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Siddiqui Z, Falkson C, Hopman W, Mahmud A. High-dose-rate brachytherapy for airway malignancy a single institution experience. Brachytherapy 2023; 22:542-546. [PMID: 37217415 DOI: 10.1016/j.brachy.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 03/11/2023] [Accepted: 04/06/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE To evaluate clinical outcomes of endobronchial malignancy treated using high-dose-rate endobronchial brachytherapy (HDREB). METHODS AND MATERIALS A retrospective chart review was conducted for all patients treated with HDREB for malignant airway disease between 2010 and 2019 at a single institution. Most patients had a prescription of 14 Gy in two fractions given a week apart. The Wilcoxon signed rank test and paired samples t test were used to compare changes in mMRC dyspnea scale prior to and after brachytherapy at first followup appointment. Toxicity data were collected for dyspnea, hemoptysis, dysphagia, and cough. RESULTS A total of 58 patients were identified. Most (84.5%) had primary lung cancer with advanced cancers, stage III or IV (86%). Eight were treated while admitted in the ICU. Previous external beam radiotherapy (EBRT) was received by 52%. An improvement in dyspnea was seen in 72%, with an mMRC dyspnoea scale score improvement of 1.13 points (p < 0.001). Most (22, 88%) had an improvement in hemoptysis and 18 out of 37 (48.6%) had an improvement in cough. Grade four to five events occurred in 8 (13%) at the median time of 2.5 months from brachytherapy. Twenty-two patients (38%) had complete obstruction of the airway treated. Median progression free survival was 6.5 months and median survival was 10 months. CONCLUSIONS We report a significant symptomatic benefit among patients receiving brachytherapy with endobronchial malignancy, with rates of treatment related toxicities similar to prior studies. Our study identified new subgroups of patients, ICU patients & those with complete obstruction, who benefited from HDREB.
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Affiliation(s)
- Zain Siddiqui
- Department of Oncology, Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Conrad Falkson
- Department of Oncology, Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Wilma Hopman
- Depratment of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Aamer Mahmud
- Department of Oncology, Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada.
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Das A, Giuliani M, Bezjak A. Radiotherapy for Lung Metastases: Conventional to Stereotactic Body Radiation Therapy. Semin Radiat Oncol 2023; 33:172-180. [PMID: 36990634 DOI: 10.1016/j.semradonc.2022.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
The lung parenchyma and adjacent tissues are one of the most common sites of metastatic disease. Traditionally, the approach to treatment of a patient with lung metastases has been with systemic therapy, with radiotherapy being reserved for palliative management of symptomatic disease. The concept of oligo metastatic disease has paved the way for more radical treatment options, administered either alone or as local consolidative therapy in addition to systemic treatment. The modern-day management of lung metastases is guided by a number of factors, including the number of lung metastases, extra-thoracic disease status, overall performance status, and life expectancy, which all help determine the goals of care. Stereotactic body radiotherapy (SBRT) has emerged as a safe and effective method in locally controlling lung metastases, in the oligo metastatic or oligo-recurrent setting. This article outlines the role of radiotherapy in multimodality management of lung metastases.
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Sur R, Pond G, Falkson C, Pan M, Wright J, Bezjak A, Dagnault A, Yu E, Almahmudi M, Puksa S, Gopaul D, Tsakiridis T, Swaminath A, Ellis P, Whelan T. BRACHY: A Randomized Trial to Evaluate Symptom Improvement in Advanced Non-Small Cell Lung Cancer Treated With External Beam Radiation With or Without High-Dose-Rate Intraluminal Brachytherapy. Int J Radiat Oncol Biol Phys 2023:S0360-3016(22)03703-8. [PMID: 36610615 DOI: 10.1016/j.ijrobp.2022.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Uncontrolled studies suggest that the addition of high-dose-rate intraluminal brachytherapy (HDRIB) to external beam radiation therapy (EBRT) may improve palliation for patients with advanced non-small cell lung cancer (NSCLC). The purpose of this study was to evaluate the potential clinical benefit of adding HDRIB to EBRT in a multicenter randomized trial. METHODS AND MATERIALS Patients with symptomatic stage III or IV NSCLC with endobronchial disease were randomized to EBRT (20 Gy in 5 daily fractions over 1 week or 30 Gy in 10 daily fractions over 2 weeks) or the same EBRT plus HDRIB (14 Gy in 2 fractions separated by 1 week). The primary outcome was the proportion of patients who achieved symptomatic improvement in patient-reported overall lung cancer symptoms on the Lung Cancer Symptom Scale (LCSS) at 6 weeks after randomization. Secondary outcomes included improvement in individual symptoms, symptom-progression-free survival, overall survival, and toxicity. The planned sample size was 250 patients based on detection of symptomatic improvement from 40% to 60% with a 2-sided α of .05 and 80% power. RESULTS A total of 134 patients were randomized over 4.5 years: 67 to each arm. The study closed early owing to slow accrual. The mean age was 69.8 years, and 67% of patients had metastatic disease. At 6 weeks, 19 patients (28.4%) in the EBRT arm and 20 patients (29.9%) in the EBRT plus HDRIB arm experienced an improvement in lung cancer symptoms (P = .84). When limited to patients who completed the LCSS, percentages were 40.4% versus 47.6%, respectively (P = .49). Between group differences in mean change scores (0.3-0.5 standard deviations) in favor of EBRT plus HDRIB were observed for overall symptoms, but only hemoptysis was significantly improved (P = .03). No significant differences were observed in progression-free or overall survival. Grade 3/4 toxicities were similar between groups. CONCLUSIONS Small to moderate improvements were seen in symptom relief with the combined therapy, but they did not reach statistical significance. Further research is necessary before recommending HDRIB in addition to EBRT for palliation of lung cancer symptoms.
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Affiliation(s)
- Ranjan Sur
- Department of Oncology, McMaster University and Juravinski Cancer Centre at Hamilton Health Sciences, Division of Radiation Oncology, Hamilton, Ontario, Canada
| | - Gregory Pond
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Conrad Falkson
- Department of Radiation Oncology, Queen's University, Kingston, Ontario, Canada
| | - Ming Pan
- Windsor Regional Hospital Cancer Program, Windsor, Ontario, Canada
| | - James Wright
- Department of Oncology, McMaster University and Juravinski Cancer Centre at Hamilton Health Sciences, Division of Radiation Oncology, Hamilton, Ontario, Canada
| | - Andrea Bezjak
- Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada
| | - Anne Dagnault
- Department of Radiation Oncology, CHU de Quebec and Universite Laval, Québec City, Québec, Canada
| | - Edward Yu
- Department of Radiation Oncology, Western University, London Regional Cancer Program, London, Ontario, Canada
| | - Maha Almahmudi
- Department of Radiation Oncology, BC Cancer Agency, Abbotsford, British Columbia, Canada
| | - Serge Puksa
- Department of Medicine, McMaster University, and Juravinski Cancer Centre at Hamilton Health Sciences, Division of Respirology, Hamilton, Ontario, Canada
| | - Darin Gopaul
- Department of Radiation Oncology, Grand River Regional Cancer Centre, Kitchener, Ontario, Canada
| | - Theos Tsakiridis
- Department of Oncology, McMaster University and Juravinski Cancer Centre at Hamilton Health Sciences, Division of Radiation Oncology, Hamilton, Ontario, Canada
| | - Anand Swaminath
- Department of Oncology, McMaster University and Juravinski Cancer Centre at Hamilton Health Sciences, Division of Radiation Oncology, Hamilton, Ontario, Canada
| | - Peter Ellis
- Department of Oncology, McMaster University, and Division of Medical Oncology, Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Timothy Whelan
- Department of Oncology, McMaster University and Juravinski Cancer Centre at Hamilton Health Sciences, Division of Radiation Oncology, Hamilton, Ontario, Canada.
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Johnson AG, Soike MH, Farris MK, Hughes RT. Efficacy and Survival after Palliative Radiotherapy for Malignant Pulmonary Obstruction. J Palliat Med 2021; 25:46-53. [PMID: 34255568 DOI: 10.1089/jpm.2021.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The purpose of this study was to determine the efficacy of palliative radiotherapy (PRT) for patients with pulmonary obstruction from advanced malignancy and identify factors associated with lung re-expansion and survival. Materials and Methods: We reviewed all patients treated with PRT for malignant pulmonary obstruction (n = 108) at our institution between 2010 and 2018. Radiographic evidence of lung re-expansion was determined through review of follow-up CT or chest X-ray. Cumulative incidence of re-expansion and overall survival (OS) were estimated using competing risk methodology. Clinical characteristics were evaluated for association with re-expansion, OS, and early mortality. Treatment time to remaining life ratio (TT:RL) was evaluated as a novel metric for palliative treatment. Results: Eighty-one percent of patients had collapse of an entire lung lobe, 46% had Eastern Cooperative Oncology Group (ECOG) performance status 3-4, and 64% were inpatient at consultation. Eighty-four patients had follow-up imaging available, and 25 (23%) of all patients had lung re-expansion at median time of 35 days. Rates of death without re-expansion were 38% and 65% at 30 and 90 days, respectively. Median OS was 56 days. Death within 30 days of PRT occurred in 38%. Inpatients and larger tumors trended toward lower rates of re-expansion. Notable factors associated with OS were re-expansion, nonlung histology, tumor size, and performance status. Median TT:RL was 0.11 and significantly higher for subgroups: ECOG 3-4 (0.19), inpatients (0.16), patients with larger tumors (0.14), those unfit for systemic therapy (0.17), and with 10-fraction PRT (0.14). Conclusion: One-fourth of patients experienced re-expansion after PRT for malignant pulmonary obstruction. Survival is poor and a significant proportion of remaining life may be spent on treatment. Careful consideration of these clinical factors is recommended when considering PRT fractionation.
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Affiliation(s)
- Adam G Johnson
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael H Soike
- Hazelrig-Salter Radiation Oncology Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael K Farris
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Jumeau R, Vilotte F, Durham AD, Ozsahin EM. Current landscape of palliative radiotherapy for non-small-cell lung cancer. Transl Lung Cancer Res 2019; 8:S192-S201. [PMID: 31673524 DOI: 10.21037/tlcr.2019.08.10] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Radiotherapy (RT) is a cornerstone in the management of advanced stage III and stage IV non-small-cell lung cancer (NSCLC) patients. Despite international guidelines, clinical practice remains heterogeneous. Additionally, the advent of stereotactic ablative RT (SABR) and new systemic treatments such as immunotherapy have shaken up dogmas in the approach of these patients. This review will focus on palliative thoracic RT for NSCLC but will also discuss the role of stereotactic radiotherapy, endobronchial brachytherapy (EBB), the interest of concomitant treatments (chemotherapy and immunotherapy), and the role of RT in lung cancer emergencies with palliative intent.
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Affiliation(s)
- Raphael Jumeau
- Department of Radiation-Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Florent Vilotte
- Department of Radiation-Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - André-Dante Durham
- Department of Radiation-Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Esat-Mahmut Ozsahin
- Department of Radiation-Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Zhang R, Li P, Li Q, Qiao Y, Xu T, Ruan P, Song Q, Fu Z. Radiotherapy improves the survival of patients with stage IV NSCLC: A propensity score matched analysis of the SEER database. Cancer Med 2018; 7:5015-5026. [PMID: 30239162 PMCID: PMC6198236 DOI: 10.1002/cam4.1776] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/17/2018] [Accepted: 08/18/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The survival advantage of radiotherapy (RT) for patients with stage IV non-small cell lung cancer (NSCLC) has not been adequately evaluated. METHODS We analyzed stage IV NSCLC patients enrolled from the Surveillance, Epidemiology, and End Results (SEER) registry through January 2010 to December 2012. Propensity score (PS) analysis with 1:1 nearest neighbor matching method was used to ensure well-balanced characteristics of all comparison groups by histological types and metastatic sites. Kaplan-Meier and Cox proportional hazardous model were used to evaluate the overall survival (OS), cancer-specific survival (CSS), and corresponding 95% confidence interval (95%CI). RESULTS Generally speaking, there was a trend toward improved OS and CSS for using RT to stage IV NSCLC patients for any metastatic sites and for any histological types except adenocarcinoma (AD). Radiotherapy significantly improved the survival of NSCLC patients with metastasis to brain (P < 0.001), especially for AD (P < 0.001). For stage IV lung cancer patients with squamous cell carcinoma (SQC), RT for any metastatic sites could universally improve the OS (P < 0.001) and CSS (P < 0.001). In particular, RT was also associated with improving OS (P < 0.001) and CSS (P = 0.012) for stage IV patients with metastases of two or more sites, ie, polymetastatic disease. Furthermore, for those stage IV SQC patients without metastasis, RT, most likely to the primary site, also significantly improved the survival (P < 0.001). CONCLUSIONS The results support that RT might improve the survival of patients with metastatic NSCLC in a PS-matched patient cohort from the large SEER database. It is prudent to carefully select patients for RT in metastatic NSCLC.
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Affiliation(s)
- Rui Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ping Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qin Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yunfeng Qiao
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tangpeng Xu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Peng Ruan
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qibin Song
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhenming Fu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
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Shuja M, Elghazaly AA, Iqbal A, Mohamed R, Marie A, Tunio MA, Aly MM, Balbaid A, Asiri M. Efficacy of 8 Gy Single Fraction Palliative Radiation Therapy in Painful Bone Metastases: A Single Institution Experience. Cureus 2018. [PMID: 29541557 PMCID: PMC5843385 DOI: 10.7759/cureus.2036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Bone metastasis (BM) is a major complication of many solid tumors like breast, prostate, lung and renal cancers. BM leads to serious sequelae of pain, fractures, spinal cord compression and hypercalcemia. Radiotherapy has an established role in relieving pain caused by BM. Worldwide different radiotherapy schedules are being used for BM. The aim of this study is to determine the efficacy of single fraction palliative radiotherapy for painful bone metastases. Methods Between April 2014 and April 2017, single fraction radiotherapy was used to treat 73 patients in our institution. They had pathologically proven breast, prostate, lung or renal cancer with radiological evidence of bone metastases. There were 39 males (53%) and 34 females (47%). The median age was 58 years (range 33-87 years). 39% patients (n = 28) had breast cancer, 35% had prostate cancer (n = 26), 23% had lung cancer (n = 17), and 3% had renal cancer (n = 2). On presentation, all the patients had a pain score of more than five on Brief Pain Inventory (BPI). Results Response assessment to pain after three months from single fraction radiotherapy was found to be complete response (CR) in 23% patients (n = 17), partial response (PR) in 38% patients (n = 28), stable disease (SD) in 26% patients (n = 19) and progressive disease (PD) in 12% patients (n = 9). The overall efficacy of treatment was 62%, with CR 23% and PR 38%. Pre-treatment mean pain score was 8.15 compared to 4.68 post-treatment (p < 0.001). Conclusions Single fraction palliative radiotherapy of 8 Gy showed significant efficacy in painful bone metastases in our setting and merits further investigation in our population.
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Affiliation(s)
- Muhammad Shuja
- Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Asif Iqbal
- Medical Physics Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Reham Mohamed
- Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Amal Marie
- Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mutahir A Tunio
- Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Moamen M Aly
- Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ali Balbaid
- Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mushabbab Asiri
- Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
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Støchkel Frank M, Schou Nørøxe D, Nygård L, Fredberg Persson G. Fractionated palliative thoracic radiotherapy in non-small cell lung cancer - futile or worth-while? BMC Palliat Care 2018; 17:15. [PMID: 29304789 PMCID: PMC5756366 DOI: 10.1186/s12904-017-0270-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 12/28/2017] [Indexed: 12/25/2022] Open
Abstract
Background Palliative thoracic radiotherapy (PTR) can relieve symptoms originating from intra-thoracic disease. The optimal timing and fractionation of PTR is unknown. Time to effect is 2 months. The primary aim of this retrospective study was to investigate survival after PTR, hypothesizing that a significant number of patients received futile fractionated PTR. The secondary aim was to find prognostic factors to guide treatment decisions. Methods Patients with non-small-cell lung cancer (NSCLC) planned for PTR in the period of 2010-2011 at the University Hospital of Copenhagen were included. We noted pathology, tumor, node and metastasis (TNM) classification of malignant tumors, stage, indication, start date, schedule for PTR, completed y/n, performance status (PS) and time of death. Analyses were performed as an intention-to-treat using Cox regression, Fishers exact test and Kaplan Meier. Results A total of 159 patients were included. Median overall survival (OS) was 4.2 months. Sixteen patients (10%) did either not begin or finish PTR. Of these, eight (5%) died prior to or during PTR. Of the 151 patients receiving PTR, sixteen patients (11%) died within 14 days, thirty-three (22%) within 30 days and fifty (33%) within 2 months. PS 0-1 and squamous cell carcinoma were correlated with a better survival. Conclusions Our study show that a significant number of patients who received PTR died before they could achieve optimal effect of the treatment. PS and histology were significant prognostic factors favoring PS 0-1 and squamous cell carcinoma. Based on our study, we suggest that patients with PS 0-1 should be considered for fractionated PTR whereas patients with PS ≥ 2 should be considered for high dose single fraction only or supportive palliative care. Electronic supplementary material The online version of this article (10.1186/s12904-017-0270-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Malene Støchkel Frank
- Department of Oncology, Finsen Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Dorte Schou Nørøxe
- Department of Oncology, Finsen Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Lotte Nygård
- Department of Oncology, Finsen Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Gitte Fredberg Persson
- Department of Oncology, Finsen Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Nieder C, Tollali T, Yobuta R, Reigstad A, Flatoy LR, Pawinski A. Palliative Thoracic Radiotherapy for Lung Cancer: What Is the Impact of Total Radiation Dose on Survival? J Clin Med Res 2017; 9:482-487. [PMID: 28496548 PMCID: PMC5412521 DOI: 10.14740/jocmr2980w] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2017] [Indexed: 12/25/2022] Open
Abstract
Background Effective symptom palliation can be achieved with low-dose palliative thoracic radiotherapy. In several studies, median survival was not improved with higher doses of radiation. More controversy exists regarding the impact of higher doses on 1- and 2-year survival rates. Therefore, a comparison of survival outcomes after radiotherapy with different biologically equivalent doses (equivalent dose in 2-Gy fractions, EQD2) was performed. Methods This was a retrospective single-institution study of 232 patients with small or non-small cell lung cancer. Most commonly 2 fractions of 8.5 Gy were prescribed (34%), followed by 10 fractions of 3 Gy or equivalent regimens (30%, EQD2 circa 33 Gy). The highest EQD2 consisted of 45 Gy. Intention-to-treat analyses were performed. Results Survival was significantly shorter with regimens of intended EQD2 < 33 Gy, e.g., 2 fractions of 8.5 Gy (median 2.5 months compared to 5.0 and 7.5 months with EQD2 of circa 33 and 45 Gy, respectively). The 2-year survival rates were 0%, 7% and 11%, respectively. In 128 prognostically favorable patients, median survival was comparable for the three different dose levels (6 - 8.3 months). The 2-year survival rates were 0%, 10%, and 13%, respectively (not statistically significant). Conclusion Although most of the observed survival differences diminished after exclusion of poor prognosis patients with reduced performance status and/or progressive extrathoracic disease, a slight increase in 2-year survival rates with higher EQD2 cannot be excluded. Because of relatively small improvements, a confirmatory randomized trial in this subgroup would have to include a large number of patients.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, Bodo, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromso, Tromso, Norway
| | - Terje Tollali
- Department of Pulmonology, Nordland Hospital Trust, Bodo, Norway
| | - Rosalba Yobuta
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, Bodo, Norway
| | - Anne Reigstad
- Department of Pulmonology, Nordland Hospital Trust, Bodo, Norway
| | - Liv Randi Flatoy
- Department of Pulmonology, Nordland Hospital Trust, Bodo, Norway
| | - Adam Pawinski
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, Bodo, Norway
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10
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Koshy M, Malik R, Mahmood U, Husain Z, Weichselbaum RR, Sher DJ. Prevalence and Predictors of Inappropriate Delivery of Palliative Thoracic Radiotherapy for Metastatic Lung Cancer. J Natl Cancer Inst 2015; 107:djv278. [PMID: 26424779 PMCID: PMC4862415 DOI: 10.1093/jnci/djv278] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/08/2015] [Accepted: 09/01/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND High-level evidence has established well-recognized standard treatment regimens for patients undergoing palliative chest radiotherapy (RT) for stage IV non-small cell lung cancer (NSCLC), including treating with fewer than 15 fractions of RT, and not delivering concurrent chemoradiation (CRT) because of its increased toxicity and limited efficacy in the palliative setting. METHODS The study included patients in the National Cancer Database from 2004 to 2012 with stage IV lung cancer who received palliative chest radiation therapy. Logistic regression was performed to determine predictors of standard vs nonstandard regimens (>15 fractions or CRT). All statistical tests were two-sided. RESULTS There were 46 803 patients in the analysis and 49% received radiotherapy for longer than 15 fractions, and 28% received greater than 25 fractions. Approximately 19% received CRT. The strongest independent predictors of long-course RT were private insurance (odds ratio [OR] = 1.40 vs uninsured, 95% confidence interval [CI] = 1.28 to 1.53) and treatment in community cancer programs (OR = 1.49, 95% CI = 1.38 to 1.58) compared with academic research programs. The strongest factors that predicted for concurrent chemoradiotherapy were private insurance (OR = 1.38 95% CI = 1.23 to 1.54) compared with uninsured patients and treatment in community cancer programs (OR = 1.44, 95% CI = 1.33 to 1.56) compared with academic programs. CONCLUSIONS Approximately half of all patients with metastatic lung cancer received a higher number of radiation fractions than recommended. Patients with private insurance and treated in community cancer centers were more likely to receive longer courses of RT or CRT. This demonstrates that a substantial number of patients requiring palliative thoracic radiotherapy are overtreated and further work is necessary to ensure these patients are treated according to evidenced-based guidelines.
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Affiliation(s)
- Matthew Koshy
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL (MK, RRW); Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL (MK, RM, RRW); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (UM); Department of Radiation Oncology, Yale University, New Haven, CT (ZH); Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (DJS).
| | - Renuka Malik
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL (MK, RRW); Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL (MK, RM, RRW); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (UM); Department of Radiation Oncology, Yale University, New Haven, CT (ZH); Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (DJS)
| | - Usama Mahmood
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL (MK, RRW); Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL (MK, RM, RRW); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (UM); Department of Radiation Oncology, Yale University, New Haven, CT (ZH); Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (DJS)
| | - Zain Husain
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL (MK, RRW); Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL (MK, RM, RRW); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (UM); Department of Radiation Oncology, Yale University, New Haven, CT (ZH); Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (DJS)
| | - Ralph R Weichselbaum
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL (MK, RRW); Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL (MK, RM, RRW); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (UM); Department of Radiation Oncology, Yale University, New Haven, CT (ZH); Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (DJS)
| | - David J Sher
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL (MK, RRW); Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL (MK, RM, RRW); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (UM); Department of Radiation Oncology, Yale University, New Haven, CT (ZH); Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (DJS)
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Stewart A, Parashar B, Patel M, O'Farrell D, Biagioli M, Devlin P, Mutyala S. American Brachytherapy Society consensus guidelines for thoracic brachytherapy for lung cancer. Brachytherapy 2015; 15:1-11. [PMID: 26561277 DOI: 10.1016/j.brachy.2015.09.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 08/28/2015] [Accepted: 09/02/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To update brachytherapy recommendations for pretreatment evaluation, treatment, and dosimetric issues for thoracic brachytherapy for lung cancer. METHODS AND MATERIALS Members of the American Brachytherapy Society with expertise in thoracic brachytherapy updated recommendations for thoracic brachytherapy based on literature review and clinical experience. RESULTS The American Brachytherapy Society consensus guidelines recommend the use of endobronchial brachytherapy for disease palliation in patients with central obstructing lesions, particularly in patients who have previously received external beam radiotherapy. The use of interstitial implants after incomplete resection may improve outcomes and provide enhanced palliation. Early reports support the use of CT-guided intratumoral volume implants within clinical studies. The use of brachytherapy routinely after sublobar resection is not generally recommended, unless within the confines of a clinical trial or a registry. CONCLUSIONS American Brachytherapy Society recommendations for thoracic brachytherapy are provided. Practitioners are encouraged to follow these guidelines and to develop further clinical trials to examine this treatment modality to increase the evidence base for its use.
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Affiliation(s)
- A Stewart
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK; University of Surrey, Guildford, UK.
| | - B Parashar
- Department of Stich Radiation Oncology, Weill Cornell Medical College, New York, NY
| | - M Patel
- Department of Radiation Oncology, Baylor Scott and White Health, Temple, TX
| | - D O'Farrell
- Dana Faber Cancer Centre, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - M Biagioli
- Florida Hospital Cancer Institute, Department of Radiation Oncology, H.Lee Moffitt Cancer Center, Tampa, FL
| | - P Devlin
- Dana Faber Cancer Centre, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - S Mutyala
- Department of Radiation Medicine, St. Joseph's Hospital and Medical Center, University of Arizona Cancer Center at Dignity Health, Phoenix, AZ
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12
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Early palliative radiation therapy in patients with newly diagnosed cancer: Reasons, clinical practice, and survival. Pract Radiat Oncol 2015; 5:e537-e542. [DOI: 10.1016/j.prro.2015.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/09/2015] [Accepted: 02/11/2015] [Indexed: 12/25/2022]
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13
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Comparative effectiveness of aggressive thoracic radiation therapy and concurrent chemoradiation therapy in metastatic lung cancer. Pract Radiat Oncol 2015; 5:374-82. [PMID: 26412340 DOI: 10.1016/j.prro.2015.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/17/2015] [Accepted: 07/24/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE We aimed to determine the comparative effectiveness of radiation dose escalation and concurrent chemoradiation therapy (CCRT) in a population-based cohort of patients with stage IV non-small cell lung cancer who underwent palliative thoracic radiation therapy (RT). METHODS AND MATERIALS The cohort consisted of 27,063 patients in the National Cancer Database with stage IV non-small cell lung cancer treated with thoracic RT between 20 and 55 Gy in 2004 to 2011. High- versus intermediate- vs low-dose (HD vs ID vs LD, respectively) RT was defined as biologically effective dose above 50 Gy, between 35 and 50 Gy, and below 35 Gy, respectively. Among patients who received any chemotherapy, separate analyses were performed to examine the impact of CCRT on overall survival (OS). RESULTS The median follow-up was 3.9 months for the entire cohort and 18 months for surviving patients. The 5 most common treatment schemes were 30/10 (Gy/fraction, 23% of entire cohort), 35/14 (8%), 37.5/15 (7%), 40/20 (3%), and 50/20 (3%). On multivariable analysis, the survival hazard ratios (HRs) for HD and ID compared with LD RT were 0.37 and 0.51, respectively (P < .0001). Propensity score matching found a superior survival benefit for ID and HD (HR, 0.41 and 0.57 for HD and ID RT, respectively, vs LD, P < .0001). Among those who received any chemotherapy (59% of total), the median OS for patients treated with CCRT (19% of total) was 5.3 versus 5.6 months (P = .667). On multivariable analysis, the HR for CCRT was 1.01 (P = .46). CONCLUSIONS The delivery of higher-dose RT but not concurrent chemotherapy was associated with a significant improvement of OS. This population-based study supports higher-dose palliative regimens and motivates prospective study of escalation beyond a biologically effective dose of 35 Gy.
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Stavas MJ, Arneson KO, Ning MS, Attia AA, Phillips SE, Perkins SM, Shinohara ET. The Refusal of Palliative Radiation in Metastatic Non-Small Cell Lung Cancer and Its Prognostic Implications. J Pain Symptom Manage 2015; 49:1081-1087.e4. [PMID: 25596010 DOI: 10.1016/j.jpainsymman.2014.11.298] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/15/2014] [Accepted: 11/23/2014] [Indexed: 12/25/2022]
Abstract
CONTEXT Patients with metastatic non-small cell lung cancer (NSCLC) have limited survival. Population studies have evaluated the impact of radiation refusal in the curative setting; however, no data exist concerning the prognostic impact of radiation refusal in the palliative care setting. OBJECTIVES To investigate the patterns of radiation refusal in newly diagnosed patients with metastatic NSCLC. METHODS Patients with Stage IV NSCLC diagnosed between 1988 and 2010 were identified in the Surveillance, Epidemiology, and End Results database. Univariate and multivariate analyses were used to identify predictors for refusal of radiation and the impact of radiation and refusal on survival in the palliative setting. RESULTS A total of 285,641 patients were initially included in the analysis. Palliative radiation was recommended in 42% and refused by 3.1% of patients. Refusal rates remained consistent across included years of study. On multivariate analysis, older, nonblack/nonwhite, unmarried females were more likely to refuse radiation (P < 0.001 in all cases). Median survival for patients refusing radiation was three months vs. five months for those receiving radiation and two months for those whom radiation was not recommended. CONCLUSION Patients with metastatic NSCLC who refuse recommended palliative radiation have a poor survival. Radiation refusal or the recommendation against treatment can serve as a trigger for integrating palliative care services sooner and contributes greatly to prognostic awareness. Further investigation into this survival difference and the factors behind refusal are warranted.
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Affiliation(s)
- Mark J Stavas
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Kyle O Arneson
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew S Ning
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Albert A Attia
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sharon E Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephanie M Perkins
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric T Shinohara
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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15
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Palliative thoracic radiotherapy for patients with advanced non-small cell lung cancer and poor performance status. Lung Cancer 2015; 87:130-5. [DOI: 10.1016/j.lungcan.2014.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 11/18/2014] [Accepted: 11/24/2014] [Indexed: 11/15/2022]
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Gao Y, Gao F, Ma JL, Zhao DL. Palliative whole-brain radiotherapy and health- related quality of life for patients with brain metastasis in cancer. Neuropsychiatr Dis Treat 2015; 11:2185-90. [PMID: 26346192 PMCID: PMC4552255 DOI: 10.2147/ndt.s87109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the use of palliative whole-brain radiotherapy (WBRT) in the treatment of brain metastases (BMs) and to evaluate the health-related quality of life (HRQOL) of these patients. MATERIALS AND METHODS We conducted a retrospective study of 46 patients with BMs who were treated with WBRT at the First Affiliated Hospital of Xi'an Jiaotong University between January 2013 and January 2015. External beam radiotherapy techniques were used to deliver 40 Gy in 20 fractions or 30 Gy in ten fractions with a 10 MV photon beam from a linear accelerator to the whole brain. Data were stored and analyzed using SPSS version 17.0. RESULTS Of the 46 patients, the survival time of patients in our study was 10.8±0.55 months: 11.8±0.46 months in patients with WBRT, 11.75±1.00 in patients with WBRT + chemotherapy, and 3±0.79 months in patients with supportive care, respectively (P<0.01). The HRQOL scores of all the patients were 70±1.16 (before therapy) and 76.83±1.04 (after therapy) (P<0.01). The HRQOL scores of the patients with WBRT were 72.23±0.88 (before therapy) and 78.49±0.87 (after therapy) (P<0.01). There was no central nervous system toxicity; only two (4.3%) patients were found to have BM hemorrhage. Radiation necrosis happened in one patient (2.2%). CONCLUSION Effective treatment options for patients with BMs are important. WBRT was evaluated to ensure survival outcomes and QOL were enhanced after therapy for patients with BMs.
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Affiliation(s)
- Ying Gao
- Department of Radiotherapy Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Fei Gao
- Department of Neurology, First Affiliated Hospital of Xi'an Medical University, Xi'an, People's Republic of China
| | - Jin-Lu Ma
- Department of Radiotherapy Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Dong-Li Zhao
- Department of Radiotherapy Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
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Patterns of practice in radiation therapy for non-small cell lung cancer among members of the American Society for Radiation Oncology. Pract Radiat Oncol 2014; 4:e133-e141. [DOI: 10.1016/j.prro.2013.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 05/02/2013] [Accepted: 05/02/2013] [Indexed: 12/25/2022]
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18
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Survival and prognostic factors after moderately hypofractionated palliative thoracic radiotherapy for non-small cell lung cancer. Strahlenther Onkol 2014; 190:270-5. [DOI: 10.1007/s00066-013-0507-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/08/2013] [Indexed: 01/09/2023]
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19
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Chen AB, Cronin A, Weeks JC, Chrischilles EA, Malin J, Hayman JA, Schrag D. Expectations about the effectiveness of radiation therapy among patients with incurable lung cancer. J Clin Oncol 2013; 31:2730-5. [PMID: 23775958 DOI: 10.1200/jco.2012.48.5748] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Although radiation therapy (RT) can palliate symptoms and may prolong life, it is not curative for patients with metastatic lung cancer. We investigated patient expectations about the goals of RT for incurable lung cancers. PATIENTS AND METHODS The Cancer Care Outcomes Research and Surveillance Consortium enrolled a population- and health system-based cohort of patients diagnosed with lung cancer from 2003 to 2005. We identified patients with stage wet IIIB or IV lung cancer who received RT and answered questions on their expectations about RT. We assessed patient expectations about the goals of RT and identified factors associated with inaccurate beliefs about cure. RESULTS In all, 384 patients completed surveys on their expectations about RT. Seventy-eight percent of patients believed that RT was very or somewhat likely to help them live longer, and 67% believed that RT was very or somewhat likely to help them with problems related to their cancer. However, 64% did not understand that RT was not at all likely to cure them. Older patients and nonwhites were more likely to have inaccurate beliefs, and patients whose surveys were completed by surrogates were less likely to have inaccurate beliefs. Ninety-two percent of patients with inaccurate beliefs about cure from RT also had inaccurate beliefs about chemotherapy. CONCLUSION Although patients receiving RT for incurable lung cancer believe it will help them, most do not understand that it is not at all likely to cure their disease. This indicates a need to improve communication regarding the goals and limitations of palliative RT.
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Affiliation(s)
- Aileen B Chen
- Dana-Farber Cancer Institute, 450 Brookline Ave, D1111, Boston, MA 02215, USA.
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Louie AV, Rodrigues G, Cheung P, Palma DA, Movsas B. A review of palliative radiotherapy for lung cancer and lung metastases. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13566-012-0042-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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