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Araújo A, Barroso A, Parente B, Travancinha C, Teixeira E, Martelo F, Fernandes G, Paupério G, Queiroga H, Duarte I, da Costa JD, Soares M, Borralho P, Costa P, Chinita P, Almodôvar T, Barata F. Unresectable stage III non-small cell lung cancer: Insights from a Portuguese expert panel. Pulmonology 2024; 30:159-169. [PMID: 36717296 DOI: 10.1016/j.pulmoe.2022.11.008] [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: 11/08/2021] [Revised: 10/29/2022] [Accepted: 11/29/2022] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION The management of unresectable stage III non-small cell lung cancer (NSCLC) is clinically challenging and there is no current consensus on optimal strategies. Herein, a panel of Portuguese experts aims to present practical recommendations for the global management of unresectable stage III NSCLC patients. METHODS A group of Portuguese lung cancer experts debated aspects related to the diagnosis, staging and treatment of unresectable stage III NSCLC in light of current evidence. Recent breakthroughs in immunotherapy as part of a standard therapeutic approach were also discussed. This review exposes the major conclusions obtained. RESULTS Practical recommendations for the management of unresectable stage III NSCLC were proposed, aiming to improve the pathways of diagnosis and treatment in the Portuguese healthcare system. Clinical heterogeneity of patients with stage III NSCLC hinders the development of single standardised algorithm where all fit. CONCLUSIONS A timely diagnosis and a proper staging contribute to the best management of each patient, optimizing treatment tolerance and effectiveness. The expert panel considered chemoradiotherapy as the preferable approach when surgery is not possible. Management of adverse events and immunotherapy as a consolidation therapy are also essential steps for a successful strategy.
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Affiliation(s)
- A Araújo
- Medical Oncology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - A Barroso
- Pulmonology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal
| | - B Parente
- Hospital CUF Porto, Estrada da Circunvalação 14341, 4100-180 Porto, Portugal
| | - C Travancinha
- Instituto Português de Oncologia Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - E Teixeira
- Centro Hospitalar Lisboa Norte - Hospital Pulido Valente, Alameda das Linhas de Torres, 117 1769-001 Lisboa, Portugal; Hospital CUF Descobertas, Rua Mário Botas, 1998-018 Lisboa, Portugal; Hospital CUF Tejo, Avenida 24 de Julho 171A, 1350-352 Lisboa, Portugal
| | - F Martelo
- Hospital da Luz Lisboa, Avenida Lusíada 100, 1500-650 Lisboa, Portugal
| | - G Fernandes
- Centro Hospitalar Universitário de São João, Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - G Paupério
- Instituto Português de Oncologia Porto Francisco Gentil, Rua Dr. António Bernardino de Almeida 62, 4200-072 Porto, Portugal
| | - H Queiroga
- Centro Hospitalar Universitário de São João, Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - I Duarte
- Instituto Português de Oncologia Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - J D da Costa
- Instituto Português de Oncologia Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - M Soares
- Instituto Português de Oncologia Porto Francisco Gentil, Rua Dr. António Bernardino de Almeida 62, 4200-072 Porto, Portugal
| | - P Borralho
- Hospital CUF Descobertas, Rua Mário Botas, 1998-018 Lisboa, Portugal
| | - P Costa
- Instituto CUF Porto, Rua Fonte das Sete Bicas 170, 4460-188 Senhora da Hora, Porto, Portugal
| | - P Chinita
- Hospital do Espírito Santo de Évora, Largo do Sr. da Pobreza, 7000-811 Évora, Portugal
| | - T Almodôvar
- Instituto Português de Oncologia Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - F Barata
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal.
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Ko JJ, Banerji S, Blais N, Brade A, Clelland C, Schellenberg D, Snow S, Wheatley-Price P, Yuan R, Melosky B. Follow-Up Imaging Guidelines for Patients with Stage III Unresectable NSCLC: Recommendations Based on the PACIFIC Trial. Curr Oncol 2023; 30:3817-3828. [PMID: 37185402 PMCID: PMC10137068 DOI: 10.3390/curroncol30040289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/13/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023] Open
Abstract
The PACIFIC trial showed a survival benefit with durvalumab through five years in stage III unresectable non-small cell lung cancer (NSCLC). However, optimal use of imaging to detect disease progression remains unclearly defined for this population. An expert working group convened to consider available evidence and clinical experience and develop recommendations for follow-up imaging after concurrent chemotherapy and radiation therapy (CRT). Voting on agreement was conducted anonymously via online survey. Follow-up imaging was recommended for all suitable patients after CRT completion regardless of whether durvalumab is received. Imaging should occur every 3 months in Year 1, at least every 6 months in Year 2, and at least every 12 months in Years 3–5. Contrast computed tomography was preferred; routine brain imaging was not recommended for asymptomatic patients. The medical oncologist should follow-up during Year 1 of durvalumab therapy, with radiation oncologist involvement if pneumonitis is suspected; medical and radiation oncologists can subsequently alternate follow-up. Some patients can transition to the family physician/community primary care team at the end of Year 2. In Years 1–5, patients should receive information regarding smoking cessation, comorbidity management, vaccinations, and general follow-up care. These recommendations provide guidance on follow-up imaging for patients with stage III unresectable NSCLC whether or not they receive durvalumab consolidation therapy.
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Zarrabi KK, Galloway TJ, Flieder DB, Kumar SS, Judd J, Bauman JR. Assessing plasma circulating tumor human papillomavirus (HPV) DNA in determining treatment response in HPV-associated oropharyngeal cancer. Head Neck 2022; 44:E25-E30. [PMID: 35546490 DOI: 10.1002/hed.27081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/24/2022] [Accepted: 04/27/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-mediated oropharyngeal squamous cell carcinoma is a subset of head and neck cancer with a unique mechanism of carcinogenesis. Local disease is treated definitively with a multimodal approach. Navigating recurrences can be challenging, as they are sometimes indiscernible from de novo primary malignancies. Identification of dynamic biomarkers that are specific to HPV-mediated disease may assist in disease monitoring. We present a 78-year-old man who developed a squamous cell carcinoma in the lung 7 years after completing definitive chemoradiation for his p16+ head and neck squamous cell carcinoma. METHODS A novel assay for plasma circulating tumor HPV DNA was employed and provided a tool for longitudinal disease monitoring during therapy. CONCLUSION We bring attention to a novel assay and highlight its potential for use in the treatment paradigm of HPV-mediated oropharyngeal carcinoma.
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Affiliation(s)
- Kevin K Zarrabi
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Douglas B Flieder
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Sameera S Kumar
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Julia Judd
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jessica R Bauman
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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Jagoda P, Fleckenstein J, Sonnhoff M, Schneider G, Ruebe C, Buecker A, Stroeder J. Diffusion-weighted MRI improves response assessment after definitive radiotherapy in patients with NSCLC. Cancer Imaging 2021; 21:15. [PMID: 33478592 PMCID: PMC7818746 DOI: 10.1186/s40644-021-00384-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 01/08/2021] [Indexed: 01/15/2023] Open
Abstract
Background Computed tomography (CT) is the standard procedure for follow-up of non-small-cell lung cancer (NSCLC) after radiochemotherapy. CT has difficulties differentiating between tumor, atelectasis and radiation induced lung toxicity (RILT). Diffusion-weighted imaging (DWI) may enable a more accurate detection of vital tumor tissue. The aim of this study was to determine the diagnostic value of MRI versus CT in the follow-up of NSCLC. Methods Twelve patients with NSCLC stages I-III scheduled for radiochemotherapy were enrolled in this prospective study. CT with i.v. contrast agent and non enhanced MRI were performed before and 3, 6 and 12 months after treatment. Standardized ROIs were used to determine the apparent diffusion weighted coefficient (ADC) within the tumor. Tumor size was assessed by the longest longitudinal diameter (LD) and tumor volume on DWI and CT. RILT was assessed on a 4-point-score in breath-triggered T2-TSE and CT. Results There was no significant difference regarding LD and tumor volume between MRI and CT (p ≥ 0.6221, respectively p ≥ 0.25). Evaluation of RILT showed a very high correlation between MRI and CT at 3 (r = 0.8750) and 12 months (r = 0.903). Assessment of the ADC values suggested that patients with a good tumor response have higher ADC values than non-responders. Conclusions DWI is equivalent to CT for tumor volume determination in patients with NSCLC during follow up. The extent of RILT can be reliably determined by MRI. DWI could become a beneficial method to assess tumor response more accurately. ADC values may be useful as a prognostic marker.
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Affiliation(s)
- Philippe Jagoda
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 1, 66421, Homburg, Saar, Germany.
| | - Jochen Fleckenstein
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Kirrberger Str. Geb. 6.5, 66421, Homburg, Saar, Germany
| | - Mathias Sonnhoff
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Kirrberger Str. Geb. 6.5, 66421, Homburg, Saar, Germany
| | - Günther Schneider
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 1, 66421, Homburg, Saar, Germany
| | - Christian Ruebe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Kirrberger Str. Geb. 6.5, 66421, Homburg, Saar, Germany
| | - Arno Buecker
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 1, 66421, Homburg, Saar, Germany
| | - Jonas Stroeder
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 1, 66421, Homburg, Saar, Germany
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Gambazzi F, Frey LD, Bruehlmeier M, Janthur WD, Heuberger J, Spirig A, Williams R, Zweifel R, Boerner B, Tini GM, Irani S. Image analysis in posttreatment non-small cell lung cancer surveillance: specialists' interpretations reviewed by the thoracic multidisciplinary tumor board. Multidiscip Respir Med 2019; 14:34. [PMID: 31827794 PMCID: PMC6891985 DOI: 10.1186/s40248-019-0198-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Data show that the initial specialist’s image interpretation and final multidisciplinary tumor board (MTB) assessment can vary substantially in the pretherapeutic cancer setting. The aim of this post hoc analysis was to investigate the concordance of the specialist’s and MTB’s image interpretations in patients undergoing systematic posttreatment lung cancer image surveillance. Methods In the initial prospective study, lung cancer patients who had received curative-intent treatment were randomly assigned to undergo either contrast-enhanced computed tomography (CE-CT) or integrated 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT). Imaging was performed every 6 months for 2 years, and all imaging studies were finally assessed by our MTB. This post hoc analysis assessed differences between the initial specialist’s image interpretation and the final MTB’s image interpretation. Results In 89 patients, 266 imaging studies (129 PET-CT, 137 CE-CT) were analyzed. In 87.2% (88.4, 86.1%) of the studies, complete concordance was found. Out of the 12.8% (11.6, 13.9%) with discordant results, 7.5% (6.9, 8.0%) had implications for alterations in patient management (major disagreements). Twenty major disagreements were detected in 17 study patients. Retrospectively, in eight out of these 17 (47%) patients, in contrast to the MTB’s view, the specialist’s interpretation was more appropriate, whereas in nine out of 17 patients (53%), the MTB’s interpretation was more accurate. Conclusions In an experienced MTB, the agreement between imaging specialists and the rest of the MTB with regard to the interpretation of images is high in a setting of posttreatment lung cancer image surveillance. It seems that in cases of disagreements, the rates of more accurate interpretation are well balanced between imaging specialists and the MTB. Trial registration ISRCTN16281786, Date 23. February 2017.
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Affiliation(s)
- Franco Gambazzi
- 1Clinic of Thoracic Surgery, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Lukas D Frey
- 2Institute of Nuclear Medicine and PET-Center, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Matthias Bruehlmeier
- 2Institute of Nuclear Medicine and PET-Center, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Wolf-Dieter Janthur
- 3Clinic of Oncology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Juerg Heuberger
- 4Clinic of Radio-Oncology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Andres Spirig
- 5Department of Radiology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Richard Williams
- 5Department of Radiology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Roland Zweifel
- 6Institute of Pathology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Bettina Boerner
- 7Clinic of Pulmonary and Sleep Medicine, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Gabrielo M Tini
- 7Clinic of Pulmonary and Sleep Medicine, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Sarosh Irani
- 7Clinic of Pulmonary and Sleep Medicine, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
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Zhou Y, Yu Q, Chu Y, Zhu X, Deng J, Liu Q, Wang Q. Downregulation of fibroblast growth factor 5 inhibits cell growth and invasion of human nonsmall-cell lung cancer cells. J Cell Biochem 2019; 120:8238-8246. [PMID: 30520094 DOI: 10.1002/jcb.28107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/29/2018] [Indexed: 01/24/2023]
Abstract
The morbidity and mortality rates of nonsmall-cell lung cancer (NSCLC) have increased in recent years. We aimed to explore the biological role of fibroblast growth factor 5 (FGF5) in NSCLC. We first established that the expression of FGF5 was increased in NSCLC tissues compared with the normal adjacent tissues. The expression of FGF5 was also increased in NSCLC cell lines. The effect of FGF5 silencing on cell proliferation, cell cycle, apoptosis, migration, and invasion of H661 and CALU1 cells was then examined. Downregulation of FGF5 significantly inhibited cell proliferation and induced G1 phase cell cycle arrest compared with the negative control small interfering (siNC) groups. Cell apoptosis was promoted by siFGF5 treatment. Cell migration and invasion of H661 and CALU1 cells with siFGF5 transfection were markedly diminished compared with the siNC groups. In addition, migration and invasion-associated proteins (E-cadherin, matrix metalloproteinase-2 [MMP-2], and MMP-9) and epithelial mesenchymal transition markers (N-cadherin, vimentin, snail, and slug) were also regulated by FGF5 siRNA treatment. Gene set enrichment analysis on The Cancer Genome Atlas dataset showed that the Kyoto Encyclopedia of Genes and Genomes (KEGG) cell cycle and vascular endothelial growth factor (VEGF) pathways were correlated with FGF5 expression, which was further confirmed in NSCLC cells by Western blot analysis. Our results indicated that FGF5 silencing suppressed cell growth and invasion via regulation of the cell cycle and VEGF pathways. Therefore, FGF5 may serve as a promising therapeutic strategy for NSCLC.
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Affiliation(s)
- Yanjuan Zhou
- Department of Pneumology, Wujin People's Hospital of Changzhou, Changzhou, China
| | - Qiuhua Yu
- Department of Cardio-Thoracic, Wujin People's Hospital of Changzhou, Changzhou, China
| | - Ying Chu
- Central laboratory, Wujin People's Hospital of Changzhou, Changzhou, China
| | - Xiaobo Zhu
- Department of Cardio-Thoracic, Wujin People's Hospital of Changzhou, Changzhou, China
| | - Jianzhong Deng
- Department of Oncology, Wujin People's Hospital of Changzhou, Changzhou, China
| | - Qian Liu
- Department of Oncology, Wujin People's Hospital of Changzhou, Changzhou, China
| | - Qiang Wang
- Department of Cardio-Thoracic, Wujin People's Hospital of Changzhou, Changzhou, China
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