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Alaswad M. Locally advanced non-small cell lung cancer: current issues and recent trends. Rep Pract Oncol Radiother 2023; 28:286-303. [PMID: 37456701 PMCID: PMC10348324 DOI: 10.5603/rpor.a2023.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/29/2023] [Indexed: 07/18/2023] Open
Abstract
The focus of this paper was to review and summarise the current issues and recent trends within the framework of locally advanced (LA) non-small cell lung cancer (NSCLC). The recently proposed 8th tumour-node-metastases (TNM) staging system exhibited significant amendments in the distribution of the T and M descriptors. Every revision to the TNM classification should contribute to clinical improvement. This is particularly necessary regarding LA NSCLC stratification, therapy and outcomes. While several studies reported the superiority of the 8th TNM edition in comparison to the previous 7th TNM edition, in terms of both the discrimination ability among the various T subgroups and clinical outcomes, others argued against this interpretation. Synergistic cytotoxic chemotherapy with radiotherapy is most prevalent in treating LA NSCLC. Clinical trial experience from multiple references has reported that the risk of locoregional relapse and distant metastasis was less evident for patients treated with concomitant radiochemotherapy than radiotherapy alone. Nevertheless, concern persists as to whether major incidences of toxicity may occur due to the addition of chemotherapy. Cutting-edge technologies such as four-dimensional computed tomography (4D-CT) and volumetric modulated arc therapy (VMAT) should yield therapeutic gains due to their capability to conform radiation doses to tumours. On the basis of the preceding notion, the optimum radiotherapy technique for LA NSCLC has been a controversial and much-disputed subject within the field of radiation oncology. Notably, no single-perspective research has been undertaken to determine the optimum radiotherapy modality for LA NSCLC. The landscape of immunotherapy in lung cancer is rapidly expanding. Currently, the standard of care for patients with inoperable LA NSCLC is concurrent chemoradiotherapy followed by maintenance durvalumab according to clinical outcomes from the PACIFIC trial. An estimated 42.9% of patients randomly assigned to durvalumab remained alive at five years, and free of disease progression, thereby establishing a new benchmark for the standard of care in this setting.
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Affiliation(s)
- Mohammed Alaswad
- Comprehensive Cancer Centre, Radiation Oncology, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
- Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
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Xiao W, Hong M. Concurrent vs sequential chemoradiotherapy for patients with advanced non-small-cell lung cancer: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e21455. [PMID: 33725921 PMCID: PMC7982214 DOI: 10.1097/md.0000000000021455] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 06/25/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Chemotherapy in combination with thoracic radiotherapy yields significant results in patients with advanced non-small-cell lung cancer (NSCLC) compared with thoracic radiotherapy alone. However, whether concurrent or sequential delivery of chemotherapy combined with thoracic radiotherapy is optimal remains unclear. Herein, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of concurrent vs sequential chemoradiotherapy in patients with NSCLC. METHODS PubMed, EmBase, and Cochrane Library were systematically searched for RCTs focusing on concurrent and sequential chemoradiotherapy for patients with NSCLC. The pooled-effect estimate was calculated using the random-effects model. Sensitivity, subgroup, and publication biases were also evaluated. A total of 14 RCTs (2634 patients with NSCLC) were selected for the final meta-analysis. RESULTS Compared with sequential chemoradiotherapy, concurrent chemoradiotherapy did not increase the 1-year survival rates; however, concurrent chemoradiotherapy significantly increased the 2-, 3-, 4-, and 5-year survival rates. Moreover, although there were no significant differences between concurrent and sequential chemoradiotherapy in terms of distant relapse and locoregional plus distant relapse, concurrent chemoradiotherapy significantly reduced the risk of locoregional relapse. Furthermore, concurrent chemoradiotherapy yielded positive results with respect to overall response rates. Unfortunately, concurrent chemoradiotherapy could result in esophagitis, nausea/vomiting, and reduced leukocyte and platelet counts in patients with NSCLC. CONCLUSION Compared with sequential chemoradiotherapy, concurrent chemoradiotherapy may be significantly beneficial in terms of long-term survival and locoregional relapse, although it increases the risk of grade 3 (or greater) adverse events.
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Or M, Liu B, Lam J, Vinod S, Xuan W, Yeghiaian-Alvandi R, Hau E. A systematic review and meta-analysis of treatment-related toxicities of curative and palliative radiation therapy in non-small cell lung cancer. Sci Rep 2021; 11:5939. [PMID: 33723301 PMCID: PMC7971013 DOI: 10.1038/s41598-021-85131-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/10/2021] [Indexed: 12/25/2022] Open
Abstract
Treatment-related toxicity is an important component in non-small cell lung cancer (NSCLC) management decision-making. Our aim was to evaluate and compare the toxicity rates of curative and palliative radiotherapy with and without chemotherapy. This meta-analysis provides better quantitative estimates of the toxicities compared to individual trials. A systematic review of randomised trials with > 50 unresectable NSCLC patients, treated with curative or palliative conventional radiotherapy (RT) with or without chemotherapy. Data was extracted for oesophagitis, pneumonitis, cardiac events, pulmonary fibrosis, myelopathy and neutropenia by any grade, grade ≥ 3 and treatment-related deaths. Mantel–Haenszel fixed-effect method was used to obtain pooled risk ratio. Forty-nine trials with 8609 evaluable patients were included. There was significantly less grade ≥ 3 acute oesophagitis (6.4 vs 22.2%, p < 0.0001) and any grade oesophagitis (70.4 vs 79.0%, p = 0.04) for sequential CRT compared to concurrent CRT, with no difference in pneumonitis (grade ≥ 3 or any grade), neutropenia (grade ≥ 3), cardiac events (grade ≥ 3) or treatment-related deaths. Although the rate of toxicity increased with intensification of treatment with RT, the only significant difference between treatment regimens was the rate of oesophagitis between the use of concurrent and sequential CRT. This can aid clinicians in radiotherapy decision making for NSCLC.
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Affiliation(s)
- M Or
- Department of Radiation Oncology, The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead Sydney, NSW, 2145, Australia.
| | - B Liu
- Department of Radiation Oncology, The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead Sydney, NSW, 2145, Australia
| | - J Lam
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
| | - S Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - W Xuan
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - R Yeghiaian-Alvandi
- Department of Radiation Oncology, The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead Sydney, NSW, 2145, Australia
| | - E Hau
- Department of Radiation Oncology, The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead Sydney, NSW, 2145, Australia
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Xu S, Shi L. High expression of miR-155 and miR-21 in the recurrence or metastasis of non-small cell lung cancer. Oncol Lett 2019; 18:758-763. [PMID: 31289551 PMCID: PMC6539534 DOI: 10.3892/ol.2019.10337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/24/2019] [Indexed: 11/13/2022] Open
Abstract
High expression of miR-155 and miR-21 in the recurrence or metastasis of non-small cell lung cancer (NSCLC) was investigated. Retrospective analysis on the clinical information of 180 patients with NSCLC was carried out. The patients were admitted to Daqing Oil Field General Hospital from February 2012 to March 2015 and they were the research group. Moreover, the physical examination information of 88 normal medical examinees were selected at the same period of time as the control group. In the research group, 68 patients diagnosed with NSCLC were the newly diagnosed group and 112 cases of recurrence or metastasis of NSCLC were the recurrence group. The quantitative real-time polymerase chain reaction was used to detect the expression levels of serum miR-115 and miR-21. In addition, the expression levels between miR-155 and miR-21 and the relationship between the recurrence rate and metastasis of NSCLC were analyzed. The impact on the prognosis of patients were also analyzed. The expression levels of serum miR-155 and miR-21 were higher in the research group than those in the control group (P<0.05). The expression levels of serum miR-155 and miR-21 were higher in the recurrence group than those in the newly diagnosed group (P<0.05). We followed up the patients in the research group for 36 months, the median survival time and mortality rate in the recurrence group was higher than that of in the newly diagnosed group (χ2=9.705, P<0.01). In conclusion, miR-155 and miR-21 were highly expressed in the serum of patients, however, the recurrence and metastasis of NSCLC were even higher. The highly expressed levels of miR-155 and miR-21 were associated with the recurrence and metastasis in NSCLC patients, affecting the prognosis of patients.
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Affiliation(s)
- Shuang Xu
- Department of Cardiothoracic Surgery, Daqing Oil Field General Hospital, Daqing, Heilongjiang 163000, P.R. China
| | - Lei Shi
- Department of Hematology and Oncology, Daqing Longnan Hospital, Daqing, Heilongjiang 163000, P.R. China
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Takhar H, Singhal N, Mislang A, Kumar R, Kim L, Selva-Nayagam S, Pittman K, Karapetis C, Borg M, Olver IN, Brown MP. Phase II study of celecoxib with docetaxel chemoradiotherapy followed by consolidation chemotherapy docetaxel plus cisplatin with maintenance celecoxib in inoperable stage III nonsmall cell lung cancer. Asia Pac J Clin Oncol 2017; 14:91-100. [DOI: 10.1111/ajco.12749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Harminder Takhar
- Cancer Clinical Trials Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Nimit Singhal
- Cancer Clinical Trials Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Anna Mislang
- Cancer Clinical Trials Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Raj Kumar
- Department of Medical Oncology; Flinders Medical Centre and Flinders University; Adelaide South Australia Australia
| | - Laurence Kim
- Cancer Clinical Trials Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Sid Selva-Nayagam
- Cancer Clinical Trials Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Ken Pittman
- Department of Medical Oncology; The Queen Elizabeth Hospital; Woodville South Australia Australia
| | - Chris Karapetis
- Department of Medical Oncology; Flinders Medical Centre and Flinders University; Adelaide South Australia Australia
| | - Martin Borg
- Adelaide Radiotherapy Centre; Adelaide South Australia Australia
| | - Ian N. Olver
- Sansom Institute; University of South Australia; Adelaide South Australia Australia
| | - Michael P. Brown
- Cancer Clinical Trials Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
- Sansom Institute; University of South Australia; Adelaide South Australia Australia
- Centre for Cancer Biology; SA Pathology and University of South Australia; Adelaide South Australia Australia
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
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Hansen O, Knap MM, Khalil A, Nyhus CH, McCulloch T, Holm B, Brink C, Hoffmann L, Schytte T. A randomized phase II trial of concurrent chemoradiation with two doses of radiotherapy, 60 Gy and 66 Gy, concomitant with a fixed dose of oral vinorelbine in locally advanced NSCLC. Radiother Oncol 2017; 123:276-281. [DOI: 10.1016/j.radonc.2017.03.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/15/2017] [Accepted: 03/21/2017] [Indexed: 12/25/2022]
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Ardizzoni A, Tiseo M, Boni L, Di Maio M, Buffoni L, Belvedere O, Grossi F, D'Alessandro V, de Marinis F, Barbera S, Caroti C, Favaretto A, Cortinovis D, Morrica B, Tixi L, Ceschia T, Parisi S, Ricardi U, Grimaldi A, Loreggian L, Navarria P, Huber RM, Belani C, Brunsvig PF, Scagliotti GV, Scolaro T. Randomized phase III PITCAP trial and meta-analysis of induction chemotherapy followed by thoracic irradiation with or without concurrent taxane-based chemotherapy in locally advanced NSCLC. Lung Cancer 2016; 100:30-37. [PMID: 27597278 DOI: 10.1016/j.lungcan.2016.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/18/2016] [Accepted: 07/26/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Chemo-radiotherapy is standard of care in the treatment of unresectable stage III NSCLC. We aimed at assessing whether the addition of concurrent taxane-chemotherapy to thoracic irradiation following chemotherapy was able to improve treatment outcome. MATERIAL AND METHODS In PITCAP trial, patients with unresectable stage III NSCLC were randomized to receive 2 cycles of platinum-paclitaxel followed by 60-61.2Gy thoracic irradiation (control arm) or by same radiotherapy with concomitant weekly paclitaxel (experimental arm). A literature-based meta-analysis including all studies with same design was also performed. RESULTS At the time of the second interim analysis, when 151 patients were randomized, accrual was terminated. With a median follow-up of 6.1 years, median survival was 13.2 vs 15.1 months, with a 3-year survival rate of 19.5 vs 21.2% in the control and experimental arm, respectively (HR: 0.97; 95% CI 0.69-1.36; p=0.845). Treatment toxicity was manageable in both arms. The meta-analysis of 5 trials (n=866) confirmed the lack of a meaningful effect on 1-year overall survival of a taxane added concurrently to radiotherapy. CONCLUSIONS These results do not support a meaningful survival benefit with the addition of single agent taxane given concurrently to radiotherapy after platinum-based induction in locally advanced NSCLC.
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Affiliation(s)
- Andrea Ardizzoni
- Medical Oncology Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital, Parma, Italy.
| | - Luca Boni
- Clinical Trials Coordinating Center, Istituto Toscano Tumori, University Hospital Careggi, Firenze, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Torino, Orbassano, Torino, Italy
| | - Lucio Buffoni
- Department of Oncology, University of Torino, Orbassano, Torino, Italy
| | - Ornella Belvedere
- Department of Oncology, Medical Oncology Unit, University Hospital, Udine, Italy
| | - Francesco Grossi
- Medical Oncology Unit A, IRCCS San Martino University Hospital - IST National Cancer Research Institute, Genova, Italy
| | - Vito D'Alessandro
- Respiratory Oncology Section, I Internal Medicine Department, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, European Institute of Oncology (IEO), Milan, Italy
| | - Santi Barbera
- Division of Oncologic Pneumology, Mariano Santo Hospital, Cosenza, Italy
| | - Cinzia Caroti
- Academic Unit of Medical Oncology, IRCCS San Martino University Hospital - IST National Cancer Research Institute, Genova, Italy
| | - Adolfo Favaretto
- Department of Clinical and Experimental Oncology, Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | | | - Brunello Morrica
- Radiotherapy Unit, Istituto Nazionale Tumori Fondazione G. Pascale, Napoli, Italy
| | - Lucia Tixi
- Department of Internal Medicine, IRCCS San Martino University Hospital - IST National Cancer Research Institute, Genova, Italy
| | - Tino Ceschia
- Department of Oncology, Radiotherapy Unit, University Hospital, Udine, Italy
| | - Salvatore Parisi
- Radiotherapy Department, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Torino, Italy
| | | | - Lucio Loreggian
- Radiotherapy Department, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Rudolf M Huber
- Pneumologie, Medizinische Klinik Innenstadt, University of Munich, Munich, Germany
| | - Chandra Belani
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, United States
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Zhao J, Xia Y, Kaminski J, Hao Z, Mott F, Campbell J, Sadek R, Kong FM(S. Treatment-Related Death during Concurrent Chemoradiotherapy for Locally Advanced Non-Small Cell Lung Cancer: A Meta-Analysis of Randomized Studies. PLoS One 2016; 11:e0157455. [PMID: 27300551 PMCID: PMC4907424 DOI: 10.1371/journal.pone.0157455] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/31/2016] [Indexed: 12/25/2022] Open
Abstract
Treatment related death (TRD) is the worst adverse event in chemotherapy and radiotherapy for patients with cancer, the reports for TRDs were sporadically. We aimed to study TRDs in non-small cell lung cancer (NSCLC) patients treated with concurrent chemoradiotherapy (CCRT), and determine whether high radiation dose and newer chemotherapy regimens were associated with the risk of TRD. Data from randomized clinical trials for locally advanced/unresectable NSCLC patients were analyzed. Eligible studies had to have at least one arm with CCRT. The primary endpoint was TRD. Pooled odds ratios (ORs) for TRDs were calculated. In this study, a total of fifty-three trials (8940 patients) were eligible. The pooled TRD rate (accounting for heterogeneity) was 1.44% for all patients. In 20 trials in which comparison of TRDs between CCRT and non-CCRT was possible, the OR (95% CI) of TRDs was 1.08 (0.70-1.66) (P = 0.71). Patients treated with third-generation chemotherapy and concurrent radiotherapy had an increase of TRDs compared to those with other regimens in CCRT (2.70% vs. 1.37%, OR = 1.50, 95% CI: 1.09-2.07, P = 0.008). No significant difference was found in TRDs between high (≥ 66 Gy) and low (< 66 Gy) radiation dose during CCRT (P = 0.605). Neither consolidation (P = 0.476) nor induction chemotherapy (P = 0.175) had significant effects with increased TRDs in this study. We concluded that CCRT is not significantly associated with the risk of TRD compared to non-CCRT. The third-generation chemotherapy regimens may be a risk factor with higher TRDs in CCRT, while high dose radiation is not significantly associated with more TRDs. This observation deserves further study.
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Affiliation(s)
- Jing Zhao
- Department of Radiation Oncology, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, GA, United States of America
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingfeng Xia
- The First Hospital of Yichang, The People's Hospital of Three Gorges University, Yichang, China
| | - Joseph Kaminski
- Department of Radiation Oncology, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, GA, United States of America
| | - Zhonglin Hao
- Department of Internal Medicine, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, GA, United States of America
| | - Frank Mott
- Department of Internal Medicine, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, GA, United States of America
| | - Jeff Campbell
- Department of Radiation Oncology, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, GA, United States of America
| | - Ramses Sadek
- Department of Biostatistics and Epidemiology, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, GA, United States of America
| | - Feng-Ming (Spring) Kong
- Department of Radiation Oncology, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, GA, United States of America
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Bearz A, Minatel E, Rumeileh IA, Borsatti E, Talamini R, Franchin G, Gobitti C, Del Conte A, Trovò M, Baresic T. Concurrent chemoradiotherapy with tomotherapy in locally advanced Non-Small Cell Lung Cancer: a phase I, docetaxel dose-escalation study, with hypofractionated radiation regimen. BMC Cancer 2013; 13:513. [PMID: 24176164 PMCID: PMC4228391 DOI: 10.1186/1471-2407-13-513] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 10/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Concurrent chemo-radiotherapy is demonstrately superior to sequential chemo-radiotherapy in the treatment of advanced Non-Small-Cell Lung Cancer not suitable for surgery. Docetaxel is considered to enhance the cytotoxic effect of radiotherapy on the tumour cells. Tomotherapy (HT) is a novel radiotherapeutic technique, which allows the delivery of Image Guided-IMRT (IG-IMRT), with a highly conformal radiation dose distribution.The goal of the study was to estimate tolerability of Docetaxel concurrent with IMRT and to find the maximum tolerated dose of weekly Docetaxel concurrent with IMRT delivered with HT Tomotherapy after induction chemotherapy with Cisplatin and Docetaxel in patients affected with stage III Non-Small Cell Lung Cancer. METHODS We designed a phase I, dose-finding study to determine the dose of weekly Docetaxel concurrent with Tomotherapy after induction chemotherapy, in patients affected by Non-Small Cell Lung Cancer with Stage III disease, not suitable for surgery. RESULTS Concurrent weekly Docetaxel and Tomotherapy are feasible; we did not reach a maximum tolerated dose, because no life-threatening toxicity was observed, stopping the accrual at a level of weekly docetaxel 38 mg/m2, a greater dose than in previous assessments, from both phase-I studies with weekly docetaxel alone and with Docetaxel concomitant with standard radiotherapy. CONCLUSIONS Concurrent weekly Docetaxel and Tomotherapy are feasible, and even with Docetaxel at 38 mg/m2/week we did not observe any limiting toxicity. For those patients who completed the combined chemo-radio treatment, median progression-free survival (PFS) was 20 months and median overall survival (OS) was 24 months.
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Affiliation(s)
- Alessandra Bearz
- Medical Oncology Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
| | - Emilio Minatel
- Radiation Oncology Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
| | - Imad Abu Rumeileh
- Radiation Oncology Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
| | - Eugenio Borsatti
- Nuclear Medicine Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
| | - Renato Talamini
- Division of Epidemiology and Biostatistics, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
| | - Giovanni Franchin
- Radiation Oncology Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
| | - Carlo Gobitti
- Radiation Oncology Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
| | | | - Marco Trovò
- Radiation Oncology Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
| | - Tanja Baresic
- Nuclear Medicine Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy
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Fakhrejahani F, Hashemi Sadraei N, Mekhail T. The Role of Consolidation Treatment in Locally Advanced Unresectable NSCLC. Curr Oncol Rep 2013; 15:424-32. [DOI: 10.1007/s11912-013-0330-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Petrović M, Mitrovic S, Stankovic V, Jurisic V, Atkinson HD. Neuroendocrine Markers–Useful Predictors of Therapeutic Responses in Non-resectable Non-small Cell Lung Cancer. Lab Med 2012. [DOI: 10.1309/lm0ikao8z0mutvfe] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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12
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Aydiner A, Sen F, Saglam EK, Oral EN, Eralp Y, Tas F, Toker A, Dilege S. Induction Chemotherapy With Triweekly Docetaxel and Cisplatin Followed by Concomitant Chemoradiotherapy With or Without Surgery in Stage III Non–Small-Cell Lung Cancer: A Phase II Study. Clin Lung Cancer 2011; 12:286-92. [DOI: 10.1016/j.cllc.2011.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 02/15/2011] [Accepted: 03/15/2011] [Indexed: 11/17/2022]
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14
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Senan S, Cardenal F, Vansteenkiste J, Stigt J, Akyol F, De Neve W, Bakker J, Dupont JM, Scagliotti G, Ricardi U, van Meerbeeck J. A randomized phase II study comparing induction or consolidation chemotherapy with cisplatin–docetaxel, plus radical concurrent chemoradiotherapy with cisplatin–docetaxel, in patients with unresectable locally advanced non-small-cell lung cancer. Ann Oncol 2011; 22:553-558. [DOI: 10.1093/annonc/mdq388] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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15
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Bral S, De Ridder M, Duchateau M, Gevaert T, Engels B, Schallier D, Storme G. Daily megavoltage computed tomography in lung cancer radiotherapy: correlation between volumetric changes and local outcome. Int J Radiat Oncol Biol Phys 2010; 80:1338-42. [PMID: 20638192 DOI: 10.1016/j.ijrobp.2010.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 04/08/2010] [Accepted: 04/08/2010] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the predictive or comparative value of volumetric changes, measured on daily megavoltage computed tomography during radiotherapy for lung cancer. PATIENTS AND METHODS We included 80 patients with locally advanced non-small-cell lung cancer treated with image-guided intensity-modulated radiotherapy. The radiotherapy was combined with concurrent chemotherapy, combined with induction chemotherapy, or given as primary treatment. Patients entered two parallel studies with moderately hypofractionated radiotherapy. Tumor volume contouring was done on the daily acquired images. A regression coefficient was derived from the volumetric changes on megavoltage computed tomography, and its predictive value was validated. Logarithmic or polynomial fits were applied to the intratreatment changes to compare the different treatment schedules radiobiologically. RESULTS Regardless of the treatment type, a high regression coefficient during radiotherapy predicted for a significantly prolonged cause-specific local progression free-survival (p = 0.05). Significant differences were found in the response during radiotherapy. The significant difference in volumetric treatment response between radiotherapy with concurrent chemotherapy and radiotherapy plus induction chemotherapy translated to a superior long-term local progression-free survival for concurrent chemotherapy (p = 0.03). An enhancement ratio of 1.3 was measured for the used platinum/taxane doublet in comparison with radiotherapy alone. CONCLUSION Contouring on daily megavoltage computed tomography images during radiotherapy enabled us to predict the efficacy of a given treatment. The significant differences in volumetric response between treatment strategies makes it a possible tool for future schedule comparison.
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Affiliation(s)
- Samuel Bral
- Department of Radiation Oncology, Oncology Center, Universitair Ziekenhuis Brussel, Brussels, Belgium.
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Liang HY, Zhou H, Li XL, Yin ZH, Guan P, Zhou BS. Chemo-radiotherapy for advanced non-small cell lung cancer: concurrent or sequential? It's no longer the question: a systematic review. Int J Cancer 2010; 127:718-28. [PMID: 19957329 DOI: 10.1002/ijc.25087] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There has been conflicting evidence concerning the best sequence of radiotherapy (RT) and chemotherapy (CT) for advanced non-small-cell-lung-cancer (NSCLC). To investigate whether current clinical trials can clarify this schedule and offer further bases for clinical decision making, we performed a systematic review of 11 trials (2,043 patients; concurrent-1,019, sequential-1,024) that compared concurrent RT-CT with sequential arm in advanced NSCLC patients. Primary end point was overall survival (OS). Pooled median ratios (MRs) and progression-free-survival ratios (FRs) for median survival and progression-free survival (PFS) were calculated using the weighted sum of the log ratio of MR and FR of individual study. Pooled odds ratios (ORs) for the objective response rate, relapse control rate, and toxic events were calculated using the Mantel-Haenszel estimate. Results confirmed that concurrent RT-CT determined a statistically significant increase in median survival time (16.3 vs. 13.9 months; MR = 1.17,95%CI:1.09-1.26), response rate (64.0% vs. 56.3%; OR = 1.38,95%CI:1.10-1.72), and tumor-relapse control (OR = 0.82,95%CI:0.69-0.97), though at the expense of increased hematological toxicity (neutropenia and thrombocytopenia) and non-hematological toxicity (nausea/vomiting, stomatitis, and esophagitis). Similar results were obtained from the sensitivity analysis of all Phase-III/trials designed to evaluate the primary end point of OS. Subgroup analysis revealed that concurrent strategy was mainly associated with improved loco-regional control (OR = 0.68,95%CI:0.52-0.87). However, no difference in PFS is shown. While careful interpretation of our conclusions is required because of potential bias, the present study, to some extent, exhibits the superiority of the concurrent arm over the sequential in the treatment of advanced NSCLC. Further improvements will be obtained by optimizing the conditions for a concurrent regimen.
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Affiliation(s)
- Hui-Ying Liang
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
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O'Rourke N, Roqué I Figuls M, Farré Bernadó N, Macbeth F. Concurrent chemoradiotherapy in non-small cell lung cancer. Cochrane Database Syst Rev 2010:CD002140. [PMID: 20556756 DOI: 10.1002/14651858.cd002140.pub3] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND This is an updated version of the original review published in Issue 4, 2004. The use of concurrent chemotherapy and radiotherapy in non-small cell lung cancer (NSCLC) might be seen as a way of increasing the effectiveness of radical radiotherapy at the same time as reducing the risks of metastatic disease. OBJECTIVES To determine the effectiveness of concurrent chemoradiotherapy as compared to radiotherapy alone with regard to overall survival, tumour control and treatment-related morbidity. To determine the effectiveness of concurrent versus sequential chemoradiotherapy. SEARCH STRATEGY For this update we ran a new search in October 2009, using a search strategy adapted from the design in the original review. We searched: CENTRAL (accessed through The Cochrane Library, 2009, Issue 4), MEDLINE (accessed through PubMed), and EMBASE (accessed through Ovid). SELECTION CRITERIA Randomised trials of patients with stage I-III NSCLC undergoing radical radiotherapy and randomised to receive concurrent chemoradiotherapy versus radiotherapy alone, or concurrent versus sequential chemoradiotherapy. DATA COLLECTION AND ANALYSIS Study selection, data extraction and assessment of risk of bias was performed independently by two authors. Pooled hazard ratios and relative risks were calculated according to a random-effects model. MAIN RESULTS Nineteen randomised studies (2728 participants) of concurrent chemoradiotherapy versus radiotherapy alone were included. Chemoradiotherapy significantly reduced overall risk of death (HR 0.71, 95% CI 0.64 to 0.80; I(2) 0%; 1607 participants) and overall progression-free survival at any site (HR 0.69, 95% CI 0.58 to 0.81; I(2) 45%; 1145 participants). Incidence of acute oesophagitis, neutropenia and anaemia were significantly increased with concurrent chemoradiation. Six trials (1024 patients) of concurrent versus sequential chemoradiation were included. A significant benefit of concurrent treatment was shown in overall survival (HR 0.74, 95% CI 0.62 to 0.89; I(2) 0%; 702 participants). This represented a 10% absolute survival benefit at 2 years. More treatment-related deaths (4% vs 2%) were reported in the concurrent arm without statistical significance (RR 2.02, 95% CI 0.90 to 4.52; I(2) 0%; 950 participants). There was increased severe oesophagitis with concurrent treatment (RR 4.96, 95%CI 2.17 to 11.37; I(2) 66%; 947 participants). AUTHORS' CONCLUSIONS This update of the review published in 2004 incorporates additional trials and more mature data. It demonstrates the benefit of concurrent chemoradiation over radiotherapy alone or sequential chemoradiotherapy. Patient selection is an important consideration in view of the added toxicity of concurrent treatment. Uncertainty remains as to how far this is purely due to a radiosensitising effect and whether similar benefits could be achieved by using modern radiotherapy techniques and more dose intensive accelerated and/ or hyperfractionated radiotherapy regimens.
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Affiliation(s)
- Noelle O'Rourke
- Beatson Oncology Centre, Gartnavel General Hospital, Glasgow, UK, G12 0YN
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Gubens MA, Wakelee HA. Docetaxel in the treatment of non-small cell lung carcinoma: an update and analysis. LUNG CANCER-TARGETS AND THERAPY 2010; 1:63-76. [PMID: 28210107 DOI: 10.2147/lctt.s6499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Docetaxel, a semisynthetic taxane, was the first agent to show efficacy in the second-line treatment of non-small cell lung cancer (NSCLC), and has since become a mainstay of NSCLC therapy. We review its mode of action, pharmacology, toxicity and efficacy and describe both its established role in the treatment of NSCLC and future directions in research. Docetaxel works primarily by promoting microtubule assembly and polymerization, and through this hyperstabilization, causes cell cycle arrest and death. The primary toxicity of docetaxel is neutropenia, which can be mitigated by weekly administration in selected patients. Less common toxicities are peripheral edema, which can be reduced by appropriate premedication and interstitial pneumonitis. Hypersensitivity reactions are less frequent than with paclitaxel. Docetaxel has shown a survival and quality of life advantage as a single agent first- and second-line versus placebo, as well as first-line in a platinum-based doublet therapy compared to a single agent. Increasingly docetaxel has also been used effectively in adjuvant regimens in earlier stages of the disease. Future areas of research include combinations with novel targeted therapies, and a greater understanding of biomarkers that might help predict efficacy and personalize therapy.
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Affiliation(s)
- Matthew A Gubens
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Heather A Wakelee
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA
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Huber RM, Borgmeier A, Flentje M, Willner J, Schmidt M, Manegold C, Bramlage P, Debus J. Concurrent Chemoradiation Therapy With Docetaxel/Cisplatin Followed by Docetaxel Consolidation Therapy in Inoperable Stage IIIA/B Non–Small-Cell Lung Cancer: Results of a Phase I Study. Clin Lung Cancer 2010; 11:45-50. [DOI: 10.3816/clc.2010.n.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vokes EE, Senan S, Treat JA, Iscoe NA. PROCLAIM: A phase III study of pemetrexed, cisplatin, and radiation therapy followed by consolidation pemetrexed versus etoposide, cisplatin, and radiation therapy followed by consolidation cytotoxic chemotherapy of choice in locally advanced stage III non-small-cell lung cancer of other than predominantly squamous cell histology. Clin Lung Cancer 2009; 10:193-8. [PMID: 19443340 DOI: 10.3816/clc.2009.n.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This clinical trial summary provides the background and rationale for a randomized trial examining the benefits of pemetrexed/ cisplatin chemotherapy combined with radiation followed by consolidation pemetrexed in patients with unresectable stage IIIA/B non-small-cell lung cancer. The rationale for the selection of the control arm is provided, and study design limitations are discussed. The primary outcome is survival, and secondary outcomes include progression-free survival, toxicities, and 1-, 2-, and 3-year survival rates. Radiation quality control is a key component of the trial.
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Bayman NA, Blackhall F, Jain P, Lee L, Thatcher N, Faivre-Finn C. Management of Unresectable Stage III Non–Small-Cell Lung Cancer with Combined-Modality Therapy: A Review of the Current Literature and Recommendations for Treatment. Clin Lung Cancer 2008; 9:92-101. [DOI: 10.3816/clc.2008.n.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Brunsvig PFR, Andersen A, Aamdal S, Kristensen V, Olsen H. Pharmacokinetic analysis of two different docetaxel dose levels in patients with non-small cell lung cancer treated with docetaxel as monotherapy or with concurrent radiotherapy. BMC Cancer 2007; 7:197. [PMID: 17956601 PMCID: PMC2175508 DOI: 10.1186/1471-2407-7-197] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Accepted: 10/23/2007] [Indexed: 11/16/2022] Open
Abstract
Background Previous pharmacokinetic studies with docetaxel have mostly used 3-weekly (75 mg/m2 and 100 mg/m2) or weekly regimens (35–40 mg/m2). The pharmacokinetics and radiosensitizing efficacy of weekly 20 mg/m2 docetaxel, has however not been well characterized. We examined the pharmacokinetics of weekly docetaxel when administered with concurrent radiotherapy and compared the results with a 3-weekly 100 mg/m2 regimen. Methods Thirty-four patients with non small cell lung cancer (NSCLC) were included in this study, 19 receiving 100 mg/m2 docetaxel 3-weekly as single therapy, and 15 receiving 20 mg/m2 docetaxel weekly with concurrent radiotherapy. A newly developed HPLC method was used for measuring docetaxel levels, capable of quantifying docetaxel in plasma down to the nanomolar level. Results The HPLC method showed detectable concentrations of docetaxel in plasma even after 72 hours. In the present study we have demonstrated that median docetaxel plasma levels of 3 nM can be obtained 72 hours after a dose of 20 mg/m2. Conclusion The pharmacokinetics of docetaxel is characterized by great inter-individual variability and at some time points plasma concentrations for 20 mg/m2 and 100 mg/m2 docetaxel were overlapping. Extrapolation of these results indicates that radio sensitizing docetaxel concentrations may be present for as long as 1 week, thus supporting the use of 20 mg/m2 weekly docetaxel.
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Affiliation(s)
- Paal F R Brunsvig
- Department of Medical Oncology, Cancer Clinic, Rikshospitalet-Radiumhospitalet Medical Centre, Montebello, 0310 Oslo, Norway.
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