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Yamada T, Goto Y, Tanaka H, Kimura H, Minato K, Gyotoku H, Honda T, Watanabe S, Morimoto K, Kiyomi F, Uchino J, Takayama K. A phase 2 trial of durvalumab treatment following radiation monotherapy in patients with non-small cell lung cancer ineligible for stage III chemoradiotherapy: The SPIRAL-RT study. Eur J Cancer 2023; 195:113373. [PMID: 37890349 DOI: 10.1016/j.ejca.2023.113373] [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: 08/08/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Although concurrent chemoradiotherapy (CCRT) followed by durvalumab is the standard treatment for patients with stage III non-small cell lung cancer (NSCLC), only half of the patients are allowed to receive CCRT in real-world settings. We evaluated the efficacy and safety of durvalumab after radiation monotherapy for NSCLC patients who are ineligible for chemoradiotherapy. METHODS A single-arm, prospective, open-label, multicenter phase II trial was conducted in Japan. The patients received radiation (54-66 Gy) followed by durvalumab (10 mg/kg every 2 weeks for up to 12 months). The primary endpoint was the 1-year progression-free survival (PFS) rate. The secondary endpoints were the objective response rate (ORR), PFS, overall survival (OS), and safety. RESULTS Between September 2019 and April 2021, 33 patients were enroled from eight institutions. The median patient age was 79 years, and the majority of patients were male (78.8%). The 1-year PFS rate was 39.1% (90% confidence interval [CI]: 24.7-54.6%). Three patients (9.1%) had a performance status of 2. The ORR was 42.4% (95% CI: 27.2-59.2%). The median PFS and OS were 8.9 (95% CI: 7.4-19.4) and 20.8 (95% CI: 15.8-not estimable) months, respectively. The most common adverse event was radiation pneumonitis (51.5%). The median treatment duration was 6.4 (range: 0.50-12.0) months for durvalumab. At the endpoint, 30.3% (10/33) of the patients had completed 1 year of durvalumab therapy. CONCLUSIONS Durvalumab is an effective treatment with tolerable toxicity following radiation monotherapy in stage III NSCLC patients who are ineligible for chemoradiotherapy. TRIAL REGISTRATION JMA-IIA00434 (jRCT).
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Affiliation(s)
- Tadaaki Yamada
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuhiro Goto
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Tanaka
- Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hideharu Kimura
- Respiratory Medicine, Kanazawa University Hospital, Ishikawa, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
| | - Hiroshi Gyotoku
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takeshi Honda
- Department of Internal Medicine Division of Medical Oncology, Teikyo University School of Medicine, Tokyo, Japan
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Kenji Morimoto
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumiaki Kiyomi
- Statistics and Data Center, Clinical Research Support Center Kyushu, Fukuoka, Japan
| | - Junji Uchino
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Koichi Takayama
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Hasegawa T, Ariyasu R, Tanaka H, Saito R, Kawashima Y, Horiike A, Sakatani T, Tozuka T, Shiihara J, Saiki M, Tambo Y, Sonoda T, Miyazaki A, Uematsu S, Tsuchiya-Kawano Y, Yanagitani N, Nishino M. Subsequent treatment for locally advanced non-small-cell lung cancer that progressed after definitive chemoradiotherapy and consolidation therapy with durvalumab: a multicenter retrospective analysis (TOPGAN 2021-02). Cancer Chemother Pharmacol 2023; 92:29-37. [PMID: 37243795 DOI: 10.1007/s00280-023-04547-2] [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: 03/08/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE For patients with locally advanced non-small-cell lung cancer (LA-NSCLC) that progressed after definitive chemoradiotherapy (CRT) and durvalumab consolidation therapy, no subsequent standard treatment exists. The type of treatment selected for each timing of disease progression and its efficacy have not been investigated. METHODS We retrospectively enrolled patients with LA-NSCLC or inoperable NSCLC that progressed after definitive CRT and durvalumab consolidation therapy at 15 Japanese institutions. Patients were classified into the following: Early Discontinuation group (disease progression within 6 months after durvalumab initiation), Late Discontinuation group (disease progression from 7 to 12 months after durvalumab initiation), and Accomplishment group (disease progression from 12 months after durvalumab initiation). RESULTS Altogether, 127 patients were analyzed, including 50 (39.4%), 42 (33.1%) and 35 (27.5%) patients from the Early Discontinuation, Late Discontinuation, and Accomplishment groups, respectively. Subsequent treatments were Platinum plus immune checkpoint inhibitors (ICI) in 18 (14.2%), ICI in 7 (5.5%), Platinum in 59 (46.4%), Non-Platinum in 35 (27.6%), and tyrosine kinase inhibitor in 8 (6.3%) patients. In the Early Discontinuation, Late Discontinuation, and Accomplishment groups, 4 (8.0%), 7 (16.7%), and 7 (20.0%) patients were receiving Platinum plus ICI; 21 (42.0%), 22 (52.4%), and 16 (45.7%) were receiving Platinum, and 20 (40.0%), 8 (19.0%), and 7 (20.0%) were receiving Non-Platinum, respectively. No significant difference in progression-free survival was observed in the timing of disease progression. CONCLUSION In patients with LA-NSCLC hat progressed after definitive CRT and durvalumab consolidation therapy, subsequent treatment may change depending on the timing of disease progression.
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Affiliation(s)
- Tsukasa Hasegawa
- Division of Respiratory Disease, Department of Internal Medicine, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Ryo Ariyasu
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Hisashi Tanaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ryota Saito
- Department of Respiratory Medicine, Tohoku University Hospital, Sendai, Japan
| | - Yosuke Kawashima
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Atsushi Horiike
- Division of Medical Oncology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | | | - Takehiro Tozuka
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Jun Shiihara
- Department of Pulmonary Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masafumi Saiki
- Department of Respiratory Medicine, Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yuichi Tambo
- Department of Respiratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Tomoaki Sonoda
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Akito Miyazaki
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Shinya Uematsu
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Osaka, Japan
| | - Yuko Tsuchiya-Kawano
- Department of Respiratory Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Noriko Yanagitani
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Makoto Nishino
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Tatebe H, Harada H, Mori K, Iwata H, Akimoto T, Murakami M, Waki T, Ogino T, Nakamura M, Taguchi H, Nakayama H, Satouchi M, Aoyama H. Clinical results of proton beam radiotherapy for inoperable stage III non-small cell lung cancer: a Japanese national registry study. JOURNAL OF RADIATION RESEARCH 2023:7150736. [PMID: 37137157 DOI: 10.1093/jrr/rrad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/19/2023] [Indexed: 05/05/2023]
Abstract
This study presents the first data of a Japanese nationwide multi-institutional cohort and compares them with the findings of systematic literature reviews on radiation therapies and inoperable stage III non-small cell lung cancer (NSCLC) conducted by the Lung Cancer Working Group in the Particle Beam Therapy (PBT) Committee and Subcommittee at Japanese Society for Radiation Oncology. The Lung Cancer Working Group extracted eight reports and compared their data with those of the PBT registry from May 2016 to June 2018. All the analyzed 75 patients aged ≤80 years underwent proton therapy (PT) with concurrent chemotherapy for inoperable stage III NSCLC. The median follow-up period of the surviving patients was 39.5 (range, 1.6-55.6) months. The 2- and 3-year overall survival (OS) and progression-free survival rates were 73.6%/64.7% and 28.9%/25.1%, respectively. During the follow-up period, six patients (8.0%) had adverse events of Grade ≥ 3, excluding abnormal laboratory values. These included esophagitis in four patients, dermatitis in one and pneumonitis in one. Adverse events of Grade ≥ 4 were not observed. The results of these PBT registry data in patients with inoperable stage III NSCLC suggest that the OS rate was at least equivalent to that of radiation therapy using X-rays and that the incidence of severe radiation pneumonitis was low. PT may be an effective treatment to reduce toxicities of healthy tissues, including the lungs and heart, in patients with inoperable stage III NSCLC.
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Affiliation(s)
- Hitoshi Tatebe
- Proton Therapy Center, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui 910-0846, Japan
| | - Hideyuki Harada
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagamubo, Nagaizumi-cho, Sunto-Gun, Shizuoka 411-8777, Japan
| | - Keita Mori
- Department of Biostatistics, Clinical Research Center, Shizuoka Cancer Center, 1007 Shimonagamubo, Nagaizumi-cho, Sunto-Gun, Shizuoka 411-8777, Japan
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya 462-8508, Japan
| | - Tetsuo Akimoto
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa 277-0882, Japan
| | - Masao Murakami
- Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Fukushima, Koriyama 963-8052, Japan
| | - Takahiro Waki
- Department of Radiology, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama City, Okayama 708-0841, Japan
| | - Takashi Ogino
- Medipolis Proton Therapy and Research Center, 4423 Higashikata, Ibusuki City, Kagoshima 891-0304, Japan
| | - Masatoshi Nakamura
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Ibaraki, Tsukuba 305-8577, Japan
| | - Hiroshi Taguchi
- Department of Radiation Oncology, Hokkaido University Hospital, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-0808, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama City, Kanagawa 241-8515, Japan
| | - Miyako Satouchi
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70 kitaojicho, Akashi, Hyogo 673-8558, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine, Hokkaido 060-0808, Japan
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Zhao Y, Feng H, Tian J, Li B, Wang C, Ge L, Wang JK, Yang K, Yu Q. Consolidation treatments after chemoradiotherapy in patients with locally advanced inoperable non-small cell lung cancer: a systematic review and network meta-analysis protocol. BMJ Open 2022; 12:e060900. [PMID: 35414564 PMCID: PMC9006802 DOI: 10.1136/bmjopen-2022-060900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Concurrent chemoradiotherapy (CCRT) is the standard of care for inoperable locally advanced non-small cell lung cancer. To further improve prognosis, the use of consolidation treatments after CCRT has been explored extensively. Although durvalumab is the only consolidation treatment recommended by national clinical practice guidelines, there have been many studies exploring the effectiveness of other agents. However, until now, no studies have compared all agents systematically, and no studies have provided evidence for the optimal combination of different CCRTs and consolidation treatments regimens. This systematic review will evaluate the comparative clinical efficacy of consolidation therapies after CCRT as well as various combinations of CCRTs and consolidation therapies. METHODS AND ANALYSIS PubMed, the Cochrane Controlled Register of Trials (CENTRAL), EMBASE and ClinicalTrials.gov will be searched for relevant information. The estimated end date for the search will be 3 February 2022. Each stage of the review, including the study section, data extraction and risk of bias and quality of evidence assessments, will be performed in duplicate. We will include randomised controlled trials that included participants who received CCRT and consolidation treatment in at least one treatment arm. The primary endpoints will be overall survival and progression-free survival. Tumour response, health-related quality of life, disease-free survival and treatment-related toxicity will be presented as secondary outcomes. Both traditional meta-analysis and network meta-analysis (NMA) with the Bayesian approach will be conducted. Subgroup analyses and meta-regression will be completed to investigate heterogeneity, and sensitivity analyses will be conducted to assess the robustness of the findings. ETHICS AND DISSEMINATION Ethical approval and patient consent are not required as this study is a meta-analysis based on published studies. The results of this study will be submitted to a peer-reviewed journal for publication. In case of any changes in the protocol, protocol amendments will be updated in PROSPERO and explanations of these modifications will be described in the final report of this review. The results of this systematic review and NMA will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021239433.
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Affiliation(s)
- Ye Zhao
- First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Haiming Feng
- Department of Thoracic Surgery, The Second Affiliated Hospital of Lanzhou University, Lanzhou University, Lanzhou, Gansu, China
| | - Jinhui Tian
- Evidence Based Medicine Center, Lanzhou University, Lanzhou, Gansu, China
| | - Bin Li
- Department of Thoracic Surgery, The Second Affiliated Hospital of Lanzhou University, Lanzhou University, Lanzhou, Gansu, China
| | - Cheng Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Lanzhou University, Lanzhou University, Lanzhou, Gansu, China
| | - Long Ge
- Evidence Based Medicine Center, Lanzhou University, Lanzhou, Gansu, China
| | - Jian Kai Wang
- Department of Radiotherapy, Gansu Province People's Hospital, Lanzhou, Gansu, China
| | - Kehu Yang
- Evidence Based Medicine Center, Lanzhou University, Lanzhou, Gansu, China
| | - Qin Yu
- First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
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Yamamoto T, Tsukita Y, Katagiri Y, Matsushita H, Umezawa R, Ishikawa Y, Takahashi N, Suzuki Y, Takeda K, Miyauchi E, Saito R, Katsuta Y, Kadoya N, Jingu K. Durvalumab after chemoradiotherapy for locally advanced non-small cell lung cancer prolonged distant metastasis-free survival, progression-free survival and overall survival in clinical practice. BMC Cancer 2022; 22:364. [PMID: 35379201 PMCID: PMC8981776 DOI: 10.1186/s12885-022-09354-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background In clinical practice, the effect of durvalumab and radiation pneumonitis (RP) on survival after intensity-modulated radiotherapy (IMRT) is not fully understood. The purpose of this retrospective study was to investigate factors related to distant metastasis-free survival (DMFS), progression-free survival (PFS) and overall survival (OS) after IMRT for locally advanced non-small cell lung cancer (LA-NSCLC). Methods All patients who were treated with conventional fractionated IMRT for LA-NSCLC between April 2016 and March 2021 were eligible. Time-to-event data were assessed by using the Kaplan–Meier estimator, and the Cox proportional hazards model was used for prognostic factor analyses. Factors that emerged after the start of IMRT, such as durvalumab administration or the development of RP, were analysed as time-dependent covariates. Results A total of 68 consecutive patients treated with conventional fractionated IMRT for LA-NSCLC were analysed. Sixty-six patients completed radiotherapy, 50 patients received concurrent chemotherapy, and 36 patients received adjuvant durvalumab. During the median follow-up period of 14.3 months, 23 patients died, and tumour progression occurred in 37 patients, including 28 patients with distant metastases. The 1-year DMFS rate, PFS rate and OS rate were 59.9%, 48.7% and 84.2%, respectively. Grade 2 RP occurred in 16 patients, grade 3 in 6 patients and grade 5 in 1 patient. The 1-year cumulative incidences of grade 2 or higher RP and grade 3 or higher RP were 33.8% and 10.3%, respectively. The results of multivariate analyses showed that durvalumab had a significantly lower hazard ratio (HR) for DMFS, PFS and OS (HR 0.31, p < 0.01; HR 0.33, p < 0.01 and HR 0.32, p = 0.02), respectively. Grade 2 or higher RP showed significance for DMFS and a nonsignificant trend for OS (HR 2.28, p = 0.04 and HR 2.12, p = 0.13), respectively, whereas a higher percentage of lung volume receiving 20 Gy or higher was significant for PFS (HR 2.25, p = 0.01). Conclusions In clinical practice, durvalumab administration following IMRT with concomitant chemotherapy showed a significant survival benefit. Reducing the risk of grade 2 or higher RP would also be beneficial.
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Affiliation(s)
- Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Yoko Tsukita
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yu Katagiri
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yu Suzuki
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuya Takeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Eisaku Miyauchi
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryota Saito
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiyuki Katsuta
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Multi-institutional feasibility study of intensity-modulated radiotherapy with chemotherapy for locally advanced non-small cell lung cancer. Int J Clin Oncol 2022; 27:1025-1033. [PMID: 35305192 DOI: 10.1007/s10147-022-02151-7] [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: 11/01/2021] [Accepted: 02/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND This multi-institutional clinical trial evaluated the feasibility of intensity-modulated radiotherapy (IMRT) for patients with locally advanced non-small cell lung cancer (NSCLC). METHODS The major inclusion criteria were clinical stage III NSCLC, age 20-74 years, and Eastern Cooperative Oncology Group performance status 0-1. Patients were treated with either cisplatin + S-1 (CS; four cycles every 4 weeks) or carboplatin + paclitaxel (CP; administered weekly with thoracic radiotherapy [RT], plus two consolidation cycles) concurrently with IMRT (60 Gy in 30 fractions). The primary endpoint was a treatment completion rate, defined as at least two cycles of CS or five cycles of CP during IMRT and completing 60 Gy IMRT within 56 days after the start of treatment, assumed its 90% confidence interval exceeds 60%. RT quality assurance was mandatory for all the patients. RESULTS Twenty-two patients were registered. One patient withdrew due to pulmonary infection before starting treatment. RT plans were reviewed and none was judged as a protocol violation. Grade 2 and 3 pneumonitis occurred in four (19%) and one (5%) patients, respectively. Seventeen patients met the primary endpoint, with a treatment completion rate of 77.3% (90% confidence interval [CI] 58.0%-90.6%). Four patients failed to complete chemotherapy due to chemotherapy-related adverse events, but 20 patients completed IMRT. There were no treatment-related deaths. The 2-year progression-free and overall survival rates were 31.8% (95% CI 17.3%-58.7%) and 77.3% (95% CI 61.6%-96.9%), respectively. CONCLUSION The treatment completion rate did not meet the primary endpoint, but 20 of 22 patients completed IMRT.
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Research Progress of Heavy Ion Radiotherapy for Non-Small-Cell Lung Cancer. Int J Mol Sci 2022; 23:ijms23042316. [PMID: 35216430 PMCID: PMC8876478 DOI: 10.3390/ijms23042316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/10/2022] [Accepted: 02/18/2022] [Indexed: 02/05/2023] Open
Abstract
Non-small-cell lung cancer (NSCLC) has a high incidence and poses a serious threat to human health. However, the treatment outcomes of concurrent chemoradiotherapy for non-small-cell lung cancer are still unsatisfactory, especially for high grade lesions. As a new cancer treatment, heavy ion radiotherapy has shown promising efficacy and safety in the treatment of non-small-cell lung cancer. This article discusses the clinical progress of heavy ion radiotherapy in the treatment of non-small-cell lung cancer mainly from the different cancer stages, the different doses of heavy ion beams, and the patient’s individual factors, and explores the deficiency of heavy ion radiotherapy in the treatment of non-small-cell lung cancer and the directions of future research, in order to provide reference for the wider and better application of heavy ion radiotherapy in the future.
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Matsubara T, Takamori S, Fujishita T, Toyozawa R, Ito K, Yamaguchi M, Seto T, Okamoto T. Successful treatment of locally advanced lung cancer using late concurrent chemoradiation therapy administered after immune checkpoint inhibitor plus platinum chemotherapy. Thorac Cancer 2021; 12:3286-3289. [PMID: 34689423 PMCID: PMC8636214 DOI: 10.1111/1759-7714.14200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022] Open
Abstract
Concurrent chemoradiation therapy (CRT) is the standard of care for patients with unresectable stage II/III lung cancer. However, systemic chemotherapy is required for patients who are ineligible for radical radiation therapy. There is little evidence to date for the safety and efficacy of CRT administered after treatment with immune checkpoint inhibitors (ICIs). The cases reported here had inoperable stage III lung cancer (non‐small cell lung cancer and small cell lung cancer) and were ineligible for radical radiation therapy. They were administered ICIs plus chemotherapy and subsequently underwent late concurrent CRT. Because of the remarkable tumor shrinkage achieved by the ICIs plus chemotherapy, adverse events of CRT were tolerable. They were alive without tumor progression as of this report, over 1 year after CRT was terminated. CRT is administered with curative intent, while the intent of immunochemotherapy is palliative. Late concurrent CRT after immunochemotherapy is probably effective and tolerable. After treatment with systemic chemotherapy in patients judged ineligible for radical radiation therapy, radiation therapy should be reconsidered because of its importance once tumor shrinkage has been achieved.
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Affiliation(s)
- Taichi Matsubara
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Shinkichi Takamori
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Takatoshi Fujishita
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Ryo Toyozawa
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Kensaku Ito
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Masafumi Yamaguchi
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Takashi Seto
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Tatsuro Okamoto
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
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A randomized trial of sodium alginate prevention of esophagitis in LA-NSCLC receiving chemoradiotherapy: OLCSG1401. Support Care Cancer 2021; 29:5237-5244. [PMID: 33649919 DOI: 10.1007/s00520-021-06092-1] [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: 07/13/2020] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Radiation esophagitis is a critical adverse event that needs to be appropriately managed while administering thoracic irradiation. This trial aimed to investigate whether sodium alginate has preventative effects on esophagitis in patients with non-small-cell lung cancer (NSCLC) receiving concurrent chemoradiotherapy (CRT). METHODS Patients with untreated stage III NSCLC who were eligible for concurrent CRT were randomly assigned at a 1:1:1 ratio to receive one of the following treatments: initial or late use of oral sodium alginate (arms A and B) or water as control (arm C). The primary endpoint was the proportion of patients developing G3 or worse esophagitis. RESULTS Overall, 94 patients were randomly assigned between February 2014 and September 2018. The study was prematurely terminated because of slow accrual. The proportions of patients with G3 or worse esophagitis were 12.5%, 9.8%, and 19.4% in arms A, B, and C, respectively. Patients receiving sodium alginate had fewer onsets of G3 esophagitis; however, differences compared with arm C were not significant (A vs. C: p = 0.46; B vs. C: p = 0.28). The rates of grade 3 or worse non-hematologic toxicities besides esophagitis were 29%, 26%, and 43% in arms A, B, and C, respectively. Interestingly, compared with arm C, a low rate of febrile neutropenia was observed in arm A (3.1% vs. 19.4%: p = 0.04). CONCLUSIONS Sodium alginate did not show significant preventative effects on radiation-induced esophagitis in patients with NSCLC. The frequency of CRT-induced febrile neutropenia was lower in the early use sodium alginate arm. TRIAL REGISTRATION ClinicalTrials.gov Identifier Registry number: UMIN000013133.
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Pathy S, Thimmarayappa A, Malik P, Mallick S, Upadhyay A. Treatment outcomes and prognostic factors in locally advanced non-small cell lung cancer – An experience from normal India. J Cancer Res Ther 2021; 18:27-32. [DOI: 10.4103/jcrt.jcrt_1855_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Önal Ö, Koçer M, Eroğlu HN, Yilmaz SD, Eroğlu I, Karadoğan D. Survival analysis and factors affecting survival in patients who presented to the medical oncology unit with non-small cell lung cancer. Turk J Med Sci 2020; 50:1838-1850. [PMID: 32512671 PMCID: PMC7775717 DOI: 10.3906/sag-1912-205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/05/2020] [Indexed: 12/24/2022] Open
Abstract
Background/aim This study aimed to investigate the effect of clinical and pathological indicators at the time of the diagnosis on overall survival in patients recently diagnosed with non-small cell lung cancer. Materials and methods The study population consisted of patients who were diagnosed at the Faculty of Medicine at Isparta Süleyman Demirel University Hospital between January 1, 2010 and December 31, 2017 and presented to the medical oncology outpatient clinic. Results A total of 518 patients were evaluated, including 260 patients with squamous cell carcinoma, 207 patients with adenocarcinoma, 50 patients with non-small cell lung cancer-not otherwise specified, and 1 patient with large cell carcinoma. The average life expectancy was found to be 11.50 ± 1.40 months in patients with squamous cell carcinoma, 12.60 ± 1.59 months in patients with adenocarcinoma, and 8.70 ± 1.87 months in the other patients. The estimated 5-year relative survival rate for non-small cell lung cancer was 8% (7% for men and 18% for women). In the multivariate analysis, sex being male (HR, 2.41; P < 0.001), a performance status >2 (HR, 1.70; P < 0.001), the stage of cancer (HR, 1.37; P = 0.045), the presence of bone or liver metastasis (HR, 1.44, P = 0.009, HR, 1.57; P = 0.016, respectively), and the patient not having received radiotherapy (HR, 3.25; P < 0.001) or chemotherapy (HR, 1.85; P = 0.001) were defined as statistically significant predictive factors that reduced the overall survival. Conclusions In this study, sex, stage, performance status, the presence of liver or bone metastases, and treatment had an effect on overall survival.
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Affiliation(s)
- Özgür Önal
- Department of Public Health, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Murat Koçer
- Department of Medical Oncology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Hande Nur Eroğlu
- Department of Public Health, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Servet Derya Yilmaz
- Department of Public Health, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Ismet Eroğlu
- Department of Internal Medical Sciences, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Dilek Karadoğan
- Department of Chest Diseases, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
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12
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Pravosud V, Vanderford NL, Huang B, Tucker TC, Arnold SM. Exceptional Survival Among Kentucky Stage IV Non-small Cell Lung Cancer Patients: Appalachian Versus Non-Appalachian Populations. J Rural Health 2020; 38:14-27. [PMID: 33210370 DOI: 10.1111/jrh.12537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine differences in exceptional survival (ES)-survival of 5 years or more past diagnosis-between stage IV non-small cell lung cancer (NSCLC) patients residing in the Appalachian versus non-Appalachian regions of Kentucky. METHODS This was a population-based, retrospective case-control study of Kentucky patients, diagnosed with stage IV NSCLC between January 1, 2000, and December 31, 2011. The data were drawn from the Kentucky Cancer Registry. FINDINGS Findings from the multivariable logistic regression revealed no significant differences in the odds of ES between patients who resided in Appalachian versus non-Appalachian Kentucky. Being female and undergoing surgery only as the first course of treatment were associated with higher odds of ES. Increasing age, unspecified histology, having poorly differentiated or undifferentiated carcinomas, and receiving radiation therapy only as the first course of treatment were associated with decreased odds of ES. CONCLUSION Differences in the odds of ES among stage IV NSCLC patients were not related to residence in Appalachian versus non-Appalachian Kentucky. ES was associated with other nongenetic and treatment factors that warrant further investigations.
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Affiliation(s)
- Vira Pravosud
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Nathan L Vanderford
- Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, Lexington, Kentucky.,Markey Cancer Center, a National Cancer Institute Designated Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Bin Huang
- Division of Cancer Biostatistics, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky.,Markey Cancer Center, a National Cancer Institute Designated Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Thomas C Tucker
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky.,Markey Cancer Center, a National Cancer Institute Designated Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Susanne M Arnold
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky.,Markey Cancer Center, a National Cancer Institute Designated Cancer Center, University of Kentucky, Lexington, Kentucky
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Tanaka H, Hasegawa Y, Makiguchi T, Okumura F, Tabe C, Shiratori T, Ishioka Y, Itoga M, Taima K, Yokouchi J, Hatayama Y, Aoki M, Tasaka S. A Phase I/II Study of Biweekly Carboplatin and Nab-paclitaxel With Concurrent Radiotherapy for Patients With Locally Advanced Unresectable Stage III Non-small-cell Lung Cancer. Clin Lung Cancer 2020; 22:42-48. [PMID: 33158764 DOI: 10.1016/j.cllc.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Concurrent chemoradiotherapy (CCRT) is the standard treatment for patients with locally advanced non-small-cell lung cell cancer (LA-NSCLC). We conducted a phase I/II study of biweekly carboplatin and nab-paclitaxel (nab-PTX) with radiotherapy (RT). MATERIALS AND METHODS In the phase I part, patients with inoperable stage IIIA/IIIB NSCLC were treated with carboplatin (area under the time-concentration curve, 4) and nab-PTX (60-100 mg/m2) on days 1, 15, and 29. Thoracic RT was administered from day 1 to a total dose of 60 Gy in 30 fractions. In the phase II part, patients were administered carboplatin and nab-PTX on days 1, 15, and 29 at the recommended dose (RD). The primary endpoint of the phase I part was to determine the maximum tolerated dose and the RD. In the phase II part, the primary endpoint was 2-year overall survival (OS) rate, and secondary endpoints were the objective response rate, progression-free survival, OS, and safety profile. RESULTS In the phase I part, although maximum tolerated dose was not obtained, the RD was carboplatin (area under the time-concentration curve, 4) and nab-PTX (100 mg/m2). Of the evaluable 28 patients, the rate of 2-year OS was 67.8% (95% confidence interval, 49.3%-82.1%). The objective response rate was 96.4%, and the median follow-up time was 33.2 months. The median progression-free survival was 18.2 months (95% confidence interval, 13.1 months to not reached). The most common toxicities of grade 3 or higher were neutropenia (60.5%), anemia (14.2%), thrombocytopenia (7.2%), and pneumonitis (3.6%). CONCLUSIONS This study achieved the primary endpoint. Biweekly carboplatin and nab-PTX with concurrent RT was well-tolerated and exerted promising antitumor activity.
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Affiliation(s)
- Hisashi Tanaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Yukihiro Hasegawa
- Department of Respiratory Medicine, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Tomonori Makiguchi
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Fumihiko Okumura
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chiori Tabe
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Toshihiro Shiratori
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshiko Ishioka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masamichi Itoga
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kageaki Taima
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Junichi Yokouchi
- Department of Radiation Oncology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Yoshiomi Hatayama
- Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masahiko Aoki
- Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Sadatomo Tasaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Yamada T, Uchino J, Chihara Y, Shimamoto T, Iwasaku M, Tamiya N, Kaneko Y, Kiyomi F, Takayama K. Rationale and design of a phase II trial of durvalumab treatment in patients with NSCLC ineligible for stage III chemoradiotherapy following radiation monotherapy (SPIRAL-RT study). Ther Adv Med Oncol 2020; 12:1758835920927841. [PMID: 32536981 PMCID: PMC7268142 DOI: 10.1177/1758835920927841] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 04/28/2020] [Indexed: 12/18/2022] Open
Abstract
Background: In the PACIFIC study, progression-free survival (PFS) and overall survival (OS) of patients with unresectable, locally advanced, stage III non-small cell lung cancer (NSCLC) were prolonged by durvalumab as maintenance therapy after radical concurrent chemoradiotherapy using platinum-based antitumor agents. However, no data were obtained to reveal the efficacy of durvalumab after radiation monotherapy in patients unsuitable for chemoradiotherapy. Here, we describe an ongoing single-arm, prospective, open-label, multicenter phase II trial of durvalumab in patients with NSCLC ineligible for stage III chemoradiotherapy following radiation monotherapy (SPIRAL-RT study). Methods: Durvalumab at 10 mg/kg body weight is administered every 2 weeks after radiation therapy until individual patients meet the discontinuation criteria. The treatment duration is up to 12 months. The primary endpoint is the 1-year PFS rate. Secondary endpoints are response rate, PFS, OS, and safety. Durvalumab treatment after radiation monotherapy is expected to prolong 1-year PFS rate and have acceptable adverse events. Discussion: We are conducting an intervention study to investigate the safety and efficacy of durvalumab treatment in patients with NSCLC ineligible for stage III chemoradiotherapy following radiation monotherapy.
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Affiliation(s)
- Tadaaki Yamada
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Junji Uchino
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto 602-0857, Japan
| | - Yusuke Chihara
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takayuki Shimamoto
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Iwasaku
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nobuyo Tamiya
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshiko Kaneko
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumiaki Kiyomi
- Statistics and Data Center, Clinical Research Support Center Kyushu, Fukuoka, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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De Michino S, Aparnathi M, Rostami A, Lok BH, Bratman SV. The Utility of Liquid Biopsies in Radiation Oncology. Int J Radiat Oncol Biol Phys 2020; 107:873-886. [PMID: 32417410 DOI: 10.1016/j.ijrobp.2020.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/03/2020] [Indexed: 12/17/2022]
Abstract
The use of therapeutic radiation is primarily guided by clinicopathologic factors and medical imaging, whereas molecular biomarkers currently play a comparatively minor role in most settings. Liquid biopsies provide a rich source of noninvasive tumor-specific biomarkers and are amenable to repeated and noninvasive assessment. Here, we review the current status of liquid biopsies and their potential impact on the field of radiation oncology. We focus on established and emerging approaches to analyze circulating tumor DNA and circulating tumor cells from peripheral blood. These promising classes of biomarkers could have an outsized impact on cancer management by meaningfully stratifying patients into risk groups, tracking radiation therapy efficacy during and after treatment, and identifying patients with radiosensitive or radioresistant disease. Finally, we highlight opportunities for future investigation including the need for prospective interventional studies employing liquid biopsies to guide the management of radiation therapy-treated patients.
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Affiliation(s)
- Steven De Michino
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Mansi Aparnathi
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ariana Rostami
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin H Lok
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Scott V Bratman
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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16
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de Vos-Geelen J, Geurts SME, van Putten M, Valkenburg-van Iersel LBJ, Grabsch HI, Haj Mohammad N, Hoebers FJP, Hoge CV, Jeene PM, de Jong EJM, van Laarhoven HWM, Rozema T, Slingerland M, Tjan-Heijnen VCG, Nieuwenhuijzen GAP, Lemmens VEPP. Trends in treatment and overall survival among patients with proximal esophageal cancer. World J Gastroenterol 2019; 25:6835-6846. [PMID: 31885424 PMCID: PMC6931002 DOI: 10.3748/wjg.v25.i47.6835] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/04/2019] [Accepted: 12/14/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The management of proximal esophageal cancer differs from that of tumors located in the mid and lower part of the esophagus due to the close vicinity of vital structures. Non-surgical treatment options like radiotherapy and definitive chemoradiation (CRT) have been implemented. The trends in (non-)surgical treatment and its impact on overall survival (OS) in patients with proximal esophageal cancer are unclear, related to its rare disease status. To optimize treatment strategies and counseling of patients with proximal esophageal cancer, it is therefore essential to gain more insight through real-life studies.
AIM To establish trends in treatment and OS in patients with proximal esophageal cancer.
METHODS In this population-based study, patients with proximal esophageal cancer diagnosed between 1989 and 2014 were identified in the Netherlands Cancer Registry. The proximal esophagus consists of the cervical esophagus and the upper thoracic section, extending to 24 cm from the incisors. Trends in radiotherapy, chemotherapy, and surgery, and OS were assessed. Analyses were stratified by presence of distant metastasis. Multivariable Cox proportional hazards regression analyses was performed to assess the effect of period of diagnosis on OS, adjusted for patient, tumor, and treatment characteristics.
RESULTS In total, 2783 patients were included. Over the study period, the use of radiotherapy, resection, and CRT in non-metastatic disease changed from 53%, 23%, and 1% in 1989-1994 to 21%, 9%, and 49% in 2010-2014, respectively. In metastatic disease, the use of chemotherapy and radiotherapy increased over time. Median OS of the total population increased from 7.3 mo [95% confidence interval (CI): 6.4-8.1] in 1989-1994 to 9.5 mo (95%CI: 8.1-10.8) in 2010-2014 (logrank P < 0.001). In non-metastatic disease, 5-year OS rates improved from 5% (95%CI: 3%-7%) in 1989-1994 to 13% (95%CI: 9%-17%) in 2010-2014 (logrank P < 0.001). Multivariable regression analysis demonstrated a significant treatment effect over time on survival. In metastatic disease, median OS was 3.8 mo (95%CI: 2.5-5.1) in 1989-1994, and 5.1 mo (95%CI: 4.3-5.9) in 2010-2014 (logrank P = 0.26).
CONCLUSION OS significantly improved in non-metastatic proximal esophageal cancer, likely to be associated with an increased use of CRT. Patterns in metastatic disease did not change significantly over time.
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Affiliation(s)
- Judith de Vos-Geelen
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Sandra ME Geurts
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Margreet van Putten
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven 5612 HZ, Netherlands
| | - Liselot BJ Valkenburg-van Iersel
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Heike I Grabsch
- Department of Pathology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
- Pathology and Data Analytics, Leeds Institute of Medical Research at St James”s, University of Leeds, Leeds LS9 7TF, United Kingdom
| | - Nadia Haj Mohammad
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht 3584 CX, Netherlands
| | - Frank JP Hoebers
- Department of Radiation Oncology (MAASTRO clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6229 ET, Netherlands
| | - Chantal V Hoge
- Department of Internal Medicine, Division of Gastroenterology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Paul M Jeene
- Department of Radiotherapy, Radiotherapiegroep, Deventer 7416 SE, Netherlands
| | - Evelien JM de Jong
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Hanneke WM van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam 1105 AZ, Netherlands
| | - Tom Rozema
- Department of Radiotherapy, Insituut Verbeeten, Tilburg 5042 SB, Netherlands
| | - Marije Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden 2333 ZA, Netherlands
| | - Vivianne CG Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | | | - Valery EPP Lemmens
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven 5612 HZ, Netherlands
- Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam 3015 GD, Netherlands
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17
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Ito H, Matsuo Y, Ohtsu S, Nishimura T, Terada Y, Sakamoto T, Mizowaki T. Impact of histology on patterns of failure and clinical outcomes in patients treated with definitive chemoradiotherapy for locally advanced non-small cell lung cancer. Int J Clin Oncol 2019; 25:274-281. [PMID: 31667664 DOI: 10.1007/s10147-019-01566-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 10/19/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chemoradiotherapy is the standard treatment for locally advanced non-small cell lung cancer. Unlike metastatic disease, histological differences are usually not considered while planning chemoradiotherapy. This study aimed to compare clinical outcomes and relapse patterns between squamous cell carcinomas and adenocarcinomas, and investigated possible histology-specific approaches for chemoradiotherapy in locally advanced non-small cell lung cancer. METHODS We retrospectively analyzed the outcomes and relapse patterns in patients who received definitive chemoradiotherapy for locally advanced non-small cell lung cancer in Katsura hospital between 2003 and 2012. RESULTS A total of 68 and 33 patients with squamous cell carcinomas and adenocarcinomas, respectively, were enrolled. Patients with adenocarcinoma had less advanced T stages, and a larger proportion of female patients. Other factors were not different between the two groups. The median follow-up duration in all patients and survivors was 21.3 months and 91.4 months, respectively. Median survival and relapse-free survival were not significantly different between the two groups. In contrast, the failure patterns and incidences of distant failure were significantly different. Patients with squamous cell carcinomas had predominantly locoregional disease features and a shorter duration from relapse to death compared to patients with adenocarcinoma. CONCLUSION Failure pattern was significantly different between the two histologies. Among relapsed patients, the prognosis was poorer in those with squamous cell carcinomas than those with adenocarcinomas. Further studies, to evaluate histology-specific approaches in chemoradiotherapy, are warranted.
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Affiliation(s)
- Hitoshi Ito
- Department of Radiation Oncology, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nsikyo-ku, Kyoto, 615-8256, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Shuji Ohtsu
- Department of Radiation Oncology, Kyoto City Hospital, 1-2 Mibu Takadahigashi-cho, Nakagyo-ku, Kyoto, 604-8845, Japan
| | - Takashi Nishimura
- Department of Respiratory Medicine, Respiratory Disease Center, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nsikyo-ku, Kyoto, 615-8256, Japan
| | - Yasuji Terada
- Department of Thoracic Surgery, Respiratory Disease Center, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nsikyo-ku, Kyoto, 615-8256, Japan
| | - Takashi Sakamoto
- Department of Radiation Oncology, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nsikyo-ku, Kyoto, 615-8256, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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18
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Bobbili P, Ryan K, Duh MS, Dua A, Fernandes AW, Pavilack M, Gomez JE. Treatment patterns and overall survival among patients with unresectable, stage III non-small-cell lung cancer. Future Oncol 2019; 15:3381-3393. [PMID: 31544510 DOI: 10.2217/fon-2019-0282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: To analyze treatment patterns and overall survival (OS) across time (2009-2014) among patients with unresected, stage III non-small-cell lung cancer (NSCLC). Patients & methods: Stage III NSCLC patients aged ≥65 years who initiated therapy were identified using SEER-Medicare data. Results: Among 4564 patients, 84% received chemotherapy (with or without radiotherapy), and 59% received chemoradiotherapy (CRT). Carboplatin + paclitaxel was the most frequent regimen. Median (interquartile range) OS among chemotherapy patients was 13.2 (6.0-28.9) months, and 14.8 (6.7-33.4) months among CRT patients. Among CRT patients, there was no difference in OS across years of CRT initiation. Conclusion: OS remained static across 2009-2014, indicating stagnancy in clinical outcomes for stage III NSCLC patients and a need for more effective therapeutic options.
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Affiliation(s)
| | - Kellie Ryan
- US Medical Affairs, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Mei S Duh
- Analysis Group, Inc., Boston, MA 02199, USA
| | | | | | | | - Jorge E Gomez
- Icahn School of Medicine at Mt Sinai, New York, NY 10029, USA
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19
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Liu R, Wei S, Zhang Q, Zhang X, Luo H, Tian J, Li Y, Ge L, Wang X. Epidermal growth factor receptor tyrosine kinase inhibitors combined with thoracic radiotherapy or chemoradiotherapy for advanced or metastatic non-small cell lung cancer: A systematic review and meta-analysis of single-arm trials. Medicine (Baltimore) 2019; 98:e16427. [PMID: 31335695 PMCID: PMC6708798 DOI: 10.1097/md.0000000000016427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 05/24/2019] [Accepted: 06/17/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Preclinical in vitro experiments demonstrated that epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) might have synergistic effect in combination with radiotherapy on Non-small cell lung cancer (NSCLC), but the clinical trials showed inconsistence results in NSCLC patients with EGFR status unknow or mutations. This study aimed to determine if added TKIs to Thoracic radiotherapy (TRT) improve primary disease response rate (RR) and survival outcomes in advanced or metastatic NSCLC. METHODS We searched MEDLINE, EMBASE, and Cochrane Library from January 2000 to December 2017 for eligible studies where patients received concurrent EGFR TKIs and TRT or CRT. Concerned outcomes were primary tumor RR, overall survival (OS), and adverse events (AEs). The meta-analysis was performed using Stata software (version 12.0). Random effects models were used to pool outcomes across studies. Sensitivity analysis was performed to determine if the results would be different. RESULTS We found 16 prospective clinical trials with mature results for meta-analyses. Twelve studies including 446 patients reported the RR and survival outcomes of TRT combined TKIs. The CR, PR, SD, and PD, respectively, were 0.06 (95% CI 0.03-0.09, I = 0%), 0.44 (95% CI 0.38-0.49, I = 64.9%), 0.29 (95% CI 0.24-0.34, I = 78.4%), and 0.15 (95% CI 0.11-0.19, I = 84.2%). One- and 2-year OS, respectively, were 0.52 (95% CI 0.44-0.60, I = 38.8%) and 0.26 (95% CI 0.18-0.33, I = 0%). Four studies including 182 patients reported the RR and survival outcomes of CRT combined TKIs. The pooled CR, PR, SD, and PD, respectively, were 0.12 (95% CI 0.02-0.22, I = 69.1%), 0.41 (95% CI 0.27-0.55, I71.6%), 0.31 (95% CI 0.16-0.46, I = 79%), and 0.14 (95% CI -0.01-0.30, I = 87.8%). Only 1 study reported the survival event rate, 1- and 2-year OS, respectively, were 0.83 (95% CI 0.71-0.94) and 0.67 (95% CI 0.54-0.81). There were not severe adverse events (SAEs) reported either TRT combined TKIs or CRT combined TKIs. CONCLUSION There is evidence, albeit of low quality, that added the TKIs to TRT or CRT may improve RR and survival outcomes in patients with EGFR mutant status unknown advanced or metastatic NSCLC relative to other studies of TKIs alone, TRT alone or CRT.
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Affiliation(s)
- Ruifeng Liu
- The First Clinical Medical College of Lanzhou University
- Radiotherapy Oncology Department, Gansu Provincial Cancer Hospital
| | - Shihong Wei
- Radiotherapy Oncology Department, Gansu Provincial Cancer Hospital
| | - Qiuning Zhang
- The First Clinical Medical College of Lanzhou University
- Radiotherapy Oncology Department, Gansu Provincial Cancer Hospital
| | - Xueliang Zhang
- Radiotherapy Oncology Department, Gansu Provincial Cancer Hospital
| | - Hongtao Luo
- The First Clinical Medical College of Lanzhou University
- Radiotherapy Oncology Department, Gansu Provincial Cancer Hospital
| | - Jinhui Tian
- Center of Evidence Based Medicine, Lanzhou University, Lanzhou
| | - Yi Li
- The First Clinical Medical College of Lanzhou University
- Hebei provincial chest Hospital, Shijiazhuang, PR China
| | - Long Ge
- The First Clinical Medical College of Lanzhou University
- Center of Evidence Based Medicine, Lanzhou University, Lanzhou
| | - Xiaohu Wang
- The First Clinical Medical College of Lanzhou University
- Radiotherapy Oncology Department, Gansu Provincial Cancer Hospital
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20
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Addition of chemotherapy improves overall survival in patients with T2N0M0 non-small cell lung cancer undergoing definitive radiation therapy: An analysis of the SEER database. Radiother Oncol 2019; 131:75-80. [DOI: 10.1016/j.radonc.2018.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/27/2018] [Accepted: 12/02/2018] [Indexed: 12/25/2022]
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21
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Majem M, Juan O, Insa A, Reguart N, Trigo JM, Carcereny E, García-Campelo R, García Y, Guirado M, Provencio M. SEOM clinical guidelines for the treatment of non-small cell lung cancer (2018). Clin Transl Oncol 2019; 21:3-17. [PMID: 30446985 PMCID: PMC6339680 DOI: 10.1007/s12094-018-1978-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/29/2018] [Indexed: 12/14/2022]
Abstract
Non-small cell lung cancer (NSCLC) accounts for up to 85% of all lung cancers. The last few years have seen the development of a new staging system, diagnostic procedures such as liquid biopsy, treatments like immunotherapy, as well as deeper molecular knowledge; so, more options can be offered to patients with driver mutations. Groups with specific treatments account for around 25% and demonstrate significant increases in overall survival, and in some subgroups, it is important to evaluate each treatment alternative in accordance with scientific evidence, and even more so with immunotherapy. New treatments similarly mean that we must reconsider what should be done in oligometastatic disease where local treatment attains greater value.
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Affiliation(s)
- M. Majem
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - O. Juan
- Medical Oncology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - A. Insa
- Medical Oncology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - N. Reguart
- Medical Oncology Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - J. M. Trigo
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - E. Carcereny
- Medical Oncology Department, Institut Català d’Oncologia Badalona-Hospital Germans Trias i Pujol, Badalona, Spain
| | - R. García-Campelo
- Medical Oncology Department, Complexo Hospitalario Universitario A Coruña, Coruña, Spain
| | - Y. García
- Medical Oncology Department, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - M. Guirado
- Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain
| | - M. Provencio
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
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22
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Kobayashi H, Naito T, Omae K, Omori S, Nakashima K, Wakuda K, Ono A, Kenmotsu H, Murakami H, Endo M, Harada H, Takahashi T. Impact of Interstitial Lung Disease Classification on the Development of Acute Exacerbation of Interstitial Lung Disease and Prognosis in Patients with Stage III Non-Small-Cell Lung Cancer and Interstitial Lung Disease Treated With Chemoradiotherapy. J Cancer 2018; 9:2054-2060. [PMID: 29896291 PMCID: PMC5995939 DOI: 10.7150/jca.24936] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/10/2018] [Indexed: 01/23/2023] Open
Abstract
Introduction: Data on the efficacy and risk of curative-intent chemoradiotherapy in patients with inoperable stage III non-small-cell lung cancer (NSCLC) and interstitial lung disease (ILD) are limited. The aim of this study was to explore the impact of ILD classification on acute exacerbation (AE) of ILD and prognosis in patients with stage III NSCLC and ILD treated with chemoradiotherapy. Materials and methods: We retrospectively reviewed the medical records of patients with stage III NSCLC and ILD treated with curative-intent chemoradiotherapy as the first-line treatment at the Shizuoka Cancer Center between June 2009 and May 2014. Results: Of 37 patients, 17 (46%) developed AE of ILD worse than grade 3 within 1 year after the last irradiation. In univariate analysis, the incidence rate of AE of ILD was lower in patients with a non-usual interstitial pneumonia (UIP) pattern than in those with a UIP pattern. Multivariate analysis showed that ILD classification was significantly associated with the incidence of AE of ILD. The median overall survival (OS) durations in patients with a non-UIP pattern and a UIP pattern were 16.5 and 9.3 months, respectively. In univariate analysis, patients with a non-UIP pattern showed better survival. Multivariate analysis showed that ILD classification was a significant independent prognostic factor. Conclusion: The incidence of AE of ILD was high in patients with stage III NSCLC and ILD treated with chemoradiotherapy as the first-line treatment. However, diagnosis of a non-UIP pattern could predict lower risk of AE of ILD and longer OS durations.
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Affiliation(s)
- Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Katsuhiro Omae
- Clinical Research Promotion Unit, Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shota Omori
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kazuhisa Nakashima
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.,Clinical Research Promotion Unit, Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan.,Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan.,Division of Radiation Therapy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masahiro Endo
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideyuki Harada
- Division of Radiation Therapy, Shizuoka Cancer Center, Shizuoka, Japan
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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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Uemura T, Hida T. Durvalumab showed long and durable effects after chemoradiotherapy in stage III non-small cell lung cancer: results of the PACIFIC study. J Thorac Dis 2018; 10:S1108-S1112. [PMID: 29850190 DOI: 10.21037/jtd.2018.03.180] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Takehiro Uemura
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Toyoaki Hida
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Aichi, Japan
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25
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Benveniste MF, Betancourt Cuellar SL, Gomez D, Shroff GS, Carter BW, Benveniste APA, Marom EM. Imaging of Radiation Treatment of Lung Cancer. Semin Ultrasound CT MR 2018; 39:297-307. [PMID: 29807640 DOI: 10.1053/j.sult.2018.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Radiation therapy is an important modality in the treatment of patients with lung cancer. Recent advances in delivering radiotherapy were designed to improve loco-regional tumor control by focusing higher doses on the tumor. More sophisticated techniques in treatment planning include 3-dimensional conformal radiation therapy, intensity-modulated radiotherapy, stereotactic body radiotherapy, and proton therapy. These methods may result in nontraditional patterns of radiation injury and various radiologic appearances that can be mistaken for recurrence, infection and other lung diseases. Knowledge of radiological manifestations, awareness of new radiation delivery techniques and correlation with radiation treatment plans are essential in order to correctly interpret imaging in these patients.
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Affiliation(s)
- Marcelo F Benveniste
- Department of Diagnostic Radiology, The University of Texas, M. D. Anderson Cancer Center, Houston, TX.
| | | | - Daniel Gomez
- Department of Radiation Oncology, The University of Texas, M. D. Anderson Cancer Center, Houston, TX
| | - Girish S Shroff
- Department of Diagnostic Radiology, The University of Texas, M. D. Anderson Cancer Center, Houston, TX
| | - Brett W Carter
- Department of Diagnostic Radiology, The University of Texas, M. D. Anderson Cancer Center, Houston, TX
| | | | - Edith M Marom
- Department of Diagnostic Radiology, The University of Texas, M. D. Anderson Cancer Center, Houston, TX
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26
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Dyer BA, Daly ME. Surveillance imaging following definitive radiotherapy for non-small cell lung cancer: What is the clinical impact? Semin Oncol 2017; 44:303-309. [PMID: 29580432 PMCID: PMC5903453 DOI: 10.1053/j.seminoncol.2018.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/31/2018] [Indexed: 12/17/2022]
Abstract
Lung cancer is the leading cause of cancer death worldwide. Recurrence rates at all stages are high, but evidence-based post-treatment surveillance imaging strategies to detect recurrence are poorly defined, and salvage options are frequently limited. A number of national and international oncology guidelines address post-treatment imaging, but are largely based on low-level, retrospective evidence because of a paucity of high-quality data, particularly in regard to cost-effectiveness and quality-of-life endpoints. Given the lack of randomized data addressing appropriate surveillance imaging modality and interval following definitive treatment of lung cancer, there remains an unmet clinical need. Meaningful surveillance endpoints should include the financial impact, patient quality-of-life outcomes, and access-to-care issues associated with intensive follow-up to ensure that guidelines reflect quality and sustainability. A need for prospective randomized data on the subject of imaging surveillance after definitive local therapy remains an unmet need, and an opportunity for collaboration and further research.
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Affiliation(s)
- Brandon A Dyer
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA.
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27
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Takemoto S, Nakamura Y, Fukuda M, Senju H, Gyotoku H, Taniguchi H, Shimada M, Ikeda T, Yamaguchi H, Nakatomi K, Hayashi N, Soda H, Mukae H. Phase I study of pemetrexed and concurrent radiotherapy for previously untreated elderly patients with locally advanced non-squamous non-small cell lung cancer. Thorac Cancer 2017; 8:577-581. [PMID: 28771961 PMCID: PMC5668476 DOI: 10.1111/1759-7714.12483] [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: 04/26/2017] [Revised: 06/20/2017] [Accepted: 06/20/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chemoradiotherapy is the standard treatment for locally advanced non-small cell lung cancer (NSCLC); however, it is disputed whether this treatment is suitable for patients aged ≥75. This study was conducted to determine the maximum tolerated dose (MTD) of pemetrexed for use in concurrent radiotherapy for elderly patients with locally advanced non-squamous NSCLC. METHODS The eligibility criteria were as follows: aged ≥75 with inoperable stage IIIA or IIIB non-squamous NSCLC, no history of chemotherapy or radiotherapy, a performance status of 0 or 1, and adequate organ function. The patients were scheduled to receive pemetrexed on days 1, 22, 43, and 64 with concurrent once daily thoracic radiotherapy (60 Gy). The initial pemetrexed dose was 400 (level 1), and it was planned to increase the dose to 500 mg/m2 (level 2). RESULTS Two patients were enrolled in this trial. In the first case, the patient suffered prolonged leukocytopenia, and treatment was discontinued on day 35. In the second case, febrile neutropenia occurred on day 32, and the patient developed drug-induced pneumonitis and acute respiratory distress syndrome. Both patients experienced dose-limiting toxicities; therefore, the level 1 dose was considered to be the MTD. CONCLUSIONS During combined treatment with pemetrexed and concurrent radiotherapy, a pemetrexed dose of 400 mg/m2 was the MTD; we did not set up a phase II study. Concurrent chemoradiotherapy might be too toxic for elderly patients aged ≥75 with locally advanced NSCLC.
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Affiliation(s)
- Shinnosuke Takemoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Respiratory Medicine, National Hospital Nagasaki Medical Center, Omura, Japan
| | - Yoichi Nakamura
- Division of Thoracic Oncology, Department of Medical Oncology, Tochigi Cancer Center, Tochigi, Japan
| | - Minoru Fukuda
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Clinical Oncology Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroaki Senju
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Gyotoku
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hirokazu Taniguchi
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Midori Shimada
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takaya Ikeda
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroyuki Yamaguchi
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Katsumi Nakatomi
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Nobuyuki Hayashi
- Department of Radiotherapy, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Hiroshi Soda
- Department of Respiratory Medicine, Sasebo City General Hospital, Sasebo, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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28
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Ishihara M, Igawa S, Sasaki J, Otani S, Fukui T, Ryuge S, Katono K, Hiyoshi Y, Kasajima M, Mitsufuji H, Kubota M, Yokoba M, Katagiri M, Sekiguchi A, Soda I, Ishiyama H, Hayakawa K, Masuda N. Evaluation of concurrent chemoradiotherapy for locally advanced NSCLC according to EGFR mutation status. Oncol Lett 2017; 14:885-890. [PMID: 28693247 DOI: 10.3892/ol.2017.6231] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 01/31/2017] [Indexed: 01/19/2023] Open
Abstract
Concurrent chemoradiotherapy (cCRT) is the standard treatment for patients with locally advanced non-small cell lung cancer (LA-NSCLC). However, the efficacy and safety of this treatment has not been compared between patients who possess epidermal growth factor receptor (EGFR) mutations and patients with wild-type EGFR. The objective of the present study was to evaluate the effect of the presence of EGFR gene mutations in patients with LA-NSCLC receiving cCRT. Between January 2007 and December 2013, the records of 64 patients were reviewed retrospectively. The data were statistically analyzed to evaluate the efficacy of cCRT according to EGFR mutation status. In total, 15/64 were revealed to possess EGFR mutations, 23%, and comprised the mutant EGFR group. The progression-free survival time was significantly shorter in the mutant EGFR group compared with the patient group with tumors exhibiting wild-type EGFR, 6.3 and 9.5 months, respectively (P<0.001). The overall survival rate was longer in the mutant EGFR group compared with the wild-type EGFR group, although the difference was not statistically significant, 37.1 and 21.1 months, respectively (P=0.26). The disease recurred in all of the patients of the mutant EGFR group, whilst the recurrence rate in the wild-type EGFR group was 89%. The frequency of distant metastasis was significantly higher in the mutant EGFR group compared with the wild-type EGFR group. In conclusion, these data suggest that additional studies are required to identify strategies for reinforcing the efficacy of cCRT, with a focus on the potential use of EGFR tyrosine kinase inhibitors for patients exhibiting an EGFR mutation.
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Affiliation(s)
- Mikiko Ishihara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Satoshi Igawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Sakiko Otani
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Tomoya Fukui
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Shinichiro Ryuge
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Ken Katono
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Yasuhiro Hiyoshi
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Masashi Kasajima
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Hisashi Mitsufuji
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Masaru Kubota
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Masanori Yokoba
- School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa 252-0373, Japan
| | - Masato Katagiri
- School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa 252-0373, Japan
| | - Akane Sekiguchi
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Itaru Soda
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Hiromichi Ishiyama
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Kazushige Hayakawa
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Noriyuki Masuda
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
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29
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Shirai K, Kawashima M, Saitoh JI, Abe T, Fukata K, Shigeta Y, Irie D, Shiba S, Okano N, Ohno T, Nakano T. Clinical outcomes using carbon-ion radiotherapy and dose-volume histogram comparison between carbon-ion radiotherapy and photon therapy for T2b-4N0M0 non-small cell lung cancer-A pilot study. PLoS One 2017; 12:e0175589. [PMID: 28399182 PMCID: PMC5388495 DOI: 10.1371/journal.pone.0175589] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/28/2017] [Indexed: 12/25/2022] Open
Abstract
The safety and efficacy of carbon-ion radiotherapy for advanced non-small cell lung cancer have not been established. We evaluated the clinical outcomes and dose-volume histogram parameters of carbon-ion radiotherapy compared with photon therapy in T2b–4N0M0 non-small cell lung cancer. Twenty-three patients were treated with carbon-ion radiotherapy between May 2011 and December 2015. Seven, 14, and 2 patients had T2b, T3, and T4, respectively. The median age was 78 (range, 53−91) years, with 22 male patients. There were 12 adenocarcinomas, 8 squamous cell carcinomas, 1 non-small cell lung carcinoma, and 2 clinically diagnosed lung cancers. Eleven patients were operable, and 12 patients were inoperable. Most patients (91%) were treated with carbon-ion radiotherapy of 60.0 Gy relative biological effectiveness (RBE) in 4 fractions or 64.0 Gy (RBE) in 16 fractions. Local control and overall survival rates were calculated. Dose-volume histogram parameters of normal lung and tumor coverages were compared between carbon-ion radiotherapy and photon therapies, including three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT). The median follow-up of surviving patients was 25 months. Three patients experienced local recurrence, and the 2-year local control rate was 81%. During follow-up, 5 patients died of lung cancer, and 1 died of intercurrent disease. The 2-year overall survival rate was 70%. Operable patients had a better overall survival rate compared with inoperable patients (100% vs. 43%; P = 0.04). There was no grade ≥2 radiation pneumonitis. In dose-volume histogram analysis, carbon-ion radiotherapy had a significantly lower dose to normal lung and greater tumor coverage compared with photon therapies. Carbon-ion radiotherapy was effectively and safely performed for T2b–4N0M0 non-small cell lung cancer, and the dose distribution was superior compared with those for photon therapies. A Japanese multi-institutional study is ongoing to prospectively evaluate these patients and establish the use of carbon-ion radiotherapy.
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Affiliation(s)
- Katsuyuki Shirai
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
- * E-mail:
| | | | - Jun-ichi Saitoh
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
| | - Takanori Abe
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
| | - Kyohei Fukata
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
| | - Yuka Shigeta
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
| | - Daisuke Irie
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
| | - Shintaro Shiba
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
| | - Naoko Okano
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
| | - Takashi Nakano
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
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30
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Ninomiya K, Ichihara E, Hotta K, Sone N, Murakami T, Harada D, Oze I, Kubo T, Tanaka H, Kuyama S, Kishino D, Bessho A, Harita S, Katsui K, Tanimoto M, Kiura K. Three-Arm Randomized Trial of Sodium Alginate for Preventing Radiation-Induced Esophagitis in Locally Advanced Non–Small Cell Lung Cancer Receiving Concurrent Chemoradiotherapy: The OLCSG1401 Study Protocol. Clin Lung Cancer 2017; 18:245-249. [DOI: 10.1016/j.cllc.2016.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 08/23/2016] [Indexed: 12/28/2022]
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31
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Sumita K, Harada H, Asakura H, Ogawa H, Onoe T, Murayama S, Nakamura S, Tanigawa N, Takahashi T, Nishimura T. Re-irradiation for locoregionally recurrent tumors of the thorax: a single-institution, retrospective study. Radiat Oncol 2016; 11:104. [PMID: 27485533 PMCID: PMC4971641 DOI: 10.1186/s13014-016-0673-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 07/22/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Re-irradiation (re-RT) of the thorax is challenging due to the impact of prior therapies on normal tissues, and there are few reports of definitive re-RT. The treatment toxicities and efficacy of re-RT are not well known. The aim of the present study was to assess the safety and efficacy of definitive re-RT of the thorax. METHODS Patients who were treated with thoracic re-RT between March 2007 and December 2014 were retrospectively analyzed. Primary and re-irradiation plans were required to have an overlap of dose distributions for the 80 % isodose level. All doses were recalculated to an equivalent dose of 2 Gy per fraction (EQD2). When possible, analysis of dose accumulation was carried out using the medical image merge (MIM) (®) software program (version 6.5, MIM Software Inc., Cleveland, OH). Administration dosages for organs at risk were defined. RESULTS Fourteen (67 %) and seven (33 %) patients with non-small cell carcinoma (NSCLC) and small cell carcinoma (SCLC), respectively, were identified. The patients' median age was 72 (range 53-85) years. Fifteen patients (71 %) had "proximal" tumors, defined as tumors at the distal 2 cm of the trachea, carina, and main bronchi. The median interval from initial RT to re-RT was 26.8 (range 11.4-92.3) months. Re-RT was delivered by X-ray beam and proton beam therapy in 20 (95 %) patients and 1 (5 %) patient, respectively. The median radiation dose of re-RT was 60 (range 54-87.5) Gy10 and 50 (range 50.0-87.5) Gy10 for patients with NSCLC and SCLC, respectively. Grade 3 acute radiation pneumonitis occurred in only one patient. There were no other serious complications. The median follow-up time was 22.1 (range 2.3-56.4) months. The median local progression-free survival time (LPFS) and overall survival time (OS) were 12.9 (95 % confidence interval (CI): 8.9-27.9) months and 31.4 (95 % CI: 16.9-45.9) months, respectively. Patients receiving ≥ 60 Gy10 at re-RT had longer LPFS (p = 0.04). CONCLUSIONS Good safety with longer OS than in previous reports was demonstrated. Re-RT seems to be a promising treatment option. Further study to define the risk-benefit ratios is necessary.
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Affiliation(s)
- Kiyomi Sumita
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan. .,Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakatashi, Osaka, 573-1010, Japan.
| | - Hideyuki Harada
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hirofumi Asakura
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hirofumi Ogawa
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Tsuyoshi Onoe
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Shigeyuki Murayama
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Satoaki Nakamura
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakatashi, Osaka, 573-1010, Japan
| | - Noboru Tanigawa
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakatashi, Osaka, 573-1010, Japan
| | - Toshiaki Takahashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Tetsuo Nishimura
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
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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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Martínez E, Martínez M, Rico M, Hernández B, Casas F, Viñolas N, Pérez-Casas A, Dómine M, Mínguez J. Feasibility, tolerability, and efficacy of the concurrent addition of erlotinib to thoracic radiotherapy in locally advanced unresectable non-small-cell lung cancer: a Phase II trial. Onco Targets Ther 2016; 9:1057-66. [PMID: 27042098 PMCID: PMC4780183 DOI: 10.2147/ott.s89755] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Although many studies have confirmed the synergic effects of combining chemotherapy (CT) and radiotherapy (RT), clinical data evaluating safety and efficacy of erlotinib in combination with RT in locally advanced non-small-cell lung cancer (NSCLC) are limited. The aim of this study was to determine the feasibility, tolerability, and efficacy of the concurrent addition of erlotinib to the standard three-dimensional conformal thoracic RT in patients with unresectable or locally advanced NSCLC who are not candidates for receiving standard CT. Patients and methods Feasibility and tolerability, assessed by evaluating adverse events (AEs), and effectiveness, by calculating progression-free survival (PFS), overall survival (OS), cancer-specific survival (CSS), and objective response rate (ORR), were analyzed in 30 patients receiving RT alone and 60 receiving RT and erlotinib. Results Erlotinib with RT showed an extended CSS and a higher rate of complete responses compared with RT alone. No differences between groups were found regarding OS, PFS, and ORR. AEs were significantly higher in the combined treatment, which mainly included cutaneous toxicity, dyspnea, fatigue, hyporexia, diarrhea, and infection. Erlotinib did not increase the toxicity produced by RT. Conclusion The combination of erlotinib with RT produced, in our study, a scarce clinical benefit in the treatment of unresectable or locally advanced NSCLC, limited to complete responses and longer CSS rate compared with RT alone. Increased toxicity events were associated with combined therapy, which mainly included cutaneous toxicity. In our opinion, further studies in molecularly unselected lung cancer patients treated with EGFR TKIs and RT are not indicated. The use of biomarkers for the identification of patients that are most likely to benefit from this treatment is an essential next step in the research of this condition.
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Affiliation(s)
- Enrique Martínez
- Radiation Oncology Services, Hospital of Navarra, Pamplona, Spain
| | - Maite Martínez
- Radiation Oncology Services, Hospital of Navarra, Pamplona, Spain
| | - Mikel Rico
- Radiation Oncology Services, Hospital of Navarra, Pamplona, Spain
| | - Berta Hernández
- Radiation Oncology Services, Hospital of Navarra, Pamplona, Spain
| | - Francesc Casas
- Medical Oncology Department, Clinical Hospital of Barcelona, Barcelona, Spain
| | - Nuria Viñolas
- Medical Oncology Department, Clinical Hospital of Barcelona, Barcelona, Spain
| | - Ana Pérez-Casas
- Department of Radiation Oncology, Jiménez Díaz Foundation, Madrid, Spain
| | - Manuel Dómine
- Department of Radiation Oncology, Jiménez Díaz Foundation, Madrid, Spain
| | - Julián Mínguez
- Department of Radiation Oncology, University Hospital of Donostia, San Sebastian, Spain
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Hasegawa T, Futamura Y, Horiba A, Yoshida T, Suzuki T, Kato T, Kaito D, Ohno Y, Iida T, Hayashi S, Sawa T. A phase II study of nab-paclitaxel plus carboplatin in combination with thoracic radiation in patients with locally advanced non-small-cell lung cancer. JOURNAL OF RADIATION RESEARCH 2016; 57:50-54. [PMID: 26442970 PMCID: PMC4708916 DOI: 10.1093/jrr/rrv062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 08/07/2015] [Accepted: 08/25/2015] [Indexed: 06/05/2023]
Abstract
We investigated the efficacy and safety of albumin-bound paclitaxel (nab-PTX) and carboplatin (CBDCA) with concurrent radiotherapy for unresectable locally advanced non-small-cell lung cancer (NSCLC). Patients with Stage III NSCLC and an Eastern Cooperative Oncology Group performance status of 0 or 1 were eligible. Concurrent chemoradiotherapy consisted of weekly administration of nab-PTX (40 mg/m(2)) plus CBDCA (area under the plasma concentration time curve (AUC) 2) and thoracic radiotherapy (60 Gy/30 fractions) for a total of 6 weeks. After concurrent chemoradiotherapy, patients received an additional two cycles of consolidation phase chemotherapy that consisted of 4-week cycles of nab-PTX (100 mg/m(2) on Days 1, 8 and 15)/CBDCA (AUC 5 mg/ml/min on Day 1). Response was evaluated in accordance with the Response Evaluation Criteria in Solid Tumors. Progression-free survival and overall survival were estimated using the Kaplan-Meier method. Toxicity was graded using the National Cancer Institute Common Terminology Criteria for Adverse Events. A total of 10 patients were enrolled in this trial between September 2013 and January 2014 from three institutes. The overall response rate was 40.0% and the median progression-free survival was 6.7 months. Treatment-related death occurred in two patients. Grade 2 or worse severe radiation pneumonitis was observed in all three patients that had the volume of lung receiving at least 20 Gy (V20) >30%. The results of this study indicate that no further investigation is warranted into nab-PTX and CBDCA with concurrent thoracic radiation for Stage III NSCLC with V20 > 30% due to severe toxicity.
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Affiliation(s)
- Takaaki Hasegawa
- Department of Respiratory Medicine and Medical Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu-shi, Gifu 500-8323, Japan
| | - Yohei Futamura
- Department of Respiratory Medicine and Medical Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu-shi, Gifu 500-8323, Japan
| | - Akane Horiba
- Department of Respiratory Medicine and Medical Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu-shi, Gifu 500-8323, Japan
| | - Tsutomu Yoshida
- Department of Respiratory Medicine and Medical Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu-shi, Gifu 500-8323, Japan
| | - Toshitaka Suzuki
- Respirtory Medicine, National Hospital Organization Nagara Medical Center, 1300-7, Nagara, Gifu-shi, Gifu 502-8558, Japan
| | - Tatsuo Kato
- Respirtory Medicine, National Hospital Organization Nagara Medical Center, 1300-7, Nagara, Gifu-shi, Gifu 502-8558, Japan
| | - Daizo Kaito
- Department of Respirology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu 501-1194, Japan
| | - Yasuhi Ohno
- Department of Respirology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu 501-1194, Japan
| | - Takayoshi Iida
- Department of Radiology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu-shi, Gifu 500-8323, Japan
| | - Shinya Hayashi
- Department of Radiology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu 501-1194, Japan
| | - Toshiyuki Sawa
- Department of Respiratory Medicine and Medical Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu-shi, Gifu 500-8323, Japan
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SEOM clinical guidelines for the treatment of non-small cell lung cancer (NSCLC) 2015. Clin Transl Oncol 2015; 17:1020-9. [PMID: 26691657 PMCID: PMC4689744 DOI: 10.1007/s12094-015-1455-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 12/19/2022]
Abstract
Lung cancer is the most common cancer worldwide as well as the leading cause of cancer related deaths as reported by Torre et al (CA Cancer J Clin 65:87–108, 2015]. Non-small cell lung cancer (NSCLC) accounts for up to 85 % of all lung cancers. Multiple advances in the staging, diagnostic procedures, therapeutic options, as well as molecular knowledge have been achieved during the past years, although the overall outlook has not greatly changed for the majority of patients with the overall 5-year survival having marginally increased over the last decade from 15.7 to 17.4 % as reported by Howlader et al. (SEER Cancer Statistics Review 2015).
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Méry B, Guy JB, Swalduz A, Vallard A, Guibert C, Almokhles H, Ben Mrad M, Rivoirard R, Falk AT, Fournel P, Magné N. The evolving locally-advanced non-small cell lung cancer landscape: Building on past evidence and experience. Crit Rev Oncol Hematol 2015; 96:319-27. [DOI: 10.1016/j.critrevonc.2015.05.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 03/30/2015] [Accepted: 05/19/2015] [Indexed: 12/25/2022] Open
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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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Ren Z, Zhou S, Liu Z, Xu S. Randomized controlled trials of induction treatment and surgery versus combined chemotherapy and radiotherapy in stages IIIA-N2 NSCLC: a systematic review and meta-analysis. J Thorac Dis 2015; 7:1414-22. [PMID: 26380768 DOI: 10.3978/j.issn.2072-1439.2015.08.14] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/06/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND The efficacy of induction treatment plus surgery for improving postoperative survival in patients with non-small-cell lung cancer (NSCLC) in stages IIIA-N2 is controversial, especially compared with the combined chemotherapy and radiotherapy. We therefore performed a systematic review and meta-analysis of the published phase III randomized clinical trials (RCTs) to quantitatively evaluate the survival benefit of preoperative induction treatment vs. combined chemoradiotherapy. METHODS We systematically searched for trials that started after January, 1980. We excluded relevant studies using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards. Our primary endpoint, overall survival (OS), was defined as the time from randomisation until death (any cause). Secondary endpoint was progression free survival (PFS). PubMed, EMBASE and Cochrane library were used for the study search. All analyses were by intention to treat. RESULTS Three studies (1,084 patients) were centrally selected and analyzed for the present meta-analysis. Combination of the three randomized controlled trials showed that there was no significant benefit of induction treatment plus surgery compared to combined chemoradiotherapy on 2-year OS [risk ratio (RR) =1.00; 95% CI, 0.85-1.17; P=0.98] and 4-year OS (RR =1.13; 95% CI, 0.85-1.51; P=0.39). However, from the subgroup analysis, it showed a significant PFS benefit (RR =1.78; 95% CI, 1.08-2.92; P=0.02) regarded chemoradiotherapy as preoperative induction treatment, compared with chemotherapy alone for induction treatment (PFS) (RR =1.05; 95% CI, 0.61-1.81; P=0.86). CONCLUSIONS There was no significant OS benefit of induction treatment plus surgery compared with combined chemoradiotherapy in patients with NSCLC (stages IIIA-pN2) at 2 and 4 years. However, we could conclude PFS could be improved when radiation therapy was added into preoperative induction treatment. Given the potential advantages of adding radiation preoperatively, clinicians should consider using this treatment strategy in the stage IIIA-N2 disease after fully assessment of the patients.
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Affiliation(s)
- Zuen Ren
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Tumor Research Institute, Beijing 101149, China
| | - Shijie Zhou
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Tumor Research Institute, Beijing 101149, China
| | - Zhidong Liu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Tumor Research Institute, Beijing 101149, China
| | - Shaofa Xu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Tumor Research Institute, Beijing 101149, China
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Komiya T, Palla SL, Wang F, Perez RP, Huang CH. Infrequent chemoradiation-induced acute esophagitis in the Asian population: A meta-analysis of published clinical trials for unresectable stage III non-small cell lung cancer. Thorac Cancer 2014; 5:565-9. [PMID: 26767053 DOI: 10.1111/1759-7714.12141] [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: 04/22/2014] [Accepted: 05/15/2014] [Indexed: 12/28/2022] Open
Abstract
Severe (grade 3 or higher) esophagitis is one of the major toxicities for chemoradiation in the treatment of stage III non-small cell lung cancer (NSCLC). The difference among ethnic groups has never been investigated in detail. Prospective trials with concurrent platinum-containing chemoradiation in unresectable disease were investigated, and a total of 116 treatment arms with 7520 patients were identified. Univariate analysis demonstrated that treatment arms conducted in Asia had significantly lower incidence of severe esophagitis (170/2534, 6.7%, odds ratio 0.289) than in other nations (1025/4986, 20.6%). In the multivariable model, Asian/non-Asian ethnicity, multi-/single-agent, and split are jointly significant predictors after adjusting for all possible factors. This study suggests that severe esophagitis occurs less frequently in the Asian population compared to the non-Asian population.
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Affiliation(s)
- Takefumi Komiya
- Division of Hematology/Oncology, The University of Kansas Medical Center Fairway, KS, USA
| | - Shana L Palla
- Department of Biostatistics, The University of Kansas Medical Center Kansas City, KS, USA
| | - Feng Wang
- Department of Radiation Oncology, The University of Kansas Medical Center Kansas City, KS, USA
| | - Raymond P Perez
- Division of Hematology/Oncology, The University of Kansas Medical Center Fairway, KS, USA
| | - Chao H Huang
- Division of Hematology/Oncology, The University of Kansas Medical Center Westwood, KS, USA
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Ramnath N, Dilling TJ, Harris LJ, Kim AW, Michaud GC, Balekian AA, Diekemper R, Detterbeck FC, Arenberg DA. Treatment of stage III non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e314S-e340S. [PMID: 23649445 DOI: 10.1378/chest.12-2360] [Citation(s) in RCA: 312] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Stage III non-small cell lung cancer (NSCLC) describes a heterogeneous population with disease presentation ranging from apparently resectable tumors with occult microscopic nodal metastases to unresectable, bulky nodal disease. This review updates the published clinical trials since the last American College of Chest Physicians guidelines to make treatment recommendations for this controversial subset of patients. METHODS Systematic searches were conducted through MEDLINE, Embase, and the Cochrane Database for Systematic Review up to December 2011, focusing primarily on randomized trials, selected meta-analyses, practice guidelines, and reviews. RESULTS For individuals with stage IIIA or IIIB disease, good performance scores, and minimal weight loss, treatment with combined chemoradiotherapy results in better survival than radiotherapy alone. Consolidation chemotherapy or targeted therapy following definitive chemoradiation for stage IIIA is not supported. Neoadjuvant therapy followed by surgery is neither clearly better nor clearly worse than definitive chemoradiation. Most of the arguments made regarding patient selection for neoadjuvant therapy and surgical resection provide evidence for better prognosis but not for a beneficial impact of this treatment strategy; however, weak comparative data suggest a possible role if only lobectomy is needed in a center with a low perioperative mortality rate. The evidence supports routine platinum-based adjuvant chemotherapy following complete resection of stage IIIA lung cancer encountered unexpectedly at surgery. Postoperative radiotherapy improves local control without improving survival. CONCLUSIONS Multimodality therapy is preferable in most subsets of patients with stage III lung cancer. Variability in the patients included in randomized trials limits the ability to combine results across studies and thus limits the strength of recommendations in many scenarios. Future trials are needed to investigate the roles of individualized chemotherapy, surgery in particular cohorts or settings, prophylactic cranial radiation, and adaptive radiation.
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Affiliation(s)
- Nithya Ramnath
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | - Loren J Harris
- Thoracic Surgery, Maimonides Medical Center, Brooklyn, NY
| | | | | | | | | | | | - Douglas A Arenberg
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI.
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Nieder C, Pawinski A, Andratschke NH. Combined radio- and chemotherapy for non-small cell lung cancer: systematic review of landmark studies based on acquired citations. Front Oncol 2013; 3:176. [PMID: 23847765 PMCID: PMC3705186 DOI: 10.3389/fonc.2013.00176] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 06/21/2013] [Indexed: 12/25/2022] Open
Abstract
The important role of combined chemoradiation for several groups of patients with non-small cell lung cancer (NSCLC) is reflected by the large number of scientific articles published during the last 30 years. Different measures of impact and clinical relevance of published research are available, each with its own pros and cons. For this review, article citation rate was chosen. Highly cited articles were identified through systematic search of the citation database Scopus. Among the 100 most often cited articles, meta-analyses (n = 5) achieved a median of 203 citations, guidelines (n = 7) 97, phase III trials (n = 29) 168, phase II trials (n = 21) 135, phase I trials (n = 7) 88, and others combined 115.5 (p = 0.001). Numerous national and international cooperative groups and several single institutions were actively involved in performing often cited, high-impact trials, reflecting the fact that NSCLC is a world-wide challenge that requires research collaboration. Platinum-containing combinations have evolved into a standard of care, typically administered concurrently. The issue of radiotherapy fractionation and total dose has also been studied extensively, yet with less conclusive results. Differences in target volume definition have been addressed. However, it was not possible to test all theoretically possible combinations of radiotherapy regimens, drugs, and drug doses (lower radiosensitizing doses compared to higher systemically active doses). That is why current guidelines offer physicians a choice of different, presumably equivalent treatment alternatives. This review identifies open questions and strategies for further research.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital , Bodø , Norway ; Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø , Tromsø , Norway
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Patel N, Carnell D. Lung Radiotherapy. Lung Cancer 2013. [DOI: 10.1002/9781118702857.ch4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shiraishi T, Hiratsuka M, Yanagisawa J, Miyahara S, Yoshida Y, Makimoto Y, Hamatake D, Yamashita SI, Iwasaki A. Pulmonary resection after chemoradiotherapy for advanced non-small cell lung cancer: the impact of presurgical radiation therapy. Surg Today 2013; 44:123-30. [DOI: 10.1007/s00595-013-0520-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 10/26/2012] [Indexed: 10/27/2022]
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Analysis of the risk factors for myelosuppression after concurrent chemoradiotherapy for patients with advanced non-small cell lung cancer. Support Care Cancer 2012; 21:785-91. [PMID: 22936496 DOI: 10.1007/s00520-012-1580-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 08/20/2012] [Indexed: 12/25/2022]
Abstract
PURPOSE Myelosuppression induced by concurrent chemotherapy and radiotherapy can be a significant problem in patients with non-small cell lung cancer (NSCLC), but its risk factors remain largely unknown. The objective of this study was to retrospectively evaluate clinical data obtained before chemoradiotherapy (CRT) to identify the risk factors for myelosuppression in patients with advanced NSCLC. METHODS Between January 2007 and January 2012, 141 patients with advanced NSCLC were treated with curative intent according to the CRT protocol (50-70 Gy at 2 Gy/day with paclitaxel 135-175 mg/m(2) and carboplatin 100 mg/m(2) on days 1, 22, and 43). The endpoint of this survey was the occurrence of grade 3 or higher myelosuppression (neutropenia, leukopenia, thrombocytopenia, or anemia). Risk factors significantly related to myelosuppression were extracted using logistic regression analysis. RESULTS Grade 3 or higher neutropenia, leukopenia, thrombocytopenia, or anemia occurred in 19.9, 16.3, 14.9, and 0% of the patients, respectively. According to the multivariate analysis, the risk factors included age, albumin, and body surface area (BSA) for neutropenia; performance status and bone metastases for leukopenia; and age, gender, and serum creatinine concentration for thrombocytopenia (p < 0.05). CONCLUSIONS It was found that age, BSA, creatinine level, and female gender were the most important factors for CRT-induced myelosuppression in advanced NSCLC. By identifying these risk factors, medical staff can improve application of appropriate medical care to reduce the myelosuppression in advanced NSCLC patients treated by CRT.
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Provencio M, Isla D, Sánchez A, Cantos B. Inoperable stage III non-small cell lung cancer: Current treatment and role of vinorelbine. J Thorac Dis 2012; 3:197-204. [PMID: 22263088 DOI: 10.3978/j.issn.2072-1439.2011.01.02] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 01/07/2011] [Indexed: 12/25/2022]
Abstract
Most lung cancer patients are diagnosed with a non-resectable disease; and around 40% in advanced stages. Stage III non-small cell lung cancer (NSCLC) is a heterogeneous disease with great variations in its clinical extent which presents a major therapeutic challenge. Although chemo-radiotherapy treatment has become the most widely used, there is currently no consensus on the best standard treatment and the experience of the therapy team plays an important role in the decision taking. We review the treatment of inoperable stage III NSCLC and the role of concomitant vinorelbine in this clinical scenario.
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Affiliation(s)
- Mariano Provencio
- Department of Medical Oncology, University Hospital Puerta de Hierro, Madrid, Spain
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Abstract
Among all nonmetastatic non-small-cell lung cancer (NSCLC) patients, the best survival rates are observed in patients who undergo surgery. Nevertheless, 5-year survival rates vary between 20% and 60% depending on the stage of the disease. Several combined modality treatments have been investigated to improve outcome in localized NSCLC. These include local treatment, systemic before local treatment, concomitant systemic and local treatments, and systemic after local treatment. Preoperative irradiation was shown to be of no benefit on local recurrence rates or overall survival. Even doses of radiation >/=40 grays (Gy) were associated with lower survival rates. Postoperative irradiation did not influence survival in stage III disease and seemed to be deleterious in stages I and II disease. Modern radiotherapy techniques might be of interest in this setting but have been insufficiently tested. The early phase III studies of preoperative chemotherapy versus primary surgery in stage III NSCLC showed a tremendous difference in favor of chemotherapy. A larger study did not confirm these results but suggested that preoperative chemotherapy might have a greater effect in stages I and II of the disease. In locally advanced disease, chemotherapy followed by radiotherapy was shown to increase survival when compared with radiotherapy alone. Studies comparing concurrent chemoradiation with radiotherapy only were in favor of the concomitant schedule, which improved local control. Promising results have been reported with chemoradiation followed by surgery in stage IIIa and even stage IIIb disease. Randomized studies of postoperative chemotherapy demonstrated a 5% improvement in 5-year survival over adjuvant-free treatment. Postoperative chemoradiation showed no advantage over postoperative radiotherapy. Several trials that are ongoing or whose accrual was recently completed should further define the role of perioperative chemotherapy in resectable NSCLC and of trimodality treatments in advanced disease. Targeted agents are being developed in the postoperative setting. New schedules of chemoradiation with higher therapeutic indexes are also being investigated in nonresectable stage III NSCLC.
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Affiliation(s)
- Virginie Westeel
- Chest Disease Department, Jean Minjoz University Hospital, Besançon Cedex, France.
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47
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Phase I Study of Pemetrexed, Cisplatin, and Concurrent Radiotherapy in Patients With Locally Advanced Non-small Cell Lung Cancer. Am J Clin Oncol 2012; 35:115-9. [DOI: 10.1097/coc.0b013e318209ab93] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nitsche M, Christiansen H, Lederer K, Griesinger F, Schmidberger H, Pradier O. Fludarabine combined with radiotherapy in patients with locally advanced NSCLC lung carcinoma: a phase I study. J Cancer Res Clin Oncol 2012; 138:1113-20. [PMID: 22402597 PMCID: PMC3605492 DOI: 10.1007/s00432-012-1185-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 02/24/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE Fludarabine is an adenine nucleoside analogue that has significant activity in hematological malignancies and has shown promising activity in combination with radiation in preclinical solid tumor models. We designed a phase I trial exploring concurrent fludarabine and radiotherapy in patients with advanced non-small cell lung cancer (NSCLC) to determine the maximum tolerated dose (MTD) of fludarabine given with concurrent irradiation. MATERIALS AND METHODS Thirteen patients with stage IIIB NSCLC received thoracic irradiation of 60 Gy. Fludarabine was administered during the 5th and 6th week of radiotherapy. Doses started at 10 mg/m(2) per day and increased by steps of 3 mg/m(2) per day. RESULTS At a daily dose of 16 mg/m(2), one out of six patients developed a grade 4 leukopenia, and one a grad 3 pneumonitis. Further grade III toxicity was not observed. The dose of 13 mg/m(2) was identified as the MTD. All patients developed a fludarabine dose-dependent lymphocytopenia. CONCLUSION Fludarabine can be safely administered concurrently with radiation at a daily dose of 13 mg/m(2) during the final 2 weeks of radiotherapy. Further prospective clinical studies are required to establish the potential role of concurrent fludarabine and radiotherapy in the treatment of locally advanced inoperable NSCLC.
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Affiliation(s)
- Mirko Nitsche
- Center of Radiation-Oncology, Gröpelinger Heerstr. 406-408, 28239 Bremen, Germany.
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Wisnivesky JP, Bonomi M, Lurslurchachai L, Mhango G, Halm EA. Radiotherapy and chemotherapy for elderly patients with stage I-II unresected lung cancer. Eur Respir J 2012; 40:957-64. [PMID: 22241748 DOI: 10.1183/09031936.00176911] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Radiotherapy (RT) is the standard therapy for unresected stage I-II nonsmall cell lung cancer (NSCLC). Using population-based data, we compared survival and toxicity among unresected elderly patients treated with combined chemoradiotherapy (CRT) or RT alone. Using the Surveillance, Epidemiology and End Results (SEER) registry (National Cancer Institute, Bethesda, MD, USA) we identified 3,006 cases of unresected stage I-II NSCLC. We used propensity score methods to compare survival and rates of toxicity of patients treated with RT versus CRT. Overall, 844 (28%) patients received CRT. Adjusted analyses showed that CRT was associated with improved survival (hazard ratio 0.85, 95% CI 0.78-0.94). Combination therapy was also associated with better survival among stage I patients treated with intermediate complexity RT (HR 0.80, 95% CI 0.70-0.90); however, no difference in survival was observed among patients treated with complex RT. In stage II patients, CRT was associated with improved survival regardless of the RT technique (HR 0.61-0.72). CRT was associated with increased odds of toxicity. Despite increased toxicity, CRT may improve survival of elderly unresected patients with stage II disease as well as stage I NSCLC treated with intermediate RT complexity. Randomised trials are needed to clarify the balance of benefits and risk of CRT in unresected patients.
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Affiliation(s)
- Juan P Wisnivesky
- Division of General Internal Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1087, New York, NY 10029, USA.
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Vallejo Ocańa C, Garrido López P, Muguruza Trueba I. Multidisciplinary approach in stage III non-small-cell lung cancer: standard of care and open questions. Clin Transl Oncol 2012; 13:629-35. [PMID: 21865134 DOI: 10.1007/s12094-011-0708-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Lung cancer is the most frequent cause of cancer death worldwide and its global incidence has been steadily increasing during recent decades. A third of patients with newly diagnosed non-small-cell lung cancer (NSCLC) present with locally advanced disease. There is not a single widely accepted standard of care for these patients because of the wide spectrum of presentation of the disease. Although feasible and safe in experienced hands, evidence that surgical resection after induction treatment improves overall survival (OS) is lacking. For resectable or potentially resectable stage III, the findings of two phase III trials suggest that surgical resection should not be considered a standard of care but rather reserved for selected patients after critical multidisciplinary assessment, in whom surgery improves survival after downstaging if pneumonectomy can be avoided or in some T4N0-1 resectable tumours. For unresectable stage III NSCLC the standard of care is a combination of chemotherapy and radiotherapy. In those patients with good performance status and minimal weight loss, the concurrent approach has resulted in a statistically significant improvement in OS rates compared with a sequential approach in randomised clinical trials, although several questions remain unresolved.
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Affiliation(s)
- Carmen Vallejo Ocańa
- Servicio de Oncología Radioterápica, Hospital Ramón y Cajal, Carretera Colmenar km. 9,100, Madrid, Spain.
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