251
|
Detection of Local Cancer Recurrence After Stereotactic Ablative Radiation Therapy for Lung Cancer: Physician Performance Versus Radiomic Assessment. Int J Radiat Oncol Biol Phys 2016; 94:1121-8. [DOI: 10.1016/j.ijrobp.2015.12.369] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/11/2015] [Accepted: 12/21/2015] [Indexed: 12/25/2022]
|
252
|
Louie AV, Damhuis RA, Haasbeek CJ, Warner A, Rodin D, Slotman BJ, Leemans C, Senan S. Treatment and survival of second primary early-stage lung cancer, following treatment of head and neck cancer in the Netherlands. Lung Cancer 2016; 94:54-60. [DOI: 10.1016/j.lungcan.2016.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/26/2016] [Accepted: 01/30/2016] [Indexed: 01/10/2023]
|
253
|
Patterns of Recurrence and Survival after Surgery or Stereotactic Radiotherapy for Early Stage NSCLC. J Thorac Oncol 2016; 10:826-831. [PMID: 25629639 DOI: 10.1097/jto.0000000000000483] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Surgery is the standard treatment for early stage non-small-cell lung cancer (NSCLC). For medically inoperable patients, stereotactic ablative radiotherapy (SABR) has emerged as widely used standard treatment. The aim of this study was to analyze survival and patterns of tumor recurrence in patients with clinical stage I NSCLC treated with surgery or SABR. METHODS Clinical data from all subsequent fluoro-deoxyglucose positron emission tomography/computed tomography-based stage I NSCLC patients (cT1-T2aN0M0) treated with surgery or SABR at our center between 2007 and 2010 were collected. Primary endpoints were overall survival and tumor recurrences/new primary lung tumors. Treatment groups were compared using multivariable Cox regression and competing risk analyses. RESULTS Three hundred-forty patients treated with surgery (n = 143) or SABR (n = 197) were included. Surgical patients were younger, had a better WHO performance status and less comorbidities. After adjustment for prognostic covariables, treatment did not influence overall survival (adjusted hazard ratio [HR], SABR versus surgery 1.07; 95% confidence interval [CI]: 0.74-1.54; p = 0.73). Local control and distant recurrence were equal, whereas locoregional recurrences were significantly more frequent after SABR compared with surgery (adjusted sub-HR 2.51; 95% CI: 1.10-5.70; p = 0.028). Nodal failure (HR: 2.16; 95% CI: 1.34-3.48) and distant metastases (HR: 2.12; 95% CI: 1.52-2.97), but not local failure (HR: 1.00; 95% CI: 0.53-1.89) predicted overall survival. CONCLUSIONS In patients with fluoro-deoxyglucose positron emission tomography/computed tomography-based stage I NSCLC, SABR confers worse locoregional tumor control because of more nodal failures compared with surgery, stressing the need to improve mediastinal and hilar staging.
Collapse
|
254
|
Tekatli H, Haasbeek N, Dahele M, De Haan P, Verbakel W, Bongers E, Hashemi S, Nossent E, Spoelstra F, de Langen AJ, Slotman B, Senan S. Outcomes of Hypofractionated High-Dose Radiotherapy in Poor-Risk Patients with "Ultracentral" Non-Small Cell Lung Cancer. J Thorac Oncol 2016; 11:1081-9. [PMID: 27013408 DOI: 10.1016/j.jtho.2016.03.008] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/11/2016] [Accepted: 03/12/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We defined "ultracentral" lung tumors as centrally located non-small cell lung cancers with planning target volumes overlapping the trachea or main bronchi. Increased toxicity has been reported after both conventional and stereotactic radiotherapy for such lesions. We studied outcomes after 12 fractions of 5 Gy (BED10 = 90 Gy, heterogeneous dose distribution) to ultracentral tumors in patients unfit for surgery or conventional chemoradiotherapy. METHODS Clinical outcomes and dosimetric details were analyzed in 47 consecutive patients with single primary or recurrent ultracentral non-small cell lung cancer treated between 2010 and 2015. Those irradiated previously or with metastasis to sites other than the brain and adrenal glands were excluded. Treatments were delivered using volumetric modulated arc therapy. RESULTS The median age was 77.5 years, 49% of patients had a World Health Organization performance score of 2 or higher, and the median planning target volume was 104.5cm(3) (range 17.7-508.5). At a median follow-up of 29.3 months, median overall survival was 15.9 months, and 3-year survival was 20.1%. No isolated local recurrences were observed. Grade 3 or higher toxicity was recorded in 38% of patients, with 21% scored as having a "possible" (n = 2) or "likely" (n = 8) treatment-related death between 5.2 and 18.2 months after treatment. Fatal pulmonary hemorrhage was observed in 15% of patients. CONCLUSIONS Unfit patients with ultracentral tumors who were treated using this scheme had a high local control and a median survival of 15.9 months. Despite manifestation of rates of a fatal lung bleeding comparable to those seen with conventional radiotherapy for endobronchial tumors, the overall rate of G5 toxicity is of potential concern. Additional work is needed to identify tumor and treatment factors related to hemorrhage.
Collapse
Affiliation(s)
- Hilâl Tekatli
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Niels Haasbeek
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Patricia De Haan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Wilko Verbakel
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Eva Bongers
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Sayed Hashemi
- Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Esther Nossent
- Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Femke Spoelstra
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Adrianus J de Langen
- Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Ben Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| |
Collapse
|
255
|
Moon Y, Kim KS, Lee KY, Sung SW, Kim YK, Park JK. Clinicopathologic Factors Associated With Occult Lymph Node Metastasis in Patients With Clinically Diagnosed N0 Lung Adenocarcinoma. Ann Thorac Surg 2016; 101:1928-35. [PMID: 26952299 DOI: 10.1016/j.athoracsur.2015.11.056] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/15/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND In some patients, clinical N0 (cN0) lung adenocarcinoma diagnosed by preoperative computed tomography scanning and positron emission tomography scanning was staged as pathologic N1 (pN1) or N2 (pN2) postoperatively. The aim of this study was to determine the preoperative and postoperative clinicopathologic factors related to nodal upstaging after a surgical operation. METHODS We conducted a retrospective chart review of 350 patients treated for cN0 lung adenocarcinoma by curative resection. We analyzed clinicopathologic findings, comparing pN0 patients with the nodal upstaging group. RESULTS Of 350 patients treated for cN0 tumors, 305 (87.1%) were confirmed postoperatively as having pN0 tumors, and 45 (12.9%) were confirmed as having pN1 or pN2 tumors. The mean maximum standardized uptake value (SUVmax) was higher in the nodal upstaging group than in the pN0 group (6.9 versus 3.8, p = 0.004); the upstaging group also included more cases in which SUVmax was greater than 5 (70.5% versus 24.8%, p < 0.001). Pleural invasion, lymphatic invasion, and vascular invasion were all more frequently seen in the nodal upstaging group than in the pN0 group (all p < 0.001). The presence of tumors with a micropapillary component was higher in the nodal upstaging group (p < 0.001). Multivariate logistic regression analysis identified SUVmax greater than 5, lymphatic invasion, vascular invasion, and a micropapillary component as significant risk factors for nodal upstaging. CONCLUSIONS In lung adenocarcinoma diagnosed as clinical N0 by chest computed tomography and positron emission tomography scanning, the possibility of occult lymph node metastasis increases with SUVmax greater than 5 and when lymphatic invasion, vascular invasion, and a micropapillary component are present.
Collapse
Affiliation(s)
- Youngkyu Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Kyo Young Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Sook Whan Sung
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Young Kyoon Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
256
|
Crombag LMMJ, Annema JT. Left Adrenal Gland Analysis in Lung Cancer Patients Using the Endobronchial Ultrasound Scope: A Feasibility Trial. Respiration 2016; 91:235-40. [PMID: 26930053 DOI: 10.1159/000443991] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/08/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In lung cancer patients, the adrenal glands are predilection sites for distant metastases. Esophageal endoscopic ultrasound - fine-needle aspiration (EUS-FNA) is a minimally invasive and accurate method for left adrenal gland (LAG) analysis but requires a conventional gastrointestinal echoendoscope. Complete endobronchial and esophageal mediastinal nodal staging can be achieved by just a single endobronchial ultrasound (EBUS) scope, introducing it into the esophagus (EUS-B) following the endobronchial procedure. Whether the LAG can also be assessed with the EBUS scope is unknown. OBJECTIVES The aim of the study was to investigate the feasibility of identifying the LAG with the EBUS scope. METHODS We conducted a retrospective analysis of lung cancer patients who underwent EBUS and EUS-B for mediastinal staging and LAG assessment between January 2013 and May 2015. RESULTS A total of 143 patients with (suspected) lung cancer were investigated by the combination of EBUS and EUS-B. In 68 of the 80 patients (85%) in whom an attempt was made to identify the LAG, it was feasible to transgastrically detect the LAG with the EBUS scope. In 9 patients with endosonographic signs of malignant involvement, diagnostic transgastric FNAs were obtained in all. In the 12 patients (15%) in whom the LAG was not detected, the contact between the ultrasound transducer and the gastric wall was suboptimal - the length of the scope was not a limiting factor. CONCLUSIONS The EBUS scope allows identification of the LAG in the vast majority of lung cancer patients. IMPLICATION In patients with (suspected) lung cancer, in addition to complete hilar and mediastinal staging, LAG assessment using just a single EBUS scope also seems feasible. Prospective studies are indicated.
Collapse
Affiliation(s)
- Laurence M M J Crombag
- Department of Pulmonology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
257
|
Long-term follow-up of patients with locally advanced non-small cell lung cancer receiving concurrent hypofractionated chemoradiotherapy with or without cetuximab. Radiother Oncol 2016; 118:442-6. [PMID: 26900091 DOI: 10.1016/j.radonc.2016.02.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Radiation dose escalation using hypofractionation might improve overall survival (OS). We investigated OS in a phase II multicenter study in locally advanced non-small cell lung cancer (LA-NSCLC) patients treated with hypofractionated concurrent chemoradiotherapy. MATERIALS AND METHODS A 2-armed phase II, multi-center study (NTR2230) was performed with the aim to assess the effect of cetuximab to concurrent chemoradiotherapy in LA-NSCLC patients (stage II/IIIA/B). Arm A received high dose radiotherapy (24 × 2.75 Gy) and concurrent daily low-dose cisplatin (6 mg/m(2)). Arm B received an identical treatment regimen with additional weekly cetuximab. Kaplan-Meier survival curves and 1-, 2- and 5-year OS proportions were calculated. RESULTS Between February 2009 and May 2011, 102 patients were randomly allocated in two arms. Median OS was 31.5 months (range 12.8-52.3), not significantly different between arms A and B; 33.0 (range 17.0-57.0) and 30.0 (11.0-52.0) months. 1-, 2- and 5-year OS rates were 74.5%, 59.4% and 37.3%, respectively. In multivariate analyses, worse performance score, V35 of the esophagus and the existence of comorbidities were significantly (P-value<0.05) associated with a shorter OS. DISCUSSION In this phase II trial, the median OS for the entire group was remarkably high; 31.5 months. Furthermore, 5-year OS was still 37.3%. Hypofractionation might contribute to improved OS in LA-NSCLC patients.
Collapse
|
258
|
Malottki K, Popat S, Deeks JJ, Riley RD, Nicholson AG, Billingham L. Problems of variable biomarker evaluation in stratified medicine research--A case study of ERCC1 in non-small-cell lung cancer. Lung Cancer 2016; 92:1-7. [PMID: 26775588 PMCID: PMC4729317 DOI: 10.1016/j.lungcan.2015.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/18/2015] [Accepted: 11/23/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Consistency of procedures for the evaluation of a predictive biomarker (including sample collection, processing, assay and scoring system) based on adequate evidence is necessary to implement research findings in clinical practice. As a case study we evaluated how a particular predictive biomarker, ERCC1, was assessed in research on platinum-based chemotherapy in non-small-cell lung cancer and what motivated the choice of procedure. MATERIALS AND METHODS A systematic review of studies completed since 2007 and ongoing was undertaken. Questionnaires on details of ERCC1 evaluation procedures and the rationale for their choice were sent to contacts of identified studies. RESULTS Thirty-three studies of platinum-based chemotherapy in non-small-cell lung cancer using ERCC1 were identified. A reply to the questionnaire was received for 16 studies. Procedures for ERCC1 evaluation varied substantially and included reverse transcriptase quantitative polymerase chain reaction (nine studies), immunohistochemistry (five studies) and other methods (multiple methods-two studies, NER polymorphism-one study). In five studies ERCC1 use was planned, but not undertaken. In nine data was insufficient to identify the procedure. For each assay there was variation across studies in the details of the laboratory techniques, scoring systems and methods for obtaining samples. CONCLUSIONS We found large variation across studies in ERCC1 evaluation procedures. This will limit the future comparability of results between these different studies. To enable evidence-based clinical practice, consensus is needed on a validated procedure to assess a predictive biomarker in the early phase of research. We believe that ERCC1 is not untypical of biomarkers being investigated for stratified medicine.
Collapse
Affiliation(s)
- Kinga Malottki
- Cancer Research UK Clinical Trials Unit (CRCTU), MRC Midland Hub for Trials Methodology Research, Institute of Cancer and Genomic Sciences, University of Birmingham, United Kingdom.
| | - Sanjay Popat
- Department of Medicine, Royal Marsden Hospital, London SW3 6JJ, United Kingdom
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - Richard D Riley
- Research Institute for Primary Care and Health Sciences, Keele University, United Kingdom
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National heart and Lung Institute, Imperial College, London, United Kingdom
| | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit (CRCTU), MRC Midland Hub for Trials Methodology Research, Institute of Cancer and Genomic Sciences, University of Birmingham, United Kingdom
| |
Collapse
|
259
|
Burger IA, Casanova R, Steiger S, Husmann L, Stolzmann P, Huellner MW, Curioni A, Hillinger S, Schmidtlein CR, Soltermann A. 18F-FDG PET/CT of Non-Small Cell Lung Carcinoma Under Neoadjuvant Chemotherapy: Background-Based Adaptive-Volume Metrics Outperform TLG and MTV in Predicting Histopathologic Response. J Nucl Med 2016; 57:849-54. [PMID: 26823566 DOI: 10.2967/jnumed.115.167684] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/22/2015] [Indexed: 01/08/2023] Open
Abstract
UNLABELLED Assessment of tumor response after chemotherapy using (18)F-FDG PET metrics is gaining acceptance. Several studies have suggested that the parameters metabolically active tumor volume (MTV) and total lesion glycolysis (TLG) are superior to SUVmax for measuring tumor burden. However, the measurement of MTV and TLG is still controversial; the most common method uses an absolute threshold of 42% of SUVmax Recently, we implemented a background-adaptive method to determine the background-subtracted lesion activity (BSL) and the background-subtracted volume (BSV). In this study, we investigated the correlation between such PET metrics and histopathologic response in non-small cell lung carcinoma (NSCLC). METHODS Forty-four NSCLC patients were retrospectively identified. Their PET/CT data on both types of scan before and after neoadjuvant chemotherapy were analyzed regarding SUVmax, MTV, TLG, BSL, and BSV, as well as the relative changes in these parameters. The tumor regression score as an indicator of histopathologic response was scored on hematoxylin- and eosin-stained sections of the surgical specimens using a 4-tiered scale (scores 1-4). The correlation between score and the absolute and relative PET metrics after chemotherapy was analyzed using Spearman rank correlation tests. RESULTS Tumors that demonstrated a good response after neoadjuvant chemotherapy had significantly lower (18)F-FDG activity than nonresponding tumors (scores 3 and 4: SUVmax, 4.2 [range, 1.8-7.9] vs. scores 1 and 2: SUVmax, 8.1 [range, 1.4-40.4]; P = 0.001). The same was found for change in SUVmax and score (P = 0.001). PET volume metrics based on a 42% fixed threshold for SUVmax did not correlate with score (TLG, P = 0.505; MTV, P = 0.386). However, both of the background activity-based PET volume metrics-BSL and BSV-significantly correlated with score (P < 0.001 each). CONCLUSION PET volume metrics based on background-adaptive methods correlate better with histopathologic tumor regression score in NSCLC patients under neoadjuvant chemotherapy than algorithms and methods using a fixed threshold (42% SUVmax).
Collapse
Affiliation(s)
- Irene A Burger
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland Department of Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Ruben Casanova
- Department of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Seraina Steiger
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Lars Husmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Paul Stolzmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Martin W Huellner
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Alessandra Curioni
- Department of Medical Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland; and
| | - C Ross Schmidtlein
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alex Soltermann
- Department of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
260
|
Senan S, Brade A, Wang LH, Vansteenkiste J, Dakhil S, Biesma B, Martinez Aguillo M, Aerts J, Govindan R, Rubio-Viqueira B, Lewanski C, Gandara D, Choy H, Mok T, Hossain A, Iscoe N, Treat J, Koustenis A, San Antonio B, Chouaki N, Vokes E. PROCLAIM: Randomized Phase III Trial of Pemetrexed-Cisplatin or Etoposide-Cisplatin Plus Thoracic Radiation Therapy Followed by Consolidation Chemotherapy in Locally Advanced Nonsquamous Non-Small-Cell Lung Cancer. J Clin Oncol 2016; 34:953-62. [PMID: 26811519 DOI: 10.1200/jco.2015.64.8824] [Citation(s) in RCA: 297] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The phase III PROCLAIM study evaluated overall survival (OS) of concurrent pemetrexed-cisplatin and thoracic radiation therapy (TRT) followed by consolidation pemetrexed, versus etoposide-cisplatin and TRT followed by nonpemetrexed doublet consolidation therapy. PATIENTS AND METHODS Patients with stage IIIA/B unresectable nonsquamous non-small-cell lung cancer randomly received (1:1) pemetrexed 500 mg/m(2) and cisplatin 75 mg/m(2) intravenously every 3 weeks for three cycles plus concurrent TRT (60 to 66 Gy) followed by pemetrexed consolidation every 3 weeks for four cycles (arm A), or standard therapy with etoposide 50 mg/m(2) and cisplatin 50 mg/m(2) intravenously, every 4 weeks for two cycles plus concurrent TRT (60 to 66 Gy) followed by two cycles of consolidation platinum-based doublet chemotherapy (arm B). The primary objective was OS. The study was designed as a superiority trial with 80% power to detect an OS hazard ratio of 0.74 with a type 1 error of .05. RESULTS Enrollment was stopped early because of futility. Five hundred ninety-eight patients were randomly assigned (301 to arm A, 297 to arm B) and 555 patients (283 in arm A, 272 in arm B) were treated. Arm A was not superior to arm B in terms of OS (hazard ratio, 0.98; 95% CI, 0.79 to 1.20; median, 26.8 v 25.0 months; P = .831). Arm A had a significantly lower incidence of any drug-related grade 3 to 4 adverse events (64.0% v 76.8%; P = .001), including neutropenia (24.4% v 44.5%; P < .001), during the overall treatment period. CONCLUSION Pemetrexed-cisplatin combined with TRT followed by consolidation pemetrexed was not superior to standard chemoradiotherapy for stage III unresectable nonsquamous non-small-cell lung cancer.
Collapse
Affiliation(s)
- Suresh Senan
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France.
| | - Anthony Brade
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Lu-Hua Wang
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Johan Vansteenkiste
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Shaker Dakhil
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Bonne Biesma
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Maite Martinez Aguillo
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Joachim Aerts
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Ramaswamy Govindan
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Belén Rubio-Viqueira
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Conrad Lewanski
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - David Gandara
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Hak Choy
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Tony Mok
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Anwar Hossain
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Neill Iscoe
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Joseph Treat
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Andrew Koustenis
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Bélen San Antonio
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Nadia Chouaki
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Everett Vokes
- Suresh Senan, VU Medical Center, Amsterdam; Bonne Biesma, Jeroen Bosch Hospital, 's-Hertogenbosch; and Joachim Aerts, Erasmus MC Rotterdam/Amphia Hospital Breda, Breda, the Netherlands; Anthony Brade, Princess Margaret Hospital, University of Toronto; Neill Iscoe, Eli Lilly Canada, Toronto, Ontario, Canada; Lu-hua Wang, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Tony Mok, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China; Johan Vansteenkiste, University Hospital KU Leuven, Leuven, Belgium; Shaker Dakhil, Cancer Center of Kansas, Wichita, KS; Ramaswamy Govindan, Washington University School of Medicine, Saint Louis, MO; David Gandara, University of California, Davis Health System, Sacramento, CA; Hak Choy, UT Southwestern Medical Center, Dallas, TX; Anwar Hossain, Joseph Treat, and Andrew Koustenis, Eli Lilly and Company, Indianapolis, IN; Everett Vokes, University of Chicago, Chicago, IL; Maite Martinez Aguillo, Hospital of Navarre, Irunlarrea, Pamplona; Belén Rubio-Viqueira, Hospital Universitario Quirón Madrid; and Bélen San Antonio, Eli Lilly and Company, Madrid, Spain; Conrad Lewanski, Charing Cross Hospital, London, United Kingdom; and Nadia Chouaki, Eli Lilly and Company, Neuilly-sur-Seine, France
| |
Collapse
|
261
|
Watanabe K, Tsuboi M, Sakamaki K, Nishii T, Yamamoto T, Nagashima T, Ando K, Ishikawa Y, Woo T, Adachi H, Kumakiri Y, Maehara T, Nakayama H, Masuda M. Postoperative follow-up strategy based on recurrence dynamics for non-small-cell lung cancer. Eur J Cardiothorac Surg 2016; 49:1624-31. [PMID: 26792922 DOI: 10.1093/ejcts/ezv462] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 11/19/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Our study was designed to visually represent recurrence patterns after surgery for non-small-cell lung cancer (NSCLC) with the use of event dynamics and to clarify postoperative follow-up methods based on the times of recurrence. METHODS A total of 829 patients with NSCLC who underwent complete pulmonary resection from 2005 to 2007 in 9 hospitals affiliated with the Yokohama Consortium of Thoracic Surgeons were studied. Event dynamics, based on the hazard rate, were evaluated. Only first events involving the development of distant metastases, local recurrence or both were considered. The effects of sex, histological type, pathological stage and age were studied. RESULTS The hazard rate curve displayed an initial surge that peaked about 6-8 months after surgery. The next distinct peak was noted at the end of the second year of follow-up. On non-parametric kernel smoothing, the maximum peak was found 6-8 months after surgery in men. In women, the highest peak occurred 22-24 months after surgery, which was about 16 months later than the peak in men. The peak timing of the hazard curve was not affected by histological type, pathological stage or age in either sex. CONCLUSIONS Our results suggest that the timing of recurrence after surgery for lung cancer is characterized by a bimodal pattern, and the times with the highest risk of recurrence were suggested to differ between men and women. Postoperative follow-up strategies should be based on currently recommended follow-up programmes, take into account the recurrence patterns of lung cancer, and be modified as required to meet the needs of individual patients.
Collapse
Affiliation(s)
- Katsuya Watanabe
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Masahiro Tsuboi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kentaro Sakamaki
- Department of Biostatistics and Epidemiology, Yokohama City University, Yokohama, Japan
| | - Teppei Nishii
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | | | - Takuya Nagashima
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Kohei Ando
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | | | - Tekkan Woo
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Adachi
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Yutaka Kumakiri
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | | | | | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| |
Collapse
|
262
|
Kristiansen C, Schytte T, Hansen KH, Holtved E, Hansen O. Trends in lung cancer in elderly in Denmark, 1980-2012. Acta Oncol 2016; 55 Suppl 1:46-51. [PMID: 26769559 DOI: 10.3109/0284186x.2015.1114676] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Lung cancer is an increasing problem in the older patient population due to the improvement in life expectation of the Western population. In this study we examine trends in lung cancer incidence and mortality in Denmark from 1980 to 2012 with special focus on the elderly. MATERIAL AND METHODS Lung cancer was defined as ICD-10 codes C33-34. Data derived from the NORDCAN database with comparable data on cancer incidence, mortality, prevalence, and relative survival in the Nordic countries, where the Danish data were delivered from the Danish Cancer Registry and the Danish Cause of Death Registry with follow-up for death or emigration until the end of 2013. RESULTS In 2012, about 50% of lung cancers were diagnosed among persons aged 70 years or more. For men and women older than 75 years the incidence rates have been increasing and for those aged 80-84 years, the rates have doubled since 1980. Due to the poor survival, similar trends were seen in mortality rates. Over the period, the one-year relative survival rates almost doubled in patients aged 70 years or more, but still only 25% of the patients aged 80-89 years survived their lung cancer for one year. CONCLUSION The incidence of lung cancer is closely linked to the pattern of tobacco smoking with the differences between gender and age groups reflecting smoking behavior in birth cohorts. Elderly patients with lung cancer are a heterogeneous group in whom treatment should be offered according to comorbidity and a geriatric assessment.
Collapse
Affiliation(s)
| | - Tine Schytte
- a Department of Oncology , Odense University Hospital , Odense , Denmark
| | | | - Eva Holtved
- a Department of Oncology , Odense University Hospital , Odense , Denmark
| | - Olfred Hansen
- a Department of Oncology , Odense University Hospital , Odense , Denmark
- b Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| |
Collapse
|
263
|
Robinson AG, Young K, Balchin K, Owen T, Ashworth A. Reasons for palliative treatments in stage III non-small-cell lung cancer: what contribution is made by time-dependent changes in tumour or patient status? ACTA ACUST UNITED AC 2015; 22:399-404. [PMID: 26715872 DOI: 10.3747/co.22.2689] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Stage iii lung cancer is the most advanced stage of lung cancer for which the potential of curative treatment is often discussed. However, a large proportion of patients are treated with palliative intent. An understanding of the time-dependent and -independent factors contributing to the choice of palliative-intent treatment is needed to help optimize patient outcomes. METHODS This retrospective cohort study of patients with stage iii non-small-cell lung cancer (nsclc) newly diagnosed between 1 January 2008 and 31 December 2012 at the Cancer Centre of Southeastern Ontario collected data including patient demographics, clinical characteristics, tumour characteristics, treatment, and outcomes. RESULTS Of 237 patients with stage iii nsclc included in the study, 130 were not treated with radical or curative intent (55%). Major time-independent variables cited for palliative-intent treatment included extreme age (5%), comorbidity (27%), patient choice (5%), and poor lung function (5%). Time-dependent variables included tumour progression on imaging (15%), weight loss (33%), performance status (32%), and the occurrence of a major complication such as hemoptysis, lung collapse, or pulmonary embolism (7%). A significant number of patients (20%) experienced a decline in performance status-to 2, 3, or 4 from 0 or 1-over the course of the diagnostic journey, and 12% experienced a transition from no weight loss to more than 10% weight loss. CONCLUSIONS A significant proportion of patients receive palliative therapy for stage iii nsclc because of changes that occur during the diagnostic journey. Shortening or altering that pathway to avoid tumour growth or patient deterioration during care could allow for more patients to be treated with curative intent.
Collapse
Affiliation(s)
- A G Robinson
- Department of Oncology, Queen's University, Kingston, ON; ; Cancer Centre of Southeastern Ontario-Kingston General Hospital, Kingston, ON
| | - K Young
- Department of Oncology, Queen's University, Kingston, ON
| | - K Balchin
- Cancer Centre of Southeastern Ontario-Kingston General Hospital, Kingston, ON
| | - T Owen
- Department of Oncology, Queen's University, Kingston, ON; ; Cancer Centre of Southeastern Ontario-Kingston General Hospital, Kingston, ON
| | - A Ashworth
- Department of Oncology, Queen's University, Kingston, ON; ; Cancer Centre of Southeastern Ontario-Kingston General Hospital, Kingston, ON
| |
Collapse
|
264
|
Brade A, MacRae R, Laurie SA, Bezjak A, Burkes R, Chu Q, Goffin JR, Cho J, Hope A, Sun A, Leighl N, Capobianco S, Feld R, Mahalingam E, Hossain A, Iscoe N, Shepherd FA. Phase II Study of Concurrent Pemetrexed, Cisplatin, and Radiation Therapy for Stage IIIA/B Unresectable Non-Small Cell Lung Cancer. Clin Lung Cancer 2015; 17:133-41. [PMID: 26872764 DOI: 10.1016/j.cllc.2015.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Concurrent thoracic radiation and platinum-based chemotherapy is the standard of care for treatment of unresectable stage IIIA-IIIB non-small-cell lung cancer (NSCLC), but the optimal drug regimen has not been established. PATIENTS AND METHODS In the present single-arm phase II trial, patients with previously untreated, unresectable stage IIIA-IIIB NSCLC (all histologic types) were treated with pemetrexed-cisplatin (500 mg/m(2) intravenously on days 1 and 22, 20 mg/m(2) intravenously on days 1-5 and days 22-26) concurrent with radiotherapy (61-66 Gy in 31-35 fractions), followed by 2 cycles of consolidation pemetrexed-cisplatin (75 mg(2)) therapy. The primary endpoint was the 1-year overall survival (OS) rate. The study treatment was considered active if the 1-year OS rate was ≥ 70%. RESULTS A total of 39 patients, including 6 from the previous phase I trial who had been treated at the recommended phase II dose, were eligible for analysis. The most common drug-related grade 3 to 4 adverse events during the concurrent phase were hematologic and 5.1% of patients experienced grade 3 esophagitis. The response rate was 45.9% (17 of 37 patients), with no complete responses. The 1-, 2-, and 3-year OS survival rates were 79.5%, 56.4%, and 46.2%, respectively. The median OS, time to progressive disease, and progression-free survival was 30.3, 13.7, and 11.8 months, respectively. CONCLUSION Full-dose cisplatin and pemetrexed can be administered concurrently with conventional doses of thoracic radiation. The median and 1-year OS rates were favorable compared with published clinical trials in this setting. The regimen was tolerable, and the toxicity profile was consistent with the known toxicity profiles of pemetrexed, cisplatin, and radiation.
Collapse
Affiliation(s)
- Anthony Brade
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
| | - Robert MacRae
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Scott A Laurie
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Andrea Bezjak
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Ronald Burkes
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Quincy Chu
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - John R Goffin
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - John Cho
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Andrew Hope
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Alex Sun
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Natasha Leighl
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Ronald Feld
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Essai Mahalingam
- Eli Lilly Canada Inc, Medicines Development Unit, Toronto, ON, Canada
| | | | - Neill Iscoe
- Eli Lilly Canada Inc., Scarborough, ON, Canada
| | - Frances A Shepherd
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
265
|
Wang Z, Jiang C. Endoscopic ultrasound in the diagnosis of mediastinal diseases. Open Med (Wars) 2015; 10:560-565. [PMID: 28352755 PMCID: PMC5368883 DOI: 10.1515/med-2015-0095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 11/10/2015] [Indexed: 12/25/2022] Open
Abstract
EUS is a useful tool for diagnosis of mediastinal diseases. EUS-FNA plays an important role in staging of lung cancer and in tissue acquisition in patients with mediastinal masses. In this review, the following issues will be addressed: EUS-FNA and EBUS-TBNA, metastatic mediastinal lymph nodes diagnosed by EUS, EUS in assessment of mediastinal lymph node status for staging of lung cancer, mediastinal lymphoma diagnosed by EUS, sarcoidosis and tuberculosis diagnosed by EUS.
Collapse
Affiliation(s)
- Zhiguo Wang
- The Second Hospital of Dalian Medical University, China
| | - Chunmeng Jiang
- The Second Hospital of Dalian Medical University, NO.467, Zhongshan Road, 116027 Dalian, Liaoning, China
| |
Collapse
|
266
|
Spano JP, Poizot-Martin I, Costagliola D, Boué F, Rosmorduc O, Lavolé A, Choquet S, Heudel PE, Leblond V, Gabarre J, Valantin MA, Solas C, Guihot A, Carcelain G, Autran B, Katlama C, Quéro L. Non-AIDS-related malignancies: expert consensus review and practical applications from the multidisciplinary CANCERVIH Working Group. Ann Oncol 2015; 27:397-408. [PMID: 26681686 DOI: 10.1093/annonc/mdv606] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 12/01/2015] [Indexed: 01/01/2023] Open
Abstract
Malignancies represent a major cause of morbidity and mortality in human immunodeficiency virus (HIV)-infected patients. The introduction of combined antiretroviral therapy has modified the spectrum of malignancies in HIV infection with a decreased incidence of acquired immunodeficiency syndrome (AIDS) malignancies such as Kaposi's sarcoma and non-Hodgkin's lymphoma due to partial immune recovery and an increase in non-AIDS-defining malignancies due to prolonged survival. Management of HIV-infected patients with cancer requires a multidisciplinary approach, involving both oncologists and HIV physicians to optimally manage both diseases and drug interactions between anticancer and anti-HIV drugs. The French CANCERVIH group presents here a review and an experience of managing non-AIDS malignancies in HIV-infected individuals.
Collapse
Affiliation(s)
- J-P Spano
- Department of Medical Oncology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, AP-HP, Paris INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - I Poizot-Martin
- Clinical Immunohaematology Service, Université Aix-Marseille, AP-HM Sainte-Marguerite, Marseille INSERM, U912 (SESSTIM), Marseille
| | - D Costagliola
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - F Boué
- Department of Internal Medicine and Immunology, Hôpital Antoine Béclère, Clamart Faculty of Medicine, Université Paris-Sud, Le Kremlin-Bicêtre
| | - O Rosmorduc
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Hepatology Service, Hôpital Saint-Antoine, Paris
| | - A Lavolé
- Pneumology Service, Hôpital Tenon, Paris
| | - S Choquet
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris Department of Hematology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - P-E Heudel
- Medical Oncology Service, Centre Léon Bérard, Lyon
| | - V Leblond
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Department of Hematology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris Centre for Research in Immunology and Infectious Diseases, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - J Gabarre
- Department of Hematology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - M-A Valantin
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris Department of Infectious Diseases, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - C Solas
- Laboratory of Pharmacokinetics and Toxicology, Hôpital de La Timone, Marseille
| | - A Guihot
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Department of Immunology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - G Carcelain
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Centre for Research in Immunology and Infectious Diseases, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - B Autran
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Centre for Research in Immunology and Infectious Diseases, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - C Katlama
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris Department of Infectious Diseases, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - L Quéro
- Department of Oncology and Radiotherapy, Hôpital Saint Louis, Paris INSERM UMR_S 965, Université Paris Denis Diderot, Paris, France
| |
Collapse
|
267
|
Hopmans W, Damman OC, Senan S, Hartemink KJ, Smit EF, Timmermans DRM. A patient perspective on shared decision making in stage I non-small cell lung cancer: a mixed methods study. BMC Cancer 2015; 15:959. [PMID: 26673216 PMCID: PMC4682255 DOI: 10.1186/s12885-015-1974-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/05/2015] [Indexed: 12/25/2022] Open
Abstract
Background Surgery and stereotactic ablative radiotherapy (SABR) are both curative treatment options for patients with a stage I non-small cell lung cancer (NSCLC). Consequently, there is growing interest in studying the role of patients in treatment decision making. We studied how patients with stage I NSCLC perceived shared decision making (SDM) in general, and how they viewed different aspects of SDM. Methods A sequential mixed methods design was used, consisting of qualitative interviews (N = 11), as well as a survey study (N = 76) focusing on different SDM-related aspects. Participants were interviewed to understand their own experience with treatment decision making. In the survey study, patients rated the importance of 20 aspects of shared decision making that were identified during interviews. Descriptive analysis and explorative factor analysis were performed. Results We assessed six qualitative themes covering SDM aspects that were determined by patients to be important. The survey identified four SDM-related factors with sufficient internal consistency, namely (1) ‘guidance by clinician’ (α = .741), (2) ‘conduct of clinician’ (α = .774); (3) ‘preparation for treatment decision making’ (α = .864); and (4) ‘active role of patient in treatment decision making’ (α = .782). Of these, clinician guidance was rated as most important by patients (M = 3.61; SD = .44). Only 28.9 % of patients in the survey study reported that both treatment options were discussed with them. Conclusions Patients with a stage I NSCLC found clinician guidance to be important when making treatment decisions. Nevertheless, the majority of patients reported not being offered both treatment options, which might have influenced this finding.
Collapse
Affiliation(s)
- Wendy Hopmans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Olga C Damman
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Koen J Hartemink
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Egbert F Smit
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands. .,Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| |
Collapse
|
268
|
Wu T, Wang MC, Jing L, Liu ZY, Guo H, Liu Y, Bai YY, Cheng YZ, Nan KJ, Liang X. Autophagy facilitates lung adenocarcinoma resistance to cisplatin treatment by activation of AMPK/mTOR signaling pathway. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:6421-31. [PMID: 26715839 PMCID: PMC4686226 DOI: 10.2147/dddt.s95606] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Resistance to cisplatin-based therapy is a major challenge in the control of lung cancer progression. However, the underlying mechanisms remain largely unclear. Autophagy is closely associated with resistance to lung cancer therapy, but the function of autophagy in cisplatin treatment is still controversial. Here, we investigated whether autophagy was involved in lung adenocarcinoma resistance to cisplatin and further elucidated the underlying molecular mechanisms. Cisplatin-refractory lung adenocarcinoma cells increased autophagic vacuole formation detected by monodansylcadaverine staining. When exposed to cisplatin, lung adeno-carcinoma cells demonstrated increased levels of autophagy detected by MAP1A/1B LC3B and mammalian homologue of yeast Atg6 (Beclin-1) expression using Western blot analysis. Activation of cisplatin-induced autophagic flux was increased by using chloroquine (CQ), which can accumulate LC3B-II protein and increase punctate distribution of LC3B localization. The combination of cisplatin with CQ was more potent than cisplatin alone in inhibiting lung adenocarcinoma cell growth, which also increased cisplatin-induced apoptosis. Compared to cisplatin treatment alone, the combination of cisplatin and CQ decreased p-AMPK and increased p-mTOR protein expressions, in addition, the AMPK inhibitor Compound C plus cisplatin downregulated p-AMPK and upregulated p-mTOR as well as depressed LC3B cleavage. These findings demonstrate that activation of autophagy is a hallmark of cisplatin exposure in human lung adenocarcinoma cells, and that there is a cisplatin-induced autophagic response via activation of the AMPK/mTOR signaling pathway. We speculate that autophagy can be used as a novel therapeutic target to overcome cisplatin-resistant lung adenocarcinoma.
Collapse
Affiliation(s)
- Tao Wu
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Min-Cong Wang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Li Jing
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Zhi-Yan Liu
- Department of Respiratory Medicine, Xi'an Central Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Hui Guo
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Ying Liu
- Department of Medical Oncology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Yi-Yang Bai
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Yang-Zi Cheng
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Ke-Jun Nan
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Xuan Liang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| |
Collapse
|
269
|
Robinson AG, Young K, Balchin K, Ashworth A, Owen T. Causes of death and subsequent treatment after initial radical or palliative therapy of stage III non-small-cell lung cancer. ACTA ACUST UNITED AC 2015; 22:333-40. [PMID: 26628866 DOI: 10.3747/co.22.2432] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Stage iii lung cancer is the most advanced stage of lung cancer for which radical (potentially curative) treatment is often discussed. Understanding the reasons for mortality and subsequent treatments in patients with stage iii non-small-cell lung cancer (nsclc) is important. METHODS This retrospective cohort study extracted demographic, clinical, treatment, and outcomes data for patients with newly diagnosed stage iii nsclc diagnosed between 1 January 2008 and 31 December 2012 at a single institution. RESULTS The study included 237 patients with stage iii nsclc, 130 of whom were not treated with radical or curative intent (55%). Median survival in the entire cohort was 14 months from diagnosis. For patients treated with radical-intent therapy, causes of death varied with the time period. The hazard rate for death was approximately 2.8 per 100 person-months of follow-up over the entire disease course and was highest between 6 months and 24 months. Over the entire time period, local causes accounted for 29% of deaths; systemic non-central nervous system metastases, for 25%; and brain metastases, for 14%. For patients treated with palliative intent, the overwhelming cause of death was local disease complications or progression (56% of deaths). Only 12% of patients in the palliative treatment group who progressed received subsequent chemotherapy; 23% of patients in the radical group who progressed received palliative chemotherapy. The most frequent subsequent treatment in both groups was radiation therapy. CONCLUSIONS The eventual life-ending event in stage iii nsclc varied for the patients who qualified for, and were treated with, radical or curative intent and for the patients who received palliative-intent therapy. Utilization of systemic chemotherapy in patients not fit for radical therapy is low.
Collapse
Affiliation(s)
- A G Robinson
- Department of Oncology, Queen's University, Kingston, ON; ; Cancer Centre of Southeastern Ontario, Kingston General Hospital, Kingston, ON
| | - K Young
- Department of Oncology, Queen's University, Kingston, ON
| | - K Balchin
- Cancer Centre of Southeastern Ontario, Kingston General Hospital, Kingston, ON
| | - A Ashworth
- Department of Oncology, Queen's University, Kingston, ON; ; Cancer Centre of Southeastern Ontario, Kingston General Hospital, Kingston, ON
| | - T Owen
- Department of Oncology, Queen's University, Kingston, ON; ; Cancer Centre of Southeastern Ontario, Kingston General Hospital, Kingston, ON
| |
Collapse
|
270
|
Jenssen C, Annema JT, Clementsen P, Cui XW, Borst MM, Dietrich CF. Ultrasound techniques in the evaluation of the mediastinum, part 2: mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography. J Thorac Dis 2015; 7:E439-58. [PMID: 26623120 DOI: 10.3978/j.issn.2072-1439.2015.10.08] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node (MLN) staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [endobronchial ultrasound combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [endoscopic ultrasound fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all MLNs can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review in two integrative parts is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part 1 deals with an introduction into ultrasound techniques, MLN anatomy and diagnostic reach of ultrasound techniques and part 2 with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.
Collapse
Affiliation(s)
- Christian Jenssen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Jouke Tabe Annema
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Paul Clementsen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Xin-Wu Cui
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Mathias Maximilian Borst
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Christoph Frank Dietrich
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| |
Collapse
|
271
|
Schmid-Bindert G, Engel-Riedel W, Reck M, Schuette W, Stöhlmacher J, Fischer JR, Mazières J, Chouaid C, Wolf M, Vinolas N, Soldatenkova V, Ripoche V, Nguyen T, Visseren-Grul C. A randomized Phase 2 study of pemetrexed in combination with cisplatin or carboplatin as adjuvant chemotherapy in patients with completely resected stage IB or II Non-Small-Cell Lung Cancer. Lung Cancer 2015; 90:397-404. [DOI: 10.1016/j.lungcan.2015.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/28/2015] [Accepted: 11/04/2015] [Indexed: 11/24/2022]
|
272
|
Talebian Yazdi M, Egberts J, Schinkelshoek MS, Wolterbeek R, Nabers J, Venmans BJ, Tournoy KG, Annema JT. Endosonography for lung cancer staging: predictors for false-negative outcomes. Lung Cancer 2015; 90:451-6. [DOI: 10.1016/j.lungcan.2015.09.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 08/30/2015] [Accepted: 09/19/2015] [Indexed: 12/25/2022]
|
273
|
Deben C, Deschoolmeester V, Lardon F, Rolfo C, Pauwels P. TP53 and MDM2 genetic alterations in non-small cell lung cancer: Evaluating their prognostic and predictive value. Crit Rev Oncol Hematol 2015; 99:63-73. [PMID: 26689115 DOI: 10.1016/j.critrevonc.2015.11.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/23/2015] [Accepted: 11/26/2015] [Indexed: 12/16/2022] Open
Abstract
The p53 pathway has been extensively studied for its role in carcinogenesis. Disruption of the pathway occurs in more than half of all cancers, often leading to a worse prognosis for the patient. In recent years several compounds have been successfully developed to target and restore the p53 pathway, either by blocking the MDM2-p53 interaction, restoring wild type conformation of mutant p53, or exploiting the presence of mutant p53 by blocking DNA damage repair pathways. In this review the known data on the role of p53 on prognosis and response to commonly used chemotherapeutics in non-small cell lung cancer is summarized. The focus is on the presence of genetic alterations in the TP53 or MDM2 gene, p53's main negative regulator. In addition, promising therapeutic options will be discussed in relation to specific alterations in the p53 pathway.
Collapse
Affiliation(s)
- Christophe Deben
- Center for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium; Department of Pathology, Antwerp University Hospital, Antwerp, Belgium
| | - Vanessa Deschoolmeester
- Center for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium; Department of Pathology, Antwerp University Hospital, Antwerp, Belgium
| | - Filip Lardon
- Center for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium
| | - Christian Rolfo
- Department of Medical Oncology, Antwerp University Hospital, Antwerp, Belgium; Phase-1 Early Clinical Trials Unit, Antwerp University Hospital, Antwerp, Belgium.
| | - Patrick Pauwels
- Center for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium; Department of Pathology, Antwerp University Hospital, Antwerp, Belgium
| |
Collapse
|
274
|
Warner A, Dahele M, Hu B, Palma DA, Senan S, Oberije C, Tsujino K, Moreno-Jimenez M, Kim TH, Marks LB, Rengan R, De Petris L, Ramella S, De Ruyck K, De Dios NR, Bradley JD, Rodrigues G. Factors Associated With Early Mortality in Patients Treated With Concurrent Chemoradiation Therapy for Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2015; 94:612-20. [PMID: 26867890 DOI: 10.1016/j.ijrobp.2015.11.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/17/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE Concurrent chemoradiation therapy (con-CRT) is recommended for fit patients with locally advanced non-small cell lung cancer (LA-NSCLC) but is associated with toxicity, and observed survival continues to be limited. Identifying factors associated with early mortality could improve patient selection and identify strategies to improve prognosis. METHODS AND MATERIALS Analysis of a multi-institutional LA-NSCLC database consisting of 1245 patients treated with con-CRT in 13 institutions was performed to identify factors predictive of 180-day survival. Recursive partitioning analysis (RPA) was performed to identify prognostic groups for 180-day survival. Multivariate logistic regression analysis was used to create a clinical nomogram predicting 180-day survival based on important predictors from RPA. RESULTS Median follow-up was 43.5 months (95% confidence interval [CI]: 40.3-48.8) and 127 patients (10%) died within 180 days of treatment. Median, 180-day, and 1- to 5-year (by yearly increments) actuarial survival rates were 20.9 months, 90%, 71%, 45%, 32%, 27%, and 22% respectively. Multivariate analysis adjusted by region identified gross tumor volume (GTV) (odds ratio [OR] ≥100 cm(3): 2.61; 95% CI: 1.10-6.20; P=.029) and pulmonary function (forced expiratory volume in 1 second [FEV1], defined as the ratio of FEV1 to forced vital capacity [FVC]) (OR <80%: 2.53; 95% CI: 1.09-5.88; P=.030) as significant predictors of 180-day survival. RPA resulted in a 2-class risk stratification system: low-risk (GTV <100 cm(3) or GTV ≥100 cm(3) and FEV1 ≥80%) and high-risk (GTV ≥100 cm(3) and FEV1 <80%). The 180-day survival rates were 93% for low risk and 79% for high risk, with an OR of 4.43 (95% CI: 2.07-9.51; P<.001), adjusted by region. A clinical nomogram predictive of 180-day survival, incorporating FEV1, GTV, N stage, and maximum esophagus dose yielded favorable calibration (R(2) = 0.947). CONCLUSIONS This analysis identified several risk factors associated with early mortality and suggests that future research in the optimization of pretreatment pulmonary function and/or functional lung avoidance treatment may alter the therapeutic ratio in this patient population.
Collapse
Affiliation(s)
- Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Max Dahele
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Bo Hu
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Cary Oberije
- Department of Radiation Oncology, MAASTRO Clinic, Maastricht, The Netherlands
| | - Kayoko Tsujino
- Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Marta Moreno-Jimenez
- Department of Oncology, Clínica Universidad, Universidad de Navarra, Pamplona, Spain
| | - Tae Hyun Kim
- Department of Radiation Oncology, National Cancer Center, Goyang-si, Gyeonggi, Korea
| | - Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Luigi De Petris
- Department of Oncology and Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Ramella
- Department of Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Kim De Ruyck
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Núria Rodriguez De Dios
- Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, Barcelona, Spain
| | - Jeffrey D Bradley
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - George Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
| |
Collapse
|
275
|
Mattonen SA, Tetar S, Palma DA, Louie AV, Senan S, Ward AD. Imaging texture analysis for automated prediction of lung cancer recurrence after stereotactic radiotherapy. J Med Imaging (Bellingham) 2015; 2:041010. [PMID: 26835492 DOI: 10.1117/1.jmi.2.4.041010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 10/06/2015] [Indexed: 12/25/2022] Open
Abstract
Benign radiation-induced lung injury (RILI) is not uncommon following stereotactic ablative radiotherapy (SABR) for lung cancer and can be difficult to differentiate from tumor recurrence on follow-up imaging. We previously showed the ability of computed tomography (CT) texture analysis to predict recurrence. The aim of this study was to evaluate and compare the accuracy of recurrence prediction using manual region-of-interest segmentation to that of a semiautomatic approach. We analyzed 22 patients treated for 24 lesions (11 recurrences, 13 RILI). Consolidative and ground-glass opacity (GGO) regions were manually delineated. The longest axial diameter of the consolidative region on each post-SABR CT image was measured. This line segment is routinely obtained as part of the clinical imaging workflow and was used as input to automatically delineate the consolidative region and subsequently derive a periconsolidative region to sample GGO tissue. Texture features were calculated, and at two to five months post-SABR, the entropy texture measure within the semiautomatic segmentations showed prediction accuracies [areas under the receiver operating characteristic curve (AUC): 0.70 to 0.73] similar to those of manual GGO segmentations (AUC: 0.64). After integration into the clinical workflow, this decision support system has the potential to support earlier salvage for patients with recurrence and fewer investigations of benign RILI.
Collapse
Affiliation(s)
- Sarah A Mattonen
- The University of Western Ontario , Department of Medical Biophysics, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Shyama Tetar
- VU University Medical Center , Department of Radiation Oncology, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| | - David A Palma
- The University of Western Ontario, Department of Medical Biophysics, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; London Regional Cancer Program, Division of Radiation Oncology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Alexander V Louie
- London Regional Cancer Program , Division of Radiation Oncology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Suresh Senan
- VU University Medical Center , Department of Radiation Oncology, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| | - Aaron D Ward
- The University of Western Ontario , Department of Medical Biophysics, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| |
Collapse
|
276
|
Dietrich CF, Annema JT, Clementsen P, Cui XW, Borst MM, Jenssen C. Ultrasound techniques in the evaluation of the mediastinum, part I: endoscopic ultrasound (EUS), endobronchial ultrasound (EBUS) and transcutaneous mediastinal ultrasound (TMUS), introduction into ultrasound techniques. J Thorac Dis 2015; 7:E311-25. [PMID: 26543620 DOI: 10.3978/j.issn.2072-1439.2015.09.40] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography (EUS and EBUS) should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [EBUS combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [EUS fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all mediastinal lymph nodes can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review, in two integrative parts, is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part I is dealing with an introduction into ultrasound techniques, mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques and part II with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.
Collapse
Affiliation(s)
- Christoph Frank Dietrich
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - Jouke Tabe Annema
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - Paul Clementsen
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - Xin Wu Cui
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - Mathias Maximilian Borst
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - Christian Jenssen
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| |
Collapse
|
277
|
Eberhardt WEE, Pöttgen C, Gauler TC, Friedel G, Veit S, Heinrich V, Welter S, Budach W, Spengler W, Kimmich M, Fischer B, Schmidberger H, De Ruysscher D, Belka C, Cordes S, Hepp R, Lütke-Brintrup D, Lehmann N, Schuler M, Jöckel KH, Stamatis G, Stuschke M. Phase III Study of Surgery Versus Definitive Concurrent Chemoradiotherapy Boost in Patients With Resectable Stage IIIA(N2) and Selected IIIB Non-Small-Cell Lung Cancer After Induction Chemotherapy and Concurrent Chemoradiotherapy (ESPATUE). J Clin Oncol 2015; 33:4194-201. [PMID: 26527789 DOI: 10.1200/jco.2015.62.6812] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Concurrent chemoradiotherapy with or without surgery are options for stage IIIA(N2) non-small-cell lung cancer. Our previous phase II study had shown the efficacy of induction chemotherapy followed by chemoradiotherapy and surgery in patients with IIIA(N2) disease and with selected IIIB disease. Here, we compared surgery with definitive chemoradiotherapy in resectable stage III disease after induction. PATIENTS AND METHODS Patients with pathologically proven IIIA(N2) and selected patients with IIIB disease that had medical/functional operability received induction chemotherapy, which consisted of three cycles of cisplatin 50 mg/m(2) on days 1 and 8 and paclitaxel 175 mg/m(2) on day 1 every 21 days, as well as concurrent chemoradiotherapy to 45 Gy given as 1.5 Gy twice daily, concurrent cisplatin 50 mg/m(2) on days 2 and 9, and concurrent vinorelbine 20 mg/m(2) on days 2 and 9. Those patients whose tumors were reevaluated and deemed resectable in the last week of radiotherapy were randomly assigned to receive a chemoradiotherapy boost that was risk adapted to between 65 and 71 Gy in arm A or to undergo surgery (arm B). The primary end point was overall survival (OS). RESULTS After 246 of 500 planned patients were enrolled, the trial was closed after the second scheduled interim analysis because of slow accrual and the end of funding, which left the study underpowered relative to its primary study end point. Seventy-five patients had stage IIIA disease and 171 had stage IIIB disease according to the Union for International Cancer Control TNM classification, sixth edition. The median age was 59 years (range, 33 to 74 years). After induction, 161 (65.4%) of 246 patients with resectable tumors were randomly assigned; strata were tumor-node group, prophylactic cranial irradiation policy, and region. Patient characteristics were balanced between arms, in which 81 were assigned to surgery and 80 were assigned to a chemoradiotherapy boost. In arm B, 81% underwent R0 resection. With a median follow-up after random assignment of 78 months, 5-year OS and progression-free survival (PFS) did not differ between arms. Results were OS rates of 44% for arm B and 40% for arm A (log-rank P = .34) and PFS rates of 32% for arm B and 35% for arm A (log-rank P = .75). OS at 5 years was 34.1% (95% CI, 27.6% to 40.8%) in all 246 patients, and 216 patients (87.8%) received definitive local treatment. CONCLUSION The 5-year OS and PFS rates in randomly assigned patients with resectable stage III non-small-cell lung cancer were excellent with both treatments. Both are acceptable strategies for this good-prognosis group.
Collapse
Affiliation(s)
- Wilfried Ernst Erich Eberhardt
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands.
| | - Christoph Pöttgen
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Thomas Christoph Gauler
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Godehard Friedel
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Stefanie Veit
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Vanessa Heinrich
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Stefan Welter
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Wilfried Budach
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Werner Spengler
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Martin Kimmich
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Berthold Fischer
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Heinz Schmidberger
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Dirk De Ruysscher
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Claus Belka
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Sebastian Cordes
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Rodrigo Hepp
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Diana Lütke-Brintrup
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Nils Lehmann
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Martin Schuler
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Karl-Heinz Jöckel
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Georgios Stamatis
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Martin Stuschke
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| |
Collapse
|
278
|
Guckenberger M. Dose and Fractionation in Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer: Lessons Learned and Where Do We Go Next? Int J Radiat Oncol Biol Phys 2015; 93:765-8. [DOI: 10.1016/j.ijrobp.2015.08.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 08/06/2015] [Accepted: 08/12/2015] [Indexed: 11/29/2022]
|
279
|
Méry B, Guy JB, Swalduz A, Vallard A, Guibert C, Almokhles H, Ben Mrad M, Rivoirard R, Falk AT, Fournel P, Magné N. The evolving locally-advanced non-small cell lung cancer landscape: Building on past evidence and experience. Crit Rev Oncol Hematol 2015; 96:319-27. [DOI: 10.1016/j.critrevonc.2015.05.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 03/30/2015] [Accepted: 05/19/2015] [Indexed: 12/25/2022] Open
|
280
|
The impact of respiratory gated positron emission tomography on clinical staging and management of patients with lung cancer. Lung Cancer 2015; 90:217-23. [DOI: 10.1016/j.lungcan.2015.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/11/2015] [Accepted: 09/14/2015] [Indexed: 11/17/2022]
|
281
|
de Vries R, Brinkman P, van der Schee MP, Fens N, Dijkers E, Bootsma SK, de Jongh FHC, Sterk PJ. Integration of electronic nose technology with spirometry: validation of a new approach for exhaled breath analysis. J Breath Res 2015; 9:046001. [PMID: 26469298 DOI: 10.1088/1752-7155/9/4/046001] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
New 'omics'-technologies have the potential to better define airway disease in terms of pathophysiological and clinical phenotyping. The integration of electronic nose (eNose) technology with existing diagnostic tests, such as routine spirometry, can bring this technology to 'point-of-care'. We aimed to determine and optimize the technical performance and diagnostic accuracy of exhaled breath analysis linked to routine spirometry. Exhaled breath was collected in triplicate in healthy subjects by an eNose (SpiroNose) based on five identical metal oxide semiconductor sensor arrays (three arrays monitoring exhaled breath and two reference arrays monitoring ambient air) at the rear end of a pneumotachograph. First, the influence of flow, volume, humidity, temperature, environment, etc, was assessed. Secondly, a two-centre case-control study was performed using diagnostic and monitoring visits in day-to-day clinical care in patients with a (differential) diagnosis of asthma, chronic obstructive pulmonary disease (COPD) or lung cancer. Breathprint analysis involved signal processing, environment correction based on alveolar gradients and statistics based on principal component (PC) analysis, followed by discriminant analysis (Matlab2014/SPSS20). Expiratory flow showed a significant linear correlation with raw sensor deflections (R(2) = 0.84) in 60 healthy subjects (age 43 ± 11 years). No correlation was found between sensor readings and exhaled volume, humidity and temperature. Exhaled data after environment correction were highly reproducible for each sensor array (Cohen's Kappa 0.81-0.94). Thirty-seven asthmatics (41 ± 14.2 years), 31 COPD patients (66 ± 8.4 years), 31 lung cancer patients (63 ± 10.8 years) and 45 healthy controls (41 ± 12.5 years) entered the cross-sectional study. SpiroNose could adequately distinguish between controls, asthma, COPD and lung cancer patients with cross-validation values ranging between 78-88%. We have developed a standardized way to integrate eNose technology with spirometry. Signal processing techniques and environmental background correction ensured that the multiple sensor arrays within the SpiroNose provided repeatable and interchangeable results. SpiroNose discriminated controls and patients with asthma, COPD and lung cancer with promising accuracy, paving the route towards point-of-care exhaled breath diagnostics.
Collapse
Affiliation(s)
- R de Vries
- Department of Respiratory Medicine, Academic Medical Centre, Amsterdam, The Netherlands. Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
282
|
Huellner MW, de Galiza Barbosa F, Husmann L, Pietsch CM, Mader CE, Burger IA, Stolzmann P, Delso G, Frauenfelder T, von Schulthess GK, Veit-Haibach P. TNM Staging of Non–Small Cell Lung Cancer: Comparison of PET/MR and PET/CT. J Nucl Med 2015; 57:21-6. [DOI: 10.2967/jnumed.115.162040] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/06/2015] [Indexed: 12/25/2022] Open
|
283
|
Stereotactic ablative radiotherapy (SABR) for central lung tumors: Plan quality and long-term clinical outcomes. Radiother Oncol 2015; 117:64-70. [DOI: 10.1016/j.radonc.2015.09.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/04/2015] [Accepted: 09/26/2015] [Indexed: 02/06/2023]
|
284
|
Louie AV, van Werkhoven E, Chen H, Smit EF, Paul MA, Widder J, Groen HJ, van den Borne BE, De Jaeger K, Slotman BJ, Senan S. Patient reported outcomes following stereotactic ablative radiotherapy or surgery for stage IA non-small-cell lung cancer: Results from the ROSEL multicenter randomized trial. Radiother Oncol 2015; 117:44-8. [DOI: 10.1016/j.radonc.2015.08.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 12/31/2022]
|
285
|
Forker LJ, Choudhury A, Kiltie AE. Biomarkers of Tumour Radiosensitivity and Predicting Benefit from Radiotherapy. Clin Oncol (R Coll Radiol) 2015; 27:561-9. [PMID: 26119726 DOI: 10.1016/j.clon.2015.06.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 06/02/2015] [Indexed: 12/11/2022]
Abstract
Radiotherapy is an essential component of treatment for more than half of newly diagnosed cancer patients. The response to radiotherapy varies widely between individuals and although advances in technology have allowed the adaptation of radiotherapy fields to tumour anatomy, it is still not possible to tailor radiotherapy based on tumour biology. A biomarker of intrinsic radiosensitivity would be extremely valuable for individual dosing, aiding decision making between radical treatment options and avoiding toxicity of neoadjuvant or adjuvant radiotherapy in those unlikely to benefit. This systematic review summarises the current evidence for biomarkers under investigation as predictors of radiotherapy benefit. Only 10 biomarkers were identified as having been evaluated for their radiotherapy-specific predictive value in over 100 patients in a clinical setting, highlighting that despite a rich literature there were few high-quality studies for inclusion. The most extensively studied radiotherapy predictive biomarkers were the radiosensitivity index and MRE11; however, neither has been evaluated in a randomised controlled trial. Although these biomarkers show promise, there is not enough evidence to justify their use in routine practice. Further validation is needed before biomarkers can fulfil their potential and predict treatment outcomes for large numbers of patients.
Collapse
Affiliation(s)
- L J Forker
- Institute of Cancer Sciences, The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - A Choudhury
- Institute of Cancer Sciences, The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
| | - A E Kiltie
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Headington, Oxford, UK
| |
Collapse
|
286
|
Safety and Immunogenicity of MAGE-A3 Cancer Immunotherapeutic with or without Adjuvant Chemotherapy in Patients with Resected Stage IB to III MAGE-A3-Positive Non-Small-Cell Lung Cancer. J Thorac Oncol 2015; 10:1458-67. [DOI: 10.1097/jto.0000000000000653] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
287
|
Aragón J, Perez I, Gonzalez-Rivas D. Video-assisted thoracoscopic lobectomy versus stereotactic radiotherapy for stage I lung cancer. J Thorac Dis 2015; 7:1074-5. [PMID: 26380716 DOI: 10.3978/j.issn.2072-1439.2015.07.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 06/28/2015] [Indexed: 11/14/2022]
Affiliation(s)
- Javier Aragón
- 1 Department of thoracic surgery, Asturias University Central Hospital, Asturias, Spain ; 2 Department of thoracic surgery at Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Itzell Perez
- 1 Department of thoracic surgery, Asturias University Central Hospital, Asturias, Spain ; 2 Department of thoracic surgery at Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Diego Gonzalez-Rivas
- 1 Department of thoracic surgery, Asturias University Central Hospital, Asturias, Spain ; 2 Department of thoracic surgery at Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| |
Collapse
|
288
|
Puggina A, Broumas A, Ricciardi W, Boccia S. Cost-effectiveness of screening for lung cancer with low-dose computed tomography: a systematic literature review. Eur J Public Health 2015; 26:168-75. [PMID: 26370440 DOI: 10.1093/eurpub/ckv158] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND On 31 December 2013, the US Preventive Services Task Force rated low-dose computed tomography (LDCT) for lung cancer screening as level 'B' recommendation. Yet, lung cancer screening implementation remains controversial, particularly when considering its cost-effectiveness. The aim of this work is to investigate the cost-effectiveness of LDCT screening program for lung cancer by performing a systematic literature review. METHODS We reviewed the published economic evaluations of LDCT in lung cancer screening. MEDLINE, ISI Web of Science and Cochrane databases were searched for literature retrieval up to 31 March 2015. Inclusion criteria included: studies reporting an original full economic evaluation; reports presenting the outcomes as Quality-Adjusted Life Years (QALYs) gained or as Life Years Gained. RESULTS Nine economic evaluations met the inclusion criteria. All the cost-effectiveness analyses included high risk populations for lung cancer and compared the use of annual LDCT screening with no screening. Seven studies reported an incremental cost-effectiveness ratio below the threshold of US$ 100 000 per QALY gained. CONCLUSIONS Cost-effectiveness of LDCT screening for lung cancer is an highly debatable issue. Currently available economic evaluations suggest the cost-effectiveness of LDCT for lung cancer screening compared with no screening and indicate that the implementation of LDCT should be considered when planning a national lung cancer screening program. Additional economic evaluations, especially from a societal perspective and in an EU-setting, are needed.
Collapse
Affiliation(s)
- Anna Puggina
- 1 Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Walter Ricciardi
- 1 Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Boccia
- 1 Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
289
|
Le Péchoux C, Dunant A, Faivre-Finn C, Thomas PA, Pourel N, Lerouge D, Edwards J, Van Schil P, Rami-Porta R, Dansin E, Nestle U, Fadel E, Zalcman G. Postoperative Radiotherapy for Pathologic N2 Non-Small-Cell Lung Cancer Treated With Adjuvant Chemotherapy: Need for Randomized Evidence. J Clin Oncol 2015; 33:2930-1. [PMID: 26215941 DOI: 10.1200/jco.2015.62.1458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024] Open
Affiliation(s)
| | - Ariane Dunant
- Gustave-Roussy, Paris Sud University, Villejuif, France
| | | | | | | | | | - John Edwards
- Northern General Hospital, Sheffield, United Kingdom
| | | | | | | | - Ursula Nestle
- Freiburg University Medical Center, Freiburg im Breisgau, Germany
| | - Elie Fadel
- Centre Chirurgical Marie Lannelongue, Paris Sud University, Paris, France
| | | |
Collapse
|
290
|
Targeting Chromatin-Mediated Transcriptional Control of Gene Expression in Non-Small Cell Lung Cancer Therapy: Preclinical Rationale and Clinical Results. Drugs 2015; 75:1757-71. [DOI: 10.1007/s40265-015-0461-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
291
|
Sheridan C, Downward J. Overview of KRAS-Driven Genetically Engineered Mouse Models of Non-Small Cell Lung Cancer. CURRENT PROTOCOLS IN PHARMACOLOGY 2015; 70:14.35.1-14.35.16. [PMID: 26331885 DOI: 10.1002/0471141755.ph1435s70] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
KRAS, the most frequently mutated oncogene in non-small cell lung cancer, has been utilized extensively to model human lung adenocarcinomas. The results from such studies have enhanced considerably an understanding of the relationship between KRAS and the development of lung cancer. Detailed in this overview are the features of various KRAS-driven genetically engineered mouse models (GEMMs) of non-small cell lung cancer, their utilization, and the potential of these models for the study of lung cancer biology.
Collapse
Affiliation(s)
- Clare Sheridan
- Signal Transduction Laboratory, The Francis Crick Institute, London, United Kingdom
| | - Julian Downward
- Signal Transduction Laboratory, The Francis Crick Institute, London, United Kingdom
- Lung Cancer Group, The Institute of Cancer Research, London, United Kingdom
| |
Collapse
|
292
|
|
293
|
Predicting Overall Survival After Stereotactic Ablative Radiation Therapy in Early-Stage Lung Cancer: Development and External Validation of the Amsterdam Prognostic Model. Int J Radiat Oncol Biol Phys 2015; 93:82-90. [DOI: 10.1016/j.ijrobp.2015.05.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 04/30/2015] [Accepted: 05/01/2015] [Indexed: 11/20/2022]
|
294
|
Gridelli C, Balducci L, Ciardiello F, Di Maio M, Felip E, Langer C, Lilenbaum RC, Perrone F, Senan S, de Marinis F. Treatment of Elderly Patients With Non–Small-Cell Lung Cancer: Results of an International Expert Panel Meeting of the Italian Association of Thoracic Oncology. Clin Lung Cancer 2015; 16:325-33. [DOI: 10.1016/j.cllc.2015.02.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/18/2015] [Accepted: 02/26/2015] [Indexed: 12/29/2022]
|
295
|
Adherence to AIOM (Italian Association of Medical Oncology) lung cancer guidelines in Italian clinical practice: Results from the RIGHT-3 (research for the identification of the most effective and highly accepted clinical guidelines for cancer treatment) study. Lung Cancer 2015; 90:234-42. [PMID: 26314614 DOI: 10.1016/j.lungcan.2015.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 08/08/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Clinical practice guidelines represent a key tool to improve quality and reduce variability of cancer care. In 2004, Italian Association of Medical Oncology (AIOM) launched the RIGHT (research for the identification of the most effective and highly accepted clinical guidelines for cancer treatment) program. The third step, RIGHT-3, evaluated the concordance between AIOM lung cancer guidelines and Italian clinical practice. MATERIALS AND METHODS RIGHT-3 was a retrospective observational study, conducted in 53 Italian centers treating lung cancer. Sampling from AIOM database of 230 centers was stratified by presence of thoracic surgery and geographic distribution. To describe the adherence to AIOM guidelines (2009 edition), 11 indicators regarding diagnostic and treatment procedures were identified. Patients with non-small-cell lung cancer (NSCLC) diagnosis who had first visit in 2010 were divided into 3 groups, based on TNM stage: I-II-IIIA (5 indicators), IIIB (3 indicators) and IV (3 indicators). RESULTS 708 patients were enrolled; 680 were eligible: 225 patients in stage I-II-IIIA; 156 patients in stage IIIB; 299 patients in stage IV. Cyto-histological diagnosis was available in 96%, 97%, 96% of stage I-II-IIIA, IIIB, IV respectively. Positron-emission tomography was performed in 64% of stage I-II-IIIA and 46% of stage IIIB. 88% of stage I-II patients eligible for surgery underwent lobectomy; after surgery, 61% of stage II and 57% of stage IIIA patients received adjuvant chemotherapy. Among stage IIIB patients who received combined chemo- radiotherapy, sequential approach was more common than concomitant treatment (86% vs. 14%). Among stage IV patients, 87% received platinum-based first-line treatment, and 70% received second-line. CONCLUSION The RIGHT-3 study showed that, in 2010, adherence to Italian NSCLC guidelines was high for many indicators (including those related to treatment of stage IV patients), but lower for some diagnostic procedures. Guidelines adherence monitoring can be useful to reduce variability in cancer care.
Collapse
|
296
|
Gómez A, González JA, Couñago F, Vallejo C, Casas F, de Dios NR. Evidence-based recommendations of postoperative radiotherapy in lung cancer from Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society). Clin Transl Oncol 2015; 18:331-41. [PMID: 26280402 DOI: 10.1007/s12094-015-1374-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/04/2015] [Indexed: 12/25/2022]
Abstract
Locally advanced non-small cell lung cancer (NSCLC) is a diversified illness in which postoperative radiation therapy (PORT) for complete resection with positive hiliar (pN1) and/or mediastinal (pN2) lymph nodes is controversial. Although several studies have shown that PORT has beneficial effects, randomized trials are needed to demonstrate its impact on overall survival. In this review, the Spanish Radiation Oncology Group for Lung Cancer describes the most relevant literature on PORT in NSCLC patients stage pN1-2. In addition, we have outlined the current recommendations of different national and international clinical guidelines and have also specified practical issues regarding treatment volume definition, doses and fractionation.
Collapse
Affiliation(s)
- A Gómez
- Radiation Oncology Department, Hospital Universitario Santiago de Compostela, Tr Choupana s/n, 15706, Santiago De Compostela, Spain
| | - J A González
- Radiation Oncology Department, Instituto Oncológico Cartuja, Unidad Regional de Sevilla, Grupo IMO, Américo Vespucio 31-33, 41092, Seville, Spain
| | - F Couñago
- Radiation Oncology Department, Hospital Universitario Quirón Madrid, Diego de Velázquez, 1, Pozuelo De Alarcón, 28223, Madrid, Spain
| | - C Vallejo
- Radiation Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Carretera de Colmenar KM 9,1, 28034, Madrid, Spain
| | - F Casas
- Radiation Oncology Department, Hospital Clínic Barcelona, Villarroel 150, 08036, Barcelona, Spain
| | - N Rodríguez de Dios
- Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, San josé de la Montaña 12, 08024, Barcelona, Spain.
- IMIM (Hospital del Mar Medical Research Institut), Barcelona, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
| |
Collapse
|
297
|
Oki M, Saka H, Ando M, Asano F, Kurimoto N, Morita K, Kitagawa C, Kogure Y, Miyazawa T. Ultrathin Bronchoscopy with Multimodal Devices for Peripheral Pulmonary Lesions. A Randomized Trial. Am J Respir Crit Care Med 2015; 192:468-76. [DOI: 10.1164/rccm.201502-0205oc] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
|
298
|
Kilvaer TK, Khanehkenari MR, Hellevik T, Al-Saad S, Paulsen EE, Bremnes RM, Busund LT, Donnem T, Martinez IZ. Cancer Associated Fibroblasts in Stage I-IIIA NSCLC: Prognostic Impact and Their Correlations with Tumor Molecular Markers. PLoS One 2015; 10:e0134965. [PMID: 26252379 PMCID: PMC4529239 DOI: 10.1371/journal.pone.0134965] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/15/2015] [Indexed: 01/31/2023] Open
Abstract
Background Cancer Associated Fibroblasts (CAFs) are thought to regulate tumor growth and metastasis. Fibroblast Activating Protein 1 (FAP-1) is a marker for fibroblast activation and by many recognized as the main marker of CAFs. Alpha Smooth Muscle Actin (α-SMA) is a general myofibroblast marker, and can be used to identify CAFs. This study investigates the prognostic impact of FAP-1 and α-SMA in non-small cell lung cancer (NSCLC) patients and correlates their expression to 105 proteins investigated in the same cohort. Methods Tumor specimens from 536 NSCLC patients were obtained and tissue micro-arrays were constructed. Immunohistochemistry was used to evaluate the expression of FAP-1 and α-SMA and explore their impact on survival and association with other tumor molecular markers in NSCLC patients. Results High expression of FAP-1, but not α-SMA, in squamous cell carcinoma (SCC, P = 0.043, HR = 0.63 95% CI 0.40–0.99) was significantly associated with increased disease-specific survival. FAP-1 and α-SMA were not significantly correlated to each other. Analyses of FAP-1 and α-SMA associated with other tumor-related proteins revealed histotype-specific correlation patterns. Conclusion The presence of FAP-1 expressing CAFs is an indicator of positive outcome for NSCLC-SCC patients. In addition, correlation analyses suggest FAP-1 and α-SMA to label different subsets of fibroblasts and their associations with other tumor-related proteins diverge according to histological subtype.
Collapse
Affiliation(s)
- Thomas K. Kilvaer
- Department of Oncology, University Hospital of North Norway, Tromso, Norway
- Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
- * E-mail:
| | | | - Turid Hellevik
- Department of Oncology, University Hospital of North Norway, Tromso, Norway
| | - Samer Al-Saad
- Institute of Medical Biology, UiT The Arctic University of Norway, Tromso, Norway
- Department of Clinical Pathology, University Hospital of North Norway, Tromso, Norway
| | - Erna-Elise Paulsen
- Department of Oncology, University Hospital of North Norway, Tromso, Norway
- Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Roy M. Bremnes
- Department of Oncology, University Hospital of North Norway, Tromso, Norway
- Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Lill-Tove Busund
- Institute of Medical Biology, UiT The Arctic University of Norway, Tromso, Norway
- Department of Clinical Pathology, University Hospital of North Norway, Tromso, Norway
| | - Tom Donnem
- Department of Oncology, University Hospital of North Norway, Tromso, Norway
- Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Inigo Z. Martinez
- Institute of Medical Biology, UiT The Arctic University of Norway, Tromso, Norway
| |
Collapse
|
299
|
Troost EG, Wink KC, Zindler JD, De Ruysscher D. Management of early stage lung cancer: a radiation oncologist's perspective. Lung Cancer 2015. [DOI: 10.1183/2312508x.10010214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
300
|
Van Schil PE, De Waele M, Hendriks JM, Lauwers PR. Approaches in patients with locally advanced NSCLC: a surgeon's perspective. Lung Cancer 2015. [DOI: 10.1183/2312508x.10010414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|