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Lee YH, Kim YS, Lee HC, Lee SW, Kang YN, Kang JH, Hong SH, Kim YK, Kim SJ, Ahn MI, Han DH, Yoo IR, Park JG, Sung SW, Lee KY. Tumour volume changes assessed with high-quality KVCT in lung cancer patients undergoing concurrent chemoradiotherapy. Br J Radiol 2015; 88:20150156. [PMID: 26055505 DOI: 10.1259/bjr.20150156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We evaluated tumour volume changes in patients with lung cancer undergoing concurrent chemoradiotherapy using image-guided radiotherapy (RT). METHODS The kilovoltage image was obtained using CT on rail at every five fractions. The gross tumour volumes (GTVs), including the primary tumour and lymph nodes (LNs), were contoured to analyse the time and degree of tumour regression. RESULTS 46 patients [32, non-small-cell lung cancer (NSCLC), and 14, small-cell lung cancer (SCLC)] were included in this study. In total, 281 CT scans and 82 sites of GTVs were evaluated. Significant volume changes occurred in both the NSCLC and SCLC groups (p < 0.001 and 0.002), and the average GTV change compared with baseline was 49.85 ± 3.65 [standard error (SE)]% and 65.95 ± 4.60 (SE)% for the NSCLC and SCLC groups, respectively. A significant difference in the degree of volume reduction between the primary tumour and LNs was observed in only the NSCLC group (p < 0.0001) but not in the SCLC group (p = 0.735). The greatest volume regression compared with the volume before the five fractions occurred between the 15 and 20 fractions in the NSCLC group and between the 5 and 10 fractions in the SCLC group. CONCLUSION Both primary tumour and LNs were well defined using CT on rail. Significant volume changes occurred during RT, and there was a difference in volume reduction between the NSCLC and SCLC groups, regarding the degree and timing of the tumour reduction in the primary tumour and LNs. ADVANCES IN KNOWLEDGE NSCLC and SCLC groups showed differences in the degree and timing of volume reduction. The primary tumour and LNs in NSCLC regressed differently.
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Affiliation(s)
- Y H Lee
- 1 Department of Radiation Oncology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Y S Kim
- 1 Department of Radiation Oncology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H C Lee
- 1 Department of Radiation Oncology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S W Lee
- 1 Department of Radiation Oncology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Y N Kang
- 1 Department of Radiation Oncology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - J H Kang
- 2 Department of Medical Oncology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S H Hong
- 2 Department of Medical Oncology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Y K Kim
- 3 Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S J Kim
- 3 Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - M I Ahn
- 4 Department of Radiology, Seoul St Mary's Hospital, Seoul, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - D H Han
- 4 Department of Radiology, Seoul St Mary's Hospital, Seoul, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - I R Yoo
- 5 Department of Nuclear Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - J G Park
- 6 Department of Thoracic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S W Sung
- 6 Department of Thoracic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - K Y Lee
- 7 Department of Pathology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Byers LA, Rudin CM. Small cell lung cancer: where do we go from here? Cancer 2015; 121:664-72. [PMID: 25336398 PMCID: PMC5497465 DOI: 10.1002/cncr.29098] [Citation(s) in RCA: 423] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 08/29/2014] [Accepted: 09/10/2014] [Indexed: 12/23/2022]
Abstract
Small cell lung cancer (SCLC) is an aggressive disease that accounts for approximately 14% of all lung cancers. In the United States, approximately 31,000 patients are diagnosed annually with SCLC. Despite numerous clinical trials, including at least 40 phase 3 trials since the 1970s, systemic treatment for patients with SCLC has not changed significantly in the past several decades. Consequently, the 5-year survival rate remains low at <7% overall, and most patients survive for only 1 year or less after diagnosis. Unlike nonsmall cell lung cancer (NSCLC), in which major advances have been made using targeted therapies, there are still no approved targeted drugs for SCLC. Significant barriers to progress in SCLC include 1) a lack of early detection modalities, 2) limited tumor tissue for translational research (eg, molecular profiling of DNA, RNA, and/or protein alterations) because of small diagnostic biopsies and the rare use of surgical resection in standard treatment, and 3) rapid disease progression with poor understanding of the mechanisms contributing to therapeutic resistance. In this report, the authors review the current state of SCLC treatment, recent advances in current understanding of the underlying disease biology, and opportunities to advance translational research and therapeutic approaches for patients with SCLC.
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Affiliation(s)
- Lauren Averett Byers
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles M. Rudin
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
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Lee YH, Kim YS, Lee SN, Lee HC, Oh SJ, Kim SJ, Kim YK, Han DH, Yoo IR, Kang JH, Hong SH. Interstitial Lung Change in Pre-radiation Therapy Computed Tomography Is a Risk Factor for Severe Radiation Pneumonitis. Cancer Res Treat 2015; 47:676-86. [PMID: 25687856 PMCID: PMC4614226 DOI: 10.4143/crt.2014.180] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/13/2014] [Indexed: 02/07/2023] Open
Abstract
PURPOSE We examined clinical and dosimetric factors as predictors of symptomatic radiation pneumonitis (RP) in lung cancer patients and evaluated the relationship between interstitial lung changes in the pre-radiotherapy (RT) computed tomography (CT) and symptomatic RP. MATERIALS AND METHODS Medical records and dose volume histogram data of 60 lung cancer patients from August 2005 to July 2006 were analyzed. All patients were treated with three dimensional (3D) conformal RT of median 56.9 Gy. We assessed the association of symptomatic RP with clinical and dosimetric factors. RESULTS With a median follow-up of 15.5 months (range, 6.1 to 40.9 months), Radiation Therapy Oncology Group grade ≥ 2 RP was observed in 14 patients (23.3%). Five patients (8.3%) died from RP. The interstitial changes in the pre-RT chest CT, mean lung dose (MLD), and V30 significantly predicted RP in multivariable analysis (p=0.009, p < 0.001, and p < 0.001, respectively). MLD, V20, V30, and normal tissue complication probability normal tissue complication probability (NTCP) were associated with the RP grade but less so for grade 5 RP. The risk of RP grade ≥ 2, ≥ 3, or ≥ 4 was higher in the patients with interstitial lung change (grade 2, 15.6% to 46.7%, p=0.03; grade 3, 4.4% to 40%, p=0.002; grade 4, 4.4% to 33.3%, p=0.008). Four of the grade 5 RP patients had diffuse interstitial change in pre-RT CT and received chemoradiotherapy. CONCLUSION Our study identified diffuse interstitial disease as a significant clinical risk for RP, particularly fatal RP. We showed the usefulness of MLD, V20, V30, and NTCP in predicting the incidence and severity of RP.
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Affiliation(s)
- Yun Hee Lee
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon Sil Kim
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Nam Lee
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyo Chun Lee
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Se Jin Oh
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seoung Joon Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Kyoon Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dae Hee Han
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ie Ryung Yoo
- Department of Nuclear Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Hyung Kang
- Department of Medical Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Suk Hee Hong
- Department of Medical Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Wang P, Liu W, Zhao L, Wang P. Does the response to induction chemotherapy impact the timing of thoracic radiotherapy for limited-stage small-cell lung cancer? Thorac Cancer 2015; 6:605-12. [PMID: 26445609 PMCID: PMC4567006 DOI: 10.1111/1759-7714.12229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/14/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To investigate whether the response to induction chemotherapy (IC) would impact the timing of thoracic radiotherapy (TRT) in limited-stage small-cell lung cancer (LS-SCLC). METHODS A total of 146 patients with LS-SCLC who had received two to six cycles of IC followed by TRT from January 2009 to December 2011 at our hospital were included in this study. Patients were divided into two groups based on the time TRT was administered: early TRT (administered after 2-3 cycles of chemotherapy) or late TRT (administered after 4-6 cycles). Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method. Multivariate Cox regression analysis was performed to evaluate the independent factors affecting survival. RESULTS The median OS for patients who received early TRT and late TRT was 29.0 and 19.9 months, respectively, (P = 0.018) and the median PFS was 18.5 and 13.8 months, respectively (P = 0.049). In patients who achieved complete remission (CR) or partial remission (PR) after two to three cycles of IC, the median OS was 36.1 and 22.5 months in the early and late TRT subgroups, respectively (P = 0.009); the corresponding median PFS was 20.2 and 13.8 months, respectively (P = 0.038). In the patients who did not achieve CR or PR, no statistic difference was found in OS or PFS between the two subgroups. CONCLUSION Patients who received early TRT had more favorable outcomes than those who received late TRT. Patients who achieved CR or PR after two to three cycles of IC obtained more benefit from early TRT.
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Affiliation(s)
- Peng Wang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy Tianjin, China
| | - Weishuai Liu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy Tianjin, China
| | - Lujun Zhao
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy Tianjin, China
| | - Ping Wang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy Tianjin, China
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Kallianos A, Rapti A, Zarogoulidis P, Tsakiridis K, Mpakas A, Katsikogiannis N, Kougioumtzi I, Li Q, Huang H, Zaric B, Perin B, Courcoutsakis N, Zarogoulidis K. Therapeutic procedure in small cell lung cancer. J Thorac Dis 2014; 5 Suppl 4:S420-4. [PMID: 24102016 DOI: 10.3978/j.issn.2072-1439.2013.09.16] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 09/22/2013] [Indexed: 12/25/2022]
Abstract
Small cell lung cancer (SCLC) represents 12.95% of all lung cancer diagnoses and continues to be a major clinical problem, with an aggressive clinical course and short disease-free duration after 1st line therapy. Treatment of SCLC remains challenging because of its rapid growth and development of drug resistance during the course of the disease. Chemotherapy remains the current optimal treatment and radical thoracic radiotherapy representing the best treatment option for fit patients with LD. Platinum-based chemotherapy is the treatment of choice in patients with good performance status, and the effect of cisplatin is important for concurrent chemoradiotherapy in LD cause of his radiosensitivity. Patients with progress disease after first-line chemotherapy have poor prognosis. Second-line therapy may produce a modest clinical benefit. A number of targeted agents have been investigated in LD and ED, mostly in unselected populations, with disappointing results. Prophylactic cranial irradiation (PCI) is recommended only for patients who had full response to first line chemotherapy, as target of improving overall survival and decreasing possibilities of brain metastases. New factors for target therapy are the hope for the management of this systematic disease. If we identify these targets for treatment of SCLC and overcome drug-resistance mechanisms, we will create new chemo-radiotherapy schedules for future.
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Affiliation(s)
- Anastasios Kallianos
- Second Pulmonary Department, "SOTIRIA" Hospital of Chest Diseases, Athens, Greece
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Lu H, Fang L, Wang X, Cai J, Mao W. A meta-analysis of randomized controlled trials comparing early and late concurrent thoracic radiotherapy with etoposide and cisplatin/carboplatin chemotherapy for limited-disease small-cell lung cancer. Mol Clin Oncol 2014; 2:805-810. [PMID: 25054049 DOI: 10.3892/mco.2014.311] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/17/2013] [Indexed: 12/19/2022] Open
Abstract
The aim of the present study was to determine the optimal time for concurrent thoracic radiotherapy (TRT) with etoposide and cisplatin/carboplatin (EP/EC) chemotherapy for the treatment of limited-disease small-cell lung cancer (LD SCLC). Randomized controlled trials comparing early and late concurrent TRT with EP/EC chemotherapy for the treatment of patients with LD SCLC were identified through searching databases such as MEDLINE, the Cochrane Central Register of Controlled Trials and Embase. Early thoracic radiotherapy (ERT) was defined as initiating irradiation within 30 days after chemotherapy initiation. A total of 3 eligible randomized controlled trials were identified. No significant differences in the objective response rate were detected between early and late concurrent TRT [risk ratio (RR)=1.01; 95% confidence interval (CI): 0.86-1.18; P=0.90]. Similar results were observed in the 1-, 2-, 3- and 5-year survival rates between early and late concurrent TRT (RR=1.06, 95% CI: 0.88-1.27, P=0.56; RR=1.15, 95% CI: 0.77-1.71, P=0.49; RR=0.90, 95% CI: 0.66-1.22, P=0.49; and RR=1.18, 95% CI: 0.64-2.16, P=0.60, respectively). The total incidence of grade 3-4 adverse events, including anemia, leukopenia, neutropenia, thrombocytopenia, nausea and vomiting, infection, esophageal toxicity, pulmonary toxicity, alopecia and hemorrhage with early concurrent TRT was significantly higher compared to that with late concurrent TRT (RR=1.21, 95% CI: 1.03-1.43, P=0.02). Thus, the results of our study indicated that the prognosis of LD SCLC treated with late concurrent TRT and EP/EC chemotherapy is similar to that with early concurrent TRT, although the incidence of grade 3-4 adverse events was lower in LD SCLC patients treated with late concurrent TRT combined with EP/EC chemotherapy.
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Affiliation(s)
- Hongyang Lu
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Luo Fang
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Xiaojia Wang
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Jufen Cai
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Weimin Mao
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
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Morabito A, Carillio G, Daniele G, Piccirillo MC, Montanino A, Costanzo R, Sandomenico C, Giordano P, Normanno N, Perrone F, Rocco G, Di Maio M. Treatment of small cell lung cancer. Crit Rev Oncol Hematol 2014; 91:257-70. [PMID: 24767978 DOI: 10.1016/j.critrevonc.2014.03.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/24/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022] Open
Abstract
Treatment of small cell lung cancer (SCLC) remains a significant challenge for the oncologists. Attempts to improve the results of first-line treatment have all failed so far and no real progress has been made in last years, emphasizing the need for novel strategies of treatment and the development of validated biomarkers. Patients with limited disease and good performance status should be considered for concomitant chemoradiotherapy, followed by prophylactic cranial irradiation. Patients with extensive disease should be treated with a platinum-based chemotherapy (cisplatin or carboplatin); chest radiotherapy can be considered in patients achieving extra-thoracic complete response and prophylactic cranial irradiation is recommended for patients responsive to initial chemotherapy. A large number of molecular-targeted drugs and immunomodulators are currently in clinical development: however, only a better understanding of molecular biology of SCLC and the identification of molecular markers predictive of response to targeted agents will lead to advances in the treatment of SCLC.
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Affiliation(s)
- Alessandro Morabito
- Medical Oncology Unit, Thoraco-Pulmonary Department, Istituto Nazionale Tumori, "Fondazione G. Pascale" - IRCCS, Napoli, Italy.
| | - Guido Carillio
- Department of Oncology and Hematology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | - Gennaro Daniele
- Clinical Trials Unit, Istituto Nazionale Tumori, "Fondazione G. Pascale" - IRCCS, Napoli, Italy
| | | | - Agnese Montanino
- Medical Oncology Unit, Thoraco-Pulmonary Department, Istituto Nazionale Tumori, "Fondazione G. Pascale" - IRCCS, Napoli, Italy
| | - Raffaele Costanzo
- Medical Oncology Unit, Thoraco-Pulmonary Department, Istituto Nazionale Tumori, "Fondazione G. Pascale" - IRCCS, Napoli, Italy
| | - Claudia Sandomenico
- Medical Oncology Unit, Thoraco-Pulmonary Department, Istituto Nazionale Tumori, "Fondazione G. Pascale" - IRCCS, Napoli, Italy
| | - Pasqualina Giordano
- Clinical Trials Unit, Istituto Nazionale Tumori, "Fondazione G. Pascale" - IRCCS, Napoli, Italy
| | - Nicola Normanno
- Cellular Biology and Biotherapy, Istituto Nazionale Tumori, "Fondazione G. Pascale" - IRCCS, Napoli, Italy; Centro di Ricerche Oncologiche di Mercogliano (CROM), Mercogliano, Avellino, Italy
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale Tumori, "Fondazione G. Pascale" - IRCCS, Napoli, Italy
| | - Gaetano Rocco
- Thoracic Surgery, Thoraco-Pulmonary Department, Istituto Nazionale Tumori, "Fondazione G. Pascale" - IRCCS, Napoli, Italy
| | - Massimo Di Maio
- Clinical Trials Unit, Istituto Nazionale Tumori, "Fondazione G. Pascale" - IRCCS, Napoli, Italy
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Kepka L, Sprawka A, Casas F, Abdel-Wahab S, Agarwal JP, Jeremic B. Radiochemotherapy in small-cell lung cancer. Expert Rev Anticancer Ther 2014; 9:1379-87. [DOI: 10.1586/era.09.122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ha IB, Jeong BK, Jeong H, Choi HS, Chai GY, Kang MH, Kim HG, Lee GW, Na JB, Kang KM. Effect of early chemoradiotherapy in patients with limited stage small cell lung cancer. Radiat Oncol J 2013; 31:185-90. [PMID: 24501705 PMCID: PMC3912231 DOI: 10.3857/roj.2013.31.4.185] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/13/2013] [Accepted: 10/16/2013] [Indexed: 01/30/2023] Open
Abstract
PURPOSE We evaluated the effect of early chemoradiotherapy on the treatment of patients with limited stage small cell lung cancer (LS-SCLC). MATERIALS AND METHODS Between January 2006 and December 2011, thirty-one patients with histologically proven LS-SCLC who were treated with two cycles of chemotherapy followed by concurrent chemoradiotherapy and consolidation chemotherapy were retrospectively analyzed. The chemotherapy regimen was composed of etoposide and cisplatin. Thoracic radiotherapy consisted of 50 to 60 Gy (median, 54 Gy) given in 5 to 6.5 weeks. RESULTS The follow-up period ranged from 5 to 53 months (median, 22 months). After chemoradiotherapy, 35.5% of the patients (11 patients) showed complete response, 61.3% (19 patients) showed partial response, 3.2% (one patient) showed progressive disease, resulting in an overall response rate of 96.8% (30 patients). The 1-, 2-, and 3-year overall survival (OS) rates were 66.5%, 41.0%, and 28.1%, respectively, with a median OS of 21.3 months. The 1-, 2-, and 3-year progression free survival (PFS) rates were 49.8%, 22.8%, and 13.7%, respectively, with median PFS of 12 months. The patterns of failure were: locoregional recurrences in 29.0% (nine patients), distant metastasis in 9.7% (three patients), and both locoregional and distant metastasis in 9.7% (three patients). Grade 3 or 4 toxicities of leukopenia, anemia, and thrombocytopenia were observed in 32.2%, 29.0%, and 25.8%, respectively. Grade 3 radiation esophagitis and radiation pneumonitis were shown in 12.9% and 6.4%, respectively. CONCLUSION We conclude that early chemoradiotherapy for LS-SCLC provides feasible and acceptable local control and safety.
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Affiliation(s)
- In-Bong Ha
- Department of Radiation Oncology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Bae-Kwon Jeong
- Department of Radiation Oncology, Gyeongsang National University School of Medicine, Jinju, Korea. ; Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Hojin Jeong
- Department of Radiation Oncology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hoon-Sik Choi
- Department of Radiation Oncology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Gyu-Young Chai
- Department of Radiation Oncology, Gyeongsang National University School of Medicine, Jinju, Korea. ; Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Myoung-Hee Kang
- Institute of Health Science, Gyeongsang National University, Jinju, Korea. ; Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hoon Gu Kim
- Institute of Health Science, Gyeongsang National University, Jinju, Korea. ; Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Gyeong-Won Lee
- Institute of Health Science, Gyeongsang National University, Jinju, Korea. ; Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jae-Beom Na
- Institute of Health Science, Gyeongsang National University, Jinju, Korea. ; Department of Diagnostic Radiology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ki-Mun Kang
- Department of Radiation Oncology, Gyeongsang National University School of Medicine, Jinju, Korea. ; Institute of Health Science, Gyeongsang National University, Jinju, Korea
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Xia B, Wang JZ, Liu Q, Cheng JY, Zhu ZF, Fu XL. Quantitative analysis of tumor shrinkage due to chemotherapy and its implication for radiation treatment planning in limited-stage small-cell lung cancer. Radiat Oncol 2013; 8:216. [PMID: 24040865 PMCID: PMC3851276 DOI: 10.1186/1748-717x-8-216] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 09/03/2013] [Indexed: 01/08/2023] Open
Abstract
Background The optimal timing of chemoradiotherapy in limited-stage small-cell lung cancer (LS-SCLC) hasn’t been established, although evidence from studies supported that patients can benefit from early radiation therapy. The purpose of this study was to quantify tumor shrinkage in response to induction chemotherapy (IC), evaluate the impact of tumor shrinkage on radiation dosimetric parameters and determine its implication for the timing of radiation therapy for patients with LS-SCLC. Methods Twenty patients with LS-SCLC who were treated with IC followed by concomitant radiation therapy were investigated retrospectively. Ten patients received 1 cycle of IC, and 10 patients received 2 cycles of IC. Pre-IC CT imaging was coregistered with a simulation CT, and virtual radiation plans were created for pre- and post-IC thoracic disease in each case. The changes in the gross target volume (GTV), planning target volume (PTV) and dosimetric factors associated with the lungs, esophagus and heart were analyzed. Results The mean GTV and PTV for all of the patients decreased by 60.9% and 40.2%, respectively, which resulted in a significant reduction in the radiation exposure to the lungs, esophagus and heart. Changes in the PTV and radiation exposure of normal tissue were not significantly affected by the number of chemotherapy cycles delivered, although patients who received 2 cycles of IC had a greater decrease in GTV than those who received only 1 cycle of IC (69.6% vs. 52.1%, p = 0.273). Conclusions Our data showed that targeting the tumor post-IC may reduce the radiation dose to normal tissue in patients with LS-SCLC. However, the benefit to the normal tissue was not increased by an additional cycle of IC. These findings suggest that the first cycle of chemotherapy is very important for tumor shrinkage and that initiating thoracic radiation therapy at the second cycle of chemotherapy may be a reasonable strategy for timing of radiation therapy in LS-SCLC treatment.
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Affiliation(s)
- Bing Xia
- Department of Radiation Oncology, Shanghai Cancer Center, Fudan University, 270 Dong An Road, Shanghai 200032, China.
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Rossi A, Martelli O, Di Maio M. Treatment of patients with small-cell lung cancer: From meta-analyses to clinical practice. Cancer Treat Rev 2013; 39:498-506. [DOI: 10.1016/j.ctrv.2012.09.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 08/23/2012] [Accepted: 09/18/2012] [Indexed: 11/25/2022]
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62
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Sun JM, Ahn YC, Choi EK, Ahn MJ, Ahn JS, Lee SH, Lee DH, Pyo H, Song SY, Jung SH, Jo JS, Jo J, Sohn HJ, Suh C, Lee JS, Kim SW, Park K. Phase III trial of concurrent thoracic radiotherapy with either first- or third-cycle chemotherapy for limited-disease small-cell lung cancer. Ann Oncol 2013; 24:2088-92. [PMID: 23592701 DOI: 10.1093/annonc/mdt140] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We compared late thoracic radiotherapy (TRT) with early TRT in the treatment of limited-disease small-cell lung cancer (LD-SCLC). PATIENTS AND METHODS Patients with LD-SCLC received four cycles of etoposide plus cisplatin every 21 days. Patients were randomly assigned to receive either TRT administered concurrently with the first cycle (early TRT) or the third cycle (late TRT) of chemotherapy. The primary end point was complete response rate. RESULTS Two hundred twenty-two patients were randomly assigned.Late TRT was not inferior to early TRT in terms of the complete response rate (early v late; 36.0% v 38.0%). Other efficacy measures including overall survival [median, 24.1 v 26.8 months;hazard ratio (HR) 0.93; 95% CI = 0.67–1.29] and progression free survival (median, 12.4 v 11.2 months; HR 1.09; 95%CI = 0.80–1.48) were not different between two arms. No statistical difference was noted in the pattern of treatment failures.However, neutropenic fever occurred more commonly in the early TRT arm than the late TRT arm (21.6% v 10.2%; P = 0.02) [corrected]. CONCLUSION In LD-SCLC treatment, TRT starting in the third cycle of chemotherapy seemed to be noninferior to early TRT, and had a more favorable profile with regard to neutropenic fever.
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Affiliation(s)
- J-M Sun
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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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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64
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Colaco RJ, Huh S, Nichols RC, Morris CG, D’Agostino H, Flampouri S, Li Z, Pham DC, Bajwa AA, Hoppe BS. Dosimetric rationale and early experience at UFPTI of thoracic proton therapy and chemotherapy in limited-stage small cell lung cancer. Acta Oncol 2013; 52:506-13. [PMID: 23438357 DOI: 10.3109/0284186x.2013.769063] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Concurrent chemoradiotherapy (CRT) is the standard of care in patients with limited-stage small cell lung cancer (SCLC). Treatment with conventional x-ray therapy (XRT) is associated with high toxicity rates, particularly acute grade 3+ esophagitis and pneumonitis. We present outcomes for the first known series of limited-stage SCLC patients treated with proton therapy and a dosimetric comparison of lung and esophageal doses with intensity-modulated radiation therapy (IMRT). MATERIAL AND METHODS Six patients were treated: five concurrently and one sequentially. Five patients received 60-66 CGE in 30-34 fractions once daily and one patient received 45 CGE in 30 fractions twice daily. All six patients received prophylactic cranial irradiation. Common Terminology Criteria for Adverse Events, v3.0, was used to grade toxicity. IMRT plans were also generated and compared with proton plans. RESULTS The median follow-up was 12.0 months. The one-year overall and progression-free survival rates were 83% and 66%, respectively. There were no cases of acute grade 3+ esophagitis or acute grade 2+ pneumonitis, and no other acute grade 3+ non-hematological toxicities were seen. One patient with a history of pulmonary fibrosis and atrial fibrillation developed worsening symptoms four months after treatment requiring oxygen. Three patients died: two of progressive disease and one after a fall; the latter patient was disease-free at 36 months after treatment. Another patient recurred and is alive, while two patients remain disease-free at 12 months of follow-up. Proton therapy proved superior to IMRT across all esophageal and lung dose volume points. CONCLUSION In this small series of SCLC patients treated with proton therapy with radical intent, treatment was well tolerated with no cases of acute grade 3+ esophagitis or acute grade 2+ pneumonitis. Dosimetric comparison showed better sparing of lung and esophagus with proton therapy. Proton therapy merits further investigation as a method of reducing the toxicity of CRT.
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Affiliation(s)
- Rovel J. Colaco
- University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
| | - Soon Huh
- University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
| | - Romaine C. Nichols
- University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
| | | | - Harry D’Agostino
- Department of Thoracic Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Stella Flampouri
- University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
| | - Zuofeng Li
- University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
| | - Dat C. Pham
- Department of Hematology and Medical Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Abubakr A. Bajwa
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Bradford S. Hoppe
- University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
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Sas-Korczynska B, Sokolowski A, Korzeniowski S. The influence of time of radio-chemotherapy and other therapeutic factors on treatment results in patients with limited disease small cell lung cancer. Lung Cancer 2013; 79:14-9. [DOI: 10.1016/j.lungcan.2012.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 09/25/2012] [Accepted: 10/04/2012] [Indexed: 11/16/2022]
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Ríos I, Morales J, Viñolas N, Casas F. Radiochemotherapy in special populations with limited-disease small-cell lung cancer and locally advanced non-small-cell lung cancer. Lung Cancer Manag 2012. [DOI: 10.2217/lmt.12.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY The evidence to date confirms that concurrent radiochemotherapy (RT–ChT) is the treatment of choice in small-cell lung cancer and locally advanced non-small-cell lung cancer. But these patients require a good performance status and an interdisciplinary group of clinicians, which is hard to find at some facilities around the world. Socioeconomic differences worldwide, inadequate tolerance to RT–ChT, tobacco comorbidities, the high percentage of elderly patients and their low level of recruitment in clinical trials could explain, in part, the reason why lung cancer still remains the leading cause of cancer-related death around the world. This review focuses on RT–ChT in a special population of eldery, comorbid patients and populations with limited resources from developing countries with locally advanced non-small-cell lung cancer and limited-disease small-cell lung cancer.
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Affiliation(s)
- Iván Ríos
- Radiation Oncology Department, Hospital Clinic Barcelona, Villarroel 170, Barcelona, Spain
| | - Javier Morales
- Radiation Oncology Department, Hospital Clinic Barcelona, Villarroel 170, Barcelona, Spain
| | - Nuria Viñolas
- Clinical Oncology Department, Hospital Clinic Barcelona, Villarroel 170, Barcelona, Spain
| | - Francesc Casas
- Radiation Oncology Department, Hospital Clinic Barcelona, Villarroel 170, Barcelona, Spain
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Manapov F, Klöcking S, Niyazi M, Levitskiy V, Belka C, Hildebrandt G, Fietkau R, Klautke G. Primary tumor response to chemoradiotherapy in limited-disease small-cell lung cancer correlates with duration of brain-metastasis free survival. J Neurooncol 2012; 109:309-14. [PMID: 22610939 DOI: 10.1007/s11060-012-0894-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 04/27/2012] [Indexed: 10/28/2022]
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Komaki R, Paulus R, Ettinger DS, Videtic GMM, Bradley JD, Glisson BS, Langer CJ, Sause WT, Curran WJ, Choy H. Phase II study of accelerated high-dose radiotherapy with concurrent chemotherapy for patients with limited small-cell lung cancer: Radiation Therapy Oncology Group protocol 0239. Int J Radiat Oncol Biol Phys 2012; 83:e531-6. [PMID: 22560543 DOI: 10.1016/j.ijrobp.2012.01.075] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 01/23/2012] [Accepted: 01/24/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate whether high-dose thoracic radiation given twice daily during cisplatin-etoposide chemotherapy for limited small-cell lung cancer (LSCLC) improves survival, acute esophagitis, and local control rates relative to findings from Intergroup trial 0096 (47%, 27%, and 64%). PATIENTS AND METHODS Patients were accrued over a 3-year period from 22 US and Canadian institutions. Patients with LSCLC and good performance status were given thoracic radiation to 61.2 Gy over 5 weeks (daily 1.8-Gy fractions on days 1-22, then twice-daily 1.8-Gy fractions on days 23-33). Cisplatin (60 mg/m(2) IV) was given on day 1 and etoposide (120 mg/m(2) IV) on days 1-3 and days 22-24, followed by 2 cycles of cisplatin plus etoposide alone. Patients who achieved complete response were offered prophylactic cranial irradiation. Endpoints included overall and progression-free survival; severe esophagitis (Common Toxicity Criteria v 2.0) and treatment-related fatalities; response (Response Evaluation Criteria in Solid Tumors); and local control. RESULTS Seventy-two patients were accrued from June 2003 through May 2006; 71 were evaluable (median age 63 years; 52% female; 58% Zubrod 0). Median survival time was 19 months; at 2 years, the overall survival rate was 36.6% (95% confidence interval [CI] 25.6%-47.7%), and progression-free survival 19.7% (95% CI 11.4%-29.6%). Thirteen patients (18%) experienced severe acute esophagitis, and 2 (3%) died of treatment-related causes; 41% achieved complete response, 39% partial response, 10% stable disease, and 6% progressive disease. The local control rate was 73%. Forty-three patients (61%) received prophylactic cranial irradiation. CONCLUSIONS The overall survival rate did not reach the projected goal; however, rates of esophagitis were lower, and local control higher, than projected. This treatment strategy is now one of three arms of a prospective trial of chemoradiation for LSCLC (Radiation Therapy Oncology Group 0538/Cancer and Leukemia Group B 30610).
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Affiliation(s)
- Ritsuko Komaki
- Department of Radiation Oncology, Unit 97, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030, USA.
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Aridgides PD, Movsas B, Bogart JA. Thoracic radiotherapy for limited stage small cell lung carcinoma. Curr Probl Cancer 2012; 36:88-105. [PMID: 22495055 DOI: 10.1016/j.currproblcancer.2012.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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70
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Colaco R, Sheikh H, Lorigan P, Blackhall F, Hulse P, Califano R, Ashcroft L, Taylor P, Thatcher N, Faivre-Finn C. Omitting elective nodal irradiation during thoracic irradiation in limited-stage small cell lung cancer – Evidence from a phase II trial. Lung Cancer 2012; 76:72-7. [DOI: 10.1016/j.lungcan.2011.09.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 09/14/2011] [Accepted: 09/22/2011] [Indexed: 11/27/2022]
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71
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Kepka L, Baumann M. Radiotherapy in small cell lung cancer: Limited volumes in limited disease and adding thoracic radiotherapy in extended disease? Radiother Oncol 2012; 102:165-7. [DOI: 10.1016/j.radonc.2012.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 01/11/2012] [Indexed: 12/25/2022]
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Larsen AW, Khalil AA, Meldgaard P, Knap MM. <sup>18</sup>FDG-PET/CT Is a Useful Tool in Staging Procedure before Chemo-Radiotherapy in Patients with Limited Disease Small-Cell Lung Cancer. Pattern of Failure and Survival Is Analyzed. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/jct.2012.324049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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73
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Manapov F, Klöcking S, Niyazi M, Belka C, Hildebrandt G, Fietkau R, Klautke G. Chemoradiotherapy duration correlates with overall survival in limited disease SCLC patients with poor initial performance status who successfully completed multimodality treatment. Strahlenther Onkol 2011; 188:29-34. [PMID: 22189436 DOI: 10.1007/s00066-011-0016-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 09/14/2011] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Limited data concerning treatment-related prognostic factors in limited disease (LD) small-cell lung cancer (SCLC) patients with poor initial performance status (PS) who successfully completed chemoradiotherapy (CRT) are available. PATIENTS AND METHODS A total of 125 patients with initial PS WHO 2-3 who successfully completed CRT were retrospectively reviewed. Thoracic radiation therapy (TRT) was applied in the concurrent (group 1) or sequential (group 2) mode. Influence of treatment type, time from diagnosis to start of TRT, number of chemotherapy cycles, prophylactic cranial irradiation (PCI), occurrence of brain metastases (BMs), and duration of CRT on overall survival (OS) were analyzed. RESULTS Median duration of CRT was 156 days in group 1 and 195 days in group 2 (p < 0.001). Median progression-free survival and OS were 11.6 (95% confidence interval (CI) 10-13.2) and 14.9 (95% CI 11.7-17.6) months with no difference between the groups. The 2- and 3-year survival rates were 37.9 ± 6.9% and 22.7 ± 6.3% in group 1 and 22.4 ± 4.9% and 15.2 ± 4.3% in group 2, respectively. Duration of CRT was only treatment-related factor predicting OS in the uni- (p < 0.014) and multivariate (p < 0.025) analyses. Short dose-dense CRT was associated with improved OS. CONCLUSION Duration of CRT affects OS in LD SCLC patients with poor initial performance status who successfully completed multimodality treatment.
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Affiliation(s)
- F Manapov
- Department of Radiation Oncology, Ludwig-Maximilians-University Munich, Marchioninistra.15, 81377, Munich, Germany.
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Planchard D, Le Péchoux C. Small cell lung cancer: new clinical recommendations and current status of biomarker assessment. Eur J Cancer 2011; 47 Suppl 3:S272-83. [PMID: 21943984 DOI: 10.1016/s0959-8049(11)70173-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Small-cell lung carcinomas (SCLC) represent 15-18% of all lung cancers. As SCLC has a high propensity for early metastatic dissemination, less than a third of patients have limited disease (T0-1N0-3M0). The new TNM classification should now be used also for SCLC. Platin- and etoposide-based chemotherapy is the cornerstone treatment. Response rates to both chemotherapy and radiotherapy are impressive but relapses are frequent. The current state-of-the-art treatment for MO patients involves platin-etoposide-based chemotherapy, combined with early thoracic radiotherapy. Because of the high risk of brain metastases, prophylactic cranial irradiation is indicated in responders and should be part of the standard management. The 5-year survival rate may reach 25% in MO patients, but does not exceed 10% at 2 years in metastatic patients. Most patients relapse within the first two years, and there are few treatment options in second line as opposed to NSCLC. Many issues are subject for further clinical research such as the biology of this disease to better identify pathways that could be targeted with new drugs, optimisation of systemic treatments and radiotherapy. Pursuing clinical trials at all stages constitutes a challenge for thoracic researchers and oncologists.
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Affiliation(s)
- David Planchard
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
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75
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王 敬, 张 树. [Advances on treatment of limited-disease small cell lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2011; 14:811-8. [PMID: 22008112 PMCID: PMC5999944 DOI: 10.3779/j.issn.1009-3419.2011.10.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 07/12/2011] [Indexed: 11/05/2022]
Affiliation(s)
- 敬慧 王
- />101149 北京,首都医科大学附属北京胸科医院肿瘤内科Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - 树才 张
- />101149 北京,首都医科大学附属北京胸科医院肿瘤内科Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
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76
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Final results of the randomized phase III CHARTWEL-trial (ARO 97-1) comparing hyperfractionated-accelerated versus conventionally fractionated radiotherapy in non-small cell lung cancer (NSCLC). Radiother Oncol 2011; 100:76-85. [PMID: 21757247 DOI: 10.1016/j.radonc.2011.06.031] [Citation(s) in RCA: 125] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 06/14/2011] [Accepted: 06/14/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND Continuous hyperfractionated accelerated radiotherapy (CHART) counteracts repopulation and may significantly improve outcome of patients with non-small-cell lung cancer (NSCLC). Nevertheless high local failure rates call for radiation dose escalation. We report here the final results of the multicentric CHARTWEL trial (CHART weekend less, ARO 97-1). PATIENTS AND METHODS Four hundred and six patients with NSCLC were stratified according to stage, histology, neoadjuvant chemotherapy and centre and were randomized to receive 3D-planned radiotherapy to 60Gy/40 fractions/2.5weeks (CHARTWEL) or 66Gy/33 fractions/6.5weeks (conventional fractionation, CF). RESULTS Overall survival (OS, primary endpoint) at 2, 3 and 5yr was not significantly different after CHARTWEL (31%, 22% and 11%) versus CF (32%, 18% and 7%; HR 0.92, 95% CI 0.75-1.13, p=0.43). Also local tumour control rates and distant metastases did not significantly differ. Acute dysphagia and radiological pneumonitis were more pronounced after CHARTWEL, without differences in clinical signs of pneumopathy. Exploratory analysis revealed a significant trend for improved LC after CHARTWEL versus CF with increasing UICC, T or N stage (p=0.006-0.025) and after neoadjuvant chemotherapy (HR 0.48, 0.26-0.89, p=0.019). CONCLUSIONS Overall, outcome after CHARTWEL or CF was not different. The lower total dose in the CHARTWEL arm was compensated by the shorter overall treatment time, confirming a time factor for NSCLC. The higher efficacy of CHARTWEL versus CF in advanced stages and after chemotherapy provides a basis for further trials on treatment intensification for locally advanced NSCLC.
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77
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William WN, Glisson BS. Novel strategies for the treatment of small-cell lung carcinoma. Nat Rev Clin Oncol 2011; 8:611-9. [PMID: 21691321 DOI: 10.1038/nrclinonc.2011.90] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Small-cell lung cancer (SCLC) is a disease with a poor prognosis and limited treatment options. Over the past 30 years, basic and clinical research have translated to little innovation in the treatment of this disease. The Study of Picoplatin Efficacy After Relapse (SPEAR) evaluated best supportive care with or without picoplatin for second-line SCLC treatment and failed to meet its primary end point of overall survival. As the largest second-line, randomized study in patients with SCLC, SPEAR provides an opportunity to critically examine the drug development model in this disease. In this Review, we discuss the current standard approach for the management of SCLC that progresses after first-line therapy, analyze the preliminary data that supported the evaluation of picoplatin in this setting, and critically evaluate the SPEAR trial design and results. Lastly, we present advances in the understanding of the molecular biology of SCLC that could potentially inform future clinical trials and hopefully lead to the successful development of molecular targeted agents for the treatment of this disease.
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Affiliation(s)
- William N William
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas M D Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 432, Houston, TX 77030, USA
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78
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Xia B, Chen GY, Cai XW, Zhao JD, Yang HJ, Fan M, Zhao KL, Fu XL. The effect of bioequivalent radiation dose on survival of patients with limited-stage small-cell lung cancer. Radiat Oncol 2011; 6:50. [PMID: 21592406 PMCID: PMC3117707 DOI: 10.1186/1748-717x-6-50] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 05/19/2011] [Indexed: 12/25/2022] Open
Abstract
Background To investigate the biological radiation dose-response for patients of limited-stage small-cell lung cancer (LS-SCLC) treated with high radiation dose. Methods Two hundred and five patients of LS-SCLC treated with sequential chemotherapy and thoracic radiotherapy with involved-field between 1997 and 2006 were reviewed retrospectively. Biologically effective dose (BED) was calculated for dose homogenization and was corrected with the factor of overall radiation time. Patients were divided into low BED group (n = 70) and high BED group (n = 135) with a cut-off of BED 57 Gy (equivalent to 60 Gy in 30 fractions over 40 days). Outcomes of the two groups were compared. Results Median follow-up was 20.7 months for all analyzable patients and 50.8 months for surviving patients. Considering all patients, median survival was 22.9 months (95% confidence interval, 20.6-25.2 months); 2- and 5-year survival rates were 47.2% and 22.3%, respectively. Patients in high BED group had a significantly better local control (p = 0.024), progression-free survival (p = 0.006) and overall survival (p = 0.005), with a trend toward improved distant-metastasis free survival (p = 0.196). Multivariable Cox regression demonstrated that age (p = 0.003), KPS (p = 0.009), weight loss (p = 0.023), and BED (p = 0.004) were significant predictors of overall survival. Conclusions Our data showed that a high BED was significantly associated with favourable outcomes in the Chinese LS-SCLC population, indicating that a positive BED-response relationship still existed even in a relatively high radiation dose range.
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Affiliation(s)
- Bing Xia
- Department of Radiation Oncology, Fudan University Shanghai Cancer Centre, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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79
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van Loon J, Offermann C, Ollers M, van Elmpt W, Vegt E, Rahmy A, Dingemans AMC, Lambin P, De Ruysscher D. Early CT and FDG-metabolic tumour volume changes show a significant correlation with survival in stage I-III small cell lung cancer: a hypothesis generating study. Radiother Oncol 2011; 99:172-5. [PMID: 21571382 DOI: 10.1016/j.radonc.2011.03.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 03/07/2011] [Accepted: 03/27/2011] [Indexed: 10/25/2022]
Abstract
BACKGROUND Many patients with stage I-III small cell lung cancer (SCLC) experience disease progression short after the completion of concurrent chemoradiotherapy (CRT). The purpose of the current study was to evaluate whether CT or FDG metabolic response early after the start of chemotherapy, but before the beginning of chest RT, is predictive for survival in SCLC. METHODS Fifteen stage I-III SCLC patients treated with concurrent CRT with an FDG-PET and CT scan available before the start of chemotherapy and after or during the first cycle of chemotherapy, but before the start of radiotherapy, were selected. The metabolic volume (MV) was defined both within the primary tumour and in the involved nodal stations using the 40% (MV40) and 50% (MV50) threshold of the maximum SUV. Metabolic and CT response was assessed by the relative change in MV and CT volume, respectively, between both time points. The association between response and overall survival (OS) was analysed by univariate cox regression analysis. The minimum follow-up was 18 months. RESULTS Reductions in MV40 and MV50 were -36±38% (126.4 to 68.7cm(3)) and -44±38% (90.2 to 27.8cm(3)), respectively. The median CT volume reduction was -40±64% (190.6 to 113.8cm(3)). MV40 and MV50 changes showed a significant association with survival (HR=1.02, 95% CI: 1.00-1.04 (p=0.042); HR=1.02, 95% CI: 1.00-1.04 (p=0.048), respectively), indicating a 2% increase in survival probability for 1% reduction in metabolic volume. The CT volume change was also significantly correlated with survival (HR=1.01, 95% CI: 1.00-1.03, p=0.007). CONCLUSIONS This hypothesis generating study shows that both the early CT and the MV changes show a significant correlation with survival in SCLC. A prospective study is planned in a larger patient cohort to allow multivariate analysis, with the final aim to select patients early during treatment that could benefit from dose intensification or alternative treatment.
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Affiliation(s)
- Judith van Loon
- Department of Radiation Oncology, Maastricht University Medical Centre, The Netherlands.
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80
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Sheikh H, Colaco R, Lorigan P, Blackhall F, Califano R, Ashcroft L, Taylor P, Thatcher N, Faivre-Finn C. Use of G-CSF during concurrent chemotherapy and thoracic radiotherapy in patients with limited-stage small-cell lung cancer safety data from a phase II trial. Lung Cancer 2011; 74:75-9. [PMID: 21353720 DOI: 10.1016/j.lungcan.2011.01.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 12/23/2010] [Accepted: 01/26/2011] [Indexed: 02/02/2023]
Abstract
There is paucity of data in the literature regarding the safety of combining granulocyte colony stimulating factor (G-CSF) during chemo-radiotherapy (CTRT) in lung cancer patients. The ASCO 2006 recommendations advise against use of CSFs during concomitant mediastinal CTRT. The only randomised study evaluating CSFs in this context showed significant increase in grade 3/4 thrombocytopenia and an excess of pulmonary toxic deaths. In the context of a phase II trial, 38 patients with limited-stage small cell lung cancer were randomised to receive once-daily (66 Gy in 33 fractions) or twice-daily (45 Gy in 30 fractions) radiotherapy. Radiotherapy (RT) was given concurrently with cisplatin and etoposide. G-CSF was given as primary or secondary prophylaxis or as a therapeutic measure during an episode of febrile neutropenia according to local protocols. Common terminology criteria for adverse events (CTCAE) v3.0 was used to record toxicity. Thirteen (34%) of 38 patients received G-CSF concurrently with RT. With a median follow-up of 16.9 months, there were no treatment related deaths reported. Seven (54%) patients experienced grade 3/4 thrombocytopenia and 5 (38%) experienced grade 3/4 anaemia. Thirty-one percent required platelet transfusions. No episodes of bleeding were observed. There were no cases of grade 3/4 acute pneumonitis. These data suggests that with modern three-dimensional (3D) conformal RT, G-CSF administration concurrently with CTRT does not result in the increase risk of pulmonary toxicity, but does increase the risk of thrombocytopenia. Whether the risks of thrombocytopenia are outweighed by the outcome of timely early concurrent CTRT is being evaluated prospectively in the ongoing phase III CONVERT trial (NCT00433563) in which G-CSF is permitted during thoracic irradiation.
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Affiliation(s)
- Hamid Sheikh
- Dept of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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81
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van Loon J, van Baardwijk A, Boersma L, Ollers M, Lambin P, De Ruysscher D. Therapeutic implications of molecular imaging with PET in the combined modality treatment of lung cancer. Cancer Treat Rev 2011; 37:331-43. [PMID: 21320756 DOI: 10.1016/j.ctrv.2011.01.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 01/13/2011] [Accepted: 01/21/2011] [Indexed: 12/23/2022]
Abstract
Molecular imaging with PET, and certainly integrated PET-CT, combining functional and anatomical imaging, has many potential advantages over anatomical imaging alone in the combined modality treatment of lung cancer. The aim of the current article is to review the available evidence regarding PET with FDG and other tracers in the combined modality treatment of locally advanced lung cancer. The following topics are addressed: tumor volume definition, outcome prediction and the added value of PET after therapy, and finally its clinical implications and future perspectives. The additional value of FDG-PET in defining the primary tumor volume has been established, mainly in regions with atelectasis or post-treatment effects. Selective nodal irradiation (SNI) of FDG-PET positive nodal stations is the preferred treatment in NSCLC, being safe and leading to decreased normal tissue exposure, providing opportunities for dose escalation. First results in SCLC show similar results. FDG-uptake on the pre-treatment PET scan is of prognostic value. Data on the value of pre-treatment FDG-uptake to predict response to combined modality treatment are conflicting, but the limited data regarding early metabolic response during treatment do show predictive value. The FDG response after radical treatment is of prognostic significance. FDG-PET in the follow-up has potential benefit in NSCLC, while data in SCLC are lacking. Radiotherapy boosting of radioresistant areas identified with FDG-PET is subject of current research. Tracers other than (18)FDG are promising for treatment response assessment and the visualization of intra-tumor heterogeneity, but more research is needed before they can be clinically implemented.
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Affiliation(s)
- Judith van Loon
- Maastricht University Medical Centre, Department of Radiation Oncology, MAASTRO Clinic, GROW Research Institute, The Netherlands.
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82
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Sørensen M, Pijls-Johannesma M, Felip E. Small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 Suppl 5:v120-5. [PMID: 20555060 DOI: 10.1093/annonc/mdq172] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- M Sørensen
- Department of Oncology, The Finsen Centre, Copenhagen, Denmark
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83
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Paumier A, Le Péchoux C. Radiotherapy in small-cell lung cancer: Where should it go? Lung Cancer 2010; 69:133-40. [DOI: 10.1016/j.lungcan.2010.04.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 04/13/2010] [Accepted: 04/22/2010] [Indexed: 11/26/2022]
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Stinchcombe TE, Gore EM. Limited-stage small cell lung cancer: current chemoradiotherapy treatment paradigms. Oncologist 2010; 15:187-95. [PMID: 20145192 DOI: 10.1634/theoncologist.2009-0298] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In the U.S., the prevalence of small cell lung cancer (SCLC) is declining, probably reflecting the decreasing prevalence of tobacco use. However, a significant number of patients will receive a diagnosis of SCLC, and approximately 40% of patients with SCLC will have limited-stage (LS) disease, which is potentially curable with the combination of chemotherapy and radiation therapy. The standard therapy for LS-SCLC is concurrent chemoradiotherapy, and the 5-year survival rate observed in clinical trials is approximately 25%. The standard chemotherapy remains cisplatin and etoposide, but carboplatin is frequently used in patients who cannot tolerate or have a contraindication to cisplatin. Substantial improvements in survival have been made through improvements in radiation therapy. Concurrent chemoradiotherapy is the preferred therapy for patients who are appropriate candidates. The optimal timing of concurrent chemoradiotherapy is during the first or second cycle, based on data from meta-analyses. The optimal radiation schedule and dose remain topics of debate, but 1.5 Gy twice daily to a total of 45 Gy and 1.8-2.0 Gy daily to a total dose of 60-70 Gy are commonly used treatments. For patients who obtain a near complete or complete response, prophylactic cranial radiation reduces the incidence of brain metastases and improves overall survival. The ongoing Radiation Therapy Oncology Group and Cancer and Leukemia Group B and the European and Canadian phase III trials will investigate different radiation treatment paradigms for patients with LS-SCLC, and completion of these trials is critical.
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Affiliation(s)
- Thomas E Stinchcombe
- Lineberger Comprehensive Cancer Center at University of North Carolina at Chapel Hill, North Carolina 27599-7305, USA.
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The role of higher thoracic irradiation doses in patients with limited stage of small-cell lung cancer: Retrospective study. ARCHIVE OF ONCOLOGY 2010. [DOI: 10.2298/aoo1002008s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Small-cell lung cancer is highly chemo- and radiosensitive tumor. We evaluated two different radiotherapy doses applied sequentially with chemotherapy in relation to time to progression, progression free survival, and overall survival in patients with limited disease of small cell lung cancer. Methods: From 1998 to 2003, 81 patients were treated for small-cell lung carcinoma. Median age was 57 years (range, 36-77 years) and female: male ratio was 1:4. Patients were initially treated with four cycles of chemotherapy during three weeks (cisplatin 80mg/m2 IV, day 1 and etoposide 100 mg/m2 IV, days 1 - 3). One month later, patients received up to 44 Gy, 2 Gy per day, 5 days per week (group I, 41 patients) or above 44 Gy, standard fractionation (group II, 40 patients), to mediastinum and tumor. Range of higher radiotherapy doses was 54 Gy to 64 Gy, standard fractionation. We evaluated if different radiotherapy doses had any influence on time to progression, progression free survival, and overall survival. Results: The median follow up time was 23 months (range, 12-72 months) for both groups of patients (81). The median time to progression in group I of patients (41) was 13 months (range, 11-29 months) while median time to progression in group II of patients (40) was 20 months (min=9, max=60). There was no statistically significant difference in relapse rate between two groups of patients (p>0.05, Fisher test). However, there was difference but not statistically significant in one-year progression free survival (p=0.05, chi square test) between groups, while there was statistically significant difference in two-year progression free survival favoring higher doses of radiotherapy (p<0.05, chi-square test). The median overall survival was 18 months (range, 12-35 months) for group I of patients and 28 months (range, 15-72 months) for group II of patients. There was no statistically significant advantage between two groups of patients for one-year overall survival (p>0.05, chi-square test). However, there was statistically significant difference in overall survival favoring higher radiotherapy doses for two-year overall survival (p<0.05, chi-square test). Conclusion: We found that higher radiotherapy doses had an impact on long-term time to progression, progression free survival, and overall survival (2 years) of patients.
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Selective nodal irradiation on basis of (18)FDG-PET scans in limited-disease small-cell lung cancer: a prospective study. Int J Radiat Oncol Biol Phys 2009; 77:329-36. [PMID: 19782478 DOI: 10.1016/j.ijrobp.2009.04.075] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 04/29/2009] [Accepted: 04/29/2009] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the results of selective nodal irradiation on basis of (18)F-deoxyglucose positron emission tomography (PET) scans in patients with limited-disease small-cell lung cancer (LD-SCLC) on isolated nodal failure. METHODS AND MATERIALS A prospective study was performed of 60 patients with LD-SCLC. Radiotherapy was given to a dose of 45 Gy in twice-daily fractions of 1.5 Gy, concurrent with carboplatin and etoposide chemotherapy. Only the primary tumor and the mediastinal lymph nodes involved on the pretreatment PET scan were irradiated. A chest computed tomography (CT) scan was performed 3 months after radiotherapy completion and every 6 months thereafter. RESULTS A difference was seen in the involved nodal stations between the pretreatment (18)F-deoxyglucose PET scans and computed tomography scans in 30% of patients (95% confidence interval, 20-43%). Of the 60 patients, 39 (65%; 95% confidence interval [CI], 52-76%) developed a recurrence; 2 patients (3%, 95% CI, 1-11%) experienced isolated regional failure. The median actuarial overall survival was 19 months (95% CI, 17-21). The median actuarial progression-free survival was 14 months (95% CI, 12-16). 12% (95% CI, 6-22%) of patients experienced acute Grade 3 (Common Terminology Criteria for Adverse Events, version 3.0) esophagitis. CONCLUSION PET-based selective nodal irradiation for LD-SCLC resulted in a low rate of isolated nodal failures (3%), with a low percentage of acute esophagitis. These findings are in contrast to those from our prospective study of CT-based selective nodal irradiation, which resulted in an unexpectedly high percentage of isolated nodal failures (11%). Because of the low rate of isolated nodal failures and toxicity, we believe that our data support the use of PET-based SNI for LD-SCLC.
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88
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Hallqvist A, Rylander H, Björk-Eriksson T, Nyman J. Accelerated hyperfractionated radiotherapy and concomitant chemotherapy in small cell lung cancer limited-disease. Dose response, feasibility and outcome for patients treated in western Sweden, 1998-2004. Acta Oncol 2009; 46:969-74. [PMID: 17851846 DOI: 10.1080/02841860701316065] [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: 01/24/2023]
Abstract
Addition of thoracic radiation therapy (TRT) to chemotherapy (CHT) can increase overall survival in patients with small cell lung cancer limited-disease (SCLC-LD). Accelerated fractionation and early concurrent platinum-based CHT, in combination with prophylactic cranial irradiation, represent up-front treatment for this group of patients. Optimised and tailored local and systemic treatment is important. These concepts were applied when a new regional treatment programme was designed at Sahlgrenska University Hospital in 1997. The planned treatment consisted of six courses of CHT (carboplatin/etoposide) + TRT +/- prophylactic cranial irradiation (PCI). Standard TRT was prescribed at 1.5 Gy BID to a total of 60 Gy during 4 weeks, starting concomitantly with the second or third course of CHT. However, patients with large tumour burdens, poor general condition and/or poor lung function received 45 Gy, 1.5 Gy BID, during 3 weeks. PCI in 15 fractions to a total dose of 30 Gy was administered to all patients with complete remission (CR) and "good" partial remission (PR) at response evaluation. Eighty consecutive patients were treated between January 1998 and December 2004. Forty-six patients were given 60 Gy and 34 patients 45 Gy. Acute toxicity occurred as esophagitis grade III (RTOG/EORTC) in 16% and as pneumonitis grade I-II in 10%. There were no differences in toxicity between the two groups. Three- and five-year overall survival was 25% and 16%, respectively. Medica survival was 20.8 months with no significant difference between the two groups. In conclusion, TRT with a total dose of 60 to 45 Gy is feasible with comparable toxicity and no difference in local control or survival. Distant metastasis is the main cause of death in this disease; the future challenge is thus further improvement of the systemic therapy combines with optimised local TRT.
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Affiliation(s)
- Andreas Hallqvist
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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89
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Bayman N, Sheikh H, Kularatne B, Lorigan P, Blackhall F, Thatcher N, Faivre-Finn C. Radiotherapy for small-cell lung cancer—Where are we heading? Lung Cancer 2009; 63:307-14. [DOI: 10.1016/j.lungcan.2008.06.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 06/18/2008] [Accepted: 06/21/2008] [Indexed: 11/28/2022]
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SOLÉ MONNÉ JM, GARAU MM, CAMBRA SERÉS MJ, BLANCO GUERRERO R, MONTESIONS MUÑOZ J, GALLARDO DIAZ E, BESTÚS PIULACHS R, MESIA NIN R, MONFA BINEFAR C. Concurrent hyperfractionated radiotherapy and chemotherapy for patients with limited small-cell lung cancer. Results from a single institution. Rep Pract Oncol Radiother 2009. [DOI: 10.1016/s1507-1367(10)60021-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
A síndrome de Pancoast consiste de sinais e sintomas decorrentes do acometimento do ápice pulmonar e estruturas adjacentes por um tumor. Na maioria das vezes, o processo causal é uma neoplasia. O carcinoma broncogênico é a principal neoplasia causadora da síndrome. Os subtipos histológicos mais encontrados são o adenocarcinoma e o carcinoma epidermoide. A ocorrência de carcinoma de pequenas células de pulmão como gênese da síndrome de Pancoast é rara, com poucos relatos na literatura. Descrevemos o caso de um doente com síndrome de Pancoast causado por um carcinoma de pequenas células de pulmão, discutindo aspectos referentes ao diagnóstico e à terapêutica.
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92
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Vees H, Mach N, Hügli A, Balmer Majno S. Is there a place for low-dose chest and prophylactic brain irradiation in limited-disease small cell lung cancer. Med Oncol 2008; 26:298-302. [DOI: 10.1007/s12032-008-9119-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 10/21/2008] [Indexed: 11/24/2022]
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Sculier J, Lafitte J, Efremidis A, Florin M, Lecomte J, Berchier M, Richez M, Berghmans T, Scherpereel A, Meert A, Koumakis G, Leclercq N, Paesmans M, Van Houtte P. A phase III randomised study of concomitant induction radiochemotherapy testing two modalities of radiosensitisation by cisplatin (standard versus daily) for limited small-cell lung cancer. Ann Oncol 2008; 19:1691-7. [DOI: 10.1093/annonc/mdn354] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bogart JA. Rationale for phase III trials of thoracic radiation therapy doses in limited-stage small-cell lung cancer. Clin Lung Cancer 2008; 9:202-5. [PMID: 18650166 DOI: 10.3816/clc.2008.n.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The optimal integration of thoracic radiation therapy with systemic chemotherapy in the treatment of limited stage small-cell lung cancer remains to be defined. Although there are many unsettled issues, it has been more than 15 years since the most recent phase III Intergroup study completed accrual. In March 2008, a phase III Intergroup study assessing high-dose thoracic radiation therapy in limited-stage small-cell lung cancer was activated in the United States, and a randomized study in Europe is also investigating a thoracic radiation therapy dose escalation. The rationale for these trials is described herein.
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Affiliation(s)
- Jeffrey A Bogart
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
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95
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van Loon J, Offermann C, Bosmans G, Wanders R, Dekker A, Borger J, Oellers M, Dingemans AM, van Baardwijk A, Teule J, Snoep G, Hochstenbag M, Houben R, Lambin P, De Ruysscher D. 18FDG-PET based radiation planning of mediastinal lymph nodes in limited disease small cell lung cancer changes radiotherapy fields: A planning study. Radiother Oncol 2008; 87:49-54. [PMID: 18342967 DOI: 10.1016/j.radonc.2008.02.019] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 02/12/2008] [Accepted: 02/16/2008] [Indexed: 11/18/2022]
Affiliation(s)
- Judith van Loon
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, University Hospital Maastricht, Maastricht, The Netherlands.
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Bogart JA, Watson D, McClay EF, Evans L, Herndon JE, Laurie F, Seagren SL, Fitzgerald TJ, Vokes E, Green MR. Interruptions of once-daily thoracic radiotherapy do not correlate with outcomes in limited stage small cell lung cancer: analysis of CALGB phase III trial 9235. Lung Cancer 2008; 62:92-8. [PMID: 18367288 DOI: 10.1016/j.lungcan.2008.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 01/20/2008] [Accepted: 02/09/2008] [Indexed: 12/12/2022]
Abstract
PURPOSE Retrospective data suggests prolonging the time to complete thoracic radiotherapy (TRT) may negatively impact tumor control and survival in limited stage small cell lung cancer (LSCLC). We examined the association between TRT duration and outcomes on a prospective phase III study. MATERIAL AND METHODS This review included 267 patients who received protocol TRT on a phase III CALGB LSCLC study assessing the addition of tamoxifen to standard chemo-radiotherapy. TRT, to a planned dose of 50Gy in 2Gy daily fractions, was initiated with the fourth chemotherapy cycle. TRT interruptions were mandated for hematologic toxicity (granulocytes<1000/mm3 or platelets<75,000/mm3) and esophageal toxicity (dysphagia necessitating intravenous hydration). RESULTS TRT interruptions > or =3 days occurred in 115 patients (43%), most frequently during the 4th week of TRT, and did not differ between treatment arms. Hematologic toxicity and esophageal toxicity were the most frequent indications for interrupting TRT. Variables including advanced age (>70 years), gender, race, or radiotherapy treatment volume did not predict for TRT interruptions. Overall survival (OS) and local tumor control did not correlate with the administration of TRT interruptions or with TRT duration. CONCLUSION Toxicity mandated interruptions of conventional dose, once-daily, TRT may not adversely affect outcomes for patients receiving TRT concurrent with chemotherapy (cycle 4) for LSCLC. The implications for accelerated or high dose TRT regimens are not clear.
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Affiliation(s)
- Jeffrey A Bogart
- SUNY Upstate Medical University, Radiation Oncology Department, 750 E. Adams Street, Syracuse, NY 13210, United States.
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CARDEN CP, ROSENTHAL MA. Immediate versus delayed chemotherapy in patients with asymptomatic incurable metastatic cancer. Asia Pac J Clin Oncol 2007. [DOI: 10.1111/j.1743-7563.2007.00113.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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98
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Daveau C, Le Péchoux C, Besse B, Ferreira I, Amarouch A, Vicenzi L, Elloumi F, Roberti E, Bretel JJ. Place de la radiothérapie dans la prise en charge des carcinomes bronchiques à petites cellules localisés. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)78151-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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99
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Socinski MA, Bogart JA. Limited-stage small-cell lung cancer: the current status of combined-modality therapy. J Clin Oncol 2007; 25:4137-45. [PMID: 17827464 DOI: 10.1200/jco.2007.11.5303] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Limited-stage (LS) small-cell lung cancer (SCLC) remains a therapeutic challenge to medical and radiation oncologists. The treatment of LS-SCLC has evolved significantly over the last two decades with combined-modality therapy now the standard of care. The addition of thoracic radiotherapy (TRT) to standard chemotherapy has led to improvements in long-term survival in this population. However, many questions remain about the optimal way to deliver chemoradiotherapy. In a landmark trial, twice-daily TRT to a dose of 45 Gy increased 5-year survival by 10% compared with once-daily TRT administered to the same dose. This suggests that more intensive TRT regimens may lead to further survival gains, assuming they can be delivered safely in this setting. Strategies currently under investigation include higher total daily doses delivered once daily or novel concurrent boost techniques allowing more intensive treatments over shorter periods of time. Several trials and meta-analyses have evaluated the timing of TRT with chemotherapy, with the weight of evidence suggesting that early and concurrent TRT with chemotherapy is optimal. Novel cytotoxic chemotherapy combinations have failed thus far to provide an advantage over standard etoposide-cisplatin combinations. Prophylactic cranial irradiation in near or complete responders to induction chemoradiotherapy has also been shown to improve long-term survival rates. LS-SCLC has been a model cancer in terms of the potential benefit of combined chemoradiotherapy strategies in improving patient outcomes.
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Affiliation(s)
- Mark A Socinski
- Multidisciplinary Thoracic Oncology Program, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Abstract
PURPOSES This guideline is for the management of patients with small cell lung cancer (SCLC) and is based on currently available information. As part of the guideline, an evidence-based review of the literature was commissioned that enables the reader to assess the evidence as we have attempted to put the clinical implications into perspective. METHODS We conducted a comprehensive review of the available literature and the previous American College of Chest Physicians guidelines of SCLC. Controversial and less understood areas of the management of SCLC were then subject to an exhaustive review of the literature and detail analyses. Experts in evidence-based analyses compiled the accompanying systematic review titled "Evidence for Management of SCLC." The evidence was then assessed by a panel of experts to incorporate "clinical relevance." The resultant guidelines were then scored according to the grading system outlined by the American College of Chest Physicians grading system task force. RESULTS SCLC accounts for 13 to 20% of all lung cancers. Highly smoking related and initially responsive to treatment, it leads to death rapidly in 2 to 4 months without treatment. SCLC is staged as limited-stage and extensive-stage disease. Limited-stage disease is treated with curative intent with chemotherapy and radiation therapy, with approximately 20% of patients achieving a cure. For all patients with limited-stage disease, median survival is 16 to 22 months. Extensive-stage disease is primarily treated with chemotherapy with a high initial response rate of 60 to 70% but with a median survival of 10 months. All patients achieving a complete remission should be offered prophylactic cranial irradiation. Relapsed or refractory SCLC has a uniformly poor prognosis. CONCLUSION In this section, evidence-based guidelines for the staging and treatment of SCLC are outlined. Limited-stage SCLC is treated with curative intent. Extensive-stage SCLC has high initial responses to chemotherapy but with an ultimately dismal prognosis with few survivors beyond 2 years.
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Affiliation(s)
- George R Simon
- H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-4W, Tampa, FL 33612, USA.
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