1
|
Faber DL, Agbarya A, Caspy B, Lapidot M, Rosenberg SK, Schneer S, Sharoni E, Galili R. A Single-Center Experience in Combined Oncological-Surgical Treatment for Resectable Locally Advanced Non-Small Cell Lung Cancer (NSCLC). Diseases 2024; 12:98. [PMID: 38785753 PMCID: PMC11119286 DOI: 10.3390/diseases12050098] [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: 04/17/2024] [Revised: 04/26/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Non-small cell lung cancer (NSCLC) is the most common pulmonary malignancy, frequently diagnosed at an advanced stage (III/IV). Patients in the Locally Advanced Stage Subgroup (IIIA) are relatively few, yet compose heterogenic phenotypes, posing a diagnostic and treating challenge, leading to a lack of clinical guidelines regarding the optimal standard of care. Several approaches exist, with a general agreement that a combined oncological and surgical modality approach is required. In this current retrospective descriptive study, patients with operable stage IIIA NSCLC who underwent surgery between 2013 and 2020 were evaluated on several aspects, including the initial diagnosis, neoadjuvant regimens, outcomes of surgical intervention, and overall survival at 2 years and 5 years following treatment. A total of 35 patients had neoadjuvant oncological treatment (mostly chemoradiation therapy) prior to surgery, out of which 28 patients were diagnosed with stage IIIA NSCLC. In post-operative assessment of pathological staging, downstaging was reported in 19 patients, of which 25% of cases were defined as a complete pathological response. The 2-year overall survival rate was 65% and the 5-year overall survival rate was 62%. The main pattern of disease recurrence was distant metastasis.
Collapse
Affiliation(s)
- Dan Levy Faber
- Department of Cardiothoracic Surgery, Lady Davis Carmel Medical Center, 7 Michal St., Haifa 3436212, Israel; (B.C.); (S.S.); (E.S.); (R.G.)
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel;
| | - Abed Agbarya
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel;
- Oncology Institute, Bnai-Zion Medical Center, Haifa 3339419, Israel
| | - Ben Caspy
- Department of Cardiothoracic Surgery, Lady Davis Carmel Medical Center, 7 Michal St., Haifa 3436212, Israel; (B.C.); (S.S.); (E.S.); (R.G.)
- Azrieli Faculty of Medicine, Bar Ilan University, Tzfat 3436212, Israel;
| | - Moshe Lapidot
- Azrieli Faculty of Medicine, Bar Ilan University, Tzfat 3436212, Israel;
- Department of Thoracic Surgery, Galilee Medical Center, Nahariya 2210001, Israel
| | - Shoshana Keren Rosenberg
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel;
- Oncology Institute, Lin Medical Center and Carmel Medical Center, Haifa 3515210, Israel
| | - Sonia Schneer
- Department of Cardiothoracic Surgery, Lady Davis Carmel Medical Center, 7 Michal St., Haifa 3436212, Israel; (B.C.); (S.S.); (E.S.); (R.G.)
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel;
- Pulmonary Division, Lady Davis Carmel Medical Center, Haifa 3436212, Israel
| | - Erez Sharoni
- Department of Cardiothoracic Surgery, Lady Davis Carmel Medical Center, 7 Michal St., Haifa 3436212, Israel; (B.C.); (S.S.); (E.S.); (R.G.)
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel;
| | - Ronen Galili
- Department of Cardiothoracic Surgery, Lady Davis Carmel Medical Center, 7 Michal St., Haifa 3436212, Israel; (B.C.); (S.S.); (E.S.); (R.G.)
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel;
| |
Collapse
|
2
|
Liu T, Li S, Ding S, Qiu J, Ren C, Chen J, Wang H, Wang X, Li G, He Z, Dang J. Comparison of post-chemoradiotherapy pneumonitis between Asian and non-Asian patients with locally advanced non-small cell lung cancer: a systematic review and meta-analysis. EClinicalMedicine 2023; 64:102246. [PMID: 37781162 PMCID: PMC10539643 DOI: 10.1016/j.eclinm.2023.102246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/28/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023] Open
Abstract
Background Pneumonitis is a common complication for patients with locally advanced non-small cell lung cancer undergoing definitive chemoradiotherapy (CRT). It remains unclear whether there is ethnic difference in the incidence of post-CRT pneumonitis. Methods PubMed, Embase, Cochrane Library, and Web of Science were searched for eligible studies from January 1, 2000 to April 30, 2023. The outcomes of interest were incidence rates of pneumonitis. The random-effect model was used for statistical analysis. This meta-analysis was registered with PROSPERO (CRD42023416490). Findings A total of 248 studies involving 28,267 patients were included. Among studies of CRT without immunotherapy, the pooled rates of pneumonitis for Asian patients were significantly higher than that for non-Asian patients (all grade: 66.8%, 95% CI: 59.2%-73.9% vs. 28.1%, 95% CI: 20.4%-36.4%; P < 0.0001; grade ≥2: 25.1%, 95% CI: 22.9%-27.3% vs. 14.9%, 95% CI: 12.0%-18.0%; P < 0.0001; grade ≥3: 6.5%, 95% CI: 5.6%-7.3% vs. 4.6%, 95% CI: 3.4%-5.9%; P = 0.015; grade 5: 0.6%, 95% CI: 0.3%-0.9% vs. 0.1%, 95% CI: 0.0%-0.2%; P < 0.0001). Regarding studies of CRT plus immunotherapy, Asian patients had higher rates of all-grade (74.8%, 95% CI: 63.7%-84.5% vs. 34.3%, 95% CI: 28.7%-40.2%; P < 0.0001) and grade ≥2 (34.0%, 95% CI: 30.7%-37.3% vs. 24.6%, 95% CI: 19.9%-29.3%; P = 0.001) pneumonitis than non-Asian patients, but with no significant differences in the rates of grade ≥3 and grade 5 pneumonitis. Results from subgroup analyses were generally similar to that from the all studies. In addition, the pooled median/mean of lung volume receiving ≥20 Gy and mean lung dose were relatively low in Asian studies compared to that in non-Asian studies. Interpretation Asian patients are likely to have a higher incidence of pneumonitis than non-Asian patients, which appears to be due to the poor tolerance of lung to radiation. Nevertheless, these findings are based on observational studies and with significant heterogeneity, and need to be validated in future large prospective studies focusing on the subject. Funding None.
Collapse
Affiliation(s)
- Tingting Liu
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
- Department of Radiation Oncology, Anshan Cancer Hospital, Anshan, China
| | - Sihan Li
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Silu Ding
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Jingping Qiu
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Chengbo Ren
- Department of Radiation Oncology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Jun Chen
- Department of Radiation Oncology, Shenyang Tenth People's Hospital, Shenyang, China
| | - He Wang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Xiaoling Wang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Guang Li
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Zheng He
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Jun Dang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
3
|
Kuang Y, Pierce CM, Chang HC, Sosinsky AZ, Deitz AC, Keller SM, Samkari A, Uyei J. Chemoradiation-induced pneumonitis in patients with unresectable stage III non-small cell lung cancer: A systematic literature review and meta-analysis. Lung Cancer 2022; 174:174-185. [PMID: 35717343 DOI: 10.1016/j.lungcan.2022.06.005] [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: 03/29/2022] [Revised: 05/23/2022] [Accepted: 06/07/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION High-grade pneumonitis is a severe and potentially life-threatening adverse event associated with concurrent chemoradiation (cCRT) in patients with non-small cell lung cancer (NSCLC). The aim of this study was to summarize and quantify the incidence of severe (grade 3-5) cCRT-induced pneumonitis in unresectable stage III NSCLC patients. METHODS A systematic literature review and meta-analysis were performed in accordance with PRISMA guidelines. Published literature was searched for randomized controlled trials (RCTs), observational studies, and non-randomized trials from 2014 to April 2020. The primary outcome of interest was incidence of grade 3-5 pneumonitis. RESULTS Included were 17 studies for the review and 11 for the meta-analysis (1,788 participants); all studies examined radiation-related pneumonitis (RP). The pooled incidence of cCRT-induced grade 3-5 RP in unresectable stage III NSCLC patients was estimated to be 3.62% [95% confidence interval (CI): 1.65-6.21] in RCTs, 5.98% [95% CI: 2.26-12.91] in observational studies, and 7.85% [95% CI: 4.08-13.10] in observational studies using platinum-based doublet chemotherapies. CONCLUSION These results suggest the incidence of severe and fatal RP in patients with unresectable stage III NSCLC treated with cCRT ranges from 3.62% to 7.85%, with incidence varying by study design and chemotherapy regimen. Estimates of RP incidence were higher in the real-world setting compared to RCTs. These results can be used to contextualize the baseline risk of cCRT-induced pneumonitis in unresectable stage III NSCLC to better understand the adverse event of pneumonitis associated with novel immunotherapy treatments indicated for concomitant use with this modality.
Collapse
|
4
|
Van Dao T, Diep TB, Le Phuong T, Huggenberger R, Kumar A. Real-World Treatment Patterns and Clinical Outcomes in Patients With Stage III Non-Small-Cell Lung Cancer: Results of KINDLE-Vietnam Cohort. Front Oncol 2022; 12:842296. [PMID: 35677172 PMCID: PMC9169691 DOI: 10.3389/fonc.2022.842296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/13/2022] [Indexed: 12/24/2022] Open
Abstract
Objective KINDLE-Vietnam was a part of a real-world KINDLE study with an aim to characterise treatment patterns and clinical outcomes of patients with stage III non-small cell lung cancer (NSCLC). Materials and Methods Retrospective data from patients diagnosed with stage III NSCLC (American Joint Committee on Cancer, 7th edition) between January 2013 and December 2017 with at least 9 months of follow-up were collected from 2 centres in Vietnam. Descriptive statistics were used to summarise demographics, disease characteristics and treatment modalities. Kaplan-Meier methodology evaluated survival estimates; 2-sided 95% confidence intervals (CIs) were computed. Inferential statistics were used to correlate clinical and treatment variables with median progression-free survival (mPFS) and median overall survival (mOS). Results A total of 150 patients (median age: 60 years [range 26-82]) were enrolled; 75.3% were male, 62.0% had smoking history, 56.4% had stage IIIB disease and 62.5% had adenocarcinoma. The majority of the cases (97.3%) were not discussed at a multidisciplinary team meeting. Overall, chemotherapy alone (43.3%), radiotherapy alone (17.0%), sequential chemoradiation (13.5%) and concurrent chemoradiation (12.8%) were preferred as initial therapy. Surgery-based treatment was administered in limited patients (stage IIIA, 10%; stage IIIB, 1.3%). Palliative therapy was the most commonly administered treatment upon relapse in the second-and third-line setting. The mPFS and mOS for the Vietnam cohort were 8.7 months (95% CI, 7.59-9.72) and 25.7 months (95% CI, 19.98-42.61), respectively. The mPFS and mOS for stage IIIA were 11.9 months (95% CI, 8.64-14.95) and 28.2 months (95% CI, 24.15-not-calculable) and for stage IIIB were 7.8 months (95% CI, 6.64-8.71) and 20.0 months (95% CI, 13.01-42.61). Conclusions KINDLE-Vietnam offers insights into the clinical findings of stage III NSCLC. There is a high unmet need for identifying patients in the early stages of NSCLC. Strategies for improving clinical outcomes in this patient population include physician education, multidisciplinary management and catering to increased access to novel agents like immunotherapy and targeted therapy.
Collapse
Affiliation(s)
- Tu Van Dao
- Cancer Research and Clinical Trials Center, Vietnam National Cancer Hospital, Hanoi, Vietnam.,Oncology Department, Hanoi Medical University, Hanoi, Vietnam
| | - Tuan Bao Diep
- Ho Chi Minh City Oncology Hospital, Ho Chi Minh City, Vietnam
| | - Tri Le Phuong
- Medical Affairs, AstraZeneca Vietnam, Ho Chi Minh, Vietnam
| | | | - Amit Kumar
- Medical Affairs, AstraZeneca India, Bangalore, India
| |
Collapse
|
5
|
Real-World Utilization of Target- and Immunotherapies for Lung Cancer: A Scoping Review of Studies Based on Routinely Collected Electronic Healthcare Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147679. [PMID: 34300130 PMCID: PMC8305284 DOI: 10.3390/ijerph18147679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 01/01/2023]
Abstract
Routinely collected electronic healthcare data (rcEHD) have a tremendous potential for enriching pre-marketing evidence on target- and immunotherapies used to treat lung cancer (LC). A scoping review was performed to provide a structured overview of available rcEHD-based studies on this topic and to support the execution of future research by facilitating access to pertinent literature both for study design and benchmarking. Eligible studies published between 2016 and 2020 in PubMed and ISI Web of Science were searched. Data source and study characteristics, as well as evidence on drug utilization and survival were extracted. Thirty-two studies were included. Twenty-six studies used North American data, while three used European data only. Thirteen studies linked ≥1 data source types among administrative/claims data, cancer registries and medical/health records. Twenty-nine studies retrieved cancer-related information from medical records/cancer registries and 31 studies retrieved information on drug utilization or survival from medical records or administrative/claim data. Most part of studies concerned non-small-cell-LC patients (29 out of 32) while none focused on small-cell-LC. Study cohorts ranged between 85 to 81,983 patients. Only two studies described first-line utilization of immunotherapies. Results from this review will serve as a starting point for the execution of future rcEHD-based studies on innovative LC pharmacotherapies.
Collapse
|
6
|
Steponavičienė R, Jonušas J, Griškevičius R, Venius J, Cicėnas S. A Pilot Study of Safer Radiation Dosage to the Heart and Its Subregions. ACTA ACUST UNITED AC 2021; 57:medicina57040320. [PMID: 33807209 PMCID: PMC8065397 DOI: 10.3390/medicina57040320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/24/2022]
Abstract
Background and Objectives: The real impact of ionizing radiation on the heart and poorer overall survival for patients with non small cell lung cancer (NSCLC) remains unclear. This study aims to determine the safe dose constraints to the heart’s subregions that could prevent patients’ early non-cancerous death and improve their quality of life. Methods and Materials: A retrospective cohort study was performed containing 51 consecutive patients diagnosed with stage III NSCLC and treated using 3D, Intensity-modulated radiation therapy (IMRT), and Volumetric modulated arc therapy (VMAT) radiotherapy. For a dosimetric analysis, these structures were chosen: heart, heart base (HB), and region of great blood vessels (GBV). Dose–volume histograms (DVH) were recorded for all mentioned structures. Maximum and mean doses to the heart, HB, the muscle mass of the HB, and GBV were obtained. V10–V60 (%) parameters were calculated from the DVH. After performed statistical analysis, logistic regression models were created, and critical doses calculated. Results: The critical dose for developing a fatal endpoint for HB was 30.5 Gy, while for GBV, it was 46.3 Gy. Increasing the average dose to the HB or GBV by 1 Gy from the critical dose further increases the possibility of early death by 22.0% and 15.8%, respectively. Conclusions: We suggest that the non-canonical sub-regions of the heart (HB and GBV) should be considered during the planning stage. Additional constraints of the heart subregions should be chosen accordingly, and we propose that the mean doses to these regions be 30.5 Gy and 46.3 Gy, respectively, or less. Extrapolated DVH curves for both regions may be used during the planning stage with care.
Collapse
Affiliation(s)
- Rita Steponavičienė
- External Beam Radiotherapy Department, National Cancer Institute, Santariskiu Str. 1, LT-08406 Vilnius, Lithuania
| | - Justinas Jonušas
- Vilnius University Hospital Santaros Klinikos, Santariskiu Str. 2, LT-08410 Vilnius, Lithuania
| | - Romualdas Griškevičius
- Medical Physics Department, National Cancer Institute, Santariskiu Str. 1, LT-08406 Vilnius, Lithuania
| | - Jonas Venius
- Medical Physics Department, National Cancer Institute, Santariskiu Str. 1, LT-08406 Vilnius, Lithuania
- Laboratory of Biomedical Physics, National Cancer Institute, Baublio 3b, LT-08406 Vilnius, Lithuania
| | - Saulius Cicėnas
- Department of Thoracic Surgery and Oncology, National Cancer Institute, Santariskiu Str. 1, LT-08406 Vilnius, Lithuania
| |
Collapse
|
7
|
Casal-Mouriño A, Ruano-Ravina A, Lorenzo-González M, Rodríguez-Martínez Á, Giraldo-Osorio A, Varela-Lema L, Pereiro-Brea T, Barros-Dios JM, Valdés-Cuadrado L, Pérez-Ríos M. Epidemiology of stage III lung cancer: frequency, diagnostic characteristics, and survival. Transl Lung Cancer Res 2021; 10:506-518. [PMID: 33569332 PMCID: PMC7867742 DOI: 10.21037/tlcr.2020.03.40] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Stage III non-small cell lung cancer (NSCLC) includes a highly heterogeneous group of patients with differences in the extent and localization of disease. Many aspects of stage III disease are controversial. The data supporting treatment approaches are often subject to a number of limitations, due to the heterogeneous patient populations involved in the trials. Furthermore, the definition of stage III disease has changed over time, and early studies were frequently inadequately powered to detect small differences in therapeutic outcome, were not randomized, or had a limited follow-up times. Major improvements in therapy, including the use of more active chemotherapy agents and refinements in radiation and surgical techniques, also limit the interpretation of earlier clinical trials. Lastly, improvements in pretreatment staging have led to reclassification of patients with relatively minimal metastatic disease as stage IV rather than stage III, leading to an apparent increase in the overall survival of both stage III and IV patients. Median overall stage III NSCLC survival ranges from 9 to 34 months. Higher survival rates are observed in younger Caucasian women with good performance status, adenocarcinoma, mutations, stage IIIA, and in patients with multidisciplinary-team-based diagnoses.
Collapse
Affiliation(s)
- Ana Casal-Mouriño
- Department of Pneumology, Santiago de Compostela University Clinical Teaching Hospital, Galicia, Spain.,Department of Preventive Medicine and Public Health, University of Santiago de Compostela, A Coruña, Spain
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, A Coruña, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología and Salud Pública/CIBERESP), Madrid, Spain
| | - María Lorenzo-González
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, A Coruña, Spain.,Population Screening Unit, Galician Regional Health Authority, Santiago de Compostela, Spain
| | - Ángeles Rodríguez-Martínez
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, A Coruña, Spain.,Department of Oncology, Pontevedra University Hospital Complex, Pontevedra, Spain
| | - Alexandra Giraldo-Osorio
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, A Coruña, Spain.,Research Group for Health Promotion and Disease Prevention, Department of Public Health, University of Caldas, Manizales, Colombia
| | - Leonor Varela-Lema
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, A Coruña, Spain.,Scientific-Technical Advisory Unit, Galician Health Technology Assessment Agency, Health Knowledge Management Agency (Unidade de Asesoramento Científico-técnico/avalia-t, Axencia de Coñecemento en Saúde/ACIS), Galician Regional Health Authority, Galicia, Spain
| | - Tara Pereiro-Brea
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, A Coruña, Spain.,Department of Pneumology, A Coruña University Teaching Hospital Complex, A Coruña, Spain
| | - Juan Miguel Barros-Dios
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, A Coruña, Spain
| | - Luis Valdés-Cuadrado
- Department of Pneumology, Santiago de Compostela University Clinical Teaching Hospital, Galicia, Spain.,Interdisciplinary Group of Research in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, A Coruña, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología and Salud Pública/CIBERESP), Madrid, Spain
| |
Collapse
|
8
|
Ronden MI, Bahce I, Hashemi SMS, Dickhoff C, de Haan PF, Becker A, Spoelstra FOB, Dahele MR, Ali R, Tiemessen MA, Tarasevych S, Maassen van den Brink K, Haasbeek CJA, Daniels JMA, van Laren M, Verbakel WFAR, Senan S. Factors influencing multi-disciplinary tumor board recommendations in stage III non-small cell lung cancer. Lung Cancer 2020; 152:149-156. [PMID: 33418430 DOI: 10.1016/j.lungcan.2020.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Treatment patterns in patients with stage III non-small cell lung cancer (NSCLC) vary considerably between countries, for reasons that are not well understood. We studied factors influencing treatment decision-making at thoracic multidisciplinary tumor boards (MDT's) and outcome for patients treated between 2015-2017, at a regional network comprising 5 hospitals. MATERIALS AND METHODS Details of all patients, including comorbidities, with stage III NSCLC were collected in an ethics-approved database. Weekly MDT's were conducted. The preferred radical intent treatments (RIT) for suitable patients were assumed to be concurrent chemoradiotherapy and/or surgery and other therapies were non-radical intent treatments (n-RIT). RESULTS Of 197 patients identified, 95 % were discussed at an MDT. RIT were recommended in 61 % of patients, but only 48 % finally received RIT. The estimated median OS was significantly better for patients undergoing RIT (28.3 months, CI-95 % 17.3-39.3), versus those who did not (11.2 months, CI-95 % 8.0-14.3). Patient age ≥70 years and a WHO-PS ≥2 were the most important predictors of not recommending RIT. Deaths due to progressive lung cancer within 2 years were observed in 36, 26 and 29 % of patients who received RIT, sequential chemoradiotherapy or radical radiotherapy. Corresponding comorbidity related deaths within 2 years were 3, 12 and 38 %. CONCLUSION A large number of patients who underwent MDT review were considered too old or not fit for RIT. More effective and better tolerated systemic treatments are required for patients presenting with stage III NSCLC.
Collapse
Affiliation(s)
- Merle I Ronden
- Department of Radiation Oncology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands.
| | - Idris Bahce
- Department of Pulmonology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Sayed M S Hashemi
- Department of Pulmonology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Chris Dickhoff
- Department of Surgery, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Patricia F de Haan
- Department of Radiation Oncology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Annemarie Becker
- Department of Pulmonology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Femke O B Spoelstra
- Department of Radiation Oncology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Max R Dahele
- Department of Radiation Oncology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Rania Ali
- Department of Radiation Oncology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Marian A Tiemessen
- Department of Pulmonology, Dijklander Ziekenhuis, Hoorn & Purmerend, the Netherlands
| | | | | | - Cornelis J A Haasbeek
- Department of Radiation Oncology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Marjolein van Laren
- Department of Pulmonology, Dijklander Ziekenhuis, Hoorn & Purmerend, the Netherlands
| | - Wilko F A R Verbakel
- Department of Radiation Oncology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands
| |
Collapse
|
9
|
Xiong Q, Fan S, Duan L, Liu B, Jiang X, Chen X, Xiong C, Tao Q, Wang J, Zhang H, Chen C, Duan Y. NCAPH is negatively associated with Mcl‑1 in non‑small cell lung cancer. Mol Med Rep 2020; 22:2916-2924. [PMID: 32945371 PMCID: PMC7453632 DOI: 10.3892/mmr.2020.11359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/25/2020] [Indexed: 01/09/2023] Open
Abstract
Lung cancer has a high mortality rate worldwide. Non‑SMC condensin I complex subunit H (NCAPH) has been identified to be one of the regulatory subunits of the condensin I complex, which is essential for the correct packaging and segregation of chromosomes in eukaryotes. NCAPH is abnormally overexpressed in various types of cancer. A pro‑survival member of the Bcl‑2 family, myeloid cell leukemia sequence 1 (Mcl‑1) is also frequently overexpressed in multiple cancers and is associated with poorer clinical outcomes for patients. The association of NCAPH and Mcl‑1 proteins with the clinical and pathological features of non‑small cell lung cancer (NSCLC) remains to be elucidated. In the current study, the positive percentage of NCAPH in the non‑cancerous lung tissues was revealed to be higher compared with that in NSCLC. However, the positive percentage of Mcl‑1 in the non‑cancerous lung tissues was lower compared with NSCLC. In addition, NCAPH high‑expression patients had a higher overall survival rate compared with patients exhibiting low expression, whereas the Mcl‑1 high‑expression group had a lower survival rate. Pairwise association in 260 cases of NSCLC revealed that overexpression of the NCAPH protein was negatively associated with Mcl‑1 expression and vice versa. The results of multivariate Cox proportional hazard regression analysis also indicated that NCAPH and Mcl‑1 demonstrated potential as distinct prognostic factors that may be used in NSCLC. The expression of NCAPH and Mcl‑1 may be associated with, and act as distinct molecular marks for the prediction of a poor prognosis in patients with NSCLC.
Collapse
Affiliation(s)
- Qiuxia Xiong
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Songqing Fan
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410000, P.R. China
| | - Lincan Duan
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650118, P.R. China
| | - Baiyang Liu
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Kunming, Yunnan 650223, P.R. China
| | - Xiulin Jiang
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Kunming, Yunnan 650223, P.R. China
| | - Xiaobo Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Chunyan Xiong
- Department of Pulmonary and Critical Care Medicine, The First People's Hospital of Zhaotong, Zhaotong, Yunnan 657000, P.R. China
| | - Qingyuan Tao
- Department of Nuclear Medicine, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650021, P.R. China
| | - Juan Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Hui Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Chuanjiang Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Yong Duan
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| |
Collapse
|
10
|
West HJ. Jarring Discordance Between Idealized and Real-World Management in Stage III Non-Small-Cell Lung Cancer. JCO Oncol Pract 2020; 16:628-630. [PMID: 32574126 DOI: 10.1200/op.20.00428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
11
|
Bobbili P, Ryan K, DerSarkissian M, Dua A, Yee C, Duh MS, Gomez JE. Predictors of chemoradiotherapy versus single modality therapy and overall survival among patients with unresectable, stage III non-small cell lung cancer. PLoS One 2020; 15:e0230444. [PMID: 32187231 PMCID: PMC7080248 DOI: 10.1371/journal.pone.0230444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/29/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction Concurrent chemoradiotherapy (cCRT) was the standard of care for patients with unresectable stage III non-small cell lung cancer (NSCLC) prior to the PACIFIC trial, however, patients also received single modality therapy. This study identified predictors of therapy and differences in overall survival (OS). Methods This retrospective study included stage III NSCLC patients aged ≥65 years, with ≥1 claim for systemic therapy (ST) or radiotherapy (RT) within 90 days of diagnosis, identified in SEER-Medicare data (2009–2014). Patients who had overlapping claims for chemotherapy and RT ≤90 days from start of therapy were classified as having received cCRT. Patients who received sequential CRT or surgical resection of tumor were excluded. Predictors of cCRT were analyzed using logistic regression. OS was compared between therapies using adjusted Cox proportional hazards models. Results Of 3,799 patients identified, 21.7% received ST; 26.3% received RT; and 52.0% received cCRT. cCRT patients tended to be younger (p <0.001), White (p = 0.002), and have a good predicted performance status (p<0.001). Patients who saw all three specialist types (medical oncologist, radiation oncologist, and surgeon) had increased odds of receiving cCRT (p<0.001). ST and RT patients had higher mortality risk versus cCRT patients (hazard ratio [95% CI]: ST: 1.38 [1.26–1.51]; RT: 1.75 [1.61, 1.91]); p<0.001). Conclusions Several factors contributed to treatment selection, including patient age and health status, and whether the patient received multidisciplinary care. Given the survival benefit of receiving cCRT over single-modality therapy, physicians should discuss treatment within a multidisciplinary team, and be encouraged to pursue cCRT for patients with unresectable stage III NSCLC.
Collapse
Affiliation(s)
- Priyanka Bobbili
- Analysis Group, Inc., Boston, Massachusetts, United States of America
- * E-mail:
| | - Kellie Ryan
- AstraZeneca, Gaithersburg, Maryland, United States of America
| | | | - Akanksha Dua
- Analysis Group, Inc., Boston, Massachusetts, United States of America
| | - Christopher Yee
- Analysis Group, Inc., Boston, Massachusetts, United States of America
| | - Mei Sheng Duh
- Analysis Group, Inc., Boston, Massachusetts, United States of America
| | - Jorge E. Gomez
- Icahn School of Medicine at Mt. Sinai, New York, New York, United States of America
| |
Collapse
|