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Sridhar A, Khan H, Yohannan B, Chan KH, Kataria N, Jafri SH. A Review of the Current Approach and Treatment Landscape for Stage III Non-Small Cell Lung Cancer. J Clin Med 2024; 13:2633. [PMID: 38731161 PMCID: PMC11084624 DOI: 10.3390/jcm13092633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
The therapeutic landscape of the management of stage III non-small cell lung cancer (NSCLC) has drastically evolved with the incorporation of immunotherapy and targeted therapy. Stage III NSCLC accounts for one-third of the cases and the treatment strategy of these locally advanced presentations are diverse, ranging from surgical to non-surgical options; with the incorporation of chemo-immunotherapy, radiation, and targeted therapies wherever applicable. The staging of this disease has also changed, and it is essential to have a strong multidisciplinary approach to do justice to patient care. In this article, we aim to navigate the nuanced approaches in the diagnosis and treatment of stage III NSCLC and expand on the evolution of the management of this disease.
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Affiliation(s)
- Arthi Sridhar
- Department of Oncology, Mayo Clinic, Rochester, MN 55901, USA
| | - Hina Khan
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA
| | - Binoy Yohannan
- Department of Hematology, Mayo Clinic, Rochester, MN 55901, USA
| | - Kok Hoe Chan
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA
| | - Nilansh Kataria
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20010, USA;
| | - Syed Hasan Jafri
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA
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Berber T, Yıldırım BA, Kandemir Gürsel Ö. Stereotactic Body Radiotherapy Reirradiation Is Safe in Patients With Lung Cancer With In-Field Enlarged Tumor Recurrence. Technol Cancer Res Treat 2024; 23:15330338231208616. [PMID: 38860536 PMCID: PMC11168055 DOI: 10.1177/15330338231208616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 06/12/2024] Open
Abstract
Introduction: Recurrence after stage III lung cancer treatment usually appears with a poor prognosis, and salvage therapy for these patients is challenging, with limited data for reirradiation. Materials and Methods: Fifteen patients with recurrent stage III lung cancer treated with stereotactic body radiotherapy (SABR) between October 2013 and December 2017 were retrospectively evaluated for local control as a first endpoint; overall survival, disease-free survival, and treatment-related toxicity were secondary endpoints. Results: The median age was 68 (IQR: 50-71) years, and the median tumor size was 3.3 cm (IQR: 3.0-4.5). The radiation field was all within the previous radiation (previous 80%-90% isodose line), and the median dose was 66 Gy/(2 Gy × 33 standard fractionation). For SABR, the median biologically effective dose at an α/β ratio of 10 (BED10) was 60.0 Gy (IQR: 39.38-85.0) and given in 3 to 5 fractions. Three patients experienced grade 3 or 4 toxicity but none experienced grade 5. The median follow-up period was 14 (IQR: 10-23) months. The local control rate was found as 86.7% in the first year, 80% in the second year, and 80% in the third year. The median disease-free survival was 8 (IQR: 6-20) months and the median overall survival was 14 (IQR: 10-23) months. The rate of overall survival was 66.6% for the first year and 33.3% for the second and third years. The disease-free survival rate was 46.6% for the first year and 40% for the second and third years. Nine patients who received doses of BED10 ≥ 50 Gy developed no local recurrence (P = .044). Discussion: In local local-regional recurrence of lung cancer, radiosurgery as reirradiation can be used at doses of BED10 ≥ 50 Gy and above to provide local control for radical or palliative purposes. SABR is an important and relatively safe treatment option in such recurrences.
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Affiliation(s)
- Tanju Berber
- Department of Radiation Oncology, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Berna Akkuş Yıldırım
- Department of Radiation Oncology, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Özge Kandemir Gürsel
- Department of Radiation Oncology, Okmeydani Training and Research Hospital, Istanbul, Turkey
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Kesarwani R, Singh A, Aqueel M, Singh V, Prakash G. A Comparative Retrospective Survival Analysis Study of Brain Tumor Patients in Age Less Than or Equal to 50 Years versus More Than 50 Years of Age. Asian J Neurosurg 2023; 18:777-781. [PMID: 38161610 PMCID: PMC10756844 DOI: 10.1055/s-0043-1777271] [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] [Indexed: 01/03/2024] Open
Abstract
Introduction Approximately 2.5% of fatalities from cancer are caused by brain tumors. Even though there is literature regarding prognostic factor of adult brain tumor, studies often resort to Western demographics. Hence, we conducted this retrospective observational study to compare the demographic characteristics and prognosis in patients of glial tumors in Indian population with histological diagnosis with respect to age. Materials and Methods A single-center retrospective observational study with 76 patients of glioma who had been treated with surgery combined with radiotherapy with or without chemotherapy was conducted. Group I patients were aged less than or equal to 50 years and group II more than 50 years of age. There were 28 patients in group I and 48 in group II. Postoperatively, external beam radiation therapy was delivered in a conventional fraction (1.8 Gy/fraction, five fractions/week) using telecobalt 60. Ill patients who presented with grade III and IV gliomas received oral chemotherapy temozolomide at a dose of 100 mg daily during course of radiotherapy. Results The median age of the patients at the time of diagnosis was 45.0 years. More cases of hematologic toxicity occurred in group I than in group II. Total 55 patients were alive at 1-year follow-up (11 in group I and 44 in group II). Conclusion Grade I and II gliomas were predominant in less than 50 years of age and grade III and IV were predominant in more than 50 years age. Male preponderance was seen in age group of more than 50 years (68%). Overall survival and disease-free survival were better for patients aged less than 50 years.
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Affiliation(s)
- Radha Kesarwani
- Department of Radiotherapy, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Astha Singh
- Department of Interventional Radiology, Lal Path, New Delhi, India
| | - Mohammad Aqueel
- Department of Radiotherapy, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Virendra Singh
- Department of Radiotherapy, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Gyan Prakash
- Department of SPM, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
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Sathiyapalan A, Baloush Z, Ellis PM. Update on the Management of Stage III NSCLC: Navigating a Complex and Heterogeneous Stage of Disease. Curr Oncol 2023; 30:9514-9529. [PMID: 37999109 PMCID: PMC10670056 DOI: 10.3390/curroncol30110689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/22/2023] [Accepted: 10/25/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Stage III nonsmall cell lung cancer (NSCLC) represents a heterogeneous group of patients. Many patients are treated with curative intent multimodality therapy, either surgical resection plus systemic therapy or chemoradiation plus immunotherapy. However, many patients are not suitable for curative intent therapy and are treated with palliative systemic therapy or best supportive care. METHODS This paper is a review of recent advances in the management of patients with curative intent disease. RESULTS There have been significant advances in curative intent therapy for patients with stage III NSCLC in recent years. These include both adjuvant and neoadjuvant systemic therapies. For patients with resectable NSCLC, two trials have demonstrated that adjuvant atezolizumab or pembrolizumab, following chemotherapy, significantly improved disease-free survival (DFS). In patients with tumours harbouring a common mutation of the EGFR gene, adjuvant osimertinib therapy was associated with a large improvement in both DFS and overall survival (OS). Five randomized trials have evaluated chemotherapy plus nivolumab, pembrolizumab, durvalumab, or toripalimab, either as neoadjuvant or perioperative (neoadjuvant plus adjuvant) therapy. All five trials show significant improvements in the rate of pathologic complete response (pCR) and event-free survival (EFS). OS data are currently immature. This would now be considered the standard of care for resectable stage III NSCLC. The addition of durvalumab to chemoradiation has also become the standard of care in unresectable stage III NSCLC. One year of consolidation durvalumab following concurrent chemoradiation has demonstrated significant improvements in both progression-free and overall survival. CONCLUSIONS Immune checkpoint inhibitor (ICI) therapy has become a standard recommendation in curative intent therapy for stage III NSCLC.
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Affiliation(s)
- Arani Sathiyapalan
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON L8V 5C2, Canada; (A.S.); (Z.B.)
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Ziad Baloush
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON L8V 5C2, Canada; (A.S.); (Z.B.)
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Peter M. Ellis
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON L8V 5C2, Canada; (A.S.); (Z.B.)
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada
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Sun H, Liu Y, Yuan L, Wang N. Dosimetry study of Auto-VMAT planning and Manual-VMAT planning based on Pinnacle3 9.10 in radiotherapy for cervical cancer. Medicine (Baltimore) 2023; 102:e34129. [PMID: 37390285 PMCID: PMC10313269 DOI: 10.1097/md.0000000000034129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/07/2023] [Indexed: 07/02/2023] Open
Abstract
The purpose of this study was to compare the dose distribution characteristics of automatic volume-modulated arc therapy (Auto-VMAT) planning and manual volume-modulated arc therapy (Manual-VMAT) planning of Philips Pinnacle3 9.10 planning system, to provide a basis for optimal radiation therapy planning for cervical cancer. Ten patients with cervical cancer in our hospital from September to December 2018 were selected, and 2 treatment plans, Auto-VMAT plan and Manual-VMAT plan, were designed using Pinnacle3 9.10 planning system, respectively, to evaluate the maximum dose Dmax, mean dose Dmean, homogeneity index of the target area according to the dose volume histogram, the conformability index, plan optimization time, monitor units (MUs), organ at risk and other indicators. The results were that the Auto-VMAT plan was superior to the Manual-VMAT plan for target area Dmean, conformability index, and homogeneity index, with statistically significant differences (P < .05) and no significant difference in maximum dose Dmax (P > .05); rectal V40, V50, and Dmean in the Auto-VMAT plan, bladder V40, V50, and Dmean, small bowel V30, V40, V50 and Dmean, and right and left femoral V50 and Dmean were all lower than the Manual-VMAT plan, and the difference was statistically significant (P < .05); the mean optimization time for the Auto-VMAT and Manual-VMAT plans was 47 minutes and 35 minutes, respectively, an increase of 34%. The average number of MUs was 519 MUs and 374 MUs, respectively, an increase of 28%. This study concluded that the Pinnacle3 9.10-based Auto-VMAT plan was clinically feasible and significantly superior to the Manual-VMAT plan in terms of improved target area uniformity and conformability and reduced organ endangerment dose while reducing the impact of human factors on the quality of plan design.
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Affiliation(s)
- Haitao Sun
- Department of Radiotherapy, Zhongshan Hospital of Traditional Chinese Medicine, Guangdong Province, Zhongshan, China
| | - Ying Liu
- Department of Radiotherapy, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou, China
| | - Ling Yuan
- Department of Radiotherapy, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou, China
| | - Ning Wang
- Department of Radiotherapy, Zhongshan Hospital of Traditional Chinese Medicine, Guangdong Province, Zhongshan, China
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Petrella F, Rizzo S, Attili I, Passaro A, Zilli T, Martucci F, Bonomo L, Del Grande F, Casiraghi M, De Marinis F, Spaggiari L. Stage III Non-Small-Cell Lung Cancer: An Overview of Treatment Options. Curr Oncol 2023; 30:3160-3175. [PMID: 36975452 PMCID: PMC10047909 DOI: 10.3390/curroncol30030239] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
Lung cancer is the second-most commonly diagnosed cancer and the leading cause of cancer death worldwide. The most common histological type is non-small-cell lung cancer, accounting for 85% of all lung cancer cases. About one out of three new cases of non-small-cell lung cancer are diagnosed at a locally advanced stage—mainly stage III—consisting of a widely heterogeneous group of patients presenting significant differences in terms of tumor volume, local diffusion, and lymph nodal involvement. Stage III NSCLC therapy is based on the pivotal role of multimodal treatment, including surgery, radiotherapy, and a wide-ranging option of systemic treatments. Radical surgery is indicated in the case of hilar lymphnodal involvement or single station mediastinal ipsilateral involvement, possibly after neoadjuvant chemotherapy; the best appropriate treatment for multistation mediastinal lymph node involvement still represents a matter of debate. Although the main scope of treatments in this setting is potentially curative, the overall survival rates are still poor, ranging from 36% to 26% and 13% in stages IIIA, IIIB, and IIIC, respectively. The aim of this article is to provide an up-to-date, comprehensive overview of the state-of-the-art treatments for stage III non-small-cell lung cancer.
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Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
- Correspondence: ; Tel.: +0039-0257489362
| | - Stefania Rizzo
- Service of Radiology, Imaging Institute of Southern Switzerland (IIMSI), EOC, Via Tesserete 46, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, University of Italian Switzerland, Via Buffi 13, 6900 Lugano, Switzerland
| | - Ilaria Attili
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Thomas Zilli
- Faculty of Biomedical Sciences, University of Italian Switzerland, Via Buffi 13, 6900 Lugano, Switzerland
- Radiation Oncology, Oncological Institute of Southern Switzerland, EOC, 6500 Bellinzona, Switzerland
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Francesco Martucci
- Radiation Oncology, Oncological Institute of Southern Switzerland, EOC, 6500 Bellinzona, Switzerland
| | - Luca Bonomo
- Service of Radiology, Imaging Institute of Southern Switzerland (IIMSI), EOC, Via Tesserete 46, 6900 Lugano, Switzerland
| | - Filippo Del Grande
- Service of Radiology, Imaging Institute of Southern Switzerland (IIMSI), EOC, Via Tesserete 46, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, University of Italian Switzerland, Via Buffi 13, 6900 Lugano, Switzerland
| | - Monica Casiraghi
- Department of Thoracic Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
| | - Filippo De Marinis
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
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Muacevic A, Adler JR, Kalkan Z, Teke F, Onat S, Urakçı Z, Kaplan MA, Küçüköner M, Işıkdoğan A. Neoadjuvant Therapy and Factors Influencing Survival in Locally Advanced Non-Small Cell Lung Cancer. Cureus 2023; 15:e33392. [PMID: 36751212 PMCID: PMC9897720 DOI: 10.7759/cureus.33392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
AIM We aimed to investigate the effectiveness of neoadjuvant therapy (NAT) and clinicopathological characteristics in locally advanced non-small cell lung cancer (NSCLC) (IIIA-IIIB), as well as the influence of the post-NAT treatment modalities on survival. MATERIALS AND METHODS This study included patients who presented to the Dicle University Medical Oncology Clinic and received NAT for a diagnosis of locally advanced NSCLC between 2004 and 2020. Clinicopathological and radiological data of the 57 patients whose data could be retrieved from the hospital archive system were retrospectively reviewed. Patients' overall survival (OS) and failure-free survival (FFS) times and the factors influencing these times were evaluated. RESULTS This study included a total of 57 patients consisting of five (8.8%) females and 52 (91.2%) males. The median patient age at diagnosis was 58 (30-75) years. All patients had received four courses of chemotherapy during the neoadjuvant period. When the factors influencing OS were evaluated, the post-NAT modality was found to have a statistically significant effect on survival. FFS times were 12, 13, and 16 months in the chemotherapy, chemoradiotherapy, and surgery arms, respectively (log-rank p=0.035). FFS was longer in those who underwent surgery (Hazard ratio (HR): 0.33, 95 % CI: 0.14-0.77, (p=0.01)). OS times were 20, 21, and 55 months in the chemotherapy, chemoradiotherapy, and surgery arms, respectively (log-rank p=0.05). OS was longer in the arm undergoing surgery compared to the other arms (HR: 0.36, 95% CI: 0.14-0.87, (p=0.02)). Five-year survival rates for the chemotherapy, chemoradiotherapy, and surgery arms were 14.3%, 21.4%, and 40%, respectively. CONCLUSIONS This study shows that achieving an operable status is the most important indicator of survival and that patients undergoing surgery have a marked advantage in OS and FFS compared with patients receiving chemoradiotherapy or palliative chemotherapy.
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Liu Y, Jiang S, Lin Y, Yu H, Yu L, Zhang X. Research landscape and trends of lung cancer radiotherapy: A bibliometric analysis. Front Oncol 2022; 12:1066557. [DOI: 10.3389/fonc.2022.1066557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
Backgroundradiotherapy is one of the major treatments for lung cancer and has been a hot research area for years. This bibliometric analysis aims to present the research trends on lung cancer radiotherapy.MethodOn August 31, 2022, the authors identified 9868 articles on lung cancer radiotherapy by the Web of Science (Science Citation Indexing Expanded database) and extracted their general information and the total number of citations. A bibliometric analysis was carried out to present the research landscape, demonstrate the research trends, and determine the most cited papers (top-papers) as well as top-journals on lung cancer radiotherapy. After that, the authors analyzed the recent research hotspots based on the latest publications in top-journals.ResultsThese 9868 papers were cited a total of 268,068 times. “Durvalumab after chemoradiotherapy in stage III non–small-cell lung cancer” published in 2017 by Antonia et al.was the most cited article (2110 citations). Among the journals, New England Journal of Medicine was most influential. Moreover, J. Clin. Oncol. and Int. J. Radiat. Oncol. Biol. Phys. was both influential and productive. Corresponding authors represented the USA (2610 articles) and China mainland (2060 articles) took part in most publications and articles with corresponding authors from Netherlands were most cited (46.12 citations per paper). Chemoradiotherapy was the hottest research area, and stereotactic body radiotherapy has become a research hotspot since 2006. Radiotherapy plus immunotherapy has been highly focused since 2019.ConclusionsThis bibliometric analysis comprehensively and quantitatively presents the research trends and hotspots based on 9868 relevant articles, and further suggests future research directions. The researchers can benefit in selecting journals and in finding potential collaborators. This study can help researchers gain a comprehensive picture of the research landscape, historical development, and recent hotspots in lung cancer radiotherapy and can provide inspiration for future research.
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Grzywacz VP, Quinn TJ, Almahariq MF, Siddiqui ZA, Kim SW, Guerrero TM, Stevens CW, Grills IS. Trimodality therapy for patients with stage III non-small-cell lung cancer: A comprehensive surveillance, epidemiology, and end results analysis. Cancer Treat Res Commun 2022; 32:100571. [PMID: 35533588 DOI: 10.1016/j.ctarc.2022.100571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Debate exists regarding the optimal management for patients with stage III non-small-cell lung cancer (NSCLC). Recent inclusion of chemotherapeutic data in the Surveillance, Epidemiology, and End Results (SEER) database has made it possible to identify patients with NSCLC who received chemotherapy. We hypothesized that patients with stage III NSCLC experience improved overall survival from trimodality therapy (TMT) versus definitive chemoradiation therapy (CRT) alone. MATERIALS AND METHODS We analyzed the overall survival of stage III NSCLC patients based on the receipt of TMT versus CRT alone. This included crude and adjusted univariate models as well as crude and doubly robust adjusted multivariable analyses, both utilizing propensity score matching and inverse probability of treatment weighting. Factors included in the multivariable analyses included: age, sex, marital status, income, date of diagnosis, primary site, histology, grade, T stage, N stage, and intended treatment. Planned subset analyses were performed for stage III(N2) patients. RESULTS Adult patients with stage III NSCLC (N = 9008) from the SEER database were included in our analyses. In our univariate analyses, an overall survival benefit was observed for TMT versus CRT (CrudeHR = 0.58, 95% CI = 0.55-0.61, p < 0.001; AdjHR = 0.58, 95% CI = 0.54-0.61, p < 0.001). This persisted in both crude and doubly robust multivariable analyses (CrudeHR = 0.57, 95% CI = 0.53-0.61, p < 0.001; AdjHR = 0.56, 95% CI = 0.53-0.59, p < 0.001). Patients with stage III(N2) disease also demonstrated a significant benefit to OS with TMT versus CRT alone. CONCLUSION The significant difference in overall survival seen with TMT suggests this may be an effective treatment approach for select patients.
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Affiliation(s)
- Vincent P Grzywacz
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI United States.
| | - Thomas J Quinn
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI United States
| | - Muayad F Almahariq
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI United States
| | - Zaid A Siddiqui
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA United States
| | - Sang W Kim
- Department of Thoracic Surgery, Beaumont Health, Royal Oak, MI United States
| | - Thomas M Guerrero
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI United States
| | - Craig W Stevens
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI United States
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI United States
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Khalifa J, Lerouge D, Le Péchoux C, Pourel N, Darréon J, Mornex F, Giraud P. Radiotherapy for primary lung cancer. Cancer Radiother 2021; 26:231-243. [PMID: 34953709 DOI: 10.1016/j.canrad.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Herein are presented the recommendations from the Société française de radiothérapie oncologique regarding indications and modalities of lung cancer radiotherapy. The recommendations for delineation of the target volumes and organs at risk are detailed.
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Affiliation(s)
- J Khalifa
- Département de radiothérapie, Institut universitaire du cancer de Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France.
| | - D Lerouge
- Département de radiothérapie, centre François-Baclesse, 3, avenue du General-Harris, 14076 Caen, France
| | - C Le Péchoux
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - N Pourel
- Département de radiothérapie, institut Sainte-Catherine, 250, chemin de Baigne-Pieds, CS80005, 84918 Avignon cedex 9, France
| | - J Darréon
- Service de physique médicale, institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - F Mornex
- Service de radiothérapie, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - P Giraud
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, Paris, France; Université de Paris, 85, boulevard Saint-Germain, 75006 Paris, France
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Is IMRT or VMAT superior or inferior to 3D conformal therapy in the treatment of lung cancer? A brief literature review. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s146039692100008x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abstract
Aim:
To identify treatment outcome, dose uniformity, treatment time, toxicity among 3D conformal therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), volumetric-modulated arc therapy (VMAT) for non-small-cell lung cancer (NSCLC) based on literature review.
Methods:
A literature search was conducted using PubMed/MEDLINE, BMC—part of Springer Nature, Google Scholar and iMEDPub Ltd with the following keywords for filtering: 3D-CRT, IMRT, VMAT, lung cancer, local control and radiobiology. A total of 14 publications were finally selected for the comparison of 3D-CRT, IMRT and VMAT to determine which technique is superior or inferior among these three.
Results:
Compared to 3D-CRT, IMRT delivers more precise treatment, has better conformal dose coverage to planning target volume (PTV) that covers gross tumour with microscopic extension, respiratory tumour motion and setup margin. 3D-CRT has large number of limitations: low overall survival (OS), large toxicity, secondary malignancies.
Conclusions:
It is difficult to choose the best technique for treating NSCLC due to patient conditions and technique availability. A high-precision treatment may improve tumour control probability (TCP) and patient’s quality of life. VMAT, whether superior or not, needs more clinical trials to treat NSCLC and requires longer dose optimisation time with the greatest benefit of rapid treatment delivery, improved patient comfort, reduced intrafraction motion and increased patient throughput compared to IMRT and 3D-CRT.
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Immunotherapy for Lung Cancer-Improving Outcomes in Patients With Locally Advanced Non-Small Cell Lung Cancer With Immunotherapy. ACTA ACUST UNITED AC 2020; 26:548-554. [PMID: 33298727 DOI: 10.1097/ppo.0000000000000485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with locally advanced non-small cell lung cancer (NSCLC), a heterogenous group encompassing stage IIIA-IIIC disease, often have surgically unresectable cancer and are managed with concurrent chemoradiation. Since the establishment of platinum-based chemoradiation as standard of care for unresectable locally advanced NSCLC, various strategies including escalating radiation dose, targeted therapies, antiangiogenic agents, and induction or consolidation chemotherapy have failed to show improvement in outcomes. However, recently, use of consolidation immunotherapy with durvalumab following concurrent chemoradiation therapy has been associated with improvement in survival and has led to a paradigm shift. In this review, we will summarize results from trials of immunotherapy in locally advanced NSCLC and comment on ongoing trials and potential future investigations.
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Prasad RN, Williams TM. A narrative review of toxicity of chemoradiation and immunotherapy for unresectable, locally advanced non-small cell lung cancer. Transl Lung Cancer Res 2020; 9:2040-2050. [PMID: 33209624 PMCID: PMC7653152 DOI: 10.21037/tlcr-20-638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Despite declining smoking rates, lung cancer remains the second most common malignancy in the United States and the leading cause of cancer-related mortality. Non-small cell lung cancer (NSCLC) comprises roughly 85% of cases, and patients tend to present with advanced disease. Historically, concurrent chemoradiotherapy (CRT) has been the standard of care for stage III unresectable NSCLC but outcomes even with multimodal therapy have remained relatively poor. Efforts to improve outcomes through radiation dose escalation with conventional dose fractionation were unsuccessful with RTOG 0617, demonstrating significantly decreased overall survival (OS) with high dose radiation with respect to standard therapy. The recent PACIFIC trial established a new role for consolidative immune checkpoint blockade therapy after CRT using the programmed death ligand 1 (PD-L1) inhibitor durvalumab, by demonstrating significantly improved progression free survival and OS. Although promising, the addition of immunotherapy to multimodal therapy has generated debate regarding the most effective immune pathways to target, appropriate sequencing of therapy, most effective radiation techniques, and toxicity-related concerns. This review will highlight recent and ongoing trials in unresectable, locally advanced NSCLC that incorporate chemotherapy, radiation, and immunotherapy with an emphasis on analysis of treatment-related toxicities and implications for future study design.
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Affiliation(s)
- Rahul N Prasad
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA
| | - Terence M Williams
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA
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14
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Patel M, Bruno D, Grubb W, Biswas T. The changing landscape of stage III lung cancer: a literature review. Expert Rev Anticancer Ther 2020; 20:675-686. [PMID: 32667262 DOI: 10.1080/14737140.2020.1796645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The treatment of stage III non-small cell lung cancer (NSCLC) remains challenging and associated with overall poor outcomes. Since seminal studies in the early 90s introduced concurrent chemo-radiotherapy as standard of care for treatment of this disease, no major advances have been introduced in this landscape. Both radiation dose escalation and neoadjuvant/adjuvant chemotherapy strategies were unsuccessful to improve the survival over standard of care radiation dose and chemotherapy schedule: five-year overall survival (OS) ranging from 15-20%. However, in 2017 the PACIFIC Trial demonstrated that the addition of consolidative immune checkpoint inhibitor durvalumab for 1 year led to superior progression-free survival (PFS) and 3-year overall survival with no significant increase in toxicity compared to placebo in patients who achieved disease control with concurrent chemo-RT. AREAS COVERED This article reviews the treatment evolution of stage III NSCLC over the past decades, discusses current standard of care strategies, and highlights potential future directions for the management of this condition. EXPERT OPINION Ongoing trials incorporating upfront checkpoint inhibitors with radiotherapy will answer whether adding checkpoint inhibitors to chemotherapy or substituting them for chemotherapy altogether will improve long-term outcome.
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Affiliation(s)
- Monaliben Patel
- University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University , Cleveland, OH, USA
| | - Debora Bruno
- University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University , Cleveland, OH, USA
| | - William Grubb
- University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University , Cleveland, OH, USA
| | - Tithi Biswas
- University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University , Cleveland, OH, USA
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15
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Pattern-of-failure and salvage treatment analysis after chemoradiotherapy for inoperable stage III non-small cell lung cancer. Radiat Oncol 2020; 15:148. [PMID: 32517716 PMCID: PMC7285541 DOI: 10.1186/s13014-020-01590-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 06/03/2020] [Indexed: 12/16/2022] Open
Abstract
Background Loco-regional and distant failure are common in inoperable stage III non small-cell lung cancer (NSCLC) after chemoradiotherapy (CRT). However, there is limited real-world data on failure pattern, patient prognosis and salvage options. Methods We analysed 99 consecutive patients with inoperable stage III NSCLC treated with CRT between 2011 and 2016. Follow up CT scans from date of the first-site failure were matched with the delivered radiation treatment plans. Intra-thoracic loco-regional relapse was defined as in-field (IFR) vs. out-of-field recurrence (OFR) [in- vs. outside 50Gy isodose line in the involved lung], respectively. Extracranial distant (DMs) and brain metastases (BMs) as first site of recurrence were also evaluated. Using the Kaplan-Meier method, impact of salvage surgery (sS), radiotherapy (sRT), chemotherapy (sCT) and immunotherapy (sIO) on patient survival was assessed. Results Median follow-up was 60.0 months. Median PFS from the end of CRT for the entire cohort was 7.5 (95% CI: 6.0–9.0 months) months. Twenty-six (26%) and 25 (25%) patients developed IFR and OFR. Median time to diagnosis of IFR and OFR was 7.2 and 6.2 months. In the entire cohort, onset of IFR and OFR did not influence patient outcome. However, in 73 (74%) patients who survived longer than 12 months after initial diagnosis, IFR was a significant negative prognostic factor with a median survival of 19.3 vs 40.0 months (p < 0.001). No patients with IFR underwent sS and/or sRT. 18 (70%) and 5 (19%) patients with IFR underwent sCT and sIO. Three (12%) patients with OFR underwent sS and are still alive with 3-year survival rate of 100%. 5 (20%) patients with OFR underwent sRT with a median survival of 71.2 vs 19.1 months (p = 0.014). Four (16%) patients with OFR received sIO with a numerical survival benefit (64.6 vs. 26.4 months, p = 0.222). DMs and BMs were detected in 27 (27%) and 16 (16%) patients after median time of 5.8 and 5.13 months. Both had no impact on patient outcome in the entire cohort. However, patients with more than three BMs showed significantly poor OS (9.3 vs 26.0 months; p = 0.012). Conclusions After completion of CRT, IFR was a negative prognostic factor in those patients, who survived longer than 12 months after initial diagnosis. Patients with OFR benefit significantly from salvage local treatment. Patients with more than three BMs as first site of failure had a significantly inferior outcome.
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16
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Eby ME, Seder CW. The Landmark Series: Multimodality Therapy for Stage 3A Non-small Cell Lung Cancer. Ann Surg Oncol 2020; 27:3030-3036. [PMID: 32388738 DOI: 10.1245/s10434-020-08553-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Marcus E Eby
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Christopher W Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA
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17
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WITHDRAWN: Patterns of care for patients with non-operable T1-4 N+ M0 non-small cell lung cancer in the US and outcomes with radiation or chemotherapy monotherapies. Lung Cancer 2020. [DOI: 10.1016/j.lungcan.2020.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Abbas MN, Ayoola A, Padman S, Kumar R, Leung J, Ullah S, Koczwara B, Sukumaran S, Kichenadasse G, Roy A, Richards AM, Bowden JJ, Karapetis CS. Survival and late toxicities following concurrent chemo-radiotherapy for locally advanced stage III non-small cell lung cancer: findings of a 10-year Australian single centre experience with long term clinical follow up. J Thorac Dis 2019; 11:4241-4248. [PMID: 31737309 DOI: 10.21037/jtd.2019.09.56] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The preferred management of patients with unresectable locally advanced non-small cell lung cancer (LA-NSCLC) is concurrent chemo-radiotherapy (CRT). Acute CRT-related toxicities are well defined, however, less is known about late toxicities. The aim of the study was to examine the outcomes and late toxicities in Stage III NSCLC treated with CRT. Methods A retrospective review of the data from patients with stage III NSCLC treated with CRT was performed between May 2000 and June 2010. Demographics, tumour and treatment characteristics, toxicities and survival data were examined from hospital records of the patients. Progression free survival (PFS) and overall survival (OS) were evaluated by standard Kaplan-Meier survival curves. The censor date was set on 31 October 2016. Results Sixty-three patients were identified with a median age of 66.6 years [interquartile range (IQR) 57.2-72.1], two-third (n=41, 65.1%) were male, majority were current or ex-smokers (n=52, 82.5%), 42 (66.7%) patients had stage IIIB disease and 21 (33.3%) had stage IIIA disease. The most common histologic subtype was adenocarcinoma 30 (47.6%). The median PFS and OS of the whole population was 10.6 months (95% CI, 4.1-17.3 months) and 21 months (95% CI, 12.7-29.3 months) respectively. The 5-year OS rates for stage IIIA and IIIB were 24% and 16% respectively. The 1-, 3- and 5-year OS rates for all patients were 63.5%, 46% and 18.7% respectively. Acute grade 3 and 4 toxicities included 28 haematological and 17 non-haematological events. The incidence of late toxicities was 58.9%. Thirty-three events of late grade 3 and 4 toxicities were recorded. The most common late toxicity was symptomatic radiation-induced pulmonary fibrosis (39.3%), others include ototoxicity (7.1%), persistent dysphagia (7.1%) and one case of acute myeloid leukaemia. All patients that were alive at the censor date had developed radiation-induced fibrosis with associated symptoms of respiratory insufficiency. Conclusions The 5-year OS of patients with stage III NSCLC treated with CRT was in keeping with survival figures reported from prospective clinical trials. There is, however, significant morbidity associated with long-term survival and this should be taken into account when making informed treatment decisions.
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Affiliation(s)
- M Nazim Abbas
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Adeola Ayoola
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Sunita Padman
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Rajiv Kumar
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia
| | - John Leung
- Genesis Care, Flinders Private Hospital, Adelaide, SA, Australia
| | - Shahid Ullah
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Bogda Koczwara
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia.,Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
| | - Shawgi Sukumaran
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia.,Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
| | - Ganessan Kichenadasse
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia.,Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
| | - Amitesh Roy
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia.,Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
| | - Alison M Richards
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Jeffrey J Bowden
- Department of Respiratory and Sleep Services, Flinders Medical Centre, Adelaide, SA, Australia
| | - Christos S Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia.,Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
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19
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Gill HS, Ramalingam SS. A new standard of care for patients with surgically unresectable stage III non-small cell lung cancer. Cancer 2019; 125:2148-2153. [PMID: 30825394 DOI: 10.1002/cncr.31996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/19/2018] [Accepted: 12/27/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Harpaul S Gill
- Department of Hematology and Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia
| | - Suresh S Ramalingam
- Department of Hematology and Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia
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20
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An N, Jing W, Wang H, Li J, Liu Y, Yu J, Zhu H. Risk factors for brain metastases in patients with non-small-cell lung cancer. Cancer Med 2018; 7:6357-6364. [PMID: 30411543 PMCID: PMC6308070 DOI: 10.1002/cam4.1865] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 12/25/2022] Open
Abstract
Brain metastases (BM) are severe incidents in patients with non-small-cell lung cancer (NSCLC). The controversial value of prophylactic cranial irradiation (PCI) in NSCLC in terms of survival benefit prompted us to explore the possible risk factors for BM in NSCLC and identify the potential population most likely to benefit from PCI. Risk factors for brain metastases in NSCLC are reviewed in this article. Identifying patients with a higher risk of BM could possibly increase the benefit of PCI while reducing the discomfort and risks caused by unnecessary invasive procedures in the NSCLC patient population. Future studies might focus on finding a solid basis for the prediction of the occurrence of brain metastases and for the therapeutic decision on the use of PCI.
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Affiliation(s)
- Ning An
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong UniversityJinanChina
| | - Wang Jing
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong Academy of Medical SciencesJinanChina
| | - Haoyi Wang
- Department of HematologyQilu Hospital, Shandong UniversityJinanChina
| | - Ji Li
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong Academy of Medical SciencesJinanChina
| | - Yang Liu
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong Academy of Medical SciencesJinanChina
| | - Jinming Yu
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong Academy of Medical SciencesJinanChina
| | - Hui Zhu
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong Academy of Medical SciencesJinanChina
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21
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Harris JP, Nwachukwu C, Qian Y, Pollom E, Loo BW, Das M, Diehn M. Invasive nodal evaluation prior to stereotactic ablative radiation for non-small cell lung cancer. Lung Cancer 2018; 124:76-85. [DOI: 10.1016/j.lungcan.2018.07.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/04/2018] [Accepted: 07/22/2018] [Indexed: 12/25/2022]
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22
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Deek MP, Kim S, Beck R, Yegya-Raman N, Langenfeld J, Malhotra J, Mahmoud O, Aisner J, Jabbour SK. Variations in Initiation Dates of Chemotherapy and Radiation Therapy for Definitive Management of Inoperable Non-Small Cell Lung Cancer Are Associated With Decreases in Overall Survival. Clin Lung Cancer 2018; 19:e381-e390. [PMID: 29752011 PMCID: PMC10868642 DOI: 10.1016/j.cllc.2018.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/10/2018] [Accepted: 03/10/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND We evaluated trends in administration of concurrent chemoradiation therapy (CRT) and how variations in start dates of chemotherapy and radiotherapy affected overall survival (OS) in patients with non-small cell lung cancer (NSCLC) undergoing a course of definitive CRT. MATERIALS AND METHODS Cases of NSCLC treated with definitive CRT were obtained from the National Cancer Database. A survival analysis was performed with Kaplan-Meier curves and Cox proportional hazards models. Propensity score matching was conducted. RESULTS On a national level, only 48.6% of patients began concurrent CRT on the same day. In a propensity-matched population, starting CRT within 6 days was associated with improved OS (17.9 months) compared with starting 7 to 13 days apart (16.5 months; P = .04). Starting dual therapy within 6 days of each other was associated with a 7% reduction in the risk of death (hazard ratio, 0.93; P = .05). Furthermore, in a propensity-matched cohort, starting CRT within 3 days was associated with longer survival (18.7 months) compared with 4 to 6 days apart (17.5 months; P = .02). Starting treatment 4 to 6 days apart was associated with an 8% increased risk of death (hazard ratio, 1.08; P = .04). CONCLUSION A large proportion (48.6%) of patients with unresectable NSCLC do not initiate CRT on the same day as is considered standard by national guidelines. In this population, nonsimultaneous initiation of CRT was associated with differences in OS. Further efforts to understand the mitigating factors and barriers that interfere with timely delivery of concurrent CRT are needed.
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Affiliation(s)
- Matthew P Deek
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins Hospital, Baltimore, MD; Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Sinae Kim
- Department of Biostatistics, School of Public Health, Rutgers University, Piscataway, NJ; Biometrics Division, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Robert Beck
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Nikhil Yegya-Raman
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - John Langenfeld
- Rutgers Cancer Institute of New Jersey, Division of Thoracic Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Joyti Malhotra
- Rutgers Cancer Institute of New Jersey, Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Omar Mahmoud
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Joseph Aisner
- Rutgers Cancer Institute of New Jersey, Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Salma K Jabbour
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ.
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23
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Trovò MG, Gigante M, Minatel E, Gobitti C, Franchin G. Combined Modality Treatment of Locally Advanced Lung Cancer. TUMORI JOURNAL 2018; 84:259-69. [PMID: 9620255 DOI: 10.1177/030089169808400227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper describes the mechanisms of action of ionizing radiations combined with antineoplastic drugs. Some relevant drugs for the combined modality treatments of locally advanced lung cancer are reported. The meta-analyses including randomized trials comparing single agent (radiotherapy or chemotherapy) versus combined chemoterapy and radiotherapy in patients with unresectable non small cell lung cancer and limited small cell lung cancer are then reviewed. The clinical outcome in relation to different schedules of chemoradiotherapy (sequential, alternating and concurrent) is also focussed.
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Affiliation(s)
- M G Trovò
- Department of Radiation Oncology, Centro di Riferimento Oncologico, IRCCS, Aviano (PN), Italy.
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24
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Chao HH, Berman AT. Proton therapy for thoracic reirradiation of non-small cell lung cancer. Transl Lung Cancer Res 2018; 7:153-159. [PMID: 29876314 DOI: 10.21037/tlcr.2018.03.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Lung cancer is a leading cause of cancer death with frequent local failures after initial curative-intent treatment. Locally recurrent non-small cell lung cancer represents a challenging clinical scenario as patients have often received prior radiation as part of a definitive treatment regimen. Proton beam therapy, through its characteristic Bragg peak and lack of exit dose is a potential means of minimizing the toxicity to previously irradiated organs and improving the therapeutic ratio. This article aims to review the rationale for the use of proton beam therapy for treatment of locally recurrent non-small cell lung cancer, highlight the current published experience on the feasibility, efficacy, and limitations of proton beam reirradiation, and discuss future avenues for improved patient selection and treatment delivery.
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Affiliation(s)
- Hann-Hsiang Chao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Abigail T Berman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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25
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Jones CM, Brunelli A, Callister ME, Franks KN. Multimodality Treatment of Advanced Non-small Cell Lung Cancer: Where are we with the Evidence? CURRENT SURGERY REPORTS 2018; 6:5. [PMID: 29456881 PMCID: PMC5805813 DOI: 10.1007/s40137-018-0202-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW The majority of patients with non-small cell lung cancer (NSCLC) present with advanced disease and overall survival rates are poor. This article outlines the current and outstanding evidence for the use of multimodality treatment in this group of patients, including in combination with an increasing number of treatment options, such as immunotherapy and genotype-targeted small molecule inhibitors. RECENT FINDINGS Optimal therapy for surgically resectable stage III disease remains debatable and currently the choice of treatment reflects each individual patient's disease characteristics and the expertise and opinion of the thoracic multi-disciplinary team. Evidence for a distinct oligometastatic state in which improved outcomes can be achieved remains minimal and there is as yet no consensus definition for oligometastatic lung cancer. Whilst there is supporting evidence for the aggressive management of isolated metastases, the use of consolidative therapy for multiple metastases remains unproven. SUMMARY Evolution of new RT technologies, improved surgical technique and a plethora of interventional-radiology-guided ablative therapies are widening the choice of available treatment modalities to patients with NSCLC. In the setting of resectable locally advanced disease and the oligometastatic state, there is a growing need for randomised comparison of the available treatment modalities to guide both treatment and patient selection.
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Affiliation(s)
- Christopher M. Jones
- Leeds Institute of Cancer & Pathology, Faculty of Medicine & Health, University of Leeds, Leeds, UK
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Molecular & Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Alessandro Brunelli
- Department of Thoracic Surgery, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Matthew E. Callister
- Department of Respiratory Medicine, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kevin N. Franks
- Leeds Institute of Cancer & Pathology, Faculty of Medicine & Health, University of Leeds, Leeds, UK
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
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26
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Bütof R, Simon M, Löck S, Troost EGC, Appold S, Krause M, Baumann M. PORTAF - postoperative radiotherapy of non-small cell lung cancer: accelerated versus conventional fractionation - study protocol for a randomized controlled trial. Trials 2017; 18:608. [PMID: 29262836 PMCID: PMC5738814 DOI: 10.1186/s13063-017-2346-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 11/24/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In early-stage non-small cell lung cancer (NSCLC) without affected lymph nodes detected at staging, surgical resection is still the mainstay of treatment. However, in patients with metastatic mediastinal lymph nodes (pN2) or non-radically resected primary tumors (R1/R2), postoperative radiotherapy (possibly combined with chemotherapy) is indicated. So far, investigations about time factors affecting postoperative radiotherapy have only examined the waiting time defined as interval between surgery and start of radiotherapy, but not the overall treatment time (OTT) itself. Conversely, results from trials on primary radio(chemo)therapy in NSCLC show that longer OTT correlates with significantly worse local tumor control and overall survival rates. This time factor of primary radio(chemo)therapy is thought to mainly be based on repopulation of surviving tumor cells between irradiation fractions. It remains to be elucidated if such an effect also occurs when patients with NSCLC are treated with postoperative radiotherapy after surgery (and chemotherapy). Our own retrospective data suggest an advantage of shorter OTT also for postoperative radiotherapy in this patient group. METHODS/DESIGN This is a multicenter, prospective randomized trial investigating whether an accelerated course of postoperative radiotherapy with photons or protons (7 fractions per week, 2 Gy fractions) improves locoregional tumor control in NSCLC patients in comparison to conventional fractionation (5 fractions per week, 2 Gy fractions). Target volumes and total radiation doses will be stratified in both treatment arms based on individual risk factors. DISCUSSION For the primary endpoint of the study we postulate an increase in local tumor control from 70% to 85% after 36 months. Secondary endpoints are overall survival of patients; local recurrence-free and distant metastases-free survival after 36 months; acute and late toxicity and quality of life for both treatment methods. TRIAL REGISTRATION ClinicalTrials.gov, NCT02189967 . Registered on 22 May 2014.
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Affiliation(s)
- R Bütof
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. .,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany. .,German Cancer Consortium (DKTK), partner site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany. .,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany.
| | - M Simon
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), partner site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
| | - S Löck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
| | - E G C Troost
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany.,German Cancer Consortium (DKTK), partner site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany
| | - S Appold
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
| | - M Krause
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany.,German Cancer Consortium (DKTK), partner site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
| | - M Baumann
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany.,German Cancer Consortium (DKTK), partner site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
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Mason J, Blyth B, MacManus MP, Martin OA. Treatment for non-small-cell lung cancer and circulating tumor cells. Lung Cancer Manag 2017; 6:129-139. [PMID: 30643579 PMCID: PMC6310303 DOI: 10.2217/lmt-2017-0019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/02/2018] [Indexed: 12/25/2022] Open
Abstract
Surgery is the main curative therapy for patients with localized non-small-cell lung cancer while radiotherapy (RT), alone or with concurrent platinum-based chemotherapy, remains the primary curative modality for locoregionally advanced non-small-cell lung cancer. The risk of distant metastasis is high after curative-intent treatment, largely attributable to the presence of undetected micrometastases, but which could also be related to treatment-related increases in circulating tumor cells (CTCs). CTC mobilization by RT or systemic therapies might either reflect efficient tumor destruction with improved prognosis, or might promote metastasis and thus represent a potential therapeutic target. RT may induce prometastatic biological alterations in CTC at the cellular level, which are detectable by 'liquid biopsies', though their rarity represents a major challenge. Improved methods of isolation and ex vivo propagation will be essential for the future of CTC research.
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Affiliation(s)
- Joel Mason
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Research Division, Peter MacCallum Cancer Center, Melbourne, Australia
- Department of Pathology, The University of Melbourne, Melbourne, Australia
| | - Benjamin Blyth
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Research Division, Peter MacCallum Cancer Center, Melbourne, Australia
| | - Michael P MacManus
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Olga A Martin
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Research Division, Peter MacCallum Cancer Center, Melbourne, Australia
- Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
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Huang CY, Ju DT, Chang CF, Muralidhar Reddy P, Velmurugan BK. A review on the effects of current chemotherapy drugs and natural agents in treating non-small cell lung cancer. Biomedicine (Taipei) 2017; 7:23. [PMID: 29130448 PMCID: PMC5682982 DOI: 10.1051/bmdcn/2017070423] [Citation(s) in RCA: 253] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/20/2017] [Indexed: 12/20/2022] Open
Abstract
Lung cancer is the leading cause of cancer deaths worldwide, and this makes it an attractive disease to review and possibly improve therapeutic treatment options. Surgery, radiation, chemotherapy, targeted treatments, and immunotherapy separate or in combination are commonly used to treat lung cancer. However, these treatment types may cause different side effects, and chemotherapy-based regimens appear to have reached a therapeutic plateau. Hence, effective, better-tolerated treatments are needed to address and hopefully overcome this conundrum. Recent advances have enabled biologists to better investigate the potential use of natural compounds for the treatment or control of various cancerous diseases. For the past 30 years, natural compounds have been the pillar of chemotherapy. However, only a few compounds have been tested in cancerous patients and only partial evidence is available regarding their clinical effectiveness. Herein, we review the research on using current chemotherapy drugs and natural compounds (Wortmannin and Roscovitine, Cordyceps militaris, Resveratrol, OSU03013, Myricetin, Berberine, Antroquinonol) and the beneficial effects they have on various types of cancers including non-small cell lung cancer. Based on this literature review, we propose the use of these compounds along with chemotherapy drugs in patients with advanced and/or refractory solid tumours.
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Affiliation(s)
- Chih-Yang Huang
- Graduate Institute of Basic Medical Science, China Medical University, Taichung 404, Taiwan - Graduate Institute of Chinese Medical Science, China Medical University, Taichung 404, Taiwan - Department of Biological Science and Technology, Asia University, Taichung 413, Taiwan
| | - Da-Tong Ju
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Chih-Fen Chang
- Department of Internal Medicine, Division of Cardiology, Armed Forces Taichung General Hospital, Taichung 406, Taiwan
| | - P Muralidhar Reddy
- Department of Chemistry, Nizam College, Osmania University, Hyderabad-500001, India
| | - Bharath Kumar Velmurugan
- Faculty of Applied Sciences, Ton Duc Thang University, Tan Phong Ward, District 7, 700000 Ho Chi Minh City, Vietnam
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Yamagishi T, Kodaka N, Kurose Y, Watanabe K, Nakano C, Kishimoto K, Oshio T, Niitsuma K, Matsuse H. Analysis of predictive parameters for the development of radiation-induced pneumonitis. Ann Thorac Med 2017; 12:252-258. [PMID: 29118857 PMCID: PMC5656943 DOI: 10.4103/atm.atm_355_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION: Prevention and effective treatment of radiation-induced pneumonitis (RP) could facilitate greater use of radiation therapy (RT) for lung cancer. The purpose of this study was to determine clinical parameters useful for early prediction of RP. METHODS: Blood sampling, pulmonary function testing, chest computed tomography, and bronchoalveolar lavage (BAL) were performed in patients with pathologically confirmed lung cancer who had completed ≥60 Gy of RT, at baseline, shortly after RT, and at 1 month posttreatment. RESULTS: By 3 months post-RT, 11 patients developed RP (RP group) and the remaining 11 patients did not (NRP group). RT significantly increased total cell counts and alveolar macrophages in BAL of the NRP group, whereas lymphocyte count was increased in both groups. Matrix metallopeptidase-9 (MMP-9) increased and vascular endothelial growth factor decreased significantly in the BAL fluid (BALF) of the RP group following RT. Serum surfactant protein D (SP-D) increased significantly in the NRP group. SP-D in BALF from the RP group increased significantly with a subsequent increase in serum SP-D. Pulmonary dilution decreased similarly in both groups of patients. CONCLUSIONS: Increased SP-D in BALF, rather than that in serum, could be useful biomarkers in predicting RP. The MMP-9 in BALF might play a role in the pathogenesis of RP. Pulmonary dilution test may not be predictive of the development of RP.
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Affiliation(s)
- Toru Yamagishi
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Norio Kodaka
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yoshiyuki Kurose
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kayo Watanabe
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Chihiro Nakano
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kumiko Kishimoto
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Takeshi Oshio
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kumiko Niitsuma
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Hiroto Matsuse
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
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Nakamichi S, Horinouchi H, Asao T, Goto Y, Kanda S, Fujiwara Y, Nokihara H, Yamamoto N, Ito Y, Watanabe SI, Ohe Y. Comparison of Radiotherapy and Chemoradiotherapy for Locoregional Recurrence of Non–small-cell Lung Cancer Developing After Surgery. Clin Lung Cancer 2017; 18:e441-e448. [DOI: 10.1016/j.cllc.2017.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/30/2017] [Accepted: 05/02/2017] [Indexed: 12/17/2022]
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Chen F, Hu P, Liang N, Xie J, Yu S, Tian T, Zhang J, Deng G, Zhang J. Concurrent chemoradiotherapy with weekly nedaplatin versus radiotherapy alone in elderly patients with non-small-cell lung cancer. Clin Transl Oncol 2017; 20:294-301. [PMID: 28741074 DOI: 10.1007/s12094-017-1716-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/08/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE We conduct this study to compare the efficacy and toxicity of intensity-modulated radiotherapy (IMRT) concurrent weekly nedaplatin (NDP) versus IMRT alone in the stage III/IV non-surgical elderly patients with non-small-cell lung cancer (NSCLC). METHODS 117 patients were enrolled into our study. The patients were assigned into two different groups: radiotherapy (RT) group and chemoradiotherapy (CRT) group. Patients in RT group were treated with IMRT at a single daily dose of 2 Gy for 5 days per week, totally 52-66 Gy. The CRT group, IMRT concurrent weekly NDP at a dose of 25 mg/m2. RESULTS In CRT group, the median survival was 11.0 months (95% confidence interval [CI], 8.894-13.106 months) and in RT group, it was 7.0 months (95% CI 5.771-8.229 months). The 1-year, 2-year, 3-year, survival rates in the combined treatment arm were higher than the radiation therapy arm (46.8 vs 25.9%, 25.1 vs 11.8%, 14.7 vs 8.0%; p < 0.001). The Cox's multiple regression analysis showed that CRT had significantly better overall survival than RT (HR 0.523; 95.0% CI 0.338-0.807; p = 0.003). The objective response rate provided that 73.3% treated with CRT compared with 51.1% (p = 0.018) received RT alone. Of the hematologic toxicities, leukocytes (35.0 vs 0%; p < 0.001), neutrophils (33.3 vs 0%; p < 0.001) were significantly more common in the CRT group than the RT group. CONCLUSIONS We first discovered that NDP concurrent IMRT for treating stage III/IV non-surgical elderly patients with NSCLC was good curative effect of better objective response rate and well-tolerated. However, within the low number of patients, only stage IV gained a survival benefit.
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Affiliation(s)
- F Chen
- Department of Oncology, Weifang Medical College, Weifang, Shandong, China
| | - P Hu
- Department of Radiation Oncology, Qianfoshan Hospital Affiliated Shandong University, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - N Liang
- Department of Radiation Oncology, Qianfoshan Hospital Affiliated Shandong University, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - J Xie
- Department of Radiation Oncology, Qianfoshan Hospital Affiliated Shandong University, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - S Yu
- Department of Radiation Oncology, Qianfoshan Hospital Affiliated Shandong University, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - T Tian
- Department of Radiation Oncology, Qianfoshan Hospital Affiliated Shandong University, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Jingxin Zhang
- Department of Oncology, Weifang Medical College, Weifang, Shandong, China
| | - G Deng
- Department of Oncology, Shandong University School of Medicine, Jinan, Shandong, China
| | - Jiandong Zhang
- Department of Radiation Oncology, Qianfoshan Hospital Affiliated Shandong University, 16766 Jingshi Road, Jinan, 250014, Shandong, China.
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Identifying the Optimal Radiation Dose in Locally Advanced Non-Small-cell Lung Cancer Treated With Definitive Radiotherapy Without Concurrent Chemotherapy. Clin Lung Cancer 2017; 19:e131-e140. [PMID: 28756051 DOI: 10.1016/j.cllc.2017.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 06/27/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The optimal radiation dose for locally advanced non-small-cell lung cancer (NSCLC) is not known for patients who receive sequential chemoradiation (CRT) or definitive radiotherapy (RT) only. Our objective was to determine whether a benefit exists for radiation dose escalation for these patients. MATERIALS AND METHODS The patients included in our retrospective analysis had undergone RT for NSCLC from 2004 to 2013, had not undergone surgery, and received a dose ≥ 50.0 Gy. Patients who received concurrent CRT were excluded from the analysis, leaving 336 patients for analysis. The primary outcomes were overall survival (OS), local failure (LF), and distant failure (DF). RESULTS On multivariate analysis, after adjusting for age, Karnofsky performance status, gross tumor volume, and treatment modality, patients treated with a radiation dose > 66 Gy had significantly improved OS compared with those treated with < 60 Gy (hazard ratio [HR], 0.58; 95% confidence interval [CI], 0.39-0.87; P = .008). After adjusting for smoking history and radiologic tumor size, patients treated with a radiation dose > 66 Gy had a significantly decreased risk of LF compared with those treated with < 60 Gy (HR, 0.59; 95% CI, 0.38-0.91; P = .02). The radiation dose was not an independent prognostic factor of DF on multivariate analysis. CONCLUSION When controlling for tumor volume and/or dimensions and other independent prognostic factors, patients with locally advanced NSCLC who were not candidates for concurrent CRT benefited from a radiation dose > 66 Gy versus < 60 Gy with improved OS and reduced LF. An increased radiation dose did not appear to affect the incidence of DF.
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Rosenzweig KE, Gomez JE. Concurrent Chemotherapy and Radiation Therapy for Inoperable Locally Advanced Non–Small-Cell Lung Cancer. J Clin Oncol 2017; 35:6-10. [DOI: 10.1200/jco.2016.69.9678] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 72-year-old man with a 40-pack-year tobacco history developed a cough and decreased exercise tolerance. A chest x-ray demonstrated a right-upper-lobe opacity. Chest computed tomography (CT) scan revealed a 2.5-cm mass in the right upper lobe with multiple mediastinal lymph node disease ( Fig 1 ). A positron emission tomography (PET) scan confirmed the lung lesion and the mediastinal lymphadenopathy without distant metastases. Brain magnetic resonance imaging results were negative. The biopsy specimen revealed adenocarcinoma with no actionable mutations present. Cervical mediastinoscopy was positive for carcinoma in level 2, 3, 4R, and 7 lymph nodes; level 4L was negative. The patient’s stage was T1bN2M0, stage IIIA. His medical history was significant for hyperlipidemia and hypothyroidism. He had smoked one pack a day for 40 years and had quit 15 years earlier. Physical examination was unrevealing, and the patient had an Eastern Cooperative Oncology Group performance status of 0. Because of the extent of lung cancer in the mediastinum, the patient’s cancer was deemed inoperable, and he was referred for consideration of concurrent chemotherapy and radiation.
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Affiliation(s)
- Kenneth E. Rosenzweig
- Kenneth E. Rosenzweig and Jorge E. Gomez, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jorge E. Gomez
- Kenneth E. Rosenzweig and Jorge E. Gomez, Icahn School of Medicine at Mount Sinai, New York, NY
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Addition of Surgery After Radiation Significantly Improves Survival in Stage IIIB Non-small Cell Lung Cancer: A Population-Based Analysis. World J Surg 2016; 41:758-762. [DOI: 10.1007/s00268-016-3764-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Horinouchi H. Role of multimodality therapy in cIIIA-N2 non-small cell lung cancer: perspective. Jpn J Clin Oncol 2016; 46:1174-1178. [PMID: 27702837 PMCID: PMC5144660 DOI: 10.1093/jjco/hyw131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 12/25/2022] Open
Abstract
Constant effort via well-designed and well-conducted clinical trials is needed to decipher the heterogeneity of Stage III non–small cell lung cancer. A number of promising new approaches for both local and systemic control of locally advanced non–small cell lung cancer have been examined in clinical trials, aimed at improving the patient survival. Development of better systemic therapies by adopting newer agents (such as epidermal growth factor receptor-tyrosine kinase inhibitors and immune checkpoint inhibitors) from advanced non–small cell lung cancer is mandatory. As for radiotherapy, adaptive radiotherapy and proton therapy are under investigation after the RTOG 0617 trial unexpectedly failed to show the efficacy of high-dose radiotherapy for Stage III disease. To date, no Phase III trial has clearly shown the benefit of adding surgery as a part of multimodality therapy for locally advanced non–small cell lung cancer. Such poor progress in the development of effective treatments for Stage III non–small cell lung cancer is considered to be attributable to the existence of heterogeneities in the disease characteristics, including the biological and anatomic characteristics. Constant effort via well-designed and well-conducted clinical trials is needed to decipher the heterogeneity of Stage III non–small cell lung cancer.
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Affiliation(s)
- Hidehito Horinouchi
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo .,Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Ardizzoni A, Tiseo M, Boni L, Di Maio M, Buffoni L, Belvedere O, Grossi F, D'Alessandro V, de Marinis F, Barbera S, Caroti C, Favaretto A, Cortinovis D, Morrica B, Tixi L, Ceschia T, Parisi S, Ricardi U, Grimaldi A, Loreggian L, Navarria P, Huber RM, Belani C, Brunsvig PF, Scagliotti GV, Scolaro T. Randomized phase III PITCAP trial and meta-analysis of induction chemotherapy followed by thoracic irradiation with or without concurrent taxane-based chemotherapy in locally advanced NSCLC. Lung Cancer 2016; 100:30-37. [PMID: 27597278 DOI: 10.1016/j.lungcan.2016.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/18/2016] [Accepted: 07/26/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Chemo-radiotherapy is standard of care in the treatment of unresectable stage III NSCLC. We aimed at assessing whether the addition of concurrent taxane-chemotherapy to thoracic irradiation following chemotherapy was able to improve treatment outcome. MATERIAL AND METHODS In PITCAP trial, patients with unresectable stage III NSCLC were randomized to receive 2 cycles of platinum-paclitaxel followed by 60-61.2Gy thoracic irradiation (control arm) or by same radiotherapy with concomitant weekly paclitaxel (experimental arm). A literature-based meta-analysis including all studies with same design was also performed. RESULTS At the time of the second interim analysis, when 151 patients were randomized, accrual was terminated. With a median follow-up of 6.1 years, median survival was 13.2 vs 15.1 months, with a 3-year survival rate of 19.5 vs 21.2% in the control and experimental arm, respectively (HR: 0.97; 95% CI 0.69-1.36; p=0.845). Treatment toxicity was manageable in both arms. The meta-analysis of 5 trials (n=866) confirmed the lack of a meaningful effect on 1-year overall survival of a taxane added concurrently to radiotherapy. CONCLUSIONS These results do not support a meaningful survival benefit with the addition of single agent taxane given concurrently to radiotherapy after platinum-based induction in locally advanced NSCLC.
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Affiliation(s)
- Andrea Ardizzoni
- Medical Oncology Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital, Parma, Italy.
| | - Luca Boni
- Clinical Trials Coordinating Center, Istituto Toscano Tumori, University Hospital Careggi, Firenze, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Torino, Orbassano, Torino, Italy
| | - Lucio Buffoni
- Department of Oncology, University of Torino, Orbassano, Torino, Italy
| | - Ornella Belvedere
- Department of Oncology, Medical Oncology Unit, University Hospital, Udine, Italy
| | - Francesco Grossi
- Medical Oncology Unit A, IRCCS San Martino University Hospital - IST National Cancer Research Institute, Genova, Italy
| | - Vito D'Alessandro
- Respiratory Oncology Section, I Internal Medicine Department, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, European Institute of Oncology (IEO), Milan, Italy
| | - Santi Barbera
- Division of Oncologic Pneumology, Mariano Santo Hospital, Cosenza, Italy
| | - Cinzia Caroti
- Academic Unit of Medical Oncology, IRCCS San Martino University Hospital - IST National Cancer Research Institute, Genova, Italy
| | - Adolfo Favaretto
- Department of Clinical and Experimental Oncology, Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | | | - Brunello Morrica
- Radiotherapy Unit, Istituto Nazionale Tumori Fondazione G. Pascale, Napoli, Italy
| | - Lucia Tixi
- Department of Internal Medicine, IRCCS San Martino University Hospital - IST National Cancer Research Institute, Genova, Italy
| | - Tino Ceschia
- Department of Oncology, Radiotherapy Unit, University Hospital, Udine, Italy
| | - Salvatore Parisi
- Radiotherapy Department, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Torino, Italy
| | | | - Lucio Loreggian
- Radiotherapy Department, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Rudolf M Huber
- Pneumologie, Medizinische Klinik Innenstadt, University of Munich, Munich, Germany
| | - Chandra Belani
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, United States
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Mamdani H, Jalal SI, Hanna N. Locally Advanced Non-Small Cell Lung Cancer: Optimal Chemotherapeutic Agents and Duration. Curr Treat Options Oncol 2016; 16:47. [PMID: 26233240 DOI: 10.1007/s11864-015-0364-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OPINION STATEMENT Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality in the USA. The treatment of locally advanced NSCLC (LA-NSCLC) is challenging and must be individualized. For patients with completely resected stage III NSCLC, adjuvant cisplatin-based chemotherapy for 4 cycles is recommended. For patients with inoperable or unresectable stage III NSCLC, chemoradiation is the preferred treatment. Patients with a good performance status, minimal or no weight loss, and adequate pulmonary function should be offered concurrent chemoradiation. The optimal chemotherapeutic agents to be used concurrently with radiation remain undefined. In the USA, cisplatin plus etoposide or carboplatin plus paclitaxel are the most commonly used regimens. In addition, the optimal duration of therapy remains undefined, including the role of consolidation chemotherapy. Thus far, randomized phase III trials have failed to identify a survival advantage for administering chemotherapy beyond that delivered during radiation therapy. Molecularly targeted agents, angiogenesis inhibitors, and immunotherapy have a defined role for patients with metastatic disease. The role, if any, of these new classes of agents is undergoing investigation for patients with earlier stage disease, including stage III disease.
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Affiliation(s)
- Hirva Mamdani
- Hematology/Oncology, Indiana University Melvin and Bren Simon Cancer Center, 535, Barnhill Dr, Ste 418, Indianapolis, IN, 46202, USA,
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Hong JC, Salama JK. Dose escalation for unresectable locally advanced non-small cell lung cancer: end of the line? Transl Lung Cancer Res 2016; 5:126-33. [PMID: 26958507 DOI: 10.3978/j.issn.2218-6751.2016.01.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiation Therapy Oncology Group (RTOG) 0617 was a randomized trial that investigated both the impact of radiation dose-escalation and the addition of cetuximab on the treatment of non-small cell lung cancer (NSCLC). The results of RTOG 0617 were surprising, with the dose escalation randomization being closed prematurely due to futility stopping rules, and cetuximab ultimately showing no overall survival benefit. Locally advanced unresectable NSCLC has conventionally been treated with concurrent chemoradiation. Though advances in treatment technology have improved the ability to deliver adequate treatment dose, the foundation for radiotherapy (RT) has remained the same since the 1980s. Since then, progressive studies have sought to establish the safety and efficacy of escalating radiation dose to loco-regional disease. Though RTOG 0617 did not produce the anticipated result, much interest remains in dose escalation and establishing an explanation for the findings of this study. Cetuximab was also not found to provide a survival benefit when applied to an unselected population. However, planned retrospective analysis suggests that those patients with high epidermal growth factor receptor (EGFR) expression may benefit, suggesting that cetuximab should be applied in a targeted fashion. We discuss the results of RTOG 0617 and additional findings from post-hoc analysis that suggest that dose escalation may be limited by normal tissue toxicity. We also present ongoing studies that aim to address potential causes for mortality in the dose escalation arm through adaptive or proton therapy, and are also leveraging additional concurrent systemic agents such as tyrosine kinase inhibitors (TKIs) for EGFR-activating mutations or EML4-ALK rearrangements, and poly (ADP-ribose) polymerase (PARP) inhibitors.
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Affiliation(s)
- Julian C Hong
- Department of Radiation Oncology, Duke University, Durham, NC, USA
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University, Durham, NC, USA
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Giaj-Levra N, Ricchetti F, Alongi F. What is changing in radiotherapy for the treatment of locally advanced nonsmall cell lung cancer patients? A review. Cancer Invest 2016; 34:80-93. [PMID: 26810755 DOI: 10.3109/07357907.2015.1114121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Radiotherapy treatment continues to have a relevant impact in the treatment of nonsmall cell cancer (NSCLC). Use of concurrent chemotherapy and radiotherapy is considered the gold standard in the treatment of locally advanced NSCLC but clinical outcomes are not satisfactory. Introduction of new radiotherapy technology and chemotherapy regimens are under investigation in this setting with the goal to improve unsatisfactory results. We report how radiotherapy is changing in the treatment of locally advanced NSCLC.
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Affiliation(s)
- Niccoló Giaj-Levra
- a Radiation Oncology Department , Sacro Cuore-Don Calabria Hospital , Negrar-Verona , Italy
| | - Francesco Ricchetti
- a Radiation Oncology Department , Sacro Cuore-Don Calabria Hospital , Negrar-Verona , Italy
| | - Filippo Alongi
- a Radiation Oncology Department , Sacro Cuore-Don Calabria Hospital , Negrar-Verona , Italy
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Application of peptide displaying phage as a novel diagnostic probe for human lung adenocarcinoma. Amino Acids 2016; 48:1079-1086. [DOI: 10.1007/s00726-015-2153-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/09/2015] [Indexed: 12/25/2022]
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Kim YJ, Song SY, Jeong SY, Kim SW, Lee JS, Kim SS, Choi W, Choi EK. Definitive radiotherapy with or without chemotherapy for clinical stage T4N0-1 non-small cell lung cancer. Radiat Oncol J 2015; 33:284-93. [PMID: 26756028 PMCID: PMC4707211 DOI: 10.3857/roj.2015.33.4.284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/01/2015] [Accepted: 12/09/2015] [Indexed: 12/25/2022] Open
Abstract
Purpose To determine failure patterns and survival outcomes of T4N0-1 non-small cell lung cancer (NSCLC) treated with definitive radiotherapy. Materials and Methods Ninety-five patients with T4N0-1 NSCLC who received definitive radiotherapy with or without chemotherapy from May 2003 to October 2014 were retrospectively reviewed. The standard radiotherapy scheme was 66 Gy in 30 fractions. The main concurrent chemotherapy regimen was 50 mg/m2 weekly paclitaxel combined with 20 mg/m2 cisplatin or AUC 2 carboplatin. The primary outcome was overall survival (OS). Secondary outcomes were failure patterns and toxicities. Results The median age was 64 years (range, 34 to 90 years). Eighty-eight percent of patients (n = 84) had an Eastern Cooperative Oncology Group performance status of 0-1, and 42% (n = 40) experienced pretreatment weight loss. Sixty percent of patients (n = 57) had no metastatic regional lymph nodes. The median radiation dose was EQD2 67.1 Gy (range, 56.9 to 83.3 Gy). Seventy-one patients (75%) were treated with concurrent chemotherapy; of these, 13 were also administered neoadjuvant chemotherapy. At a median follow-up of 21 months (range, 1 to 102 months), 3-year OS was 44%. The 3-year cumulative incidences of local recurrence and distant recurrence were 48.8% and 36.3%, respectively. Pretreatment weight loss and combined chemotherapy were significant factors for OS. Acute esophagitis over grade 3 occurred in three patients and grade 3 chronic esophagitis occurred in one patient. There was no grade 3-4 radiation pneumonitis. Conclusion Definitive radiotherapy for T4N0-1 NSCLC results in favorable survival with acceptable toxicity rates. Local recurrence is the major recurrence pattern. Intensity modulated radiotherapy and radio-sensitizing agents would be needed to improve local tumor control.
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Affiliation(s)
- Yeon Joo Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Si Yeol Song
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong-Yun Jeong
- Institute of Innovative Science, Asan Medical Center, Seoul, Korea
| | - Sang We Kim
- Department of Medical Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Shin Lee
- Department of Medical Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonsik Choi
- Department of Radiation Oncology, Gangneung Asan Hospital, Gangneung, Korea
| | - Eun Kyung Choi
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Schild SE, Vokes EE. Pathways to improving combined modality therapy for stage III nonsmall-cell lung cancer. Ann Oncol 2015; 27:590-9. [PMID: 26712904 DOI: 10.1093/annonc/mdv621] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/14/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer deaths, having caused an estimated 1.6 million deaths worldwide in 2012 [Ferlay J, Soerjomataram I, Dikshit R et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136: E359-E386]. MATERIALS AND METHODS Although the majority of patients are not cured with currently available therapies, there have been significant improvements in stage-specific outcomes over time [Videtic G, Vokes E, Turrisi A et al. The survival of patients treated for stage III non-small cell lung cancer in North America has increased during the past 25 years. In The 39th Annual Meeting of the American Society of Clinical Oncology, ASCO 2003, Chicago, IL. Abstract 2557. p. 291]. This review focuses on past progress and ongoing research in the treatment of locally advanced, inoperable nonsmall-cell lung cancer (NSCLC). RESULTS In the past, randomized trials revealed advantages to the use of thoracic radiotherapy (TRT) and then, the addition of induction chemotherapy. This was followed by studies that determined concurrent chemoradiotherapy to be superior to sequential therapy. A recent large phase III trial found that the administration of 74 Gy of conventionally fractionated photon-based TRT provided poorer survival than did the standard 60 Gy. However, further research on other methods of applying radiotherapy (hypofractionation, adaptive TRT, proton therapy, and stereotactic TRT boosting) is proceeding and may improve outcomes. The molecular characterization of tumors has provided more effective and less toxic targeted treatments in the stage IV setting and these agents are currently under investigation for earlier stage disease. Similarly, immune-enhancing therapies have shown promise in stage IV disease and are also being tested in the locally advanced setting. CONCLUSION For locally advanced, inoperable NSCLC, standard therapy has evolved from TRT alone to combined modality therapy. We summarize the recent clinical trial experience and outline promising areas of investigation in an era of greater molecular and immunologic understanding of cancer care.
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Affiliation(s)
- S E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale
| | - E E Vokes
- Department of Medicine and Comprehensive Cancer Center, University of Chicago Medicine and Biologic Sciences, Chicago, USA
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Huang P, Zhang Y, Wang W, Zhou J, Sun Y, Liu J, Kong D, Liu J, Dong A. Co-delivery of doxorubicin and 131I by thermosensitive micellar-hydrogel for enhanced in situ synergetic chemoradiotherapy. J Control Release 2015; 220:456-464. [DOI: 10.1016/j.jconrel.2015.11.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/13/2015] [Accepted: 11/07/2015] [Indexed: 01/27/2023]
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Mantovani C, Filippi AR, Ricardi U. Which radiation therapy schedule in combination with chemotherapy for locally advanced NSCLC? Lung Cancer Manag 2015. [DOI: 10.2217/lmt.15.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Concurrent chemoradiotherapy is the standard of care in the management of locally advanced NSCLC, with disappointing results in terms of local tumor control and overall survival. Hystorically, it has been demonstrated a strict dose–response relationship in thoracic radiotherapy for lung cancer and, therefore, dose escalation was tested in many prospective trials. In this paper, we briefly review the most relevant publications focusing on dose management in terms of dose escalation with both conventional and altered fractionation schedules.
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Affiliation(s)
- Cristina Mantovani
- Radiation Oncology Unit, Department of Oncology, University of Torino, Via Genova 3, 10126 Torino, Italy
| | - Andrea Riccardo Filippi
- Radiation Oncology Unit, Department of Oncology, University of Torino, Via Genova 3, 10126 Torino, Italy
| | - Umberto Ricardi
- Radiation Oncology Unit, Department of Oncology, University of Torino, Via Genova 3, 10126 Torino, Italy
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A phase I/II study of bortezomib in combination with paclitaxel, carboplatin, and concurrent thoracic radiation therapy for non-small-cell lung cancer: North Central Cancer Treatment Group (NCCTG)-N0321. J Thorac Oncol 2015; 10:172-80. [PMID: 25247339 DOI: 10.1097/jto.0000000000000383] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Despite the advances in radiation techniques and chemotherapy, survival with current platinum-based chemotherapy and concomitant thoracic radiation remains dismal. Bortezomib, a proteasome inhibitor, modulates apoptosis and cell cycle through disruption of protein degradation. The combination of bortezomib and carboplatin/paclitaxel and concurrent radiation in unresectable stage III non-small-cell lung cancer was evaluated in this phase I/II study. METHODS Patients with histologic or cytologic confirmed stage III nonmetastatic non-small-cell lung cancer who were candidates for radiation therapy were eligible. In the phase I portion, patients received escalating doses of bortezomib, paclitaxel, and carboplatin concomitantly with thoracic radiation (60 Gy/30 daily fractions) using a modified 3 + 3 design. The primary endpoint for the phase II portion was the 12-month survival rate (12MS). A one-stage design with an interim analysis yielded 81% power to detect a true 12MS of 75%, with a 0.09 level of significance if the true 12MS was 60% using a sample size of 60 patients. Secondary endpoints consisted of adverse events (AEs), overall survival, progression-free survival, and the confirmed response rate. RESULTS Thirty-one patients enrolled during the phase I portion of the trial, of which four cancelled before receiving treatment, leaving 27 evaluable patients. Of these 27 patients, two dose-limiting toxicities were observed, one (grade 3 pneumonitis) at dose level 1 (bortezomib at 0.5 mg/m, paclitaxel at 150 mg/m, and carboplatin at area under the curve of 5) and one (grade 4 neutropenia lasting ≥8 days) at dose level 6 (bortezomib 1.2 mg/m, paclitaxel 175 mg/m, and carboplatin at area under the curve of 6). During the phase I portion, the most common grade 3 of 4 AEs were leukopenia (44%), neutropenia (37%), dyspnea (22%), and dysphagia (11%). Dose level 6 was declared to be the recommended phase II dose (RP2D) and the phase II portion of the study opened. After the first 26 evaluable patients were enrolled to the RP2D, a per protocol interim analysis occurred. Of these 26 patients, 23 (88%) survived at least 6 months (95% confidence interval [CI], 70-98%), which was enough to continue to full accrual per study design. However, due to slow accrual, the study was stopped after 27 evaluable patients were enrolled (6-phase I RP2D; 21-phase II). Of these 27 patients, the 12MS was 73% (95% CI, 58-92%), the median overall survival was 25.0 months (95% CI, 15.6-35.8), and the median progression-free survival was 8.4 months (95% CI, 4.1-10.5). The confirmed response rate was 26% (seven of 27; 95% CI, 11-46%), consisting of four partial responses and three complete responses. Grade 3+ and grade 4+ AEs occurred in 82% and 56% of patients, respectively. One patient experienced grade 5 pneumonitis that was possibly related to the treatment. Grade 3 and 4 hematological toxicities were observed in 82% and 56% patients, respectively. CONCLUSIONS The addition of bortezomib to concurrent carboplatin/paclitaxel and radiation seemed to be feasible, although associated with increased hematological toxicities. A favorable median overall survival of 25 months suggests a potential benefit for this regimen.
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Hatayama Y, Nakamura T, Suzuki M, Azami Y, Ono T, Yamaguchi H, Hayashi Y, Tsukiyama I, Hareyama M, Kikuchi Y, Takai Y. Preliminary results of proton-beam therapy for stage III non-small-cell lung cancer. Curr Oncol 2015; 22:e370-5. [PMID: 26628878 PMCID: PMC4608411 DOI: 10.3747/co.22.2523] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We conducted a preliminary retrospective evaluation of the efficacy and toxicity of proton-beam therapy (pbt) for stage iii non-small-cell lung cancer. METHODS Between January 2009 and August 2013, 27 patients (26 men, 1 woman) with stage iii non-small-cell lung cancer underwent pbt. The relative biologic effectiveness value of the proton beam was defined as 1.1. The beam energy and spread-out Bragg peak were fine-tuned such that the 90% isodose volume of the prescribed dose encompassed the planning target volume. Of the 27 patients, 11 underwent neoadjuvant chemotherapy. Cumulative survival curves were calculated using the Kaplan-Meier method. Treatment toxicities were evaluated using version 4 of the Common Terminology Criteria for Adverse Events. RESULTS Median age of the patients was 72 years (range: 57-91 years), and median follow-up was 15.4 months (range: 7.8-36.9 months). Clinical stage was iiia in 14 patients (52%) and iiib in 13 (48%). The median dose of pbt was 77 GyE (range: 66-86.4 GyE). The overall survival rate in the cohort was 92.3% at 1 year and 51.1% at 2 years. Locoregional failure occurred in 7 patients, and distant metastasis, in 10. In 2 patients, initial failure was both locoregional and distant. The 1-year and 2-year rates of local control were 68.1% and 36.4% respectively. The 1-year and 2-year rates of progression-free survival were 39.9% and 21.4% respectively. Two patients experienced grade 3 pneumonitis. CONCLUSIONS For patients with stage iii non-small-cell lung cancer, pbt can be an effective and safe treatment option.
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Affiliation(s)
- Y. Hatayama
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - T. Nakamura
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - M. Suzuki
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Y. Azami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - T. Ono
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - H. Yamaguchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Y. Hayashi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - I. Tsukiyama
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - M. Hareyama
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Y. Kikuchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Y. Takai
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Le QT, Shirato H, Giaccia AJ, Koong AC. Emerging Treatment Paradigms in Radiation Oncology. Clin Cancer Res 2015; 21:3393-401. [PMID: 25991820 DOI: 10.1158/1078-0432.ccr-14-1191] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/13/2015] [Indexed: 12/22/2022]
Abstract
Rapid advancements in radiotherapy and molecularly targeted therapies have resulted in the development of potential paradigm-shifting use of radiotherapy in the treatment of cancer. In this review, we discuss some of the most promising therapeutic approaches in the field of radiation oncology. These strategies include the use of highly targeted stereotactic radiotherapy and particle therapy as well as combining radiotherapy with agents that modulate the DNA damage response, augment the immune response, or protect normal tissues.
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Affiliation(s)
- Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, California.
| | - Hiroki Shirato
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan
| | - Amato J Giaccia
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Albert C Koong
- Department of Radiation Oncology, Stanford University, Stanford, California
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ACR Appropriateness Criteria(®) induction and adjuvant therapy for N2 non-small-cell lung cancer. Am J Clin Oncol 2015; 38:197-205. [PMID: 25803563 DOI: 10.1097/coc.0000000000000154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The integration of chemotherapy, radiation therapy (RT), and surgery in the management of patients with stage IIIA (N2) non-small-cell lung carcinoma is challenging. The American College of Radiology (ACR) Appropriateness Criteria Lung Cancer Panel was charged to update management recommendations for this clinical scenario. The Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. There is limited level I evidence to guide patient selection for induction, postoperative RT (PORT), or definitive RT. Literature interpretation is complicated by inconsistent diagnostic procedures for N2 disease, disease heterogeneity, and pooled analysis with other stages. PORT is an appropriate therapy following adjuvant chemotherapy in patients with incidental pN2 disease. In patients with clinical N2 disease who are potential candidates for a lobectomy, both definitive and induction concurrent chemotherapy/RT are appropriate treatments. In N2 patients who require a pneumonectomy, definitive concurrent chemotherapy/RT is most appropriate although induction concurrent chemotherapy/RT may be considered in expert hands. Induction chemotherapy followed by surgery +/- PORT may also be an option in N2 patients. For preoperative RT and PORT, 3-dimensional conformal techniques and intensity-modulated RT are most appropriate.
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Kao CJ, Wurz GT, Lin YC, Vang DP, Griffey SM, Wolf M, DeGregorio MW. Assessing the Effects of Concurrent versus Sequential Cisplatin/Radiotherapy on Immune Status in Lung Tumor-Bearing C57BL/6 Mice. Cancer Immunol Res 2015; 3:741-50. [PMID: 25672395 DOI: 10.1158/2326-6066.cir-14-0234] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/04/2015] [Indexed: 11/16/2022]
Abstract
Concurrent and sequential cisplatin-based chemoradiotherapy regimens are standard therapeutic approaches in cancer treatment. Recent clinical data suggest that these different dosing schedules may adversely affect antigen-specific immunotherapy. The goal of the present preclinical study was to explore the effects of concurrent and sequential cisplatin/radiotherapy on immune status in a lung cancer mouse model. A total of 150 C57BL/6 mice were randomized into six treatment groups: control; 8 Gy thoracic radiotherapy (dose schedules 1 and 2); cisplatin 2.5 mg/kg i.p.; cisplatin + radiotherapy (concurrent); and cisplatin + radiotherapy (sequential; n = 25, all groups). At the end of the study (week 41), serum cytokines were assessed by multiplex immunoassay, surface markers of spleen-derived lymphocytes were assessed by immunostaining and flow cytometry, lung tumor expression of programmed death ligands 1 and 2 (PD-L1/2) was evaluated by immunohistochemistry, and miRNA profiling was performed in serum and lymphocytes by quantitative real-time PCR. Lung whole mounts were prepared to assess treatment effects on lung tumor foci formation. The results showed that sequential chemoradiotherapy (two cycles of cisplatin followed by 8 Gy radiotherapy) had equivalent antitumor activity as concurrent therapy. However, sequential cisplatin/radiotherapy resulted in significant differences in several immune response biomarkers, including regulatory T cells, miR-29c, expression of costimulatory molecule CD28, and serum IFNγ. PD-L1 and PD-L2 were strongly expressed in tumor foci, but no trend was seen between groups. These results suggest that monitoring immune status may be necessary when designing treatment regimens combining immunotherapy with chemoradiotherapy.
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Affiliation(s)
- Chiao-Jung Kao
- Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis, Sacramento, California
| | - Gregory T Wurz
- Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis, Sacramento, California
| | - Yi-Chen Lin
- Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis, Sacramento, California
| | - Daniel P Vang
- Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis, Sacramento, California
| | - Stephen M Griffey
- Comparative Pathology Laboratory, UC Davis School of Veterinary Medicine, University of California, Davis, Davis, California
| | - Michael Wolf
- ImmunoOncology, Merck Serono Research, Merck KGaA, Darmstadt, Germany
| | - Michael W DeGregorio
- Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis, Sacramento, California.
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Patel NR, Lanciano R, Sura K, Yang J, Lamond J, Feng J, Good M, Gracely EJ, Komarnicky L, Brady L. Stereotactic body radiotherapy for re-irradiation of lung cancer recurrence with lower biological effective doses. ACTA ACUST UNITED AC 2014; 4:65-70. [PMID: 25774244 PMCID: PMC4348501 DOI: 10.1007/s13566-014-0175-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 11/13/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Few studies have evaluated re-irradiation of lung cancer recurrences with stereotactic body radiotherapy (SBRT). This study evaluates outcomes with SBRT re-irradiation for recurrent lung cancer. METHODS Two hundred and seventy-eight patients treated with SBRT for lung cancer were retrospectively reviewed. Of those, 26 patients with 29 tumors were re-irradiated with SBRT. Ninety percent of tumors received prior external beam irradiation and 10 % received prior SBRT. Previous median radiation dose was 61.2 Gy with a median 8-month interval from previous radiation. The median re-irradiation SBRT dose was 30 Gy (48 Gy10 biological effective dose (BED)). Endpoints evaluated included local control, overall survival, and progression-free survival. RESULTS Twenty-five of 29 tumors were evaluable for local control, with 27 tumors (93 %) considered in-field recurrences. In-field crude local control rate was 80 % (20/25) with 1 and 2-year actuarial rates of 78.6 and 65.5 %, respectively. One and 2-year actuarial survival rates were 52.3 and 37.0 %, respectively. One and 2-year actuarial progression-free survival rates were 56.7 and 37.0 %, respectively. Fifty-five percent of patients reported acute/chronic grades 1 and 2 toxicities. No grade 3 or higher toxicities were reported. CONCLUSION Patients with recurrent lung cancer have limited options. SBRT re-irradiation is tolerable even after a median 61.2 Gy to the re-irradiation site. The lower BED used provided acceptable progression-free survival with low toxicity. Given the poor prognosis with current treatment options, new paradigms for re-treatment should include SBRT-re-irradiation as an adjunct to systemic therapy for in-field lung cancer recurrence.
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Affiliation(s)
- Nisha R Patel
- Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA USA
| | - Rachelle Lanciano
- Department of Radiation Oncology, Delaware County Memorial Hospital, Philadelphia CyberKnife Center, Havertown, PA USA ; Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA USA
| | - Karna Sura
- Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA USA
| | - Jun Yang
- Department of Radiation Oncology, Delaware County Memorial Hospital, Philadelphia CyberKnife Center, Havertown, PA USA ; Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA USA
| | - John Lamond
- Department of Radiation Oncology, Delaware County Memorial Hospital, Philadelphia CyberKnife Center, Havertown, PA USA ; Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA USA
| | - Jing Feng
- Department of Radiation Oncology, Delaware County Memorial Hospital, Philadelphia CyberKnife Center, Havertown, PA USA
| | - Michael Good
- Department of Radiation Oncology, Delaware County Memorial Hospital, Philadelphia CyberKnife Center, Havertown, PA USA
| | - Ed J Gracely
- Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA USA
| | - Lydia Komarnicky
- Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA USA
| | - Luther Brady
- Department of Radiation Oncology, Delaware County Memorial Hospital, Philadelphia CyberKnife Center, Havertown, PA USA ; Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA USA
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