Dosimetric comparison between the three techniques was performed. RESULTS For the three scenarios (UC, nUC, nUnC), median gross tumor volume (GTV) doses were 63.4 ± 2.5, 74.4 ± 3.6, and 77.9 ± 3.8 Gy, and ipsilateral V10Gy lung volumes were 15.7 ± 6.1, 13.9 ± 4.7, and 12.0 ± 5.1%, respectively. Normal tissue complication probability of the ipsilateral lung was 3.9, 3.1, and 2.8%, respectively. The number of monitor units were 5141 ± 1174, 4104 ± 786, and 3657 ± 710 MU and the corresponding beam-on times were 177 ± 54, 143 ± 29, and 148 ± 26 s. CONCLUSION For SBRT treatments in DIBH, a non-uniform dose prescription in the PTV, combined with a non-coplanar VMAT arc arrangement, significantly spares the ipsilateral lung while increasing dose to the GTV without major treatment time increase.
Collapse
Affiliation(s)
- Jens Fleckenstein
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kerstin Siebenlist
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Tanya Gudzheva
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Natallia Prakofyeva
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Frank Lohr
- Unita Operativa di Radioterapia, Department of Oncology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Anna Simeonova-Chergou
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| |
Collapse
|