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Yen A, Westover KD. Case Report: Resolution of radiation pneumonitis with androgens and growth hormone. Front Oncol 2022; 12:948463. [PMID: 36091134 PMCID: PMC9449808 DOI: 10.3389/fonc.2022.948463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
Radiation pneumonitis (RP) occurs in some patients treated with thoracic radiation therapy. RP often self-resolves, but when severe it is most commonly treated with corticosteroids because of their anti-inflammatory properties. Androgens and human growth hormone (HGH) also have anti-inflammatory and healing properties in the lung, but have not been studied as a remedy for RP. Here we present a case of corticosteroid-refractory RP that resolved with androgen and HGH-based therapy.
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Feng A, Gu H, Chen H, Shao Y, Wang H, Duan Y, Huang Y, Zhou T, Xu Z. Account for the Full Extent of Esophagus Motion in Radiation Therapy Planning: A Preliminary Study of the IRV of the Esophagus. Front Oncol 2021; 11:734552. [PMID: 34900685 PMCID: PMC8656362 DOI: 10.3389/fonc.2021.734552] [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: 07/01/2021] [Accepted: 10/28/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Accounting for esophagus motion in radiotherapy planning is an important basis for accurate assessment of toxicity. In this study, we calculated how much the delineations of the esophagus should be expanded based on three-dimensional (3D) computed tomography (CT), four-dimensional (4D) average projection (AVG), and maximum intensity projection (MIP) scans to account for the full extent of esophagus motion during 4D imaging acquisition. Methods and Materials The 3D and 4D CT scans of 20 lung cancer patients treated with conventional radiotherapy and 20 patients treated with stereotactic ablative radiation therapy (SBRT) were used. Radiation oncologists contoured the esophagus on the 3DCT, AVG, MIP and 25% exhale scans, and the combination of the esophagus in every phase of 4DCT. The union of all 4D phase delineations (U4D) represented the full extent of esophagus motion during imaging acquisition. Surface distances from U4D to 3D, AVG, and MIP volumes were calculated. Distances in the most extreme surface points (1.5 cm most superoinferior, 10% most right/left/anteroposterior) were used to derive margins accounting only for systematic (delineation) errors. Results Esophagus delineations on the MIP were the closest to the full extent of motion, requiring only 6.9 mm margins. Delineations on the AVG and 3D scans required margins up to 7.97 and 7.90 mm, respectively. The largest margins were for the inferior, right, and anterior aspects for the delineations on the 3D, AVG, and MIP scans, respectively. Conclusion Delineations on 3D, AVG, or MIP scans required extensions for representing the esophagus’s full extent of motion, with the MIP requiring the smallest margins. Research including daily imaging to determine the random components for the margins and dosimetric measurements to determine the relevance of creating a planning organ at risk volume (PRV) of the esophagus is required.
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Affiliation(s)
- Aihui Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hengle Gu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hua Chen
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Shao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yanhua Duan
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Huang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Tao Zhou
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zhiyong Xu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Abstract
Treatment of stage III non-small cell lung cancer (NSCLC) traditionally has involved combinations of chemotherapy, radiation, and surgical resection. Although the multimodality approach remains standard, only a fraction of patients with stage III lung cancer can undergo complete resection, and long-term prognosis remains poor. The PACIFIC trial generated significant enthusiasm when it demonstrated that the programmed death ligand-1 inhibitor, durvalumab, improved survival in patients with unresectable stage III NSCLC after completion of definitive concurrent chemoradiation. This article reviews the indications for traditional therapies in stage III NSCLC and highlights ongoing advances that have led to the incorporation of novel therapeutic agents.
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Affiliation(s)
- Nathaniel J Myall
- Department of Medicine, Division of Medical Oncology, Stanford Cancer Institute, Stanford, CA 94305, USA
| | - Millie Das
- Department of Medicine, Division of Medical Oncology, Stanford Cancer Institute, Stanford, CA 94305, USA; Department of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue (111ONC), Palo Alto, CA 94304, USA.
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Sher A, Medavaram S, Nemesure B, Clouston S, Keresztes R. Risk Stratification of Locally Advanced Non-Small Cell Lung Cancer (NSCLC) Patients Treated with Chemo-Radiotherapy: An Institutional Analysis. Cancer Manag Res 2020; 12:7165-7171. [PMID: 32848470 PMCID: PMC7429102 DOI: 10.2147/cmar.s250868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 07/02/2020] [Indexed: 12/23/2022] Open
Abstract
Background The purpose of this study was to determine which factors predicted survival and to derive a risk prediction model for patients with locally advanced non-small cell lung cancer (NSCLC) receiving concurrent chemo-radiotherapy (cCRT). Methods This investigation included 149 patients with locally advanced NSCLC who were treated with cCRT at Stony Brook University Hospital between 2007 and 2015. A finite set of demographic, clinical, and treatment variables were evaluated as independent prognostic factors. Kaplan–Meier survival curves were generated, and log rank tests were used to evaluate difference in survival between groups. To derive a risk score for mortality, a machine learning approach was utilized. To maximize statistical power while examining replicability, the sample was split into discovery (n=99) and replication (n=50) subsamples. Elastic-net regression was used to identify a linear prediction model. Youden’s index was used to identify appropriate cutoffs. Cox proportional hazards regression was used to examine mortality risk; model concordance and hazards ratios were reported. Results One-quarter of the patients survived for three years after initiation of cCRT. Prognostic factors for survival in the discovery group included age, sex, smoking status, albumin, histology, largest tumor size, number of nodal stations, stage, induction therapy, and radiation dose. The derived model had good risk predictive accuracy (C=0.70). Median survival time was shorter in the high-risk group (0.93 years) vs the low-risk group (2.40 years). Similar findings were noted in the replication sample with strong model accuracy (C=0.69) and median survival time of 0.93 years and 2.03 years for the high- and low-risk groups, respectively. Conclusion This novel risk prediction model for overall survival in patients with stage III NSCLC highlights the importance of integrating patient, clinical, and treatment variables for accurately predicting outcomes. Clinicians can use this tool to make personalized treatment decisions for patients with locally advanced NSCLC treated with concurrent chemo-radiation.
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Affiliation(s)
- Amna Sher
- Department of Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Sowmini Medavaram
- Department of Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Barbara Nemesure
- Department of Family, Population and Preventive Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Sean Clouston
- Department of Family, Population and Preventive Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Roger Keresztes
- Department of Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
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Chang SC, Lai YC, Hung JC, Chang CY. Oral glutamine supplements reduce concurrent chemoradiotherapy-induced esophagitis in patients with advanced non-small cell lung cancer. Medicine (Baltimore) 2019; 98:e14463. [PMID: 30813149 PMCID: PMC6408144 DOI: 10.1097/md.0000000000014463] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Complications related to concurrent chemoradiotherapy (CCRT) such as acute radiation-induced esophagitis (ARIE) may cause significant morbidity and unplanned treatment delays in patients with advanced non-small cell lung cancer (NSCLC). We designed a prospective randomized study to assess the impact of glutamine (GLN) supplementation in preventing CCRT-induced toxicities of advanced NSCLC patients. METHODS From September 2014 to September 2015, 60 patients diagnosed with NSCLC were included to the study. Thirty patients (50%) received prophylactic powdered GLN orally at a dose of 10 g/8 h. The prescribed radiation dose to the planning target volume was 30 Gy in 2-Gy fractions. The endpoints were radiation-induced esophagitis, mucositis, body weight loss, overall survival and progression-free survival. RESULTS The 60 patients with NSCLC included 42 men and 18 women with a mean age ± standard deviation of 60.3 years ± 18.2 (range, 44-78 years).At a median follow-up of 26.4 months (range 10.4-32.2), all patients tolerated GLN well. A administration of GLN was associated with a decrease in the incidence of grade 2 or 3 ARIE (6.7% vs 53.4% for Gln+ vs Gln-; P = .004). GLN supplementation appeared to significantly delay ARIE onset for 5.8 days (18.2 days vs 12.4 days; P = .027) and reduced incidence of weight loss (20% vs 73.3%; P = .01). DISCUSSION Our study suggests a beneficial effect of oral glutamine supplementation for the prevention from radiation-induced injury and body weight loss in advanced NSCLC patients who receiving CCRT.
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Affiliation(s)
- Shih-Chieh Chang
- Division of Chest Medicine, Department of Internal Medicine
- Department of Critical Care Medicine, National Yang-Ming University Hospital, Yi-Lan
| | - Yi-Chun Lai
- Division of Chest Medicine, Department of Internal Medicine
| | | | - Cheng-Yu Chang
- Division of Chest Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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6
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Parisi G, Mazzola R, Ciammella P, Timon G, Fozza A, Franceschini D, Navarria F, Bruni A, Perna M, Giaj-Levra N, Alongi F, Scotti V, Trovo M. Hypofractionated radiation therapy in the management of locally advanced NSCLC: a narrative review of the literature on behalf of the Italian Association of Radiation Oncology (AIRO)-Lung Working Group. Radiol Med 2018; 124:136-144. [PMID: 30368721 DOI: 10.1007/s11547-018-0950-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/15/2018] [Indexed: 12/19/2022]
Abstract
A systematic literature was performed to assess the benefit in terms of effectiveness and feasibility of hypofractionated radiotherapy (HypoRT), with or without chemotherapy (CT), in the treatment of locally advanced non-small cell lung cancer (NSCLC). We have identified all studies, published from 2007 onwards, on patients with locally advanced NSCLC treated with HypoRT with radical intent, with a minimal dose per fraction of 2.4 Gy, with or without concurrent chemotherapy. Twenty-nine studies were identified, for a total of 2614 patients. Patients were divided in the concurrent chemo-radiation therapy group (CT-RT) and radiotherapy alone (RT). In RT group, the delivered dose ranged from 45 to 85.5 Gy, with a dose/fraction from 2.4 to 4 Gy. Actuarial 2-year PFS ranged from 13 to 57.8%, and 1, 2- and 3-year overall survival (OS) ranged from 51.3 to 95%, from 22 to 68.7%, and from 7 to 32%, respectively. Acute Grade ≥ 3 esophagitis occurred in 0-15%, while late esophageal toxicity was 0-16%. Acute pneumonitis occured in 0-44%, whereas late pneumonitis occured in 0-47%, most commonly grade ≤ G3. In CT-RT group, the delivered dose ranged from 52.5 to 75 Gy, with a dose/fraction ranging from 2.4 to 3.5 Gy. Actuarial 2-year PFS ranged from 19 to 57.8%, and OS at 1, 2 and 3 years ranged from 28 to 95%, 38.6 to 68.7%, and 31 to 44%, respectively. Acute Grade 2 and 3 esophagitis occurred in 3-41.7%, while late esophageal toxicity occurred in 0-8.3%. Acute pneumonitis ranged from 0 to 23%, whereas late pneumonitis occured 0-47%. HypoRT seems to be safe in patients with locally advanced NSCLC. The encouraging survival results of several studies analyzed suggest that hypofractionated radiation schemes should be further investigated in the future.
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Affiliation(s)
- Giuseppe Parisi
- Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata UD, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy.
| | - Rosario Mazzola
- Department of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy
| | - Patrizia Ciammella
- Department of Oncology and Advanced Technology, Arcispedale S Maria Nuova-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Giorgia Timon
- Department of Oncology and Advanced Technology, Arcispedale S Maria Nuova-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Fozza
- Department of Radiation Oncology, SS.Antonio e Biagio e C.Arrigo Hospital Alessandria, Alessandria, Italy
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | | | - Alessio Bruni
- Radiotherapy Unit - Department of Oncology and Hematology, University Hospital of Modena Italy, Modena, Italy
| | - Marco Perna
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Niccolò Giaj-Levra
- Department of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy
| | - Filippo Alongi
- Department of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy
| | - Vieri Scotti
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Marco Trovo
- Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata UD, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy
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7
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Stinchcombe TE, Fan W, Schild SE, Vokes EE, Bogart J, Le QT, Thomas CR, Edelman MJ, Horn L, Komaki R, Cohen HJ, Kishor Ganti A, Pang H, Wang X. A pooled analysis of individual patient data from National Clinical Trials Network clinical trials of concurrent chemoradiotherapy for limited-stage small cell lung cancer in elderly patients versus younger patients. Cancer 2018; 125:382-390. [PMID: 30343497 DOI: 10.1002/cncr.31813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/16/2018] [Accepted: 09/20/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Platinum and etoposide with thoracic radiation followed by prophylactic cranial irradiation constitute the standard treatment for limited-stage small cell lung cancer (LS-SCLC). Many patients with LS-SCLC are elderly with comorbidities. METHODS Individual patient data were collected from 11 phase 2 or 3 trials for LS-SCLC conducted by the National Clinical Trials Network and activated from 1990 to 2010. The primary endpoint was overall survival (OS); the secondary endpoints were progression-free survival (PFS), the rate of severe adverse events, and off-treatment reasons. The outcomes were compared for patients 70 years old or older (elderly patients) and patients younger than 70 years (younger patients). RESULTS Individual patient data from 1049 younger patients (81%) and 254 elderly patients (19%) were analyzed. In the multivariate model, elderly patients, in comparison with younger patients, had worse OS (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.18-1.63; median OS for elderly patients, 17.8 months; OS for younger patients, 23.5 months) and worse PFS (HR, 1.19; 95% CI, 1.03-1.39; median PFS for elderly patients, 10.6 months; median PFS for younger patients, 12.3 months). Elderly patients, in comparison with younger patients, experienced more grade 5 adverse events (8% vs 3%; P < .01) and more grade 3 or higher dyspnea (11% vs 7%; P = .03) but less grade 3 or higher esophagitis/dysphagia (14% vs 19%; P = .04) and less grade 3 or higher vomiting (11% vs 17%; P = .01). Elderly patients completed treatment less often, discontinued treatment because of adverse events and patient refusal more frequently, and died during treatment more frequently. CONCLUSIONS Elderly patients with LS-SCLC have worse PFS and OS and more difficulty in tolerating therapy. Future trials should incorporate assessments of elderly patients, novel monitoring of adverse events, and more tolerable radiation and systemic therapies.
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Affiliation(s)
| | - Wen Fan
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | | | | | - Jeff Bogart
- Department of Radiation Oncology, State University of New York Upstate Medical University, Syracuse, New York
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | - Martin J Edelman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Leora Horn
- Division of Hematology and Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Apar Kishor Ganti
- Veteran's Affairs Nebraska-Western Iowa Health Care System, University of Nebraska Medical Center, Omaha, Nebraska
| | - Herbert Pang
- Li Ka Shing, Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Xiaofei Wang
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina.,Alliance Statistics and Data Center, Durham, North Carolina
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8
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Miller ED, Fisher JL, Haglund KE, Grecula JC, Xu-Welliver M, Bertino EM, He K, Shields PG, Carbone DP, Williams TM, Otterson GA, Bazan JG. Identifying patterns of care for elderly patients with non-surgically treated stage III non-small cell lung cancer: an analysis of the national cancer database. Radiat Oncol 2018; 13:196. [PMID: 30290823 PMCID: PMC6173899 DOI: 10.1186/s13014-018-1142-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/26/2018] [Indexed: 12/21/2022] Open
Abstract
Background To compare patterns of care for elderly patients versus non-elderly patients with non-surgically treated stage III non-small cell lung cancer (NSCLC) using the National Cancer Database (NCDB). We hypothesize that elderly patients are less likely to receive curative treatments, including concurrent chemoradiation (CCRT), compared to non-elderly patients. Methods We identified patients from the NCDB between 2003 and 2014 with non-surgically treated stage III NSCLC. We defined elderly as ≥70 years old and non-elderly <70 years old. Treatment categories included: no treatment, palliative treatment (chemotherapy alone, radiation (RT) alone <59.4 Gy or chemoradiation (CRT) <59.4 Gy), or definitive treatment (RT alone ≥59.4 Gy or CRT ≥59.4 Gy). Differences in treatment between elderly and non-elderly were tested using the χ2 test. Results We identified 57,602 elderly and 55,928 non-elderly patients. More elderly patients received no treatment (24.5% vs. 13.2%, P < 0.0001) and the elderly were less likely to receive definitive treatment (48.5% vs. 56.3%, P < 0.0001). CCRT was delivered in a significantly smaller proportion of elderly vs. non-elderly patients (66.0% vs. 78.9%, P < 0.0001 in patients treated with definitive intent; 32.0% vs. 44.5%, P < 0.0001 in patients receiving any treatment; and 24.2% vs. 38.6%, P < 0.0001 amongst all patients). Conclusions In this large study of patients with non-surgically treated stage III NSCLC, elderly patients were less likely to receive any treatment or treatment with definitive intent compared to the non-elderly. The lack of use of concurrent or sequential chemotherapy in the elderly with stage III NSCLC suggests that the optimal treatment approach for this vulnerable population remains undefined. Electronic supplementary material The online version of this article (10.1186/s13014-018-1142-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eric D Miller
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA
| | - James L Fisher
- College of Public Health, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Karl E Haglund
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA
| | - John C Grecula
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA
| | - Meng Xu-Welliver
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA
| | - Erin M Bertino
- Department of Internal Medicine, Division of Medical Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Kai He
- Department of Internal Medicine, Division of Medical Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Peter G Shields
- Department of Internal Medicine, Division of Medical Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - David P Carbone
- Department of Internal Medicine, Division of Medical Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Terence M Williams
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA
| | - Gregory A Otterson
- Department of Internal Medicine, Division of Medical Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jose G Bazan
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA.
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Bang A, Bezjak A. Stereotactic body radiotherapy for centrally located stage I non-small cell lung cancer. Transl Lung Cancer Res 2018; 8:58-69. [PMID: 30788235 DOI: 10.21037/tlcr.2018.10.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Stereotactic body radiotherapy (SBRT) has become the standard of care for the treatment of early stage non-small cell lung cancer in high risk or medically inoperable patients. It is very well tolerated when given to peripherally located tumors and is associated with high rates of local control. Centrally located tumors represent a bigger challenge as they are closer to a number of critical structures, namely the major bronchi, esophagus, large vessels and brachial plexus, that can be damaged by the high ablative doses of SBRT needed for optimal tumor control. Thus, the fractionation schedule for centrally located tumors needs to balance the need for tumor control while minimizing the risk of significant radiotherapy toxicity. In this article, we review the current evidence, summarize the prospective and retrospective studies of SBRT for centrally located tumors, and highlight several practical considerations.
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Affiliation(s)
- Andrew Bang
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Andrea Bezjak
- Department of Radiation Oncology, University of Toronto, Toronto, Canada.,Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Canada
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Rafiq S, Raza MH, Younas M, Naeem F, Adeeb R, Iqbal J, Anwar P, Sajid U, Manzoor HM. Molecular Targets of Curcumin and Future Therapeutic Role in Leukemia. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/jbm.2018.64003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Chen C, Hu L, Li X, Hou J. Preoperative Anemia as a Simple Prognostic Factor in Patients with Urinary Bladder Cancer. Med Sci Monit 2017; 23:3528-3535. [PMID: 28723884 PMCID: PMC5531533 DOI: 10.12659/msm.902855] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND To evaluate the incidence of preoperative anemia and its prognostic role in patients with urinary bladder cancer (BC). MATERIAL AND METHODS A total of 317 patients diagnosed with BC were enrolled in this retrospective cohort study. Univariate and multivariate analysis was used to identify independent prognostic factors and Kaplan-Meier survival analysis was applied to examine the influence of anemia on survival. RESULTS 109 patients (34.4%) were anemic with a median preoperative hemoglobin of 114 g/L (interquartile range 104 to 122.5). After a median of 6 years follow-up (range: 2 to 8 years), the median recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS) in anemic patients were significantly lower than non-anemic patients (p≤0.001). Multivariate Cox analysis indicated that anemia remained an independent predictor of RFS and OS (p=0.010, 0.007). CONCLUSIONS Anemic patients with BC are likely to have a shorter RFS and OS than non-anemic patients, and anemia is an independent predictor of RFS and OS.
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Affiliation(s)
- Cheng Chen
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Linkun Hu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Xiangxiang Li
- Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Jianquan Hou
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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12
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Stinchcombe TE, Zhang Y, Vokes EE, Schiller JH, Bradley JD, Kelly K, Curran WJ, Schild SE, Movsas B, Clamon G, Govindan R, Blumenschein GR, Socinski MA, Ready NE, Akerley WL, Cohen HJ, Pang HH, Wang X. Pooled Analysis of Individual Patient Data on Concurrent Chemoradiotherapy for Stage III Non-Small-Cell Lung Cancer in Elderly Patients Compared With Younger Patients Who Participated in US National Cancer Institute Cooperative Group Studies. J Clin Oncol 2017; 35:2885-2892. [PMID: 28493811 DOI: 10.1200/jco.2016.71.4758] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose Concurrent chemoradiotherapy is standard treatment for patients with stage III non-small-cell lung cancer. Elderly patients may experience increased rates of adverse events (AEs) or less benefit from concurrent chemoradiotherapy. Patients and Methods Individual patient data were collected from 16 phase II or III trials conducted by US National Cancer Institute-supported cooperative groups of concurrent chemoradiotherapy alone or with consolidation or induction chemotherapy for stage III non-small-cell lung cancer from 1990 to 2012. Overall survival (OS), progression-free survival, and AEs were compared between patients age ≥ 70 (elderly) and those younger than 70 years (younger). Unadjusted and adjusted hazard ratios (HRs) for survival time and CIs were estimated by single-predictor and multivariable frailty Cox models. Unadjusted and adjusted odds ratio (ORs) for AEs and CIs were obtained from single-predictor and multivariable generalized linear mixed-effect models. Results A total of 2,768 patients were classified as younger and 832 as elderly. In unadjusted and multivariable models, elderly patients had worse OS (HR, 1.20; 95% CI, 1.09 to 1.31 and HR, 1.17; 95% CI, 1.07 to 1.29, respectively). In unadjusted and multivariable models, elderly and younger patients had similar progression-free survival (HR, 1.01; 95% CI, 0.93 to 1.10 and HR, 1.00; 95% CI, 0.91 to 1.09, respectively). Elderly patients had a higher rate of grade ≥ 3 AEs in unadjusted and multivariable models (OR, 1.35; 95% CI, 1.07 to 1.70 and OR, 1.38; 95% CI, 1.10 to 1.74, respectively). Grade 5 AEs were significantly higher in elderly compared with younger patients (9% v 4%; P < .01). Fewer elderly compared with younger patients completed treatment (47% v 57%; P < .01), and more discontinued treatment because of AEs (20% v 13%; P < .01), died during treatment (7.8% v 2.9%; P < .01), and refused further treatment (5.8% v 3.9%; P = .02). Conclusion Elderly patients in concurrent chemoradiotherapy trials experienced worse OS, more toxicity, and had a higher rate of death during treatment than younger patients.
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Affiliation(s)
- Thomas E Stinchcombe
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Ying Zhang
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Everett E Vokes
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Joan H Schiller
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Jeffrey D Bradley
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Karen Kelly
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Walter J Curran
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Steven E Schild
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Benjamin Movsas
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Gerald Clamon
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Ramaswamy Govindan
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - George R Blumenschein
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Mark A Socinski
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Neal E Ready
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Wallace L Akerley
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Harvey J Cohen
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Herbert H Pang
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Xiaofei Wang
- Thomas E. Stinchcombe, Neal E. Ready, and Harvey J. Cohen, Duke University Medical Center; Xiaofei Wang, Alliance Statistics and Data Center, Durham, NC; Ying Zhang, Pennsylvania State University College of Medicine, Hershey, PA; Everett E. Vokes, University of Chicago Medical Center, Chicago, IL; Joan H. Schiller, Inova Dwight and Martha Schar Cancer Institute, Falls Church, VA; Jeffrey D. Bradley and Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Karen Kelly, University of California Davis, Sacramento, CA; Walter J. Curran Jr, Winship Cancer Institute of Emory University, Atlanta, GA; Steven E. Schild, Mayo Clinic Arizona, Scottsdale, AZ; Benjamin Movsas, Henry Ford Health System, Detroit, MI; Gerald Clamon, University of Iowa Hospital and Clinics, Iowa City, IA; George R. Blumenschein, University of Texas MD Anderson Cancer Center, Houston, TX; Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL; Wallace L. Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; and Herbert H. Pang, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
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Kim YH, Ahn SJ, Kim YC, Kim KS, Oh IJ, Ban HJ, Chung WK, Nam TK, Yoon MS, Jeong JU, Song JY. Predictive factors for survival and correlation to toxicity in advanced Stage III non-small cell lung cancer patients with concurrent chemoradiation. Jpn J Clin Oncol 2015; 46:144-51. [PMID: 26590014 DOI: 10.1093/jjco/hyv174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 10/27/2015] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Concurrent chemoradiotherapy is the standard treatment for locally advanced Stage III non-small cell lung cancer in patients with a good performance status and minimal weight loss. This study aimed to define subgroups with different survival outcomes and identify correlations with the radiation-related toxicities. METHODS We retrospectively reviewed 381 locally advanced Stage III non-small cell lung cancer patients with a good performance status or weight loss of <10% who received concurrent chemoradiotherapy between 2004 and 2011. Three-dimensional conformal radiotherapy was administered once daily, combined with weekly chemotherapy. The Kaplan-Meier method was used for survival comparison and Cox regression for multivariate analysis. Multivariate analysis was performed using all variables with P values <0.1 from the univariate analysis. RESULTS Median survival of all patients was 24 months. Age > 75 years, the diffusion lung capacity for carbon monoxide ≤80%, gross tumor volume ≥100 cm(3) and subcarinal nodal involvement were the statistically significant predictive factors for poor overall survival both in univariate and multivariate analyses. Patients were classified into four groups according to these four predictive factors. The median survival times were 36, 29, 18 and 14 months in Groups I, II, III and IV, respectively (P < 0.001). Rates of esophageal or lung toxicity ≥Grade 3 were 5.9, 14.1, 12.5 and 22.2%, respectively. The radiotherapy interruption rate differed significantly between the prognostic subgroups; 8.8, 15.4, 22.7 and 30.6%, respectively (P = 0.017). CONCLUSION Severe toxicity and interruption of radiotherapy were more frequent in patients with multiple adverse predictive factors. To maintain the survival benefit in patients with concurrent chemoradiotherapy, strategies to reduce treatment-related toxicities need to be deeply considered.
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Affiliation(s)
- Yong-Hyub Kim
- Department of Radiation Oncology, Chonnam National University Medical School, Gwangju
| | - Sung-Ja Ahn
- Department of Radiation Oncology, Chonnam National University Medical School, Gwangju Lung and Esophageal Cancer Clinic, Jeonnam Regional Cancer Center, Jeollanam-do, Korea
| | - Young-Chul Kim
- Lung and Esophageal Cancer Clinic, Jeonnam Regional Cancer Center, Jeollanam-do, Korea
| | - Kyu-Sik Kim
- Lung and Esophageal Cancer Clinic, Jeonnam Regional Cancer Center, Jeollanam-do, Korea
| | - In-Jae Oh
- Lung and Esophageal Cancer Clinic, Jeonnam Regional Cancer Center, Jeollanam-do, Korea
| | - Hee-Jung Ban
- Lung and Esophageal Cancer Clinic, Jeonnam Regional Cancer Center, Jeollanam-do, Korea
| | - Woong-Ki Chung
- Department of Radiation Oncology, Chonnam National University Medical School, Gwangju
| | - Taek-Keun Nam
- Department of Radiation Oncology, Chonnam National University Medical School, Gwangju Lung and Esophageal Cancer Clinic, Jeonnam Regional Cancer Center, Jeollanam-do, Korea
| | - Mee Sun Yoon
- Department of Radiation Oncology, Chonnam National University Medical School, Gwangju Lung and Esophageal Cancer Clinic, Jeonnam Regional Cancer Center, Jeollanam-do, Korea
| | - Jae-Uk Jeong
- Department of Radiation Oncology, Chonnam National University Medical School, Gwangju Lung and Esophageal Cancer Clinic, Jeonnam Regional Cancer Center, Jeollanam-do, Korea
| | - Ju-Young Song
- Department of Radiation Oncology, Chonnam National University Medical School, Gwangju
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14
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Ahn JS, Ahn YC, Kim JH, Lee CG, Cho EK, Lee KC, Chen M, Kim DW, Kim HK, Min YJ, Kang JH, Choi JH, Kim SW, Zhu G, Wu YL, Kim SR, Lee KH, Song HS, Choi YL, Sun JM, Jung SH, Ahn MJ, Park K. Multinational Randomized Phase III Trial With or Without Consolidation Chemotherapy Using Docetaxel and Cisplatin After Concurrent Chemoradiation in Inoperable Stage III Non-Small-Cell Lung Cancer: KCSG-LU05-04. J Clin Oncol 2015; 33:2660-6. [PMID: 26150444 DOI: 10.1200/jco.2014.60.0130] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To determine the efficacy of consolidation chemotherapy (CC) with docetaxel and cisplatin (DP) after concurrent chemoradiotherapy (CCRT) with the same agents in locally advanced non-small-cell lung cancer (LA-NSCLC). PATIENT AND METHODS Patients were randomly assigned to either CCRT alone (observation arm) or CCRT followed by CC (consolidation arm). CCRT with docetaxel (20 mg/m(2)) and cisplatin (20 mg/m(2)) was administered every week for 6 weeks with a total dose of 66 Gy of thoracic radiotherapy in 33 fractions. In the consolidation arm, patients were further treated with three cycles of DP (35 mg/m(2) each on days 1 and 8, every 3 weeks). The primary end point was 40% improvement in progression-free survival (PFS) compared with observation. RESULTS From October 2005 to April 2011, 437 patients were randomly assigned. Seventeen patients did not start CCRT as a result of consent withdrawal or ineligibility reasons after random assignment, leaving 420 patients for this analysis (n = 211 for observation; n = 209 for consolidation). Patient characteristics were similar in both arms. In the consolidation arm, 143 patients (68%) received CC, of whom 88 (62%) completed three planned cycles. The median PFS was 8.1 months in the observation arm and 9.1 months in the consolidation arm (hazard ratio, 0.91; 95% CI, 0.73 to 1.12; P = .36). Median overall survival times were 20.6 and 21.8 months in the observation and consolidation arms, respectively (HR, 0.91; 95% CI, 0.72 to 1.25; P = .44). CONCLUSION CC with DP after CCRT with weekly DP in LA-NSCLC failed to further prolong PFS. CCRT alone should remain the standard of care.
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Affiliation(s)
- Jin Seok Ahn
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Yong Chan Ahn
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Joo-Hang Kim
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Chang Geol Lee
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Eun Kyung Cho
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Kyu Chan Lee
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Ming Chen
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Dong-Wan Kim
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Hoon-Kyo Kim
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Young Joo Min
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Jin-Hyoung Kang
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Jin-Hyuck Choi
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Sang-We Kim
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Guangying Zhu
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Yi-Long Wu
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Sung Rok Kim
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Kyung Hee Lee
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Hong Suk Song
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Yoon-La Choi
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Jong-Mu Sun
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Sin-Ho Jung
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Myung-Ju Ahn
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - Keunchil Park
- Jin Seok Ahn, Yong Chan Ahn, Yoon-La Choi, Jong-Mu Sun, Myung-Ju Ahn, and Keunchil Park, Samsung Medical Center, Sungkyunkwan University School of Medicine; Joo-Hang Kim and Chang Geol Lee, Yonsei Cancer Center, Yonsei University Health System; Dong-Wan Kim, Seoul National University Hospital; Jin-Hyoung Kang, Catholic University Seoul St Mary's Hospital; Sung Rok Kim, Inje University Sanggye Paik Hospital; Sang-We Kim, Asan Medical Center, University of Ulsan College of Medicine; Sin-Ho Jung, Samsung Medical Center, Office of Biomedical Science, Seoul; Eun Kyung Cho and Kyu Chan Lee, Gachon University Gil Medical Center, Incheon; Hoon-Kyo Kim, Catholic University St Vincent's Hospital; Jin-Hyuck Choi, Ajou University Hospital, Suwon; Young Joo Min, Ulsan University Hospital, Ulsan; Kyung Hee Lee, Yeungnam University Medical Center; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu, Korea; Ming Chen, Sun Yat-Sen University Cancer Center, Guangzhou; Guangying Zhu, Beijing Cancer Hospital, Beijing; Yi-Long Wu, Guandong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong, China.
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Chen Y, Wang YR, Shi Y, Han QL, Chen L, Wu ZY, Wang H, Dai GH. Relationship between chemotherapy induced hematological toxicity and prognosis in advanced colorectal cancer patients undergoing first-line FOLFOX chemotherapy. Shijie Huaren Xiaohua Zazhi 2015; 23:502-509. [DOI: 10.11569/wcjd.v23.i3.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess whether chemotherapy induced hematological toxicity is a marker of increased progression-free survival (PFS) in patients with advanced colorectal cancer receiving first-line FOLFOX chemotherapy.
METHODS: A retrospective analysis was performed of clinical data for 158 advanced colorectal cancer patients treated at Chinese PLA General Hospital. Patient and tumor characteristics and hematological toxicity (neutropenia, anemia, and thrombocytopenia) were recorded. The relationship between hematological toxicity and prognosis was analyzed.
RESULTS: Univariate analysis showed that compared with G0 neutropenia, G1/G2/G3-4 neutropenia reduced the risk of disease progression by 27%, 36%, and 29% (HR = 0.73, 95%CI: 0.286-0.891, (P = 0.018; HR = 0.64, 95%CI: 0.56-0.88, (P = 0.03; HR = 0.71, 95%CI: 0.44-0.85, P < 0.003), respectively. Thrombocytopenia reduced the risk of progression by 26% (HR = 0.74, 95%CI: 0.68-0.753, (P = 0.015). In contrast, anemia during chemotherapy was significantly associated with poorer PFS (HR = 0.823, 95%CI: 0.609-0.921, (P = 0.03).
CONCLUSION: These data suggest that occurrence of neutropenia or thrombocytopenia is associated with a better prognosis. Monitoring of neutropenia during chemotherapy and corresponding drug adjustment may contribute to favorable PFS.
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Kaster TS, Yaremko B, Palma DA, Rodrigues GB. Radical-intent hypofractionated radiotherapy for locally advanced non-small-cell lung cancer: a systematic review of the literature. Clin Lung Cancer 2014; 16:71-9. [PMID: 25450876 DOI: 10.1016/j.cllc.2014.08.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/14/2014] [Accepted: 08/26/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE To identify survival and toxicity characteristics associated with radical-intent hypofractionated radiotherapy for the treatment of stage III non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS Relevant studies were identified from a systematic PubMed search of articles published between January 1990 and January 2014. All studies were peer reviewed and included both retrospective and prospective studies of NSCLC patients being treated with radical hypofractionated radiotherapy. Data on overall survival (OS) and toxicity were extracted from each of the studies where available. RESULTS Of 685 studies initially identified by the search, a total of 33 studies were found to be relevant and were included in this systematic review. The number of fractions ranged from 15 to 35, the dose per fraction ranged from 2.3 to 3.5 Gy, and the delivered dose ranged from 45.0 to 85.5 Gy. Fifteen of the studies included concurrent chemotherapy, while 18 did not. OS was found to be associated with tumor biological effective dose, with the Pearson correlation coefficient ranging from 0.34 to 0.48. For both concurrent and nonconcurrent chemoradiotherapy acute pulmonary, late esophageal and late pulmonary incidences of toxicity ranged from 1.2% to 12.2%, but had 95% confidence intervals that included zero. The greatest incidence of toxicity was acute esophageal toxicity at 14.9% (95% confidence interval, 0.7%, 29.1%). CONCLUSIONS There is a moderate linear relationship between biological effective dose and OS, and greater acute esophageal toxicity with concurrent chemotherapy. Improving outcomes in stage III NSCLC may involve some form of hypofractionation in the context of systemic concurrent therapy.
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Affiliation(s)
- Tyler S Kaster
- Department of Radiation Oncology, Western University, London, Ontario; Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Brian Yaremko
- Department of Radiation Oncology, Western University, London, Ontario
| | - David A Palma
- Department of Radiation Oncology, Western University, London, Ontario
| | - George B Rodrigues
- Department of Radiation Oncology, Western University, London, Ontario; Department of Epidemiology and Biostatistics, Western University, London, Ontario.
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Ezer N, Smith CB, Galsky MD, Mhango G, Gu F, Gomez J, Strauss GM, Wisnivesky J. Cisplatin vs. carboplatin-based chemoradiotherapy in patients >65 years of age with stage III non-small cell lung cancer. Radiother Oncol 2014; 112:272-8. [PMID: 25150635 DOI: 10.1016/j.radonc.2014.07.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/23/2014] [Accepted: 07/26/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Combined chemoradiotherapy (CRT) is considered the standard care for unresectable stage III non-small cell lung cancer (NSCLC). There have been limited data comparing outcomes of carboplatin vs. cisplatin-based CRT, particularly in elderly. MATERIAL AND METHODS From the Surveillance, Epidemiology and End Results-Medicare registry, we identified 1878 patients >65 years of age with unresected stage III NSCLC that received concurrent CRT between 2002 and 2009. We fitted a propensity score model predicting use of cisplatin-based therapy and compared adjusted overall and lung-cancer specific survival of carboplatin- vs. cisplatin-treated patients. Rates of severe toxicity requiring hospital admission were compared in propensity score adjusted analyses. RESULTS Overall 1552 (83%) received carboplatin (77% in combination with paclitaxel) and 17% cisplatin (67% in combination with etoposide). Adjusted cox models showed similar overall (hazard ratio [HR]: 0.98; 95% confidence interval [CI]: 0.86-1.12) and lung cancer-specific (HR: 0.99; 95% CI: 0.84-1.17) survival among patients treated with carboplatin vs. cisplatin. Adjusted rates of neutropenia (odds ratio [OR]: 0.35; 95% CI: 0.21-0.61), anemia (OR: 0.67; 95% CI: 0.51-0.89), and thrombocytopenia (OR: 0.51; 95% CI: 0.31-0.85) were lower among carboplatin-treated patients; other toxicities were not different between groups. CONCLUSION Carboplatin-based CRT is associated with similar long-term survival but lower rates of toxicity. These findings suggest carboplatin may be the most appropriate chemotherapeutic agent for elderly stage III patients.
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Affiliation(s)
- Nicole Ezer
- Department of Medicine, Respiratory Division and Respiratory Epidemiology and Clinical Research Unit, McGill University, Montreal, Canada; Divisions of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, United States.
| | - Cardinale B Smith
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, United States; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, United States
| | - Matthew D Galsky
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, United States
| | - Grace Mhango
- Divisions of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Fei Gu
- Department of Medicine, UMass Memorial Medical Center, United States
| | - Jorge Gomez
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, United States
| | - Gary M Strauss
- Department of Medicine, Tufts University School of Medicine, Boston, United States; Division of Hematology-Oncology, Tufts Medical Center, Boston, United States
| | - Juan Wisnivesky
- Divisions of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, United States; Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, United States
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Debus J, Drings P, Baurecht W, Angermund R. Prospective, randomized, controlled, and open study in primarily inoperable, stage III non-small cell lung cancer (NSCLC) patients given sequential radiochemotherapy with or without epoetin alfa. Radiother Oncol 2014; 112:23-9. [PMID: 25129551 DOI: 10.1016/j.radonc.2014.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/02/2014] [Accepted: 06/08/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Induction chemotherapy is associated with anemia in non-small cell lung cancer (NSCLC) patients undergoing radiotherapy. This randomized, open-label study compared the effect of sequential radiochemotherapy (RCHT) versus RCHT + epoetin alfa (RCHT + EPO), with respect to 2-year overall survival (OS). MATERIAL AND METHODS Patients ⩾18 years received sequential RCHT; one arm also received EPO (chemotherapy day 1, when Hb<12 g/dL). Kaplan-Meier analysis with log-rank test, and Cox-regression methods were performed. RESULTS Of the 385 patients randomized (RCHT + EPO: n = 195; RCHT: n = 190), 78 (RCTH + EPO: 46 [23.6%]; RCHT: 32 [16.8%]) were anemic at baseline. Two-year OS was higher in RCHT + EPO-treated versus RCHT-treated (28.5% [95% CI: 22.2-35.1%] versus 20.6% [95% CI: 15.1-26.8%] [p = 0.2278]), and requirement for RBC transfusion was lower (24/195 [12.3%] versus 61/190 [32.1%]). In anemic (baseline) patients (post hoc analysis), median survival was shorter in RCTH-treated (212 days) versus RCHT + EPO-treated (343 days) (Hazard ratio = 1.62 [95% CI: 0.99-2.63], p = 0.0525). Adverse events were documented in 72.7% (RCHT + EPO: 75.0%; RCHT: 70.5%) patients, and thrombovascular events (TVEs) in 45 patients (RCHT + EPO: 16.7%; RCHT: 7.9%; p = 0.0099). CONCLUSIONS A statistically non-significant trend for 2-year OS was observed in a sub-group of EPO-treated NSCLC-patients with baseline anemia, although this trend was not maintained in the overall population with inoperable NSCLC.
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Takeshita J, Masago K, Fujita S, Hata A, Kaji R, Kawamura T, Tamai K, Matsumoto T, Nagata K, Otsuka K, Nakagawa A, Otsuka K, Tomii K, Shintani T, Takayama K, Kokubo M, Katakami N. Weekly administration of paclitaxel and carboplatin with concurrent thoracic radiation in previously untreated elderly patients with locally advanced non-small-cell lung cancer: A case series of 20 patients. Mol Clin Oncol 2014; 2:454-460. [PMID: 24772317 DOI: 10.3892/mco.2014.249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/23/2014] [Indexed: 12/28/2022] Open
Abstract
Elderly patients with stage III non-small-cell lung cancer (NSCLC) are frequently underrepresented in clinical trials that evaluate chemoradiotherapy, due to their poor functional status, coexisting illnesses and limited life expectancy. The Japan Clinical Oncology Group 0301 trial (JCOG0301) was the first study to demonstrate that thoracic radiation therapy (TRT) with daily low-dose carboplatin may improve the outcome of elderly patients with stage III NSCLC. However, the efficacy and safety profiles of chemoradiotherapy, including platinum doublets, have not been clearly determined in this patient population. We retrospectively assessed the efficacy and toxicity of weekly paclitaxel in combination with carboplatin and concurrent TRT in patients aged ≥75 years with previously untreated locally advanced NSCLC. Between February, 2004 and July, 2013, we collected the data of 20 patients treated with weekly paclitaxel and carboplatin for 6 weeks and concurrent TRT. The objective response rate was 90%, the disease control rate was 95%, the median progression-free survival was 8.63 months [95% confidence interval (CI): 5.7-16.7] and the median overall survival (OS) was 16.1 months (95% CI: 10.7-41.6). There were no grade 4 hematological or non-hematological toxicities and no reported treatment-related deaths. Therefore, platinum doublet therapy in combination with TRT did not provide a clinically significant survival benefit in our population of elderly patients with locally advanced NSCLC. However, the present study demonstrated the good feasibility and safety of this regimen. Further prospective clinical trials are required to evaluate the efficacy and safety of platinum doublet with TRT in elderly patients.
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Affiliation(s)
- Jumpei Takeshita
- Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Katsuhiro Masago
- Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Shiro Fujita
- Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Akito Hata
- Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Reiko Kaji
- Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Takahisa Kawamura
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Koji Tamai
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Takeshi Matsumoto
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Kazuma Nagata
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Kyoko Otsuka
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Atsushi Nakagawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Kojiro Otsuka
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Takashi Shintani
- Division of Radiation Oncology, Institute of Biomedical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Kenji Takayama
- Division of Radiation Oncology, Institute of Biomedical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Masaki Kokubo
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Nobuyuki Katakami
- Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
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20
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Zhang Z, Xu J, Zhou T, Yi Y, Li H, Sun H, Huang W, Wang D, Li B, Ying G. Risk factors of radiation-induced acute esophagitis in non-small cell lung cancer patients treated with concomitant chemoradiotherapy. Radiat Oncol 2014; 9:54. [PMID: 24528546 PMCID: PMC3937013 DOI: 10.1186/1748-717x-9-54] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 02/13/2014] [Indexed: 12/13/2022] Open
Abstract
Background To analyze the clinical and dosimetric risk factors of acute esophagitis (AE) in non-small-cell lung cancer (NSCLC) patients treated with concomitant chemoradiotherapy. Methods Seventy-six NSCLC patients treated with concomitant chemoradiotherapy were retrospectively analyzed. Forty-one patients received concomitant chemoradiotherapy with vinorelbine/cisplatin (VC), 35 with docetaxel/cisplatin (DC). AE was graded according to criteria of the Radiation Therapy Oncology Group (RTOG). The following clinical and dosimetric parameters were analyzed: gender, age, clinical stage, Karnofsky performance status (KPS), pretreatment weight loss, concomitant chemotherapy agents (CCA) (VC vs. DC), percentage of esophagus volume treated to ≥20 (V20), ≥30 (V30), ≥40 (V40), ≥50 (V50) and ≥60 Gy (V60), and the maximum (Dmax) and mean doses (Dmean) delivered to esophagus. Univariate and multivariate logistic regression analysis were used to test the association between the different factors and AE. Results Seventy patients developed AE (Grade 1, 19 patients; Grade 2, 36 patients; and Grade 3, 15 patients). By multivariate logistic regression analysis, V40 was the only statistically significant factor associated with Grade ≥2 AE (p<0.001, OR = 1.159). A V40 of <23% had a 33.3% (10/30) risk of Grade ≥2 AE, which increased to 89.1% (41/46) with a V40 of ≥23% (p<0.001). CCA (p =0.01; OR = 9.686) and V50 (p<0.001; OR = 1.122) were most significantly correlated with grade 3 AE. A V50 of <26.5% had a 6.7% (3/45) risk of Grade 3 AE, which increased to 38.7% (12/31) with a V50 of ≥26.5% (p = 0.001). On the linear regression analysis, V50 and CCA were significant independent factors affecting AE duration. Patients who received concomitant chemotherapy with VC had a decreased risk of grade 3 AE and shorter duration compared with DC. Conclusions Concomitant chemotherapy agents have potential influence on AE. Concomitant chemotherapy with VC led to lower risk of AE compared with that using DC. V40 and V50 of esophagus can predict grade ≥2 and ≥3 AE, respectively.
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Affiliation(s)
| | | | | | | | | | | | | | | | - BaoSheng Li
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
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21
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Jeremic B. Radiochemotherapy as the standard treatment for both elderly and non-elderly fit patients with locally advanced (stage III) nonsmall cell lung cancer. Lung Cancer 2013; 82:176. [PMID: 23953758 DOI: 10.1016/j.lungcan.2013.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Branislav Jeremic
- Division of Radiation Oncology, Stellenbosch University, The Tygerberg Hospital, Cape Town, South Africa.
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22
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Wang ZT, Wei LL, Ding XP, Sun MP, Sun HF, Li BS. Spect-guidance to Reduce Radioactive Dose to Functioning Lung for Stage III Non-small Cell Lung Cancer. Asian Pac J Cancer Prev 2013; 14:1061-5. [DOI: 10.7314/apjcp.2013.14.2.1061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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23
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Campian JL, Ye X, Brock M, Grossman SA. Treatment-related lymphopenia in patients with stage III non-small-cell lung cancer. Cancer Invest 2013; 31:183-8. [PMID: 23432821 DOI: 10.3109/07357907.2013.767342] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study sought to estimate the severity, etiology, and clinical importance of treatment-related lymphopenia in patients with stage III non-small-cell lung cancer. METHODS Serial lymphocyte counts and survival were analyzed retrospectively in 47 patients accounting for known prognostic factors. RESULTS Total lymphocyte counts (TLCs) were normal before therapy and did not change following neoadjuvant chemotherapy. Following radiation, TLC fell by 67% (median 500 cells/mm(3), p <.00001). Multivariate analysis revealed an association between severe TLC and survival (HR 1.70, 95% CI: 0.8-3.6). CONCLUSIONS Rapid and severe lymphopenia occurred in 50% of patients following radiation which was associated with reduced survival.
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Affiliation(s)
- Jian L Campian
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Jeremić B, Miličić B, Milisavljević S. Radiotherapy alone versus radiochemotherapy in patients with stage IIIA adenocarcinoma (ADC) of the lung. Clin Transl Oncol 2013; 15:747-53. [PMID: 23359170 DOI: 10.1007/s12094-012-1000-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 12/28/2012] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the outcome of radiotherapy (RT) versus radiochemotherapy (RT-CHT) in patients with locally advanced (stage III) inoperable adenocarcinoma of the lung. PATIENTS AND METHODS 146 patients with these characteristics were among 600 patients enrolled into five prospective trials and were treated with either hyperfractionated (Hfx) RT (64.8 and 69.6 Gy using 1.2 Gy bid) alone (n = 33) or with Hfx RT (64.8 and 69.6 Gy using 1.2 Gy bid and 67.6 Gy using 1.3 Gy bid) and concurrent carboplatin-etoposide or paclitaxel-carboplatin (n = 113). RESULTS The median times and 5-year overall survival (OS), local progression-free survival (LPFS) and the distant metastasis-free survival (DMFS) rates for all 146 patients were 17, 20 and 20 months, respectively, and 15, 26 and 33, respectively. RT-CHT was superior to RT alone in terms of both OS (MST 19 vs. 12 months, respectively, 5-year OS 18 vs. 6 %, respectively; p = 0.003) and LPFS (MTLP 21 vs. 15 months, respectively, 5-year LPFS 28 vs. 0 %; p = 0.06), but not the DMFS (p = 0.43). In all 146 patients, the most frequent acute high-grade toxicity was esophageal, bronchopulmonary and hematological (each 12 %), while the most frequent late high-grade toxicity was bronchopulmonary (4 %) and esophageal (3 %). RT-CHT caused significantly more frequent acute high-grade (>3) esophageal (15 %), and hematological (15 %), while late high-grade toxicity was similar between RT and RT-CHT groups of patients. CONCLUSION RT-CHT achieved excellent results (MST 19 months, 5-year survival 18 %) in this patient population accompanied with low toxicity, comparing favorably to results of other similar studies.
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Affiliation(s)
- B Jeremić
- Department of Oncology, University Hospital, Kragujevac, Serbia.
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25
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Senesse P, Vasson MP. Nutrition chez le patient adulte atteint de cancer : quand et comment évaluer l’état nutritionnel d’un malade atteint de cancer ? Comment faire le diagnostic de dénutrition et le diagnostic de dénutrition sévère chez un malade atteint de cancer ? Quelles sont les situations les plus à risque de dénutrition ? NUTR CLIN METAB 2012. [DOI: 10.1016/j.nupar.2012.10.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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26
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Harada H, Seto T, Igawa S, Tsuya A, Wada M, Kaira K, Naito T, Hayakawa K, Nishimura T, Masuda N, Yamamoto N. Phase I Results of Vinorelbine With Concurrent Radiotherapy in Elderly Patients With Unresectable, Locally Advanced Non-Small-Cell Lung Cancer: West Japan Thoracic Oncology Group (WJTOG3005-DI). Int J Radiat Oncol Biol Phys 2012; 82:1777-82. [DOI: 10.1016/j.ijrobp.2011.03.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 02/07/2011] [Accepted: 03/22/2011] [Indexed: 10/18/2022]
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27
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Levy A, Magné N, Chargari C. Computed tomography-based simulation for thoracic radiation therapy: technical advance or clinical evidence? J Clin Oncol 2011; 29:4335-6; author reply 4336. [PMID: 21990417 DOI: 10.1200/jco.2011.38.1400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Berghmans T, Paesmans M, Sculier JP. Prognostic factors in stage III non-small cell lung cancer: a review of conventional, metabolic and new biological variables. Ther Adv Med Oncol 2011; 3:127-38. [PMID: 21904576 DOI: 10.1177/1758834011401951] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Lung cancer is one of the most frequently occurring neoplasms and usually has a poor prognosis because most of the patients present with advanced or metastatic disease at the time of diagnosis. Numerous prognostic factors (PFs) have been studied, but the two most prominent, having both prognostic and operational values, are disease stage and performance status. Even if the literature on PFs in lung cancer is impressive, the number of publications specifically dealing with PFs in stage III non-small cell lung cancer (NSCLC) is limited. We reviewed the literature on this topic and separated the available information into three groups: conventional PFs, metabolic criteria (standardized uptake value [SUV] measured on(18)F-FDG-PET) and new biomarkers. Performance status and the distinction between stage IIIA and IIIB confirmed their prognostic value in stage III NSCLC. Other conventional PFs have been suggested such as age, weight loss, response to treatment and some characteristics describing the locoregional extension of the tumour. There is a place for the SUV as a PF for survival in early NSCLC, but its role in stage III NSCLC has to be further assessed. Some new biomarkers involved in cell cycle regulation or in apoptosis have been shown to have potential value. Their role needs to be confirmed in large prospective studies including conventional PFs to determine their independent value as a PF in stage III NSCLC. In conclusion, few PFs have been well evaluated in stage III NSCLC. New studies, taking into account the modifications derived from the 7th international staging system of the UICC, have to be performed.
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Affiliation(s)
- Thierry Berghmans
- Institut Jules Bordet, Rue Héger-Bordet, 1, B-1000 Brussels, Belgium
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29
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Brock J, McNair HA, Panakis N, Symonds-Tayler R, Evans PM, Brada M. The Use of the Active Breathing Coordinator Throughout Radical Non–Small-Cell Lung Cancer (NSCLC) Radiotherapy. Int J Radiat Oncol Biol Phys 2011; 81:369-75. [PMID: 20800379 DOI: 10.1016/j.ijrobp.2010.05.038] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2009] [Revised: 05/18/2010] [Accepted: 05/24/2010] [Indexed: 10/19/2022]
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30
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Deng Q, Yang H, Zhang X, Chen H, Qiu Y, Wen D, Xiong X, Wang W, He J. [Correlation between pre-treatment anemia and prognosis in non-small cell lung cancer patients]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2011; 13:722-6. [PMID: 20673490 PMCID: PMC6000376 DOI: 10.3779/j.issn.1009-3419.2010.07.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 05/05/2010] [Indexed: 11/29/2022]
Abstract
背景与目的 非小细胞肺癌(non-small cell lung cancer, NSCLC)患者可发生贫血, 然而贫血是否为NSCLC患者预后的独立因素之一, 仍存在争议, 故本文研究可手术的NSCLC患者贫血的发生情况和影响预后的因素。 方法 对广州医学院第一附属医院2000年1月-2008年12月住院的1 018例NSCLC患者进行回顾性分析, 分析NSCLC手术患者贫血的发生情况以及影响预后的因素。 结果 患者术前贫血发生率为252/1 018(24.1%), 无贫血患者总生存时间为(2 425.98±50.03)天; 贫血患者的总生存时间是(2 107.15±93.86)天, 有无贫血患者的总生存时间存在明显差异(P=0.001)。Kaplan-Meier生存分析显示Ⅰ期NSCLC有无贫血患者的生存时间存在显著差异(P < 0.001), 但是在Ⅱ期(P=0.310)和Ⅲa期(P=0.458)患者中, 生存时间无明显差异, 且Ⅰ期、Ⅱ期和Ⅲa期的NSCLC患者累积生存时间存在统计学差异。Cox回归分析结果显示NSCLC患者的TNM分期、性别、肿瘤大小、是否淋巴结转移均与预后显著相关。 结论 贫血可以作为NSCLC可手术患者的预后相关因素之一, 但在Ⅰ期NSCLC患者中是独立的预后因素。
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Affiliation(s)
- Qiuhua Deng
- Institute of Respiratory Diseases,First Affiliated Hospital of Guangzhou Medical College, Guangzhou 510120, China
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Kishida Y, Hirose T, Shirai T, Sugiyama T, Kusumoto S, Yamaoka T, Okuda K, Adachi M, Nakamura A. Myelosuppression induced by concurrent chemoradiotherapy as a prognostic factor for patients with locally advanced non-small cell lung cancer. Oncol Lett 2011; 2:949-955. [PMID: 22866156 DOI: 10.3892/ol.2011.348] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 06/15/2011] [Indexed: 01/21/2023] Open
Abstract
The aim of the present study was to assess whether myelosuppression during concurrent chemoradiotherapy is a prognostic factor for patients with locally advanced non‑small cell lung cancer (NSCLC). We retrospectively analyzed 86 patients with NSCLC who received concurrent platinum-based chemoradiotherapy. Patients were classified into two groups (grades 0-2 and 3-4) according to the most severe neutropenia, anemia or thrombocytopenia observed during concurrent chemoradiotherapy, and survival time and progression-free survival (PFS) time were analyzed. Univariate analysis revealed that overall survival time was significantly longer in patients with grade 0-2 anemia than in those with grade 3-4 anemia (p=0.02). Survival time did not differ significantly on the basis of the severity of neutropenia or thrombocytopenia. Although pre-treatment white blood cell count was a further prognostic factor in univariate analysis, multivariate analysis revealed that the only independent prognostic factor for overall survival time was anemia. Disease stage was an independent prognostic factor for PFS (p=0.04), whereas neutropenia, anemia and thrombocytopenia were not. In conclusion, the severity of anemia during concurrent chemoradiotherapy may be a useful prognostic factor in patients with locally advanced NSCLC.
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Affiliation(s)
- Yukiko Kishida
- Department of Pharmaceutics, Showa University School of Medicine, Shinagawa, Tokyo 142-8666, Japan
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Population-Based Estimates of Survival Benefit Associated with Combined Modality Therapy in Elderly Patients with Locally Advanced Non-small Cell Lung Cancer. J Thorac Oncol 2011; 6:934-41. [DOI: 10.1097/jto.0b013e31820eed00] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jeremić B, Miličić B, Milisavljevic S. Clinical prognostic factors in patients with locally advanced (stage III) nonsmall cell lung cancer treated with hyperfractionated radiation therapy with and without concurrent chemotherapy: single-Institution Experience in 600 Patients. Cancer 2011; 117:2995-3003. [PMID: 21692056 DOI: 10.1002/cncr.25910] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 09/29/2010] [Accepted: 12/06/2010] [Indexed: 11/06/2022]
Abstract
BACKGROUND Influence of potential clinical prognostic factors on overall survival (OS), local progression-free survival (PFS), and distant metastasis-free survival (MFS) in patients with locally advanced nonsmall cell lung cancer treated with hyperfractionated radiation therapy (HFX RT) with or without concurrent chemotherapy was investigated. METHODS Three phase 3 and 2 phase 2 studies have been designed and executed with a total of 600 patients. HFX RT alone was given in 127 and HFX RT-chemotherapy was given in 473 patients. HFX RT doses were either 64.8 grays (Gy) or 69.6 Gy using 1.2 Gy twice daily, or 67.6 Gy using 1.3 Gy twice daily. Chemotherapy consisted of concurrent carboplatin and etoposide in 409 patients and concurrent carboplatin and paclitaxel in 64 patients. Sex, age, Karnofsky performance score (KPS), weight loss (>5%), stage, histology, interfraction interval, and treatment (the addition of concurrent chemotherapy) were investigated as potential prognostic factors. RESULTS The median OS, median local PFS, and median distant MFS times were 19, 21, and 23 months, respectively. Five-year OS, local PFS, and distant MFS rates were 19%, 29%, and 35%, respectively. Univariate and multivariate analysis showed that only age did not influence OS and local PFS, whereas female sex, lower KPS, less pronounced weight loss, lower stage, squamous histology, shorter interfraction interval, and treatment independently predicted better OS and local PFS. Only age and treatment did not influence distant MFS, whereas histology was of borderline significance. CONCLUSIONS This study identified independent prognosticators of treatment outcome. These results may have implications for future studies in this disease.
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Clinical and dosimetric risk factors of acute esophagitis in patients treated with 3-dimensional conformal radiotherapy for non-small-cell lung cancer. Am J Clin Oncol 2010; 33:271-5. [PMID: 19823071 DOI: 10.1097/coc.0b013e3181a879e0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To analyze the clinical and dosimetric risk factors of acute esophagitis (AE) in non-small-cell lung cancer (NSCLC) patients treated with 3-dimensional conformal radiotherapy (3D-CRT). METHODS AND MATERIALS One hundred two NSCLC patients treated with 3D-CRT were retrospectively analyzed. Forty of these 102 patients analyzed were treated with concurrent chemotherapy (CCT). The median biologic effective dose of radiotherapy was 72.0 Gy. AE was scored according to the Radiation Therapy Oncology Group criteria. The clinical and dosimetric factors associated with grade 2 or worse AE were analyzed using univariate and multivariate binary logistic analysis. RESULTS There were no grade 4 or 5 AE observed in the 102 patients analyzed. Thirty-four of 102 patients (33.3%) developed grade 2 or 3 AE. Univariate analysis showed that clinical factors, such as lymph nodes stage (N 0/1 vs. N 2/3), pretreatment weight loss > or =5%, CCT, and the use of late-course hyperfractionated radiotherapy were significantly associated with grade 2 and 3 AE. Dose volume parameters of esophagus including mean esophageal dose, maximal esophageal dose, rV15, rV20, rV25, rV30, rV35, rV40, rV45, rV50, rV55, rV60 were also associated with AE. On multivariate forward step-wise logistic analysis, CCT, lymph nodes stage, and rV55 emerged as the statistically most significant factors of AE with OR parameters of 8.911, 4.832, and 1.083, respectively. CONCLUSION CCT, lymphatic status, and rV55 were strong predictors of grade 2 or worse AE in NSCLC treated with 3D-CRT.
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Li J, Dai CH, Yu LC, Chen P, Li XQ, Shi SB, Wu JR. Results of trimodality therapy in patients with stage IIIA (N2-bulky) and stage IIIB non-small-cell lung cancer. Clin Lung Cancer 2010; 10:353-9. [PMID: 19808194 DOI: 10.3816/clc.2009.n.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The survival rates for stage IIIA and stage IIIB non-small-cell lung cancer (NSCLC) are extremely poor with single-treatment modalities such as radiation therapy or surgery. The purpose of this study is to assess tolerability, response, surgical resectability, and survival of chemotherapy followed by chemoradiation therapy, and then followed by surgery in patients with stage IIIA (N2-bulky) or stage IIIB NSCLC. PATIENTS AND METHODS Forty-eight patients with stage IIIA (N2-bulky) or stage IIIB (T4 N1-2 M0) NSCLC received 2 cycles of chemotherapy with cisplatin, mitomycin, and vindesine, subsequent radiation therapy (45 Gy, twice-daily 1.5 Gy) with simultaneous low-dose cisplatin and vindesine, followed by surgery. RESULTS Forty-five patients completed induction chemoradiation therapy. Thirty-three patients (68.8%) had clinical response to induction treatment. Thirty-nine patients underwent a thoracotomy, with a complete resection rate of 62.5% (30/48). The pathologic response rate was 60% (27/45), with complete pathologic response of 8 patients. The median survival time for the total group of 48 patients was 23 months, with 3- and 5-year survival rates of 41.7% and 31.8%, respectively. Multivariate analysis showed that complete resection and pathologic response in surgical specimens were independent predictors of survival (P=.048 and P=.022). CONCLUSION Preoperative sequence of chemotherapy followed by concurrent chemoradiation therapy is an effective approach in patients with stage IIIA (N2-bulky) and IIIB (T4 N1-2 M0) NSCLC. The operation after induction chemoradiation therapy should be performed in carefully selected patients with surgically resectable diseases. The patients who achieved complete resection and with pathologic response of tumor can benefit from surgery following induction chemoradiation therapy.
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Affiliation(s)
- Jian Li
- Department of Pulmonary Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
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Treatment outcomes of different prognostic groups of patients on cancer and leukemia group B trial 39801: induction chemotherapy followed by chemoradiotherapy compared with chemoradiotherapy alone for unresectable stage III non-small cell lung cancer. J Thorac Oncol 2009; 4:1117-25. [PMID: 19652624 DOI: 10.1097/jto.0b013e3181b27b33] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND In Cancer and Leukemia Group B 39801, we evaluated whether induction chemotherapy before concurrent chemoradiotherapy would result in improved survival and demonstrated no significant benefit from the addition of induction chemotherapy. The primary objective of this analysis was to dichotomize patients into prognostic groups using factors predictive of survival and to investigate whether induction chemotherapy was beneficial in either prognostic group. PATIENTS AND METHODS A Cox proportional hazard model was used to assess the impact on survival of the following factors: (>or=70 versus <70 years), gender, race, stage (IIIB versus IIIA), hemoglobin (hgb) (<13 versus >or=13 g/dl), performance status (PS) (1 versus 0), weight loss (>or=5% versus <5%), treatment arm, and the interaction between weight loss and hgb. RESULTS Factors predictive of decreased survival were weight loss >or=5%, age >or=70 years, PS of 1, and hgb <13 g/dl (p < 0.05). Patients were classified as having >or=2 poor prognostic factors (n = 165) or <or=1 factor (n = 166). The hazard ratio (HR) for overall survival for the patients with >or=2 versus patients with <or=1 was 1.88 [95% confidence interval (CI), 1.49-2.37; p = <0.0001]; median survival times observed were 9 (95% CI, 8-11) and 18 (95% CI, 16-24) months, respectively. There was no significant difference in survival between treatment arms in patients with >or=2 factors (HR = 0.86, 95% CI, 0.63-1.17; p = 0.34) or <or=1 factor (HR = 0.97, 95% CI, 0.70-1.35; p = 0.87). CONCLUSIONS There is no evidence that induction chemotherapy is beneficial in either prognostic group.
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Caglar HB, Baldini EH, Othus M, Rabin MS, Bueno R, Sugarbaker DJ, Mentzer SJ, Jänne PA, Johnson BE, Allen AM. Outcomes of patients with stage III nonsmall cell lung cancer treated with chemotherapy and radiation with and without surgery. Cancer 2009; 115:4156-66. [PMID: 19551884 DOI: 10.1002/cncr.24492] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The objective of this study was to identify the factors associated with improved outcome after treatment for stage III nonsmall cell lung cancer (NSCLC). METHODS A retrospective review of stage III NSCLC patients treated at who were treated at the Dana-Farber Cancer Institute/Brigham and Women's Cancer Center was done with institutional review board approval. Patients were followed for toxicity, local and distant failure, and overall survival. Multivariate Cox logistic regression analysis was used to determine the factors associated with treatment outcome. RESULTS Between August 2000 and November 2006, 144 patients received concurrent chemoradiation (CRT) for stage III NSCLC. Eighty of 144 patients were men (56%), and the median age was 61 years (range, 33-81 years). Sixty-two patients (43%) had stage IIIA NSCLC, and 82 patients (57%) had stage IIIB NSCLC. Radiotherapy (RT) was given concurrently with chemotherapy to all patients; 100 patients (69%) received CRT without surgery, and 44 patients (31%) received with neoadjuvant CRT followed by surgical resection. The median RT dose was 60 grays (Gy) (range, 46-70 Gy). The median follow-up was 15 months (range, 3-64 months), the median potential follow-up was 37 months (range, 12-84 months), and the median overall survival was 22 months (95% confidence interval, 15-28 months). The 1-year and 2-year survival rates were 68% and 47%, respectively. Among the 44 patients who underwent resection, the median survival was 61 months, and the 2-year survival rate was 73%. On multivariate analysis, stage at the time of treatment (stage IIIA vs stage IIIB) and use of surgery were the only factors associated with improved outcome (P=.01 and P=.001, respectively). CONCLUSIONS In this retrospective series, those patients who were able to undergo resection appeared to have improved outcome after induction CRT.
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Affiliation(s)
- Hale B Caglar
- Department of Radiation Oncology Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts 02215, USA
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Neoadjuvant chemotherapy and radiotherapy followed by surgery in selected patients with stage IIIB non-small-cell lung cancer: a multicentre phase II trial. Lancet Oncol 2009; 10:785-93. [DOI: 10.1016/s1470-2045(09)70172-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Nakamura M, Koizumi T, Hayasaka M, Yasuo M, Tsushima K, Kubo K, Gomi K, Shikama N. Cisplatin and weekly docetaxel with concurrent thoracic radiotherapy for locally advanced stage III non-small-cell lung cancer. Cancer Chemother Pharmacol 2008; 63:1091-6. [DOI: 10.1007/s00280-008-0837-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 09/09/2008] [Indexed: 10/21/2022]
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Socinski MA, Blackstock AW, Bogart JA, Wang X, Munley M, Rosenman J, Gu L, Masters GA, Ungaro P, Sleeper A, Green M, Miller AA, Vokes EE. Randomized phase II trial of induction chemotherapy followed by concurrent chemotherapy and dose-escalated thoracic conformal radiotherapy (74 Gy) in stage III non-small-cell lung cancer: CALGB 30105. J Clin Oncol 2008; 26:2457-63. [PMID: 18487565 DOI: 10.1200/jco.2007.14.7371] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate 74 Gy thoracic radiation therapy (TRT) with induction and concurrent chemotherapy in stage IIIA/B non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Patients with stage IIIA/B NSCLC were randomly assigned to induction chemotherapy with either carboplatin (area under the curve [AUC], 6; days 1 and 22) with paclitaxel (225 mg/m(2); days 1 and 22; arm A) or carboplatin (AUC, 5; days 1 and 22) with gemcitabine (1,000 mg/m(2); days 1, 8, 22, and 29; arm B). On day 43, arm A received weekly carboplatin (AUC, 2) and paclitaxel (45 mg/m(2)) while arm B received biweekly gemcitabine (35 mg/m(2)) both delivered concurrently with 74 Gy of TRT utilizing three-dimensional treatment planning. The primary end point was survival at 18 months. RESULTS Forty-three and 26 patients were accrued to arms A and B, respectively. Arm B was closed prematurely due to a high rate of grade 4 to 5 pulmonary toxicity. The overall response rate was 66.6% (95% CI, 50.5% to 80.4%) and 69.2% (95% CI, 48.2% to 85.7%) on arm A and B, respectively. The median survival time (MST) and 1-year survival rate was 24.3 months (95% CI, 12.3 to 36.4) and 66.7% (95% CI, 50.3 to 78.7) and 12.5 months (95% CI, 9.4 to 27.6) and 50.0% (95% CI, 29.9 to 67.2) for arms A and B, respectively. The primary toxicities included esophagitis, pulmonary, and fatigue. CONCLUSION Arm A reached the primary end point with an estimated MST longer than 18 months and will be compared with a standard dose of TRT in a planned randomized phase III trial in the United States cooperative groups.
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Affiliation(s)
- Mark A Socinski
- Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, NC 27599, USA.
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Defining the margins in the radical radiotherapy of non-small cell lung cancer (NSCLC) with active breathing control (ABC) and the effect on physical lung parameters. Radiother Oncol 2008; 87:65-73. [DOI: 10.1016/j.radonc.2007.12.012] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Accepted: 12/11/2007] [Indexed: 11/20/2022]
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Weight loss in patients with advanced cancer: effects, causes, and potential management. Curr Opin Support Palliat Care 2008; 2:45-8. [DOI: 10.1097/spc.0b013e3282f4b734] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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de Cos Escuín JS, Delgado IU, Rodríguez JC, López MJ, Vicente CD, Miranda JAR. [Stage IIIA and IIIB non-small cell lung cancer: results of chemotherapy combined with radiation therapy and analysis of prognostic factors]. Arch Bronconeumol 2007; 43:358-65. [PMID: 17663887 DOI: 10.1016/s1579-2129(07)60086-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Most patients with stage III non-small cell lung cancer (NSCLC) are not candidates for surgery but can benefit from chemotherapy combined with radiation therapy. The objective of the present study was to analyze the results of sequential chemotherapy and radiation therapy and the prognostic value of initial clinical and laboratory variables. PATIENTS AND METHODS We carried out a retrospective study of 92 patients with stage III NSCLC treated with a sequential regimen of chemotherapy (carboplatin-etoposide, carboplatin-gemcitabine, and carboplatin-paclitaxel), and radiation therapy (6000 cGy in daily doses of 200 cGy, 5 d/wk). Response to therapy, overall survival, and the prognostic value of epidemiological, clinical, and laboratory variables were evaluated using univariate and multivariate analyses. RESULTS Median survival time was 14 months, with a 3-year survival rate of 16.1%. Poor performance status (score of 2 on the Eastern Cooperative Oncologic Group [ECOG] scale), anemia, and elevated serum concentrations of carcinoembryonic antigen were predictive of poorer survival in the multivariate analysis. In the univariate analysis, weight loss and diagnosis before the year 2000 were also associated with poorer prognosis (P<.01). TNM stage was not significantly correlated (P=.08). Toxicity was low, with 1 death and few cases of grade 3 or 4 toxicity according to World Health Organization criteria. CONCLUSIONS The use of chemotherapy combined with radiation therapy should be considered contraindicated in cases of poor performance status (ECOG scale score of 2). Weight loss, an elevated serum concentration of carcinoembryonic antigen, and a hemoglobin concentration of 12 g/dL or less carry a poor prognosis.
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Uitterhoeve ALJ, Koolen MGJ, van Os RM, Koedooder K, van de Kar M, Pieters BR, Koning CCE. Accelerated high-dose radiotherapy alone or combined with either concomitant or sequential chemotherapy; treatments of choice in patients with Non-Small Cell Lung Cancer. Radiat Oncol 2007; 2:27. [PMID: 17659094 PMCID: PMC1947993 DOI: 10.1186/1748-717x-2-27] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 07/23/2007] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Results of high-dose chemo-radiotherapy (CRT), using the treatment schedules of EORTC study 08972/22973 or radiotherapy (RT) alone were analyzed among all patients (pts) with Non Small Cell Lung Cancer (NSCLC) treated with curative intent in our department from 1995-2004. MATERIAL Included are 131 pts with medically inoperable or with irresectable NSCLC (TNM stage I:15 pts, IIB:15 pts, IIIA:57 pts, IIIB:43 pts, X:1 pt). TREATMENT Group I: Concomitant CRT: 66 Gy/2.75 Gy/24 fractions (fx)/33 days combined with daily administration of cisplatin 6 mg/m(2): 56 pts (standard).Group II: Sequential CRT: two courses of a 21-day schedule of chemotherapy (gemcitabin 1250 mg/m(2) d1, cisplatin 75 mg/m2 d2) followed by 66 Gy/2.75 Gy/24 fx/33 days without daily cisplatin: 26 pts.Group III: RT: 66 Gy/2.75 Gy/24 fx/33 days or 60 Gy/3 Gy/20 fx/26 days: 49 pts. RESULTS The 1, 2, and 5 year actuarial overall survival (OS) were 46%, 24%, and 15%, respectively.At multivariate analysis the only factor with a significantly positive influence on OS was treatment with chemo-radiation (P = 0.024) (1-, 2-, and 5-yr OS 56%, 30% and 22% respectively). The incidence of local recurrence was 36%, the incidence of distant metastases 46%.Late complications grade 3 were seen in 21 pts and grade 4 in 4 patients. One patient had a lethal complication (oesophageal). For 32 patients insufficient data were available to assess late complications. CONCLUSION In this study we were able to reproduce the results of EORTC trial 08972/22973 in a non-selected patient population outside of the setting of a randomised trial. Radiotherapy (66 Gy/24 fx/33 days) combined with either concomitant daily low dose cisplatin or with two neo-adjuvant courses of gemcitabin and cisplatin are effective treatments for patients with locally advanced Non-Small Cell Lung Cancer. The concomitant schedule is also suitable for elderly people with co-morbidity.
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Affiliation(s)
- Apollonia LJ Uitterhoeve
- Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Mia GJ Koolen
- Department of Pulmonary Disease, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Rob M van Os
- Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Kees Koedooder
- Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Marlou van de Kar
- Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Bradley R Pieters
- Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Caro CE Koning
- Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
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Sánchez de Cos Escuín J, Utrabo Delgado I, Cabrera Rodríguez J, Jiménez López M, Disdier Vicente C, Antonio Riesco Miranda J. Carcinoma de pulmón no microcítico. Estadios IIIA y B. Resultados del tratamiento combinado (quimioterapia y radioterapia) y análisis de factores pronósticos. Arch Bronconeumol 2007. [DOI: 10.1157/13107691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lavrenkov K, Christian JA, Partridge M, Niotsikou E, Cook G, Parker M, Bedford JL, Brada M. A potential to reduce pulmonary toxicity: The use of perfusion SPECT with IMRT for functional lung avoidance in radiotherapy of non-small cell lung cancer. Radiother Oncol 2007; 83:156-62. [PMID: 17493699 DOI: 10.1016/j.radonc.2007.04.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Revised: 03/19/2007] [Accepted: 04/03/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE The study aimed to examine specific avoidance of functional lung (FL) defined by a single photon emission computerized tomography (SPECT) lung perfusion scan, using intensity modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3-DCRT) in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Patients with NSCLC underwent planning computerized tomography (CT) and lung perfusion SPECT scan in the treatment position using fiducial markers to allow co-registration in the treatment planning system. Radiotherapy (RT) volumes were delineated on the CT scan. FL was defined using co-registered SPECT images. Two inverse coplanar RT plans were generated for each patient: 4-field 3-DCRT and 5-field step-and-shoot IMRT. 3-DCRT plans were created using automated AutoPlan optimisation software, and IMRT plans were generated employing Pinnacle(3) treatment planning system (Philips Radiation Oncology Systems). All plans were prescribed to 64 Gy in 32 fractions using data for the 6 MV beam from an Elekta linear accelerator. The objectives for both plans were to minimize the volume of FL irradiated to 20 Gy (fV(20)) and dose variation within the planning target volume (PTV). A spinal cord dose was constrained to 46 Gy. Volume of PTV receiving 90% of the prescribed dose (PTV(90)), fV(20), and functional mean lung dose (fMLD) were recorded. The PTV(90)/fV(20) ratio was used to account for variations in both measures, where a higher value represented a better plan. RESULTS Thirty-four RT plans of 17 patients with stage I-IIIB NSCLC suitable for radical RT were analysed. In 6 patients with stage I-II disease there was no improvement in PTV(90), fV(20), PTV/fV(20) ratio and fMLD using IMRT compared to 3-DCRT. In 11 patients with stage IIIA-B disease, the PTV was equally well covered with IMRT and 3-DCRT plans, with IMRT producing better PTV(90)/fV(20) ratio (mean ratio - 7.2 vs. 5.3, respectively, p=0.001) and reduced fMLD figures compared to 3-DCRT (mean value - 11.5 vs. 14.3 Gy, p=0.001). This was due to reduction in fV(20) while maintaining PTV coverage. CONCLUSION The use of IMRT compared to 3-DCRT improves the avoidance of FL defined by perfusion SPECT scan in selected patients with locally advanced NSCLC. If the dose to FL is shown to be the primary determinant of lung toxicity, IMRT would allow for effective dose escalation by specific avoidance of FL.
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Affiliation(s)
- Konstantin Lavrenkov
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Surrey, UK.
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Crawford J, Robert F, Perry MC, Belani C, Williams D. A randomized trial comparing immediate versus delayed treatment of anemia with once-weekly epoetin alfa in patients with non-small cell lung cancer scheduled to receive first-line chemotherapy. J Thorac Oncol 2007; 2:210-20. [PMID: 17410044 DOI: 10.1097/jto.0b013e318031cd9a] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study evaluated the safety/efficacy of once-weekly (QW) epoetin alfa measured by quality of life (QOL), hemoglobin (Hb), transfusion incidence, tumor response, and survival in patients with chemotherapy-naïve, advanced non-small cell lung cancer (NSCLC). METHODS Stage IIIB/IV NSCLC patients with Hb > or = 11 to < 15 g/dl scheduled for at least 8 weeks of first-line chemotherapy were randomized to subcutaneously receive 40,000 U of epoetin alfa QW at chemotherapy initiation (immediate) or no epoetin alfa unless Hb decreased to < or = 10 g/dl (delayed). The primary efficacy variable was change in QOL for immediate versus delayed intervention. Target accrual was 320 patients. RESULTS The study was terminated early because of slow accrual; of 216 patients enrolled, 211 were evaluable for efficacy. Hb was maintained in the immediate group, but it decreased in the delayed group (12.9 versus 11.6 g/dl final values, respectively). Numerically, fewer immediate patients required transfusions versus delayed patients. Mean QOL scores, modestly declining in both groups from baseline to final measurement, were not significantly different between groups. Tumor response and median overall survival were similar between groups. Epoetin alfa was well tolerated, with a similar thrombovascular event rate between groups. CONCLUSION Epoetin alfa in subcutaneous doses of 40,000 U QW, given immediately at chemotherapy initiation for advanced NSCLC, was well tolerated, and it effectively maintained Hb, leading to a reduced transfusion incidence versus delayed epoetin alfa. Overall QOL scores were higher than typical in this population, decreasing slightly during treatment in both groups. Overall survival was similar between groups, with no evidence of a negative effect by early epoetin alfa intervention.
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Stinchcombe TE, Fried D, Morris DE, Socinski MA. Combined modality therapy for stage III non-small cell lung cancer. Oncologist 2006; 11:809-23. [PMID: 16880240 DOI: 10.1634/theoncologist.11-7-809] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lung cancer remains the leading cause of cancer death in the U.S. among both men and women. Approximately 45% of patients present with stage III disease. A proportion of these patients is amenable to surgical resection; however, the majority are "unresectable." For patients with unresectable stage IIIA/B disease, thoracic radiation therapy (TRT) was considered the standard of care until the late 1980s despite a very poor 5-year survival rate. Several clinical trials demonstrated that the combination of chemotherapy and TRT was superior to TRT alone. Based on these data, combined modality therapy became the standard of care for patients with good performance status. Recent trials have shown that concurrent chemoradiotherapy offers a significant survival advantage over sequential chemoradiotherapy. Despite a substantial number of clinical trials, important questions on the optimal treatment paradigm remain. The most effective chemotherapy combination, the use of induction or consolidation chemotherapy in addition to the concurrent portion of therapy, and the optimal dose of chemotherapy with concurrent TRT have yet to be determined. The optimal total dose, fractionation, acceleration, treatment volume, and tumor targeting remain questions related to the TRT portion of therapy. Although significant progress has been made, the majority of patients experience locoregional or distant progression of their disease and die within 5 years of diagnosis. Thus, continued development and participation in clinical trials is crucial to further improvements in the treatment of patients with stage III disease.
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Affiliation(s)
- Thomas E Stinchcombe
- Multidisciplinary Thoracic Oncology Program, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina 27599-7305, USA.
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Stinchcombe TE, Morris DE, Moore DT, Bechtel JH, Halle JS, Mears A, Deschesne K, Rosenman JG, Socinski MA. Post-chemotherapy gross tumor volume is predictive of survival in patients with stage III non-small cell lung cancer treated with combined modality therapy. Lung Cancer 2006; 52:67-74. [PMID: 16499996 DOI: 10.1016/j.lungcan.2005.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Revised: 11/14/2005] [Accepted: 11/18/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the influence of clinical covariates, particularly pre-chemotherapy gross tumor volume (GTV), post-chemotherapy GTV, on overall survival in the treatment of stage III non-small cell lung cancer (NSCLC). METHODS AND MATERIALS We retrospectively analyzed 102 patients who were enrolled on three consecutive clinical trials, which employed the treatment paradigm of two cycles of induction chemotherapy followed by thoracic radiation therapy. The pre-chemotherapy GTV, post-chemotherapy GTV, change in GTV, histology, disease stage, performance status, age, race, treatment with concurrent chemoradiotherapy versus radiotherapy alone were evaluated to determine their impact on overall survival. The log10 of the GTV was used to normalize the data and thereby reduce the impact of exceptionally large values. RESULTS Both the log10 of the post-chemotherapy GTV and Eastern Cooperative Oncology Group (ECOG) performance status covariates were highly prognostic for overall survival (p = 0.006 and p = 0.008, respectively). Disease stage (at diagnosis) was also significant (p = 0.048). The log10 pre-chemotherapy GTV covariate was borderline significant (p = 0.067). The strongest prognostic model was the two-covariate model, which contained the log10 post-chemotherapy GTV and ECOG performance status covariates, (model chi2 of 18.67, with p = 0.001 for each covariate). CONCLUSIONS The log10 post-chemotherapy GTV has significant prognostic survival value when the strategy of induction chemotherapy is employed in the treatment on stage III NSCLC. ECOG performance status and stage were also significant prognostic factors for survival.
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Affiliation(s)
- Thomas E Stinchcombe
- Department of Hematology/Oncology, University of North Carolina, Chapel Hill NC 27599-7305, USA.
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