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Kim MS, Cha H, You SH, Kim S. Thirty-day mortality after palliative radiotherapy in advanced cancer patients: Optimizing end-of-life care in Asia. J Med Imaging Radiat Oncol 2024; 68:307-315. [PMID: 38450953 DOI: 10.1111/1754-9485.13635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/23/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Evidence-based guidelines recommend hypofractionated palliative radiotherapy (PRT); nonetheless, many patients receive prolonged course of PRT. To identify patients with limited benefits from PRT in end-of-life care, we evaluated the pattern of PRT at an Asian institution and factors associated with 30-day mortality after PRT (30dM). METHODS We retrospectively reviewed 228 patients who died after PRT in Yonsei Wonju Severance Christian hospital between October 2014 and March 2022. The associations between clinical factors and survival were assessed using the Cox proportional hazards method. Survival was analysed using the existing models to evaluate their performance in our cohort. RESULTS The median PRT duration was 13 (IQR, 7-15) days. Only 11.4% of the patients were treated with hypofractionated radiotherapy. One-third of the patients (32.9%) could not complete PRT and 39 (17.1%) died during PRT. The 30dM was 31.6%. The median time from PRT to death was 17 (IQR, 11-23) days for the patients who died within 30 days. The number of involved organs (≤2 vs. >2; P < 0.001), albumin level (<3.3 vs. ≥3.3; P = 0.016), admission during PRT (P < 0.001), admission 3 months before PRT (P = 0.036) and ICU care during PRT (P < 0.001) were prognostic factors. A comparison of survival based on the existing models yielded unsatisfactory results in our cohort. CONCLUSION Almost one-third of the patients received PRT in the last 30 days of life. The use of hypofractionation for PRT was low in this Asian population. Further research is necessary to develop a predictive model of early mortality, allowing tailored end-of-life care for Asian patients.
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Affiliation(s)
- Mi Sun Kim
- Department of Radiation Oncology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Hyejung Cha
- Department of Radiation Oncology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sei Hwan You
- Department of Radiation Oncology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sunghyun Kim
- Department of Radiation Oncology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Kim DW, Lee G, Lee H, Qian JM, Sanford NN, Lam MB, Tahir N, Mamon HJ. Stereotactic Body Radiation Therapy to a Splenic Metastasis in Oligoprogressive Non-small Cell Lung Cancer. Adv Radiat Oncol 2020; 5:516-521. [PMID: 32529149 PMCID: PMC7276683 DOI: 10.1016/j.adro.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/18/2019] [Accepted: 12/23/2019] [Indexed: 11/01/2022] Open
Affiliation(s)
- Daniel W Kim
- Departments of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
| | - Grace Lee
- Harvard Medical School, Boston, Massachusetts
| | - Hwan Lee
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jack M Qian
- Departments of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
| | - Nina N Sanford
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Miranda B Lam
- Departments of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
| | - Naeem Tahir
- Department of Hematology/Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Milford, Massachusetts
| | - Harvey J Mamon
- Departments of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
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Kim ML, Matheson L, Garrard B, Francis M, Broad A, Malone J, Eastman P, Rogers M, Yap C. Use of clinical quality indicators to improve lung cancer care in a regional/rural network of health services. Aust J Rural Health 2019; 27:183-187. [DOI: 10.1111/ajr.12493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 10/04/2018] [Accepted: 11/15/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- Michelle Lynne Kim
- Department of Cardiothoracic Surgery Barwon Health Geelong VictoriaAustralia
| | - Leigh Matheson
- Barwon South Western Integrated Cancer Services Geelong Victoria Australia
| | - Brooke Garrard
- Barwon South Western Integrated Cancer Services Geelong Victoria Australia
| | - Michael Francis
- Barwon Health Andrew Love Cancer Centre Geelong Victoria Australia
| | - Adam Broad
- Barwon Health Andrew Love Cancer Centre Geelong Victoria Australia
| | - James Malone
- Barwon Health Andrew Love Cancer Centre Geelong Victoria Australia
| | - Peter Eastman
- Barwon Health Andrew Love Cancer Centre Geelong Victoria Australia
- Department of Palliative Care Barwon Health Geelong Victoria Australia
| | - Margaret Rogers
- Barwon South Western Integrated Cancer Services Geelong Victoria Australia
- Deakin University School of Medicine Waurn Ponds Victoria Australia
| | - Cheng‐Hon Yap
- Department of Cardiothoracic Surgery Barwon Health Geelong VictoriaAustralia
- Barwon Health Andrew Love Cancer Centre Geelong Victoria Australia
- Deakin University School of Medicine Waurn Ponds Victoria Australia
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Thomas CM, Lee CS. Penetrating the evidence of EGFR and ALK tyrosine kinase inhibitors for non-small cell lung cancer brain metastases. J Oncol Pharm Pract 2018; 25:623-637. [PMID: 30176786 DOI: 10.1177/1078155218796695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The brain is a common metastatic site in lung cancer. Approximately one-third of patients will develop brain metastases during the course of their disease. Median overall survival has been reported between 3 and 14.8 months in patients with brain metastases compared to other metastatic sites. In addition, the lifetime incidence of brain metastases is increasing due to prolonged survival seen in non-small cell lung cancer (NSCLC) patients due to new systemic therapies and improved neuro-imaging techniques. Several targeted therapies-such as tyrosine kinase inhibitors targeting epidermal growth factor receptors and anaplastic lymphoma kinase-are active in NSCLC and have data to suggested possible effectiveness against brain metastases in these patients.
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Affiliation(s)
- Christan M Thomas
- 1 Hematology/Oncology, NewYork-Presbyterian Hospital, Columbia University, New York, USA
| | - Chung-Shien Lee
- 2 Department of Clinical Health Professions, College of Pharmacy and Health Sciences, St. John's University, New York, USA
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Luo H, Ge H, Cui Y, Zhang J, Fan R, Zheng A, Zheng X, Sun Y. Systemic Inflammation Biomarkers Predict Survival in Patients of Early Stage Non-Small Cell Lung Cancer Treated With Stereotactic Ablative Radiotherapy - A Single Center Experience. J Cancer 2018; 9:182-188. [PMID: 29290784 PMCID: PMC5743726 DOI: 10.7150/jca.21703] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/24/2017] [Indexed: 12/18/2022] Open
Abstract
Background: Increasing evidence indicates a relationship between systemic inflammation and survival following treatment in various tumors. However, the correlation of systematic inflammation with survival after stereotactic ablative radiotherapy (SABR) in early stage non-small cell lung cancer (NSCLC) has not been well established. Patients and methods: We retrospectively analyzed patients with newly diagnosed early stage NSCLC treated with SABR in a single institution from 2011 to 2015. The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte- monocyte ratio (LMR) were calculated as systemic inflammation biomarkers. Overall survival (OS) was the first end-point. Receiver operating characteristic (ROC) was used to determine cut-off points for OS. Univariate and multivariate Cox proportional hazards regression were used to investigate the potential factors associated with OS. Results: In the 63 patients who were eligible for analysis. The median follow up after SBRT was 29.5 months (range 8-67 months) while the 3-year OS was 74.2%. Based on ROC analysis, optimal cut-off values of NLR, PLR, and LMR were 2.06, 199.55 and 4.0, respectively. Significant survival benefit was found in the NLR ≤2.06 group (p=0.028), PLR≤199.55 group (p=0.001), and LMR˃4.0 group (p=0.046). Univariate analysis indicated that low NLR (p=0.011), low PLR (p=0.003), and high LMR (p=0.014) were correlated with improved survival. Multivariate analysis indicated that high PLR (p=0.033) and low LMR (p=0.046) were independent prognostic factors for poor survival. Conclusions: In patients of early stage NSCLC who received SABR, pretreatment NLR, PLR, and LMR could be considered useful prognostic indicators of OS. These metrics may provide reliable and convenient predictors to identify patients who would benefit from SABR.
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Affiliation(s)
- Hui Luo
- Division of Graduate, The Second Clinical Medical School and the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hong Ge
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingying Cui
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiangong Zhang
- Division of Scientific Research and Education, The Affiliated Cancer Hospital of Zhengzhou university, Zhengzhou, China
| | - Ruitai Fan
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Anping Zheng
- Department of Radiation Oncology, Anyang Cancer Hospital, Anyang, China
| | - Xiaoli Zheng
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanan Sun
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
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Tan Z, Liu C, Zhou Y, Shen W. Preliminary comparison of the registration effect of 4D-CBCT and 3D-CBCT in image-guided radiotherapy of Stage IA non-small-cell lung cancer. J Radiat Res 2017; 58:854-861. [PMID: 28992047 PMCID: PMC5710603 DOI: 10.1093/jrr/rrx040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/04/2017] [Indexed: 06/07/2023]
Abstract
In this study, we compared the registration effectiveness of 4D cone-beam computed tomography (CBCT) and 3D-CBCT for image-guided radiotherapy in 20 Stage IA non-small-cell lung cancer (NSCLC) patients. Patients underwent 4D-CBCT and 3D-CBCT immediately before radiotherapy, and the X-ray Volume Imaging software system was used for image registration. We performed automatic bone registration and soft tissue registration between 4D-CBCT or 3D-CBCT and 4D-CT images; the regions of interest (ROIs) were the vertebral body on the layer corresponding to the tumor and the internal target volume region. The relative displacement of the gross tumor volume between the 4D-CBCT end-expiratory phase sequence and 4D-CT was used to evaluate the registration error. Among the 20 patients (12 males, 8 females; 35-67 years old; median age, 52 years), 3 had central NSCLC and 17 had peripheral NSCLC, 8 in the upper or middle lobe and 12 in the lower lobe (maximum tumor diameter range, 18-27 mm). The internal motion range in three-dimensional space was 12.52 ± 2.65 mm, accounting for 47.8 ± 15.3% of the maximum diameter of each tumor. The errors of image-guided registration using 4D-CBCT and 3D-CBCT on the x (left-right), y (superior-inferior), z (anterior-posterior) axes, and 3D space were 0.80 ± 0.21 mm and 1.08 ± 0.25 mm, 2.02 ± 0.46 mm and 3.30 ± 0.53 mm, 0.52 ± 0.16 mm and 0.85 ± 0.24 mm, and 2.25 ± 0.44 mm and 3.59 ± 0.48 mm (all P < 0.001), respectively. Thus, 4D-CBCT is preferable to 3D-CBCT for image guidance in small pulmonary tumors because 4D-CBCT can reduce the uncertainty in the tumor location resulting from internal motion caused by respiratory movements, thereby increasing the image-guidance accuracy.
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Affiliation(s)
- Zhibo Tan
- Department of Oncology, Shenzhen Hospital of Southern Medical University, #1333 Xinhu Road, Bao'an District, Shenzhen 518110, Guangdong Province, PR China
- Department of Radiation Oncology, Sichuan Cancer Hospital, #55 Renmin Road South, Wuhou District, Chengdu 610041, Sichuan Province, PR China
| | - Chuanyao Liu
- Department of Rehabilitation, Shenzhen Hospital of Southern Medical University, #1333 Xinhu Road, Bao'an District, Shenzhen 518110, Guangdong Province, PR China
| | - Ying Zhou
- Department of Oncology and Hematology, Shenzhen Hospital of Southern Medical University, #1333 Xinhu Road, Bao'an District, Shenzhen 518110, Guangdong Province, PR China
| | - Weixi Shen
- Department of Oncology, Shenzhen Hospital of Southern Medical University, #1333 Xinhu Road, Bao'an District, Shenzhen 518110, Guangdong Province, PR China
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7
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Pastina P, Nardone V, Botta C, Croci S, Tini P, Battaglia G, Ricci V, Cusi MG, Gandolfo C, Misso G, Zappavigna S, Caraglia M, Giordano A, Aldinucci D, Tassone P, Tagliaferri P, Pirtoli L, Correale P. Radiotherapy prolongs the survival of advanced non-small-cell lung cancer patients undergone to an immune-modulating treatment with dose-fractioned cisplatin and metronomic etoposide and bevacizumab (mPEBev). Oncotarget 2017; 8:75904-75913. [PMID: 29100279 PMCID: PMC5652673 DOI: 10.18632/oncotarget.20411] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/20/2017] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy (RT), together with a direct cytolytic effect on tumor tissue, also elicits systemic immunological events, which sometimes result in the regression of distant metastases (abscopal effect). We have shown the safety and anti-tumor activity of a novel metronomic chemotherapy (mCH) regimen with dose-fractioned cisplatin, oral etoposide and bevacizumab, a mAb against the vasculo-endothelial-growth-factor (mPEBev regimen), in metastatic non-small-cell-lung cancer (mNSCLC). This regimen, designed on the results of translational studies, showed immune-modulating effects that could trigger and empower the immunological effects associated with tumor irradiation. In order to assess this, we carried out a retrospective analysis in a subset of 69 consecutive patients who received the mPEBev regimen within the BEVA2007 trial. Forty-five of these patients, also received palliative RT of one or more metastatic sites. Statistical analysis (a Log-rank test) revealed a much longer median survival in the group of patients who received RT [mCH vs mCH + RT: 12.1 +/-2.5 (95%CI 3.35-8.6) vs 22.12 +/-4.3 (95%CI 11.9-26.087) months; P=0.015] with no difference in progression-free survival. In particular, their survival correlated with the mPEBev regimen ability to induce the percentage of activated dendritic cells (DCs) (CD3-CD11b+CD15-CD83+CD80+) [Fold to baseline value (FBV) ≤1 vs >1: 4+/-5.389 (95%CI,0- 14.56) vs 56+/-23.05 (95%CI,10.8-101.2) months; P:0.049)] and central-memory- T-cells (CD3+CD8+CD45RA-CCR7+) [FBV ≤ 1 vs >1: 8+/-5.96 (95%CI,0-19.68) vs 31+/-12.3 (95%CI,6.94-55.1) months; P:0.045]. These results suggest that tumor irradiation may prolong the survival of NSCLC patients undergone mPEBev regimen presumably by eliciting an immune-mediated effect and provide the rationale for further perspective clinical studies.
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Affiliation(s)
- Pierpaolo Pastina
- Radiotherapy Unit, Department of Medicine, Surgery, and Neuroscience, Siena University Hospital, Siena, Italy
| | - Valerio Nardone
- Radiotherapy Unit, Department of Medicine, Surgery, and Neuroscience, Siena University Hospital, Siena, Italy
| | - Cirino Botta
- Medical Oncology Unit, AUO "Mater Domini", "Magna Graecia" University, Catanzaro, Italy
| | - Stefania Croci
- Radiotherapy Unit, Department of Medicine, Surgery, and Neuroscience, Siena University Hospital, Siena, Italy
| | - Paolo Tini
- Radiotherapy Unit, Department of Medicine, Surgery, and Neuroscience, Siena University Hospital, Siena, Italy
| | - Giuseppe Battaglia
- Radiotherapy Unit, Department of Medicine, Surgery, and Neuroscience, Siena University Hospital, Siena, Italy
| | - Veronica Ricci
- Radiology Unit,Department of Medicine, Surgery, and Neuroscience, Siena University Hospital, Siena, Italy
| | - Maria Grazia Cusi
- Department of Medical Biotechnology, Microbiology and Virology Unit, University of Siena, Siena, Italy
| | - Claudia Gandolfo
- Department of Medical Biotechnology, Microbiology and Virology Unit, University of Siena, Siena, Italy
| | - Gabriella Misso
- Department of Biochemistry, Biophysics and General Pathology, University of Campania "L. Vanvitelli", Naples, Italy
| | - Silvia Zappavigna
- Department of Biochemistry, Biophysics and General Pathology, University of Campania "L. Vanvitelli", Naples, Italy
| | - Michele Caraglia
- Department of Biochemistry, Biophysics and General Pathology, University of Campania "L. Vanvitelli", Naples, Italy.,Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, Temple University, Philadelphia, PA, USA
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, Temple University, Philadelphia, PA, USA.,Department of Medicine, Surgery, and Neuroscience, University of Siena and Istituto Toscano Tumori (ITT), Siena, Italy
| | - Donatella Aldinucci
- Department of Experimental Oncology 2, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Pierfrancesco Tassone
- Medical Oncology Unit, AUO "Mater Domini", "Magna Graecia" University, Catanzaro, Italy.,Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, Temple University, Philadelphia, PA, USA
| | | | - Luigi Pirtoli
- Radiotherapy Unit, Department of Medicine, Surgery, and Neuroscience, Siena University Hospital, Siena, Italy
| | - Pierpaolo Correale
- Radiotherapy Unit, Department of Medicine, Surgery, and Neuroscience, Siena University Hospital, Siena, Italy.,Medical Oncology Unit, Metropolitan Hospital "Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
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Stewart A, Parashar B, Patel M, O'Farrell D, Biagioli M, Devlin P, Mutyala S. American Brachytherapy Society consensus guidelines for thoracic brachytherapy for lung cancer. Brachytherapy 2015; 15:1-11. [PMID: 26561277 DOI: 10.1016/j.brachy.2015.09.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 08/28/2015] [Accepted: 09/02/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To update brachytherapy recommendations for pretreatment evaluation, treatment, and dosimetric issues for thoracic brachytherapy for lung cancer. METHODS AND MATERIALS Members of the American Brachytherapy Society with expertise in thoracic brachytherapy updated recommendations for thoracic brachytherapy based on literature review and clinical experience. RESULTS The American Brachytherapy Society consensus guidelines recommend the use of endobronchial brachytherapy for disease palliation in patients with central obstructing lesions, particularly in patients who have previously received external beam radiotherapy. The use of interstitial implants after incomplete resection may improve outcomes and provide enhanced palliation. Early reports support the use of CT-guided intratumoral volume implants within clinical studies. The use of brachytherapy routinely after sublobar resection is not generally recommended, unless within the confines of a clinical trial or a registry. CONCLUSIONS American Brachytherapy Society recommendations for thoracic brachytherapy are provided. Practitioners are encouraged to follow these guidelines and to develop further clinical trials to examine this treatment modality to increase the evidence base for its use.
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Affiliation(s)
- A Stewart
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK; University of Surrey, Guildford, UK.
| | - B Parashar
- Department of Stich Radiation Oncology, Weill Cornell Medical College, New York, NY
| | - M Patel
- Department of Radiation Oncology, Baylor Scott and White Health, Temple, TX
| | - D O'Farrell
- Dana Faber Cancer Centre, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - M Biagioli
- Florida Hospital Cancer Institute, Department of Radiation Oncology, H.Lee Moffitt Cancer Center, Tampa, FL
| | - P Devlin
- Dana Faber Cancer Centre, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - S Mutyala
- Department of Radiation Medicine, St. Joseph's Hospital and Medical Center, University of Arizona Cancer Center at Dignity Health, Phoenix, AZ
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Koshy M, Malik R, Mahmood U, Husain Z, Weichselbaum RR, Sher DJ. Prevalence and Predictors of Inappropriate Delivery of Palliative Thoracic Radiotherapy for Metastatic Lung Cancer. J Natl Cancer Inst 2015; 107:djv278. [PMID: 26424779 DOI: 10.1093/jnci/djv278] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 09/01/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND High-level evidence has established well-recognized standard treatment regimens for patients undergoing palliative chest radiotherapy (RT) for stage IV non-small cell lung cancer (NSCLC), including treating with fewer than 15 fractions of RT, and not delivering concurrent chemoradiation (CRT) because of its increased toxicity and limited efficacy in the palliative setting. METHODS The study included patients in the National Cancer Database from 2004 to 2012 with stage IV lung cancer who received palliative chest radiation therapy. Logistic regression was performed to determine predictors of standard vs nonstandard regimens (>15 fractions or CRT). All statistical tests were two-sided. RESULTS There were 46 803 patients in the analysis and 49% received radiotherapy for longer than 15 fractions, and 28% received greater than 25 fractions. Approximately 19% received CRT. The strongest independent predictors of long-course RT were private insurance (odds ratio [OR] = 1.40 vs uninsured, 95% confidence interval [CI] = 1.28 to 1.53) and treatment in community cancer programs (OR = 1.49, 95% CI = 1.38 to 1.58) compared with academic research programs. The strongest factors that predicted for concurrent chemoradiotherapy were private insurance (OR = 1.38 95% CI = 1.23 to 1.54) compared with uninsured patients and treatment in community cancer programs (OR = 1.44, 95% CI = 1.33 to 1.56) compared with academic programs. CONCLUSIONS Approximately half of all patients with metastatic lung cancer received a higher number of radiation fractions than recommended. Patients with private insurance and treated in community cancer centers were more likely to receive longer courses of RT or CRT. This demonstrates that a substantial number of patients requiring palliative thoracic radiotherapy are overtreated and further work is necessary to ensure these patients are treated according to evidenced-based guidelines.
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Affiliation(s)
- Matthew Koshy
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL (MK, RRW); Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL (MK, RM, RRW); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (UM); Department of Radiation Oncology, Yale University, New Haven, CT (ZH); Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (DJS).
| | - Renuka Malik
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL (MK, RRW); Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL (MK, RM, RRW); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (UM); Department of Radiation Oncology, Yale University, New Haven, CT (ZH); Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (DJS)
| | - Usama Mahmood
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL (MK, RRW); Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL (MK, RM, RRW); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (UM); Department of Radiation Oncology, Yale University, New Haven, CT (ZH); Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (DJS)
| | - Zain Husain
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL (MK, RRW); Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL (MK, RM, RRW); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (UM); Department of Radiation Oncology, Yale University, New Haven, CT (ZH); Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (DJS)
| | - Ralph R Weichselbaum
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL (MK, RRW); Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL (MK, RM, RRW); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (UM); Department of Radiation Oncology, Yale University, New Haven, CT (ZH); Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (DJS)
| | - David J Sher
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL (MK, RRW); Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL (MK, RM, RRW); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (UM); Department of Radiation Oncology, Yale University, New Haven, CT (ZH); Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (DJS)
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10
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Koshy M, Malik R, Mahmood U, Rusthoven CG, Sher DJ. Comparative effectiveness of aggressive thoracic radiation therapy and concurrent chemoradiation therapy in metastatic lung cancer. Pract Radiat Oncol 2015; 5:374-82. [PMID: 26412340 DOI: 10.1016/j.prro.2015.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/17/2015] [Accepted: 07/24/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE We aimed to determine the comparative effectiveness of radiation dose escalation and concurrent chemoradiation therapy (CCRT) in a population-based cohort of patients with stage IV non-small cell lung cancer who underwent palliative thoracic radiation therapy (RT). METHODS AND MATERIALS The cohort consisted of 27,063 patients in the National Cancer Database with stage IV non-small cell lung cancer treated with thoracic RT between 20 and 55 Gy in 2004 to 2011. High- versus intermediate- vs low-dose (HD vs ID vs LD, respectively) RT was defined as biologically effective dose above 50 Gy, between 35 and 50 Gy, and below 35 Gy, respectively. Among patients who received any chemotherapy, separate analyses were performed to examine the impact of CCRT on overall survival (OS). RESULTS The median follow-up was 3.9 months for the entire cohort and 18 months for surviving patients. The 5 most common treatment schemes were 30/10 (Gy/fraction, 23% of entire cohort), 35/14 (8%), 37.5/15 (7%), 40/20 (3%), and 50/20 (3%). On multivariable analysis, the survival hazard ratios (HRs) for HD and ID compared with LD RT were 0.37 and 0.51, respectively (P < .0001). Propensity score matching found a superior survival benefit for ID and HD (HR, 0.41 and 0.57 for HD and ID RT, respectively, vs LD, P < .0001). Among those who received any chemotherapy (59% of total), the median OS for patients treated with CCRT (19% of total) was 5.3 versus 5.6 months (P = .667). On multivariable analysis, the HR for CCRT was 1.01 (P = .46). CONCLUSIONS The delivery of higher-dose RT but not concurrent chemotherapy was associated with a significant improvement of OS. This population-based study supports higher-dose palliative regimens and motivates prospective study of escalation beyond a biologically effective dose of 35 Gy.
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Stavas MJ, Arneson KO, Ning MS, Attia AA, Phillips SE, Perkins SM, Shinohara ET. The Refusal of Palliative Radiation in Metastatic Non-Small Cell Lung Cancer and Its Prognostic Implications. J Pain Symptom Manage 2015; 49:1081-1087.e4. [PMID: 25596010 DOI: 10.1016/j.jpainsymman.2014.11.298] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/15/2014] [Accepted: 11/23/2014] [Indexed: 12/25/2022]
Abstract
CONTEXT Patients with metastatic non-small cell lung cancer (NSCLC) have limited survival. Population studies have evaluated the impact of radiation refusal in the curative setting; however, no data exist concerning the prognostic impact of radiation refusal in the palliative care setting. OBJECTIVES To investigate the patterns of radiation refusal in newly diagnosed patients with metastatic NSCLC. METHODS Patients with Stage IV NSCLC diagnosed between 1988 and 2010 were identified in the Surveillance, Epidemiology, and End Results database. Univariate and multivariate analyses were used to identify predictors for refusal of radiation and the impact of radiation and refusal on survival in the palliative setting. RESULTS A total of 285,641 patients were initially included in the analysis. Palliative radiation was recommended in 42% and refused by 3.1% of patients. Refusal rates remained consistent across included years of study. On multivariate analysis, older, nonblack/nonwhite, unmarried females were more likely to refuse radiation (P < 0.001 in all cases). Median survival for patients refusing radiation was three months vs. five months for those receiving radiation and two months for those whom radiation was not recommended. CONCLUSION Patients with metastatic NSCLC who refuse recommended palliative radiation have a poor survival. Radiation refusal or the recommendation against treatment can serve as a trigger for integrating palliative care services sooner and contributes greatly to prognostic awareness. Further investigation into this survival difference and the factors behind refusal are warranted.
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Affiliation(s)
- Mark J Stavas
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Kyle O Arneson
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew S Ning
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Albert A Attia
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sharon E Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephanie M Perkins
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric T Shinohara
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Abstract
Indications of treatment by stereotactic body radiotherapy are dramatically increasing due to new potential indications. The conditions associated with the treatment delivery are multiple. The first step of the process is crucial. It is related to the validation of the indication proposed during the multidisciplinary meeting as regard the evidence-based proof of the concept. These emerging techniques mainly extracranial stereotactic body irradiation do not benefit from long-term evaluation in terms of efficiency as well as normal tissue late toxicities. Priority should be given to prospective independent clinical trials, validated by an independent scientific committee, performed under a relevant and well dedicated multicentric quality assurance program aiming to improve knowledge and selection of indications. The SFRO is still working with others professionals on the definition of the conditions for the implementation of such treatments and actively collaborates with the authorities to define the appropriate conditions to preserve the quality of the treatment delivery under these specific conditions.
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Affiliation(s)
- P Maingon
- Département de radiothérapie, centre Georges-François-Leclerc, 1, rue Professeur-Marion, 21034 Dijon cedex, France.
| | - A Lisbona
- Service de physique médicale, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France
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