1
|
Salari K, Lee JS, Ye H, Seymour ZA, Lee KC, Chinnaiyan P, Grills IS. Long-term survival in patients with brain-only metastatic non-small cell lung cancer undergoing upfront intracranial stereotactic radiosurgery and definitive treatment to the thoracic primary site. Radiother Oncol 2024; 196:110262. [PMID: 38556172 DOI: 10.1016/j.radonc.2024.110262] [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: 01/17/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND PURPOSE To evaluate modern clinical outcomes for patients with brain-only metastatic non-small cell lung cancer (NSCLC) treated with intracranial stereotactic radiosurgery (SRS) with or without definitive treatment of the primary site. MATERIALS AND METHODS Patients with synchronously diagnosed NSCLC and brain-only metastatic disease treated with intracranial SRS at a single institution were retrospectively identified. Patients were stratified based on whether they did (A) or did not (B) receive definitive primary site treatment. Patient characteristics and clinical outcomes were compared. RESULTS From 2008 to 2022, 103 patients were identified, 53 of whom received definitive primary site treatment. Median follow-up was 2.1 y (A) and 0.8 y (B) (p < 0.001). 28 (53 %) patients in Group A received immune checkpoint inhibitor (ICI) therapy versus 19 (38 %) in Group B (p = 0.13) and there were no other statistically significant baseline or treatment characteristic differences between the groups. 5-year local-PFS was 34.5 % (A) versus 0 % (B) (p < 0.001). 5-year regional-PFS was 33.0 % (A) versus 0 % (B) (p < 0.001). 5-year distant body-PFS was 34.0 % (A) versus 0 % (B) (p < 0.001). 5-year CNS-PFS was 14.7 % (A) versus 0 % (B) (p = 0.12). 5-year OS was 40.2 % (A) versus 0 % (B) (p = 0.001). 5-year CSS was 67.6 % (A) versus 0 % (B) (p = 0.002). On multivariable analysis, lack of definitive treatment to the primary site (HR = 2.40), AJCC T3-4 disease (HR = 2.73), and lack of ICI therapy (HR = 2.86) were significant predictors of death. CONCLUSION Definitive treatment to the thoracic primary site in patients with brain-only metastatic NSCLC after intracranial radiosurgery was associated with slower progression of disease and improved survival.
Collapse
Affiliation(s)
- K Salari
- Department of Radiation Oncology, Corewell Health East William Beaumont University Hospital, Royal Oak, MI, United States.
| | - J S Lee
- Department of Radiation Oncology, Corewell Health East William Beaumont University Hospital, Royal Oak, MI, United States
| | - H Ye
- Department of Radiation Oncology, Corewell Health East William Beaumont University Hospital, Royal Oak, MI, United States
| | - Z A Seymour
- Department of Radiation Oncology, Corewell Health Dearborn Hospital, Dearborn, MI, United States
| | - K C Lee
- Department of Radiation Oncology, Corewell Health Troy Hospital, Troy, MI, United States
| | - P Chinnaiyan
- Department of Radiation Oncology, Corewell Health East William Beaumont University Hospital, Royal Oak, MI, United States
| | - I S Grills
- Department of Radiation Oncology, Corewell Health East William Beaumont University Hospital, Royal Oak, MI, United States
| |
Collapse
|
2
|
Zhang C, Zhang Y, Li D, Jia W. Survival benefits of primary tumor surgery for synchronous brain metastases: A SEER-based population study with propensity-matched comparative analysis. Cancer Med 2022; 12:2677-2690. [PMID: 35965407 PMCID: PMC9939173 DOI: 10.1002/cam4.5142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/17/2022] [Accepted: 08/02/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Evidence about the prognostic value of primary tumor surgery (PTS) in patients with brain metastatic malignancies is ambiguous and controversial. This study assessed the survival benefits of primary tumor surgery in patients with brain metastases (BMs). METHODS Adults patients with BMs that originated from lung, breast, kidney, skin, colon, and liver diagnosed between 2010 and 2018 were derived from the Surveillance, Epidemiology, and End Results database (SEER). Propensity score matching (PSM) was used to balance the bias between patients with or without PTS. Then the prognostic value of PTS was estimated by Kaplan-Meier analysis and Cox proportional hazard regression models. RESULTS A total of 32,760 patients with BMs secondary to non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), breast cancer, renal cancer, melanoma, colorectal cancer, and liver cancer were identified from the database. After PSM at 1:1 ratio, PTS appeared to significantly prolong cause-specific survival (CSS) time for patients with BMs secondary to NSCLC, breast cancer, renal cancer, and colorectal cancer (hazard ratio [HR] = 0.60 [0.53-0.68], 0.56 [0.43-0.73], 0.47 [0.37-0.60], and 0.59 [0.37-0.95], respectively, all p < 0.05). Patients with earlier T and N classifications, no extracranial metastasis, and cancer-specific subtypes (adenocarcinoma in NSCLC, hormone receptor-negative breast cancer) may derive more survival benefits from PTS when suffering from BMs. CONCLUSION This population-based study supported PTS could provide survival benefits for patients with BMs secondary to NSCLC, breast cancer, renal cancer, and colorectal cancer. More emphasis should be put on PTS of selected patients with BMs.
Collapse
Affiliation(s)
- Chengkai Zhang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yuan Zhang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Deling Li
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Wang Jia
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina,Beijing Neurosurgical InstituteBeijingChina
| |
Collapse
|
3
|
Wang Q, Li J, Liang X, Zhan Q. Improved Survival With Surgical Treatment of Primary Lung Lesions in Non-Small Cell Lung Cancer With Brain Metastases: A Propensity‐Matched Analysis of Surveillance, Epidemiology, and End Results Database. Front Oncol 2022; 12:888999. [PMID: 35936705 PMCID: PMC9354689 DOI: 10.3389/fonc.2022.888999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesNon-small cell lung cancer (NSCLC) with Brain metastases (BM) is an advanced disease with poor prognosis and low survival rate. Our study evaluated the survival benefit of primary lung resection with mediastinal lymph node dissection in NSCLC patients with BM using Surveillance, Epidemiology, and End-result (SEER) databases.MethodsAll cases analyzed were from Surveillance, Epidemiology, and End Results database. The data of the patients with BM of NSCLC from 2010 to 2016 was retrospectively analyzed. Patients (N=203) patients who underwent radical surgical treatment for primary lung lesions and patients (N=15500) who did not undergo surgery were compared. We successfully analyzed patients using propensity score matching (PSM). Kaplan‐Meier and Cox‐ regression analyses were applied to assess prognosis.ResultsThe median survival in the surgery group was longer than in the control group (27 months vs 5 months; P < 0.001) in the overall sample, 21 months longer compared to the control group (27 months vs 6 months; P<0.001) in a PSM cohort. Cox regression analysis showed that underwent surgery patients in the propensity-matched sample had a significantly lower risk of mortality (HR:0.243, 95%CI: 0.162-0.365, P < 0.001) compared with untreated patients. Multivariate analysis identified the following as independent risk factors for NSCLC with BM: no primary resection surgery, age >65 years, worse differentiation, squamous cell carcinoma, lymphatic metastasis, no systemic therapy. Subgroup analysis revealed that radical resection of the primary lung provided a survival benefit regardless of marital status, tumor size, tumor grade, tumor T stage, and mediastinal lymph node metastasis after PSM.ConclusionRadical resection of primary lung can improve the survival of NSCLC patients with BM. Male, age>65years, poorly differentiated tumor, tumor size>5cm, and mediastinal lymph node metastasis were factors for poor survival.
Collapse
|
4
|
Tai P, Joseph K, Assouline A, Souied O, Leong N, Ferguson M, Yu E. Metastatic Brain Tumors: To Treat or Not to Treat, and with What? CURRENT CANCER THERAPY REVIEWS 2020. [DOI: 10.2174/1573394715666181211150849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A long time ago, metastatic brain tumors were often not treated and patients were only
given palliative care. In the past decade, researchers selected those with single or 1-3 metastases
for more aggressive treatments like surgical resection, and/or stereotactic radiosurgery (SRS),
since the addition of whole brain radiotherapy (WBRT) did not increase overall survival for the
vast majority of patients. Different studies demonstrated significantly less cognitive deterioration
in 0-52% patients after SRS versus 85-94% after WBRT at 6 months. WBRT is the treatment of
choice for leptomeningeal metastases. WBRT can lower the risk for further brain metastases, particularly
in tumors of fast brain metastasis velocity, i.e. quickly relapsing, often seen in melanoma
or small cell lung carcinoma. Important relevant literature is quoted to clarify the clinical controversies
at point of care in this review. Synchronous primary lung cancer and brain metastasis
represent a special situation whereby the oncologist should exercise discretion for curative treatments,
with reported 5-year survival rates of 7.6%-34.6%. Recent research suggests that those
patients with Karnofsky performance status less than 70, not capable of caring for themselves, are
less likely to derive benefit from aggressive treatments. Among patients with brain metastases
from non-small cell lung cancer (NSCLC), the QUARTZ trial (Quality of Life after Radiotherapy
for Brain Metastases) helps the oncologist to decide when not to treat, depending on the performance
status and other factors.
Collapse
Affiliation(s)
- Patricia Tai
- Allan Blair Cancer Center, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kurian Joseph
- Cross Cancer Center, University of Alberta, Edmonton, AB, Canada
| | - Avi Assouline
- Centre Clinique de la Porte de Saint-Cloud, 30 Rue de Paris, 92100 Boulogne- Billancourt, France
| | - Osama Souied
- Allan Blair Cancer Center, University of Saskatchewan, Saskatoon, SK, Canada
| | - Nelson Leong
- Allan Blair Cancer Center, University of Saskatchewan, Saskatoon, SK, Canada
| | - Michelle Ferguson
- Allan Blair Cancer Center, University of Saskatchewan, Saskatoon, SK, Canada
| | - Edward Yu
- London Regional Cancer Program, Western University, London, ON, Canada
| |
Collapse
|
5
|
Salem U, Kumar VA, Madewell JE, Schomer DF, de Almeida Bastos DC, Zinn PO, Weinberg JS, Rao G, Prabhu SS, Colen RR. Neurosurgical applications of MRI guided laser interstitial thermal therapy (LITT). Cancer Imaging 2019; 19:65. [PMID: 31615562 PMCID: PMC6792239 DOI: 10.1186/s40644-019-0250-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/30/2019] [Indexed: 02/02/2023] Open
Abstract
MRI-guided laser interstitial thermal therapy (LITT) is the selective ablation of a lesion or a tissue using heat emitted from a laser device. LITT is considered a less invasive technique compared to open surgery that provides a nonsurgical solution for patients who cannot tolerate surgery. Although laser ablation has been used to treat brain lesions for decades, recent advances in MRI have improved lesion targeting and enabled real-time accurate monitoring of the thermal ablation process. These advances have led to a plethora of research involving the technique, safety, and potential applications of LITT.LITT is a minimally invasive treatment modality that shows promising results and is associated with decreased morbidity. It has various applications, such as treatment of glioma, brain metastases, radiation necrosis, and epilepsy. It can provide a safer alternative treatment option for patients in whom the lesion is not accessible by surgery, who are not surgical candidates, or in whom other standard treatment options have failed. Our aim is to review the current literature on LITT and provide a descriptive review of the technique, imaging findings, and clinical applications for neurosurgery.
Collapse
Affiliation(s)
- Usama Salem
- Department of Radiology, The University of Texas Medical Branch at Galveston, Galveston, TX, 77555, USA.
| | - Vinodh A Kumar
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - John E Madewell
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Donald F Schomer
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | - Pascal O Zinn
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Rivka R Colen
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA. .,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA.
| |
Collapse
|
6
|
Prognostic Impact of Missed Chemotherapy Doses During Chemoradiation Therapy for Non-Small Cell Lung Cancer. Am J Clin Oncol 2019; 41:362-366. [PMID: 27322697 DOI: 10.1097/coc.0000000000000293] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of this study is to investigate the impact of missed chemotherapy administrations (MCA) on the prognosis of non-small cell lung cancer (NSCLC) patients treated with definitive chemoradiation therapy (CRT). MATERIALS AND METHODS In total, 97 patients with NSCLC treated with definitive CRT were assessed for MCA due to toxicities. Logistic regression was used to determine factors associated with MCA. Kaplan-Meier curves, log-rank tests, and Cox Proportional Hazards models were conducted. RESULTS MCA occurred in 39% (n=38) of the patients. Median overall survival was 9.6 months for patients with MCA compared with 24.3 months for those receiving all doses (P=0.004). MCA due to decline in performance status was associated with the worst survival (4.6 mo) followed by allergic reaction (10.0 mo), hematologic toxicity (11 mo), and esophagitis (17.2 mo, P=0.027). In multivariate models, MCA was associated with higher mortality (hazard ratio, 1.97; P=0.01) and worse progression-free survival (hazard ratio, 1.96; P=0. 009). CONCLUSIONS MCA correlated with worse prognosis and increased mortality. Methods to reduce toxicity may improve administration of all chemotherapy doses and increase overall survival in NSCLC treated with CRT.
Collapse
|
7
|
Petrelli F, Ghidini A, Cabiddu M, Tomasello G, De Stefani A, Bruschieri L, Vitali E, Ghilardi M, Borgonovo K, Barni S, Trevisan F. Addition of radiotherapy to the primary tumour in oligometastatic NSCLC: A systematic review and meta-analysis. Lung Cancer 2018; 126:194-200. [PMID: 30527187 DOI: 10.1016/j.lungcan.2018.11.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 11/01/2018] [Accepted: 11/11/2018] [Indexed: 12/19/2022]
Abstract
Oligometastatic non-small cell lung cancer (NSCLC) has a discrete number of distant lesions (<5) that can be amenable to radical treatment. The treatment of the primary lung tumour in such stage IV cases is still debated. We conducted a systematic review and meta-analysis to evaluate the outcome of these patients and the added benefit in terms of overall survival (OS) and progression-free survival (PFS) when radical treatment of the primary tumour with radiotherapy (RT) was delivered. PubMed, EMBASE and Cochrane Library were systematically searched to identify relevant studies published up to July 2018. Prospective trials and retrospective series comparing RT vs no RT to the primary NSCLC in the presence of oligometastases were included. Hazard ratios (HRs) for OS and PFS were aggregated according to a fixed or random effect model. Twenty-one studies for a total of 924 synchronous oligometastatic NSCLC were analysed. Median OS and PFS were 20.4 and 12 months. Pooled 1-2-3 and 5-year OS were 70.3%, 43.5%, 29.3% and 20.2% respectively. Overall survival was improved with the addition of thoracic RT (HR = 0.44, 95%CI 0.32-0.6; P < 0.001). Similarly, RT added to the primary tumour increased PFS (HR = 0.42, 95%CI 0.33-0.55; P < 0.001). The only variable associated with the median OS was the year of publication with most recent series associated with a better outcome. In patients with oligometastatic NSCLC and disease controlled with ablative therapy of distant metastases, a consolidation with radical RT to the primary tumour is associated with better survival and could be considered as a treatment modality in selected cases.
Collapse
Affiliation(s)
- Fausto Petrelli
- Medical oncology unit, ASST Bergamo Ovest, Treviglio, BG, Italy.
| | | | - Mary Cabiddu
- Medical oncology unit, ASST Bergamo Ovest, Treviglio, BG, Italy
| | | | | | | | | | - Mara Ghilardi
- Medical oncology unit, ASST Bergamo Ovest, Treviglio, BG, Italy
| | - Karen Borgonovo
- Medical oncology unit, ASST Bergamo Ovest, Treviglio, BG, Italy
| | - Sandro Barni
- Medical oncology unit, ASST Bergamo Ovest, Treviglio, BG, Italy
| | | |
Collapse
|
8
|
Barney CL, Scoville N, Allan E, Ayan A, DiCostanzo D, Haglund KE, Grecula J, Williams T, Xu-Welliver M, Otterson GA, Bazan JG. Radiation Dose to the Thoracic Vertebral Bodies Is Associated With Acute Hematologic Toxicities in Patients Receiving Concurrent Chemoradiation for Lung Cancer: Results of a Single-Center Retrospective Analysis. Int J Radiat Oncol Biol Phys 2017; 100:748-755. [PMID: 29413286 DOI: 10.1016/j.ijrobp.2017.11.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/04/2017] [Accepted: 11/16/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE To test the hypothesis that increasing radiation therapy (RT) dose to the thoracic vertebral bodies (TVBs) contributes to the development of hematologic toxicities (HTs) in patients with lung cancer. METHODS AND MATERIALS Cases of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) treated with definitive chemoradiation with concurrent platinum-based doublet chemotherapy at our institution from 2007 to 2016 were identified. Mean TVB dose and the volume of TVBs receiving at least 5 to 60 Gy (V5-V60) were retrospectively recorded. Logistic regression was used to test associations between grade ≥3 HT (HT3+) and dosimetric/clinical parameters. Normal tissue complication probability was evaluated using the Lyman-Kutcher-Burman (LKB) model for HT3+, and receiver operating characteristics analysis was used to determine dosimetric cut-points. RESULTS We identified 201 patients, the majority having NSCLC (n=162, 81%) and stage III to IV disease (n=179, 89%). All patients received either cisplatin/etoposide (n=107, 53%) or carboplatin/paclitaxel (n=94, 47%). Median RT dose was 60 Gy (range, 60-70 Gy). The rate of HT3+ was 49% (n=99). Increasing mean TVB dose (per Gy) was associated with higher odds of developing HT3+ (odds ratio 1.041, 95% confidence interval 1.004-1.080, P=.032), as were increasing TVB V5 to V20. These dosimetric correlates to HT3+ persisted on multivariate analysis. Constrained optimization of the LKB model for HT3+ yielded the parameters: n=1, m=1.79, and TD50=21.4 Gy. Optimal cut-points identified were V5=65%, V10=60%, V20=50%, and mean dose=23.5 Gy. Patients with values above these cut-points had an approximately 2-fold increased risk of HT3+. CONCLUSIONS We found that mean TVB dose and low-dose parameters (V5-V20) were associated with HT3+ in chemoradiation for lung cancer. Per the LKB model, bone marrow behaves like a parallel organ (n=1), implying that mean TVB dose is a useful predictor for toxicity. These data suggest that efforts to spare dose to the TVBs may reduce rates of severe HT.
Collapse
Affiliation(s)
- Christian L Barney
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Nicholas Scoville
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Eric Allan
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Ahmet Ayan
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Dominic DiCostanzo
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Karl E Haglund
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - John Grecula
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Terence Williams
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Meng Xu-Welliver
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Gregory A Otterson
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Jose G Bazan
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio.
| |
Collapse
|
9
|
Outcome of radical local treatment of non-small cell lung cancer patients with synchronous oligometastases. Lung Cancer 2017; 112:134-139. [DOI: 10.1016/j.lungcan.2017.08.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/03/2017] [Accepted: 08/03/2017] [Indexed: 01/23/2023]
|
10
|
High probability and frequency of EGFR mutations in non-small cell lung cancer with brain metastases. J Neurooncol 2017; 135:413-418. [DOI: 10.1007/s11060-017-2590-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/23/2017] [Indexed: 01/01/2023]
|
11
|
Validation of the Disease-Specific GPA for Patients With 1 to 3 Synchronous Brain Metastases in Newly Diagnosed NSCLC. Clin Lung Cancer 2017; 19:e141-e147. [PMID: 28739316 DOI: 10.1016/j.cllc.2017.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/27/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The disease-specific graded prognostic assessment (DS-GPA) for brain metastases is a powerful prognostic tool but has not been validated for patients with synchronous brain metastases (SBM) in newly diagnosed non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS We identified patients with newly diagnosed NSCLC with 1 to 3 SBM treated with stereotactic radiosurgery (SRS) between 1997 and 2012. We included patients whose brain metastases were treated with SRS alone or combined SRS and whole-brain radiotherapy (WBRT). Patients were stratified according to NSCLC DS-GPA to evaluate the accuracy of survival estimates. RESULTS One hundred sixty-four patients were treated with either SRS alone (n = 85; 52%) or SRS and WBRT (n = 79; 48%). Median overall survival (OS) stratified according to DS-GPA of 0 to 1, 1.5 to 2, 2.5 to 3, and 3.5 to 4 were 2.8, 6.7, 9.8, and 13.2 months, respectively, consistent with OS reported for brain metastases in NSCLC DS-GPA (3.0, 6.5, 11.3, and 14.8 months, respectively). No difference in median progression-free survival or OS was noted with combined use of SRS and WBRT: 6.0 versus 6.1 months (P = .81) and 8.5 versus 9.1 months (P = .093), respectively. In multivariable analysis, Karnofsky performance status (hazard ratio [HR], 0.98; P = .008), extracranial metastases (HR, 0.498; P = .0003), squamous histology (HR, 1.81; P = .02), and number of brain metastases (2 vs. 1; HR, 1.504; P = .04, and 3 vs. 1; HR, 1.66; P = .05) were significant predictors of OS. CONCLUSION The DS-GPA accurately estimates the prognosis of patients with SBM in newly diagnosed NSCLC. Patients with synchronous brain metastasis in newly diagnosed NSCLC should be carefully stratified for consideration of aggressive therapy.
Collapse
|
12
|
Bates JE, Milano MT. Prognostic significance of sites of extrathoracic metastasis in patients with non-small cell lung cancer. J Thorac Dis 2017; 9:1903-1910. [PMID: 28839988 DOI: 10.21037/jtd.2017.06.117] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Metastatic non-small cell lung cancer (NSCLC) continues to have a poor prognosis despite recent advances in both targeted radiotherapy methodologies such as stereotactic body radiotherapy (SBRT) and immunotherapies. The impact of location of metastatic disease in patients with NSCLC has not been investigated; we aimed to investigate this using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS We included 39,910 patients from the SEER database treated for M1b NSCLC from 2010-2013. We identified patients with metastatic disease in the brain, lung, liver, and bone. We used Kaplan-Meier analyses and Cox proportional hazards models to assess the impact of varying sites of metastatic disease on overall survival (OS). RESULTS Patients with disease coded as in the brain without other disease in the lung, liver, or bone had improved OS relative to all other comers with M1b disease (HR =0.84, 95% CI, 0.84-0.90, P<0.001). Likewise, patients with disease coded as in the bone without other disease in the lung, liver, or brain had improved OS relative to all other comers with M1b disease (HR =0.89, 95% CI, 0.86-0.92, P<0.001). CONCLUSIONS This hypothesis-generating analysis suggests that patients with limited metastatic NSCLC to the bone or brain may particularly benefit from aggressive upfront therapies.
Collapse
Affiliation(s)
- James E Bates
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
13
|
The TNM 8 M1b and M1c classification for non-small cell lung cancer in a cohort of patients with brain metastases. Clin Transl Oncol 2017; 19:1141-1146. [PMID: 28357633 DOI: 10.1007/s12094-017-1651-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/18/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE According to the recent TNM 8 classification, patients with metastatic non-small cell lung cancer (NSCLC) and single extrathoracic metastasis should be classified as stage M1b, while those with 2 or more metastases comprise stage M1c. The purpose of this study was to analyze the impact of this classification in patients with brain metastases. MATERIALS AND METHODS This retrospective study included 172 patients treated with individualized approaches. Actuarial survival was calculated. Uni- and multivariate analyses were performed. RESULTS Thirty patients (17%) were staged as M1b. Those with squamous cell cancer were more likely to harbor M1b disease (29%, adenocarcinoma 14%, other histology 17%, p = 0.16). Median survival was 5.4 months (8.0 months in case of M1b disease and 4.5 months in case of M1c disease, p = 0.001). Multivariate analysis confirmed the role of M1b stage. M1b patients managed with upfront surgery or radiosurgery had significantly longer median survival than those who received whole-brain irradiation (21.0 vs. 3.5 months, p = 0.0001) and the potential to survive beyond 5 years. CONCLUSIONS We found the M1b classification to provide clinically relevant information. The multivariate analysis suggested that patients with M1b disease, better performance status and younger age have better survival.
Collapse
|
14
|
Zhang Q, Wu YL. Surgery in oligometastatic NSCLC patients in the targeted therapy era. Lung Cancer Manag 2016; 5:141-153. [PMID: 30643558 DOI: 10.2217/lmt-2016-0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/16/2016] [Indexed: 12/25/2022] Open
Abstract
More than 50% of NSCLC patients present with metastatic disease at first diagnosis, with a median survival of 8-11 months. However, selected patients with oligometastatic disease who receive appropriate local therapy for both the primary lesion and metastases enjoy long-term survival or are even cured. The new (eighth) edition of the tumor, node and metastasis classification of lung cancer suggests that patients with a single metastatic lesion in one distant organ should be placed into a new category, M1b, which will certainly lead to more applications of local therapy in such subpopulations. Moreover, as the applications of targeted therapy increase, surgery will play an evermore critical role in eliminating drug-resistant cancer clones of patients who exhibit mixed responses to tyrosine kinase inhibitors. The lung, brain and adrenal gland are the most common oligometastatic organs, and are reviewed separately.
Collapse
Affiliation(s)
- Qi Zhang
- Southern Medical University, Guangzhou, Guangdong 510515, PR China.,Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510515, PR China.,Southern Medical University, Guangzhou, Guangdong 510515, PR China.,Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510515, PR China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510515, PR China.,Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510515, PR China
| |
Collapse
|
15
|
Liu G, Zhang X, Tian C, Xia G, Liu P, Zhang Q, Li X, Zhang H, Qin N, Wang J, Zhang S. [Timing of Whole Brain Radiotherapy on Survival of Patients with EGFR-mutated
Non-small Cell Lung Cancer and Brain Metastases]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:501-7. [PMID: 27561798 PMCID: PMC5972982 DOI: 10.3779/j.issn.1009-3419.2016.08.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is no high-level evidence for the time of whole brain radiotherapy (WBRT) for patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) and brain metastases. The aim of this study is to assess the appropriate timing of WBRT for patients with EGFR-mutated NSCLC and brain metastases (BM). METHODS There were 78 patients diagnosed with EGFR-mutated NSCLC and BM in Beijing Chest Hospital between August 2009 and May 2015. 48 untreated patients who received both WBRT and EGFR-tyrosine kinase inhibitors (TKIs) therapy. Prognostic factors of intracranial progression-free survival (PFS) and overall survival (OS) were identified by Cox proportional hazards modeling. RESULTS Intracranial objective response rate was 81.3% and disease control rate was 93.8%. Median intracranial PFS was 10 months. Median OS was 18 months. Multivariate analysis of intracranial PFS revealed that Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-1 (HR=30.436, 95%CI: 4.721-196.211, P<0.001) and early WBRT (HR=3.663, 95%CI: 1.657-8.098, P=0.001) had a better intracranial PFS. Multivariate analysis of OS revealed that PS 0-1 (HR=57.607, 95%CI: 6.135-540.953, P<0.001), early WBRT (HR=2.757, 95%CI: 1.140-6.669, P=0.024), and stereotactic radiosurgery (HR=5.964, 95%CI: 1.895-18.767, P=0.002) were independent prognostic factors of OS. CONCLUSIONS Early WBRT combined with EGFR-TKIs can improve outcomes of patients with EGFR-mutated NSCLC and BM, but it needs to be confirmed by large-sample-size and multicenter prospective clinical trials.
Collapse
Affiliation(s)
- Guimei Liu
- Department of Radiotherapy, Beijing Chest Hospital, Capital Medicine University, Beijing
Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Xinyong Zhang
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medicine University, Beijing
Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Cuimeng Tian
- Department of Radiotherapy, Beijing Chest Hospital, Capital Medicine University, Beijing
Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Guangrong Xia
- Department of Radiotherapy, Beijing Chest Hospital, Capital Medicine University, Beijing
Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Ping Liu
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medicine University, Beijing
Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Quan Zhang
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medicine University, Beijing
Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Xi Li
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medicine University, Beijing
Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Hui Zhang
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medicine University, Beijing
Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Na Qin
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medicine University, Beijing
Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Jinghui Wang
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medicine University, Beijing
Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Shucai Zhang
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medicine University, Beijing
Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| |
Collapse
|
16
|
Tang C, Liao Z, Hess K, Chance WW, Zhuang Y, Jensen G, Xu T, Komaki R, Gomez DR. Prognosis and predictors of site of first metastasis after definitive radiation therapy for non-small cell lung cancer. Acta Oncol 2016; 55:1022-8. [PMID: 27055359 DOI: 10.3109/0284186x.2016.1154602] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background and purpose Evidence suggests that distinct biologic phenomenon produce different patterns of distant metastatic (DM) failures. We attempted to identify prognostically poor sites of first DM and to define factors predictive of their development. Methods and materials A total of 1074 patients treated with ≥60 Gy definitive radiation for initially non-metastatic non-small cell lung cancer (NSCLC) were analyzed. Uni- and multivariate Cox regression was utilized to associate clinical factors with DM site, and metastatic site with overall survival (OS). To account for competing events, multivariate Fine and Gray regression was utilized to identify treatment and disease factors predictive of site-specific metastases. Results Sites of first DM associated with worse survival were liver (median OS: 5 months after DM) and bone (median OS: 6.7 months after DM). Multivariate regression identified non-squamous histology to be associated with first DM within the liver (HR = 2.04, 95% CI 1.16-3.60, p = 0.01), while delay between diagnosis and RT (third vs. first tertile: HR = 2.3, 95% CI 1.26-4.21, p = 0.007) in addition to advanced stage (stage III vs. II/I: HR = 2.37, 95% CI 1.11-5.06, p = 0.03) were associated with first DM within bone. Conclusions Liver and bone as site of first DM is associated with worse prognosis and are predicted by different disease and treatment factors.
Collapse
Affiliation(s)
- Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kenneth Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - William W. Chance
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yan Zhuang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Garrett Jensen
- Department of Baylor School of Medicine, Houston, Texas, USA
| | - Ting Xu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel R. Gomez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
17
|
Shen H, Cao Y, Li X, Tan Y, Chen J, Yang Z, Kong Y, Yuan Y. Surgical Intervention Improves Survival for Metastatic Non-Small Cell Lung Cancer Patients. Medicine (Baltimore) 2016; 95:e3800. [PMID: 27227958 PMCID: PMC4902382 DOI: 10.1097/md.0000000000003800] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Surgical intervention for stage IV non-small cell lung cancer (NSCLC) is still controversial. This study sought to evaluate the clinical effects of surgical intervention on survival in patients with stage IV NSCLCs and to identify the cohort benefitting the most from surgery.A retrospective study from the Surveillance, Epidemiology, and End Results database was performed to compare the survival of stage IV NSCLC patients who had undergone surgery with those who did not undergo surgery. Overall survival (OS) was evaluated using the Kaplan-Meier method and the log-rank test. The Cox proportional hazards model was used for multivariate analysis.The total number of eligible patients was 43,538, including 16.8% in the M1a stage and 83.2% in the M1b stage. The percentages of patients with no surgery (NONE), only metastatic tumor resection (MTR), only primary tumor resection (PTR), and both primary and metastatic tumor resection (PMTR) were 89.0%, 6.7%, 3.5%, and 0.8%, respectively; the corresponding 5-year survival rates were 2.0%, 4.0%, 13.0%, and 20.0%, respectively (P < 0.001); and the corresponding OS rates were 11.1 months, 14.7 months, 29.4 months, and 34.9 months, respectively (P < 0.001). Notably, the pairwise comparisons of 5-year survival rate and OS among the subgroups were all statistically significant. The multivariate analysis showed that surgical intervention was correlated with longer survival in patients with stage IV NSCLC. The stratified analysis showed significant differences in the OS on strata of the M1a stage and strata of the M1b stage. In the M1a stage, patients with PTR had significantly better OS than those with NONE (P < 0.001) or MTR (P < 0.001) but showed no significant differences compared with those with PMTR (P = 0.174); patients with MTR did not have prolonged survival compared with patients with NONE (P = 0.185), and they also did not have prolonged survival compared with patients with PMTR (P = 0.052). In the M1b stage, pairwise comparisons of OS were all statistically significant among the subgroups (P < 0.001).Surgical intervention can prolong survival to different degrees according to the modalities of surgery in stage IV NSCLC.
Collapse
Affiliation(s)
- Hong Shen
- From the Department of Medical Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine (HS, YC, XL, JC, ZY, YK, YY); and Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, Chinese National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences), the Second Affiliated Hospital, Zhejiang University School of Medicine (YT, YY), Hangzhou, Zhejiang Province, China
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Wang T, Wang R, Dong Z, Liang N, Chang P. Complete remission through icotinib treatment in Non-small cell lung cancer epidermal growth factor receptor mutation patient with brain metastasis: A case report. Open Med (Wars) 2016; 11:11-15. [PMID: 28352759 PMCID: PMC5329790 DOI: 10.1515/med-2016-0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/02/2015] [Indexed: 11/25/2022] Open
Abstract
Brain metastasis (BM) has been universally recognized as a poor prognostic factor in non-small cell lung cancer (NSCLC). Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have shown efficacy in treating BM with an EGFR mutation. This paper reports a case of BM patient with EGFR-mutated NSCLC. According to the findings, a complete remission (CR) of the BM was achieved by icotinib treatment without conducting a radiotherapy, which was followed by a resection of the primary lung cancer lesion and lymph nodes. After one-year follow-up, the disease progressed to liver metastasis and liver lesion biopsy showed a T790M mutation. The patient responded well to the combination treatment of AZD9291 and icotinib after the failure of transcatheter arterial chemoembolization (TACE). This case report suggests that icotinib has a sustainable anticancer response to BM and the combination with icotinib and AZD9291 is effective for liver metastasis with T790M.
Collapse
Affiliation(s)
- Tao Wang
- Department of Thoracic Surgery, PLA General Hospital, Beijing 100853, P.R. China
| | - Ruimin Wang
- Department of Nuclear Medicine, PLA General Hospital, Beijing 100853, P.R. China
| | - Zhouhuan Dong
- Department of Pathology, PLA General Hospital, Beijing 100853, P.R. China
| | - Naichao Liang
- Department of Thoracic Surgery, PLA General Hospital, Beijing 100853, P.R. China
| | - Ping Chang
- Department of Oral and Maxillofacial Surgery, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China , Tel.:+86 10 66875514, Fax:+86 10 67817113
| |
Collapse
|
19
|
Abstract
Radiation therapy (RT) is an integral part of treating all stages of lung cancer. Stereotactic ablative radiation therapy (SABR) has emerged as a standard treatment option for stage I-II patients with medically inoperable disease. Stage IIIA-IIIB disease is typically managed with definitive concurrent chemo-radiotherapy (CRT). Intensity modulated radiation therapy (IMRT) has enabled delivery of more potent RT dose while greatly limiting dose to surrounding normal organs, including lung, esophagus, and heart. SABR may have an expanding role in the treatment of stage IV patients, with new clinical trials exploring its combination with systemic immuotherapies.
Collapse
Affiliation(s)
- Sagus Sampath
- Department of Radiation Oncology, City of Hope Medical Center Duarte, Duarte, CA, USA.
| |
Collapse
|
20
|
Palma DA, Videtic GMM. Oligometastatic Non-Small-Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2015; 93:223-6. [PMID: 26383672 DOI: 10.1016/j.ijrobp.2015.07.2277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
|
21
|
Results of surgical treatment of primary lung cancer with synchronous brain metastases. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 12:14-7. [PMID: 26336472 PMCID: PMC4520501 DOI: 10.5114/kitp.2015.50562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 09/24/2014] [Accepted: 12/23/2014] [Indexed: 11/17/2022]
Abstract
Introduction The surgical treatment of non-small cell lung cancer (NSCLC) with synchronous brain matastases is more effective than other therapeutic options, but this management is still controversial. The aim of the study The aim of the study was to evaluate the survival of patients after pulmonary resection NSCLC preceded by resection of brain metastases. Material and methods From 2007 to 2012, 645 patients underwent pulmonary resection for NSCLC at our department. In 25 of them (3.87%) thoracic surgery was preceded by resection of a single brain metastasis of NSCLC and a PET CT scan. No signs of nodal involvement or distant metastases were detected. Results The group consisted of 18 men (72%) and 7 women (28%). Average age was 57.62 years (46-70). In all cases, whole brain radiotherapy (5 × 4 Gy) was performed. The average interval between excision of brain metastasis and lung resection was 31.4 days (27-41). Pneumonectomy was performed in 1, lobectomy/bilobectomy in 17 and wedge resection in 7 cases. Pathological stage N0 was diagnosed in 17, N1 in 5 and N2 in 3 patients. Average survival was 18.68 months (4-74). Survival at 1, 2 and 5 years was 64%, 28% and 28% respectively. Average disease-free survival was 17.52 months. Histological type (p = 0.57) and G (p = 0.82) have no influence on survival. All the patients with hilar lymph node involvement died within 26 months and with mediastinal one within 12 months. Conclusions Surgical treatment of patients with NSCLC with synchronous brain metastases may prove beneficial in selected patients after excluding other distant metastases and lymph node involvement.
Collapse
|
22
|
Banerjee C, Snelling B, Berger MH, Shah A, Ivan ME, Komotar RJ. The role of magnetic resonance-guided laser ablation in neurooncology. Br J Neurosurg 2015; 29:192-6. [DOI: 10.3109/02688697.2014.996527] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
23
|
Hsia TC, Yu CC, Hsu SC, Tang NY, Lu HF, Huang YP, Wu SH, Lin JG, Chung JG. Cantharidin induces apoptosis of H460 human lung cancer cells through mitochondria-dependent pathways. Int J Oncol 2014; 45:245-54. [PMID: 24818581 DOI: 10.3892/ijo.2014.2428] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/25/2014] [Indexed: 11/05/2022] Open
Abstract
Lung cancer is one of the leading causes of death in cancer-related diseases. Cantharidin (CTD) is one of the components of natural mylabris (Mylabris phalerata Pallas). Numerous studies have shown that CTD induced cytotoxic effects on cancer cells. However, there is no report to demonstrate that CTD induced apoptosis in human lung cancer cells. Herein, we investigated the effect of CTD on the cell death via the induction of apoptosis in H460 human lung cancer cells. Flow cytometry assay was used for examining the percentage of cell viability, sub-G1 phase of the cell cycle, reactive oxygen species (ROS) and Ca²⁺ productions and the levels of mitochondrial membrane potential (∆Ψm). Annexin V/PI staining and DNA gel electrophoresis were also used for examining cell apoptosis. Western blot analysis was used to examine the changes of apoptosis associated protein expression and confocal microscopy for examining the translocation apoptosis associated protein. Results indicated that CTD significantly induced cell morphological changes and decreased the percentage of viable H460 cells. CTD induced apoptosis based on the occurrence of sub-G1 phase and DNA fragmentation. We found that CTD increased gene expression (mRNA) of caspase-3 and -8. Moreover, CTD increased ROS and Ca2+ production and decreased the levels of ∆Ψm. Western blot analysis results showed that CTD increased the expression of cleavage caspase-3 and -8, cytochrome c, Bax and AIF but inhibited the levels of Bcl-xL. CTD promoted ER stress associated protein expression such as GRP78, IRE1α, IRE1β, ATF6α and caspase-4 and it also promoted the expression of calpain 2 and XBP-1, but inhibited calpain 1 that is associated with apoptosis pathways. Based on those observations, we suggest that CTD may be used as a novel anticancer agent for the treatment of lung cancer in the future.
Collapse
Affiliation(s)
- Te-Chun Hsia
- Graduate Institute of Chinese Medicine, China Medical University, Taichung, Taiwan, R.O.C
| | - Chien-Chih Yu
- School of Pharmacy, China Medical University, Taichung, Taiwan, R.O.C
| | - Shu-Chun Hsu
- Department of Biological Science and Technology, China Medical University, Taichung, Taiwan, R.O.C
| | - Nou-Ying Tang
- Graduate Institute of Chinese Medicine, China Medical University, Taichung, Taiwan, R.O.C
| | - Hsu-Feng Lu
- Department of Clinical Pathology, Cheng Hsin General Hospital, Taipei, Taiwan, R.O.C
| | - Yi-Ping Huang
- Department of Physiology, China Medical University, Taichung, Taiwan, R.O.C
| | - Shin-Hwar Wu
- Division of Critical Care Medicine, Department of Medicine, Changhua Christian Hospital, Changhua, Taiwan, R.O.C
| | - Jaung-Geng Lin
- Graduate Institute of Chinese Medicine, China Medical University, Taichung, Taiwan, R.O.C
| | - Jing-Gung Chung
- Department of Biological Science and Technology, China Medical University, Taichung, Taiwan, R.O.C
| |
Collapse
|