1
|
Chen NB, Li QW, Zhu ZF, Wang YM, Cheng ZJ, Hui ZG, Guo SP, He HQ, Wang B, Huang XY, Li JB, Guo JY, Hu N, Ai XL, Zhou Y, Wang DQ, Liu FJ, Xie CM, Qiu B, Liu H. Developing and validating an integrated gross tumor volume (GTV)-TNM stratification system for supplementing unresectable locally advanced non-small cell lung cancer treated with concurrent chemoradiotherapy. Radiat Oncol 2020; 15:260. [PMID: 33168045 PMCID: PMC7653712 DOI: 10.1186/s13014-020-01704-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/30/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose The gross tumor volume (GTV) could be an independent prognostic factor for unresectable locally advanced non-small cell lung cancer (LANSCLC). We aimed to develop and validate a novel integrated GTV-TNM stratification system to supplement LANSCLC sub-staging in patients treated with concurrent chemoradiotherapy (CCRT).
Methods We performed a retrospective review of 340 patients with unresectable LANSCLC receiving definitive CCRT. All included patients were divided into two randomized cohorts. Then the Kaplan–Meier method and Cox regression were calculated to access the prognostic value of the integrated GTV-TNM stratification system, which was further validated by the area under the receiver operating characteristic curve (AUC) score and F1-score. Results The optimal outcome-based GTV cut-off values (70 and 180 cm3) of the modeling cohort were used to determine each patient’s integrated GTV-TNM stratum in the whole cohort. Our results indicated that a lower integrated GTV-TNM stratum could had better overall survival and progression-free survival (all P < 0.001), which was recognized as an independent prognostic factor. Also, its prognostic value was robust in both the modeling and validation cohorts. Furthermore, the prognostic validity of the integrated GTV-TNM stratification system was validated by significantly improved AUC score (0.636 vs. 0.570, P = 0.027) and F1-score (0.655 vs. 0.615, P < 0.001), compared with TNM stage. Conclusions We proposed a novel integrated GTV-TNM stratification system to supplement unresectable LANSCLC sub-staging due to its prognostic value independent of TNM stage and other clinical characteristics, suggesting that it could be considered in individual treatment decision-making process.
Collapse
Affiliation(s)
- Nai-Bin Chen
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Qi-Wen Li
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China.,Lung Cancer Institute, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zheng-Fei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Yi-Ming Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Jinan University, Guangzhou, People's Republic of China
| | - Zhangkai J Cheng
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Zhou-Guang Hui
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Su-Ping Guo
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Hao-Qiang He
- Medical Imaging, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Bin Wang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Xiao-Yan Huang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Ji-Bin Li
- Clinical Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Jin-Yu Guo
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Nan Hu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Xin-Lei Ai
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Yin Zhou
- Evidance Medical Technologies Inc., Ningbo, People's Republic of China
| | - Da-Quan Wang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Fang-Jie Liu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Chuan-Miao Xie
- Medical Imaging, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Bo Qiu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China. .,Lung Cancer Institute, Sun Yat-Sen University, Guangzhou, People's Republic of China.
| | - Hui Liu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China. .,Lung Cancer Institute, Sun Yat-Sen University, Guangzhou, People's Republic of China.
| |
Collapse
|
2
|
Zhang T, Bi N, Zhou Z, Chen D, Feng Q, Liang J, Xiao Z, Hui Z, Lv J, Wang X, Deng L, Wang W, Liu W, Wang J, Zhai Y, Wang L. The impact of age on the survival outcomes and risk of radiation pneumonitis in patients with unresectable locally advanced non-small cell lung cancer receiving chemoradiotherapy. J Thorac Dis 2020; 12:4347-4356. [PMID: 32944347 PMCID: PMC7475579 DOI: 10.21037/jtd-20-2137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Chemoradiotherapy is the recommended treatment for patients with unresectable locally advanced non-small cell lung cancer (NSCLC). This study aimed to determine the impact of age on the survival outcomes and risk of radiation pneumonitis (RP) in patients with unresectable locally advanced NSCLC. Methods The data of patients with unresectable locally advanced NSCLC who were treated with radiotherapy (RT), sequential chemoradiotherapy, or concurrent chemoradiotherapy between January, 2013, and December, 2017, in our institution were retrospectively reviewed and analyzed. Student’s t-test and χ2 test were used to evaluate the differences between groups divided by optimal cutoff. Survival rates were calculated using the Kaplan-Meier method, and multivariate cox regression was performed to determine the prognostic factors for survival outcomes. Results A total of 749 patients were included in this analysis. Based on the optimal cutoff, the patients were stratified into two age groups: <65 years old (the younger group, n=482) and ≥65 years old (the older group, n=267). The older group had more patients with poor Karnofsky Performance Score (KPS), squamous cell sarcoma (SCC), and IIIA stage than the younger group. The older patients were more likely to have received RT alone (40.1%) and less likely to have received concurrent chemoradiotherapy (cCRT) (26.6%) than the younger patients (8.1% and 54.8%, respectively, P<0.001). The median overall survival (OS) was 33 months (95% CI: 29–37 months) and 21 months (95% CI: 18–27 months) for the younger group and the older group, respectively (P<0.001). Multivariate Cox regression analysis showed that age had a significant independent association with OS (HR, 1.25; 95% CI: 1.01–1.55) after adjustment for covariates. The incidences of RP, symptomatic RP, and severe RP were similar between the two groups, but the incidence of fatal RP was higher in the older group (4.5% vs. 1.7%, P=0.039). Conclusions The clinical characteristics of the older patients in our study differed from those of the younger patients, and the older patients were more likely to choose conservative treatment. OS was longer in the older patients and more cases of fatal RP occurred in the older group.
Collapse
Affiliation(s)
- Tao Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Dongfu Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jun Liang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhouguang Hui
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jima Lv
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xin Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lei Deng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wenqing Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wenyang Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jianyang Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yirui Zhai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Luhua Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| |
Collapse
|
3
|
Chen CP, Chen YW, Chang KH, Huang SW, Wu CH, Escorpizo R, Stucki G, Liou TH. Clustering of functioning and disability profile based on the WHO disability assessment schedule 2.0 - a nationwide databank study. Disabil Rehabil 2020; 44:353-362. [PMID: 32525411 DOI: 10.1080/09638288.2020.1767703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To compare and cluster the health status and disability restrictions associated with eight major physiological functions of body systems, using functioning domains of WHO Disability Assessment Schedule 2.0.Design: Retrospective analyses of a nation-wide disability database.Setting: Population-based study.Participants: Records from patients >18 years of age with disability were obtained from the Taiwan Data Bank of Persons with Disability (July 2012-November 2017). Disability functioning profile of the following diagnosis were analyzed: stroke, schizophrenia, hearing loss, liver cirrhosis, chronic kidney disease, congestive heart failure, burn, head and neck cancer.Interventions: Not applicable.Main Outcome Measures: Demographic data, severity of impairment, and Disability Assessment Scale scores were obtained and analyzed. Radar charts were constructed using the WHO Disability Assessment Schedule 2.0. functioning domain score. Degree of similarity between any two given diagnosis was assessed by cluster analysis, comparing the Euclidean distances between radar chart data points among the six domains.Results: Based on cluster analysis of similarities between functioning domain profiles, the eight diagnoses were grouped into different disability clusters. Four clusters of disability were named according to the type restriction patterns: global-impact cluster (stroke); interaction-restriction cluster (schizophrenia, hearing loss); physical-limitation cluster, (liver cirrhosis, CKD, and congestive heart failure); and specific-impact cluster (burn, head and neck cancer). The rates of institutionalization and unemployment differed between the four clusters.Conclusion: We converted WHO Disability Assessment Schedule 2.0. functioning domain scores into six-dimensioned radar chart, and demonstrate disability restrictions can be further categorized into clusters according to similarity of functioning impairment. Understanding of disease-related disabilities provides an important basis for designing rehabilitation programs and policies on social welfare and health that reflect the daily-living needs of people according to diagnosis.Implication for RehabilitationThe use of radar charts provided a direct visualization of the scope and severity of disabilities associated with specific diagnoses.Diagnosis-related disabilities can be organized into clusters based on similarities in WHODAS 2.0 disability domain profiles.Knowledge of the characteristics of disability clusters is important to understand disease-related disabilities and provide a basis for designing rehabilitation.
Collapse
Affiliation(s)
- Chao-Pen Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yi-Wen Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kwang-Hwa Chang
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.,Graduate institute of sports science, National Taiwan Sports University, Taoyuan, Taiwan
| | - Chien-Hua Wu
- Department of Applied Mathematics, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, VT, USA.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Gerold Stucki
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
4
|
Watte G, Nunes CHDA, Sidney-Filho LA, Zanon M, Altmayer SPL, Pacini GS, Barros M, Moreira ALS, Alves RJV, Zelmanowicz ADM, Matata BM, Moreira JDS. Proportional weight loss in six months as a risk factor for mortality in stage IV non-small cell lung cancer. ACTA ACUST UNITED AC 2019; 44:505-509. [PMID: 30726327 PMCID: PMC6459746 DOI: 10.1590/s1806-37562018000000023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/22/2018] [Indexed: 01/06/2023]
Abstract
Objective: To evaluate different weight loss (WL) cut-off points as prognostic markers of 3-month survival after diagnosis of stage IV non-small cell lung cancer (NSCLC). Methods: This was a prospective study involving 104 patients with metastatic (stage IV) NSCLC who were admitted to a cancer treatment center in southern Brazil between January of 2014 and November of 2016. We evaluated total WL and WL per month, as well as WL and WL per month in the 6 months preceding the diagnosis. The patients were followed for 3 months after diagnosis. A Cox proportional hazards regression model and Kaplan-Meier curves were used in order to evaluate 3-month survival. Results: The median WL in the 6 months preceding the diagnosis was 6% (interquartile range, 0.0-12.9%). Patients with WL ≥ 5% had a median survival of 78 days, compared with 85 days for those with WL < 5% (p = 0.047). Survival at 3 months was 72% for the patients with WL ≥ 5% (p = 0.047), 61% for those with WL ≥ 10% (p < 0.001), and 45% for those with WL ≥ 15% (p < 0.001). In the multivariate analysis, the hazard ratio for risk of death was 4.51 (95% CI: 1.32-15.39) for the patients with WL ≥ 5%, 6.34 (95% CI: 2.31-17.40) for those with WL ≥ 10%, and 14.17 (95% CI: 5.06-39.65) for those with WL ≥ 15%. Conclusions: WL in the 6 months preceding the diagnosis of NSCLC is a relevant prognostic factor and appears to be directly proportional to the rate of survival at 3 months.
Collapse
Affiliation(s)
- Guilherme Watte
- . Programa de Pós-Graduação em Ciências Pneumológicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil.,. Department of Clinical Research and Radiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom.,. Programa de Pós-Graduação em Medicina e Ciências da Saúde, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Claudia Helena de Abreu Nunes
- . Programa de Pós-Graduação em Ciências Pneumológicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | | | - Matheus Zanon
- . Department of Clinical Research and Radiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom.,. Departamento de Medicina Clínica e Saúde Pública, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | - Stephan Philip Leonhardt Altmayer
- . Departamento de Medicina Clínica e Saúde Pública, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil.,. Programa de Pós-Graduação em Medicina e Ciências da Saúde, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Gabriel Sartori Pacini
- . Departamento de Medicina Clínica e Saúde Pública, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | - Marcelo Barros
- . Programa de Pós-Graduação em Medicina e Ciências da Saúde, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Ana Luiza Schneider Moreira
- . Departamento de Medicina Clínica e Saúde Pública, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | - Rafael José Vargas Alves
- . Programa de Pós-Graduação em Ciências Pneumológicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Alice de Medeiros Zelmanowicz
- . Departamento de Medicina Clínica e Saúde Pública, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | - Bashir Mnene Matata
- . Department of Clinical Research and Radiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Jose da Silva Moreira
- . Programa de Pós-Graduação em Ciências Pneumológicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| |
Collapse
|
5
|
Zhao HY, Zhou HY, Wang YT, Chen W, Qi SY, Cao JL, Li GH. Assessment on the Efficacy and Safety of Aidi Injection Combined with Vinorelbine and Cisplatin for Treatment of Advanced Nonsmall Cell Lung Cancer. Chin Med J (Engl) 2017; 129:723-30. [PMID: 26960377 PMCID: PMC4804420 DOI: 10.4103/0366-6999.178016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The aim of this study was to assess the efficacy and safety of vinorelbine and cisplatin (NP chemotherapy) alone or in combination with Aidi injection for the treatment of advanced nonsmall cell lung cancer (NSCLC). Methods: Pertinent publications were identified in PubMed, EMBASE, Cochrane Library, CNKI, CQVIP, and Wanfang databases, up to December 8, 2015. After quality assessment of all included randomized controlled trials evaluating Aidi injection combined with NP chemotherapy for the treatment of advanced NSCLC, a meta-analysis was performed by Review Manager 5.2 and STATA 12.0 for statistical analyses. Results: Twelve studies including 509 and 503 cases in the experimental and control groups, respectively, were finally analyzed. The meta-analysis revealed that when cisplatin dose ranging from 20 to 40 mg/m2, combination of Aidi injection and NP chemotherapy was statistically different compared with NP chemotherapy alone in enhancing efficiency (relative risk [RR] = 1.24, 95% confidence interval [CI] [1.05–1.47], P = 0.010) and reducing the incidence of Grade II or above nausea and vomiting (RR = 0.49, 95% CI [0.30–0.80], P = 0.005). Meanwhile, with cisplatin ranging from 80 to 120 mg/m2, no significant differences in efficiency (RR = 1.11, 95% CI [0.87–1.42], P = 0.390) and Grade II or above nausea and vomiting (RR = 0.88, 95% CI [0.71–1.10], P = 0.260) were obtained. In addition, Aidi injection combined with NP chemotherapy was superior to NP chemotherapy alone in improving the quality of life, alleviating Grade II or above leukopenia and thrombocytopenia. Conclusions: Aidi injection combined with NP chemotherapy can enhance efficiency, improve the quality of life, and decrease adverse effects in patients with advanced NSCLC.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Guo-Hui Li
- Department of Pharmacy, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China
| |
Collapse
|
6
|
Yu Y, Guan H, Xing LG, Xiang YB. Role of gross tumor volume in the prognosis of non-small cell lung cancer treated with 3D conformal radiotherapy: a meta-analysis. Clin Ther 2015; 37:2256-66. [PMID: 26293808 DOI: 10.1016/j.clinthera.2015.07.014] [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] [Received: 12/23/2014] [Revised: 07/15/2015] [Accepted: 07/16/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE Three-dimensional conformal radiotherapy (3D-CRT) has become widely applied in patients with non-small cell lung cancer (NSCLC), and gross tumor volume (GTV) is a reliable index for predicting prognosis in patients with NSCLC. This meta-analysis investigated the association between GTV and prognosis in patients with NSCLC after 3D-CRT. METHODS Electronic bibliographic databases were searched to identify articles related to NSCLC and 3D-CRT. The search results were carefully screened, using predetermined selection criteria, to select the most relevant studies. Newcastle-Ottawa Scale criteria were applied by 2 reviewers independently to evaluate the quality of the methodology of each included article., Based on GTV, each patient was assigned to either the study group (large GTV [≥112 cm(3)]) or the control group (small GTV [<112 cm(3)]), and the mean rates of overall survival (OS) and survival at 1, 3, and 5 years were calculated in each group. Summary hazard ratio (HR) with 95% CI was calculated. FINDINGS The data from 10 cohort studies were incorporated into the current meta-analysis (1473 patients; study group, 773; control group, 700). The OS in the study group was significantly less than that in the control group (HR = 1.52; 95% CI, 1.10-1.94; P < 0.01). The study and control groups also had significantly different survival rates at 1 year (HR = 1.27; 95% CI, 1.10-1.46, P = 0.01), 3 years (HR = 2.06; 95% CI, 1.63-2.61; P < 0.01), and 5 years (HR = 2.25; 95% CI, 1.63-3.10; P < 0.01). Findings from funnel plots and Egger tests of the OS and 3-year survival rate suggested no publication bias. With respect to the 1- and 5-year survival rates, however, the funnel plots and Egger tests demonstrated publication bias among the included studies. IMPLICATIONS The relatively small number of studies and small sample size, as well as the lack of a specific and standard method of defining small and large GTV, may have influenced the credibility and reliability of our results. The findings suggest that GTV influences prognosis in patients with NSCLC after 3D-CRT. However, further studies with larger sample sizes are needed to confirm our finding that a larger GTV is negatively associated with NSCLC prognosis after 3D-CRT.
Collapse
Affiliation(s)
- Yang Yu
- Department of Radiation Oncology, Shandong's Key Laboratory of Radiation Oncology
| | - Hui Guan
- Department of Radiation Oncology, Shandong's Key Laboratory of Radiation Oncology
| | - Li-Gang Xing
- Department of Oncology, Shandong Cancer Hospital and Institute, School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan.
| | - Yong-Bing Xiang
- Department of Oncology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| |
Collapse
|
7
|
Schild SE, Tan AD, Wampfler JA, Ross HJ, Yang P, Sloan JA. A new scoring system for predicting survival in patients with non-small cell lung cancer. Cancer Med 2015; 4:1334-43. [PMID: 26108458 PMCID: PMC4567018 DOI: 10.1002/cam4.479] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/24/2015] [Accepted: 04/27/2015] [Indexed: 12/19/2022] Open
Abstract
This analysis was performed to create a scoring system to estimate the survival of patients with non-small cell lung cancer (NSCLC). Data from 1274 NSCLC patients were analyzed to create and validate a scoring system. Univariate (UV) and multivariate (MV) Cox models were used to evaluate the prognostic importance of each baseline factor. Prognostic factors that were significant on both UV and MV analyses were used to develop the score. These included quality of life, age, performance status, primary tumor diameter, nodal status, distant metastases, and smoking cessation. The score for each factor was determined by dividing the 5-year survival rate (%) by 10 and summing these scores to form a total score. MV models and the score were validated using bootstrapping with 1000 iterations from the original samples. The score for each prognostic factor ranged from 1 to 7 points with higher scores reflective of better survival. Total scores (sum of the scores from each independent prognostic factor) of 32–37 correlated with a 5-year survival of 8.3% (95% CI = 0–17.1%), 38–43 correlated with a 5-year survival of 20% (95% CI = 13–27%), 44–47 correlated with a 5-year survival of 48.3% (95% CI = 41.5–55.2%), 48–49 correlated to a 5-year survival of 72.1% (95% CI = 65.6–78.6%), and 50–52 correlated to a 5-year survival of 84.7% (95% CI = 79.6–89.8%). The bootstrap method confirmed the reliability of the score. Prognostic factors significantly associated with survival on both UV and MV analyses were used to construct a valid scoring system that can be used to predict survival of NSCLC patients. Optimally, this score could be used when counseling patients, and designing future trials.
Collapse
Affiliation(s)
- Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, 5881 E. Mayo Blvd, Phoenix, Arizona, 85054
| | - Angelina D Tan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St S.W., Rochester, Minnesota, 55905
| | - Jason A Wampfler
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St S.W., Rochester, Minnesota, 55905
| | - Helen J Ross
- Division of Medical Oncology, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, Arizona, 85259
| | - Ping Yang
- Epidemiology-Cancer Research, 200 First St S.W., Rochester, Minnesota, 55905
| | - Jeff A Sloan
- Cancer Center Statistics, Mayo Clinic, 200 First St S.W., Rochester, Minnesota, 55905
| |
Collapse
|
8
|
Poor prognosis patients with inoperable locally advanced NSCLC and large tumors benefit from palliative chemoradiotherapy: a subset analysis from a randomized clinical phase III trial. J Thorac Oncol 2015; 9:825-33. [PMID: 24807158 PMCID: PMC4132042 DOI: 10.1097/jto.0000000000000184] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Poor prognosis patients with bulky stage III locally advanced non–small-cell lung cancer may not be offered concurrent chemoradiotherapy (CRT). Following a phase III trial concerning the effect of palliative CRT in inoperable poor prognosis patients, this analysis was performed to explore how tumor size influenced survival and health-related quality of life (HRQOL). Methods: A total of 188 poor prognosis patients recruited in a randomized clinical trial received four courses intravenous carboplatin day 1 and oral vinorelbine day 1 and 8, at 3-week intervals. The experimental arm (N = 94) received radiotherapy with fractionation 42 Gy/15, starting at the second chemotherapy course. This subset study compares outcomes in patients with tumors larger than 7 cm (N = 108) versus tumors 7 cm or smaller (N = 76). Results: Among those with tumors larger than 7 cm, the median overall survival in the chemotherapy versus CRT arm was 9.7 and 13.4 months, respectively (p = 0.001). The 1-year survival was 33% and 56%, respectively (p = 0.01). Except for a temporary decline during treatment, HRQOL was maintained in the CRT arm, regardless of tumor size. Among those who did not receive CRT, patients with tumors larger than 7 cm experienced a gradual decline in the HRQOL. The CRT group had significantly more esophagitis and hospitalizations because of side effects regardless of tumor size. Conclusion: In patients with poor prognosis and inoperable locally advanced non–small-cell lung cancer, large tumor size should not be considered a negative predictive factor. Except for performance status 2, patients with tumors larger than 7 cm apparently benefit from CRT.
Collapse
|
9
|
Russell K, Healy B, Pantarotto J, Laurie SA, MacRae R, Sabri E, Wheatley-Price P. Prognostic factors in the radical nonsurgical treatment of stage IIIB non-small-cell lung cancer. Clin Lung Cancer 2013; 15:237-43. [PMID: 24461300 DOI: 10.1016/j.cllc.2013.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/21/2013] [Accepted: 12/23/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Many patients diagnosed with stage IIIB (AJCC sixth edition; T4, N3, or both; no pleural effusion) non-small-cell lung cancer (NSCLC) are treated with curative intent, despite a low cure rate. Guidelines are required to help select patients for radical therapy so that the patients with little chance of cure may be spared the toxicities of aggressive treatment. A retrospective analysis was performed to investigate factors influencing outcomes in these patients. MATERIALS AND METHODS From 2002 to 2009, all cases of stage IIIB NSCLC from the authors' institution were identified. Patients treated with radical radiotherapy (minimum dose, 50 Gy), with or without chemotherapy, were included. Charts were reviewed for patient demographic data, baseline blood work, tumor factors, treatment factors, and hospitalizations. The primary outcome was overall survival (OS), measured from time of diagnosis. RESULTS Of 238 patients identified, 184 eligible cases were reviewed. The median follow-up for all patients was 17.2 months (range, 1.7-237.1). The median progression-free survival was 10.8 months (95% CI, 9.6-12.4). Median survival was 17.9 months, and OS was 68%, 42%, and 28% at 1, 2, and 3 years, respectively. In multivariate analysis, female gender (hazard ratio [HR], 0.58; 95% CI, 0.37-0.88; P = .0013), ≤ 5% weight loss (HR, 0.64; 95% CI, 0.43-0.93; P = .01), and absence of N3 disease (HR, 0.64; 95% CI, 0.42-0.96; P = .03) were associated with significantly longer survival. CONCLUSION OS was significantly longer in women, in patients with ≤ 5% weight loss, and in those without N3 disease. Good patient selection remains important in the radical treatment of stage IIIB NSCLC.
Collapse
Affiliation(s)
- Kent Russell
- Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Healy
- Division of Medical Oncology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jason Pantarotto
- Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Scott A Laurie
- Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert MacRae
- Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Elham Sabri
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Wheatley-Price
- Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
| |
Collapse
|
10
|
Jeremic B. Radiochemotherapy as the standard treatment for both elderly and non-elderly fit patients with locally advanced (stage III) nonsmall cell lung cancer. Lung Cancer 2013; 82:176. [PMID: 23953758 DOI: 10.1016/j.lungcan.2013.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Branislav Jeremic
- Division of Radiation Oncology, Stellenbosch University, The Tygerberg Hospital, Cape Town, South Africa.
| |
Collapse
|
11
|
Jeremić B, Miličić B, Milisavljević S. Radiotherapy Alone vs. Radiochemotherapy in Patients With Favorable Prognosis of Clinical Stage IIIA Non–Small-Cell Lung Cancer. Clin Lung Cancer 2013; 14:172-80. [DOI: 10.1016/j.cllc.2012.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 09/29/2012] [Accepted: 10/08/2012] [Indexed: 12/28/2022]
|
12
|
Senthi S, Griffioen GHMJ, van Sörnsen de Koste JR, Slotman BJ, Senan S. Comparing rigid and deformable dose registration for high dose thoracic re-irradiation. Radiother Oncol 2013; 106:323-6. [PMID: 23453542 DOI: 10.1016/j.radonc.2013.01.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 11/30/2012] [Accepted: 01/10/2013] [Indexed: 12/25/2022]
Abstract
For patients with locally-recurrent lung cancer, high dose thoracic re-irradiation can prolong survival. Deformable image registration improves the accuracy with which initial treatments are accounted for compared to rigid image registration. Using deformable image registration will improve correlative toxicity data, and may reduce toxicity for selected patients undergoing re-irradiation.
Collapse
Affiliation(s)
- Sashendra Senthi
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
13
|
Zarogoulidis P, Kerenidi T, Huang H, Kontakiotis T, Tremma O, Porpodis K, Kalianos A, Rapti A, Foroulis C, Zissimopoulos A, Courcoutsakis N, Zarogoulidis K. Six minute walking test and carbon monoxide diffusing capacity for non-small cell lung cancer: easy performed tests in every day practice. J Thorac Dis 2013. [PMID: 23205280 DOI: 10.3978/j.issn.2072-1439.2012.08.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Several studies have demonstrated that reduced lung function is a significant risk factor for lung cancer and increased surgical risk in patients with operable stages of lung cancer. The aim of the study was to perform pulmonary function tests and investigate which is a favorable respiratory function test for overall survival between lung cancer stages. METHODS Lung function tests were performed to lung cancer patients with non-small cell lung cancer of stage I, II, III and IV (241 patients in total). They had the last follow-up consecutively between December 2006 and July 2008. The staging was decided according to the sixth edition of TNM classification of NSCLC. The Forced Expiratory Volume in 1sec (FEV1), Forced Vital Capacity (FVC) and Carbon Monoxide Diffusing Capacity (DLCO) were measured according to American Thoracic Society/European Respiratory Society guidelines. The 6 Minute Walking Test (6MWT) was measured according to the American Thoracic Society. RESULTS There was a significant association of the DLCO upon diagnosis and overall survival for stage II (P<0.007) and IV (P<0.003). Furthermore, there was a significant association between 6MWT and overall survival for stage III (P<0.001) and stage IV (P<0.010). CONCLUSIONS The significance for each lung function test is different among the stages of NSCLC. DLCO and 6MWT upon admission are the most valuable prognostic factors for overall survival of NSCLC.
Collapse
Affiliation(s)
- Paul Zarogoulidis
- Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Jeremić B, Miličić B, Milisavljević S. Radiotherapy alone versus radiochemotherapy in patients with stage IIIA adenocarcinoma (ADC) of the lung. Clin Transl Oncol 2013; 15:747-53. [PMID: 23359170 DOI: 10.1007/s12094-012-1000-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 12/28/2012] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the outcome of radiotherapy (RT) versus radiochemotherapy (RT-CHT) in patients with locally advanced (stage III) inoperable adenocarcinoma of the lung. PATIENTS AND METHODS 146 patients with these characteristics were among 600 patients enrolled into five prospective trials and were treated with either hyperfractionated (Hfx) RT (64.8 and 69.6 Gy using 1.2 Gy bid) alone (n = 33) or with Hfx RT (64.8 and 69.6 Gy using 1.2 Gy bid and 67.6 Gy using 1.3 Gy bid) and concurrent carboplatin-etoposide or paclitaxel-carboplatin (n = 113). RESULTS The median times and 5-year overall survival (OS), local progression-free survival (LPFS) and the distant metastasis-free survival (DMFS) rates for all 146 patients were 17, 20 and 20 months, respectively, and 15, 26 and 33, respectively. RT-CHT was superior to RT alone in terms of both OS (MST 19 vs. 12 months, respectively, 5-year OS 18 vs. 6 %, respectively; p = 0.003) and LPFS (MTLP 21 vs. 15 months, respectively, 5-year LPFS 28 vs. 0 %; p = 0.06), but not the DMFS (p = 0.43). In all 146 patients, the most frequent acute high-grade toxicity was esophageal, bronchopulmonary and hematological (each 12 %), while the most frequent late high-grade toxicity was bronchopulmonary (4 %) and esophageal (3 %). RT-CHT caused significantly more frequent acute high-grade (>3) esophageal (15 %), and hematological (15 %), while late high-grade toxicity was similar between RT and RT-CHT groups of patients. CONCLUSION RT-CHT achieved excellent results (MST 19 months, 5-year survival 18 %) in this patient population accompanied with low toxicity, comparing favorably to results of other similar studies.
Collapse
Affiliation(s)
- B Jeremić
- Department of Oncology, University Hospital, Kragujevac, Serbia.
| | | | | |
Collapse
|
15
|
Serracino HS, Franklin WA, Aisner DL. Molecular Pathology of Non-Small Cell Lung Cancer. Surg Pathol Clin 2012; 5:903-18. [PMID: 26838508 DOI: 10.1016/j.path.2012.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This review offers an overview of the molecular pathology of lung cancer, with a focus on analyses that are most commonly part of the current clinical testing paradigm. Molecular testing of lung cancer has proved integral to the success of new targeted therapies, and their use is now commonplace in treatment selection. Traditional pathologic evaluation, however, plays a major role in these advances and serves an equally critical role to aid in determining optimal therapy.
Collapse
Affiliation(s)
- Hilary S Serracino
- Department of Pathology, University of Colorado Denver, 12631 E. 17th Avenue, Mail Stop B216, Aurora, CO 80045, USA
| | - Wilbur A Franklin
- Department of Pathology, University of Colorado Denver, 12631 E. 17th Avenue, Mail Stop B216, Aurora, CO 80045, USA
| | - Dara L Aisner
- Department of Pathology, University of Colorado Denver, 12631 E. 17th Avenue, Mail Stop B216, Aurora, CO 80045, USA.
| |
Collapse
|
16
|
Toxicity of concurrent hyperfractionated radiation therapy and chemotherapy in locally advanced (stage III) non-small cell lung cancer (NSCLC): single institution experience in 600 patients. Clin Transl Oncol 2012; 14:613-8. [DOI: 10.1007/s12094-012-0848-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 11/14/2011] [Indexed: 10/28/2022]
|
17
|
Gupta SC, Hevia D, Patchva S, Park B, Koh W, Aggarwal BB. Upsides and downsides of reactive oxygen species for cancer: the roles of reactive oxygen species in tumorigenesis, prevention, and therapy. Antioxid Redox Signal 2012; 16:1295-322. [PMID: 22117137 PMCID: PMC3324815 DOI: 10.1089/ars.2011.4414] [Citation(s) in RCA: 505] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
SIGNIFICANCE Extensive research during the last quarter century has revealed that reactive oxygen species (ROS) produced in the body, primarily by the mitochondria, play a major role in various cell-signaling pathways. Most risk factors associated with chronic diseases (e.g., cancer), such as stress, tobacco, environmental pollutants, radiation, viral infection, diet, and bacterial infection, interact with cells through the generation of ROS. RECENT ADVANCES ROS, in turn, activate various transcription factors (e.g., nuclear factor kappa-light-chain-enhancer of activated B cells [NF-κB], activator protein-1, hypoxia-inducible factor-1α, and signal transducer and activator of transcription 3), resulting in the expression of proteins that control inflammation, cellular transformation, tumor cell survival, tumor cell proliferation and invasion, angiogenesis, and metastasis. Paradoxically, ROS also control the expression of various tumor suppressor genes (p53, Rb, and PTEN). Similarly, γ-radiation and various chemotherapeutic agents used to treat cancer mediate their effects through the production of ROS. Interestingly, ROS have also been implicated in the chemopreventive and anti-tumor action of nutraceuticals derived from fruits, vegetables, spices, and other natural products used in traditional medicine. CRITICAL ISSUES These statements suggest both "upside" (cancer-suppressing) and "downside" (cancer-promoting) actions of the ROS. Thus, similar to tumor necrosis factor-α, inflammation, and NF-κB, ROS act as a double-edged sword. This paradox provides a great challenge for researchers whose aim is to exploit ROS stress for the development of cancer therapies. FUTURE DIRECTIONS the various mechanisms by which ROS mediate paradoxical effects are discussed in this article. The outstanding questions and future directions raised by our current understanding are discussed.
Collapse
Affiliation(s)
- Subash C Gupta
- Cytokine Research Laboratory, Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | | | | | | |
Collapse
|
18
|
Sánchez-Lara K, Turcott JG, Juárez E, Guevara P, Núñez-Valencia C, Oñate-Ocaña LF, Flores D, Arrieta O. Association of Nutrition Parameters Including Bioelectrical Impedance and Systemic Inflammatory Response With Quality of Life and Prognosis in Patients With Advanced Non-Small-Cell Lung Cancer: A Prospective Study. Nutr Cancer 2012; 64:526-34. [DOI: 10.1080/01635581.2012.668744] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
19
|
Nieder C, Pawinski A, Dalhaug A, Andratschke N. A review of clinical trials of cetuximab combined with radiotherapy for non-small cell lung cancer. Radiat Oncol 2012; 7:3. [PMID: 22236606 PMCID: PMC3269364 DOI: 10.1186/1748-717x-7-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 01/11/2012] [Indexed: 12/25/2022] Open
Abstract
Treatment of non-small cell lung cancer (NSCLC) is challenging in many ways. One of the problems is disappointing local control rates in larger volume disease. Moreover, the likelihood of both nodal and distant spread increases with primary tumour (T-) stage. Many patients are elderly and have considerable comorbidity. Therefore, aggressive combined modality treatment might be contraindicated or poorly tolerated. In many cases with larger tumour volume, sufficiently high radiation doses can not be administered because the tolerance of surrounding normal tissues must be respected. Under such circumstances, simultaneous administration of radiosensitizing agents, which increase tumour cell kill, might improve the therapeutic ratio. If such agents have a favourable toxicity profile, even elderly patients might tolerate concomitant treatment. Based on sound preclinical evidence, several relatively small studies have examined radiotherapy (RT) with cetuximab in stage III NSCLC. Three different strategies were pursued: 1) RT plus cetuximab (2 studies), 2) induction chemotherapy followed by RT plus cetuximab (2 studies) and 3) concomitant RT and chemotherapy plus cetuximab (2 studies). Radiation doses were limited to 60-70 Gy. As a result of study design, in particular lack of randomised comparison between cetuximab and no cetuximab, the efficacy results are difficult to interpret. However, strategy 1) and 3) appear more promising than induction chemotherapy followed by RT and cetuximab. Toxicity and adverse events were more common when concomitant chemotherapy was given. Nevertheless, combined treatment appears feasible. The role of consolidation cetuximab after RT is uncertain. A large randomised phase III study of combined RT, chemotherapy and cetuximab has been initiated.
Collapse
Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.
| | | | | | | |
Collapse
|