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Bensenane R, Helfre S, Cao K, Carton M, Champion L, Girard N, Glorion M, Vieira T, Waissi W, Crehange G, Beddok A. Optimizing lung cancer radiation therapy: A systematic review of multifactorial risk assessment for radiation-induced lung toxicity. Cancer Treat Rev 2024; 124:102684. [PMID: 38278078 DOI: 10.1016/j.ctrv.2024.102684] [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: 10/09/2023] [Revised: 12/27/2023] [Accepted: 01/11/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Radiation therapy (RT) is essential in treating advanced lung cancer, but may lead to radiation pneumonitis (RP). This systematic review investigates the use of pulmonary function tests (PFT) and other parameters to predict and mitigate RP, thereby improving RT planning. METHODS A systematic review sifted through PubMed and on BioMed Central, targeting articles from September 2005 to December 2022 containing the keywords: Lung Cancer, Radiotherapy, and pulmonary function test. RESULTS From 1153 articles, 80 were included. RP was assessed using CTCAEv.4 in 30 % of these. Six studies evaluated post-RT quality of life in lung cancer patients, reporting no decline. Patients with RP and chronic obstructive pulmonary disease (COPD) generally exhibited poorer overall survival. Notably, forced expiratory volume in one second (FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO) declined 24 months post-RT, while forced vital capacity (FVC) stayed stable. In the majority of studies, age over 60, tumors located in the lower part of the lung, and low FEV1 before RT were associated with a higher risk of RP. Dosimetric factors (V5, V20, MLD) and metabolic imaging emerged as significant predictors of RP risk. A clinical checklist blending patient and tumor characteristics, PFT results, and dosimetric criteria was proposed for assessing RP risk before RT. CONCLUSION The review reveals the multifactorial nature of RP development following RT in lung cancer. This approach should guide individualized management and calls for a prospective study to validate these findings and enhance RP prevention strategies.
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Affiliation(s)
- Rayan Bensenane
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France
| | - Sylvie Helfre
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France
| | - Kim Cao
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France
| | | | | | - Nicolas Girard
- Institut Curie, Department of Thoracic Oncology, Paris, France
| | | | - Thibaut Vieira
- Institut Mutualist Montsouris, Department of Pneumology, Paris, France
| | - Waisse Waissi
- Centre Léon Bérard, Department of Radiation Oncology, Lyon, France
| | - Gilles Crehange
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France
| | - Arnaud Beddok
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France; Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, 91898 Orsay, France.
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Takeda Y, Kusaba Y, Tsukita Y, Uemura Y, Miyauchi E, Yamamoto T, Mayahara H, Hata A, Nakayama H, Tanaka S, Uchida J, Usui K, Toyoda T, Tamiya M, Morimoto M, Oya Y, Kodaira T, Jingu K, Sugiura H. The efficacy profiles of concurrent chemoradiotherapy with intensity-modulated radiotherapy followed by durvalumab in patients with unresectable stage III non–small cell lung cancer: A multicenter retrospective cohort study. Clin Transl Radiat Oncol 2022; 37:57-63. [PMID: 36065360 PMCID: PMC9440238 DOI: 10.1016/j.ctro.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/21/2022] [Accepted: 08/19/2022] [Indexed: 12/02/2022] Open
Abstract
The tri-modalities of chemoradiotherapy (CRT) with IMRT and durvalumab were evaluated. We have reported the efficacy and safety of tri-modalities through real-world data. A better response to CRT and increasing radiation dose are related to long PFS. Durvalumab therapy duration was linked to survival in patients.
Purpose Intensity-modulated radiotherapy (IMRT) is currently used more commonly than 3-dimensional conformal radiation for definitive thoracic radiation. We examined the efficacy profiles of concurrent chemoradiotherapy (CCRT) with IMRT after durvalumab became clinically available. Methods We reviewed the clinical records of patients with stage III non-small cell lung cancer (NSCLC) treated with CCRT and IMRT at seven centers in Japan and investigated relapse and survival from May 2018 to December 2019. The primary endpoint of this report was progression-free survival (PFS). Results Among 107 patients enrolled in the study, 87 were sequentially administered durvalumab. From CCRT commencement, patients were followed up for a median period of 29.7 months. The median PFS at the end of the CCRT was 20.7 months. Among the 87 patients, 58 experienced disease relapses, of whom 36 (62.1 %) had distant metastases. Multivariate Cox regression analysis revealed that a favorable response to CCRT, a radiation dose ≥ 62 Gy, and stage IIIA NSCLC were associated with prolonged PFS (all P = 0.04). Multivariate logistic regression by landmark analysis revealed that mortality risk factors were durvalumab treatment duration ≤ 11.7 months, a lower maximum grade of immune-related adverse events, FEV1 < 2805 mL, and radiation dose < 62 Gy (P = 0.01, 0.01, 0.03, and 0.04, respectively). Conclusions In patients with NSCLC receiving CCRT using IMRT, long PFS was associated with a better response to CCRT, stage IIIA NSCLC, and an increased radiation dose. The duration of durvalumab consolidation also played an essential role in the survival of patients receiving CCRT with IMRT. (250 words)
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Affiliation(s)
- Yuichiro Takeda
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo 162-8655, Japan
- Corresponding author at: Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
| | - Yusaku Kusaba
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo 162-8655, Japan
| | - Yoko Tsukita
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan
| | - Yukari Uemura
- Section of Biostatistics, Department of Clinical Research Center, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo 162-8655, Japan
| | - Eisaku Miyauchi
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan
| | - Hiroshi Mayahara
- Department of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1, Minatojimanakamachi, Chuo-ku, Kobe, Hyogo 650-0046, Japan
| | - Akito Hata
- Department of Respiratory Medical Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1, Minatojimanakamachi, Chuo-ku, Kobe, Hyogo 650-0046, Japan
| | - Hidetsugu Nakayama
- Department of Radiation Oncology, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo 162-8655, Japan
| | - Satoshi Tanaka
- Department of Respiratory Medicine, Osaka General Medical Center, 3-1-56, Bandaihigashi, Sumiyoshi-Ku, Osaka 558-0056, Japan
| | - Junji Uchida
- Department of Respiratory Medicine, Osaka General Medical Center, 3-1-56, Bandaihigashi, Sumiyoshi-Ku, Osaka 558-0056, Japan
| | - Kazuhiro Usui
- Division of Respirology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa, Tokyo 141-8625, Japan
| | - Tatsuya Toyoda
- Department of Radiology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa, Tokyo 141-8625, Japan
| | - Motohiro Tamiya
- Department of Thoracic Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka 541-8567, Japan
| | - Masahiro Morimoto
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka 541-8567, Japan
| | - Yuko Oya
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-Ku, Nagoya 464-8681, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-Ku, Nagoya 464-8681, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan
| | - Hisatoshi Sugiura
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan
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Mulet M, Osuna-Gómez R, Zamora C, Porcel JM, Nieto JC, Perea L, Pajares V, Muñoz-Fernandez AM, Calvo N, Sorolla MA, Vidal S. Influence of Malignant Pleural Fluid from Lung Adenocarcinoma Patients on Neutrophil Response. Cancers (Basel) 2022; 14:cancers14102529. [PMID: 35626131 PMCID: PMC9139419 DOI: 10.3390/cancers14102529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary This study provides novel information about the role of neutrophils in malignant pleural effusion (MPE) and hallmarks their clinical relevance. Since these cells have emerged as important regulators of cancer, we characterized their phenotype and functions in MPE microenvironment. We found that neutrophil-derived products (degranulation molecules and neutrophil extracellular traps (NETs)) were increased in MPE. In addition, NETs were associated with a worse outcome in lung adenocarcinoma patients with MPE. Abstract Malignant pleural effusion (MPE) is a common severe complication of advanced lung adenocarcinoma (LAC). Neutrophils, an essential component of tumor infiltrates, contribute to tumor progression and their counts in MPE have been associated with worse outcome in LAC. This study aimed to evaluate phenotypical and functional changes of neutrophils induced by MPE to determine the influence of MPE immunomodulatory factors in neutrophil response and to find a possible association between neutrophil functions and clinical outcomes. Pleural fluid samples were collected from 47 LAC and 25 heart failure (HF) patients. We measured neutrophil degranulation products by ELISA, oxidative burst capacity and apoptosis by flow cytometry, and NETosis by fluorescence. The concentration of degranulation products was higher in MPE-LAC than in PE-HF. Functionally, neutrophils cultured with MPE-LAC had enhanced survival and neutrophil extracellular trap (NET) formation but had reduced oxidative burst capacity. In MPE, NETosis was positively associated with MMP-9, P-selectin, and sPD-L1 and clinically related to a worse outcome. This is the first study associating NETs with a worse outcome in MPE. Neutrophils likely contribute to tumor progression through the release of NETs, suggesting that they are a potential therapeutic target in LAC.
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Affiliation(s)
- Maria Mulet
- Inflammatory Diseases, Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain; (M.M.); (R.O.-G.); (C.Z.); (J.C.N.); (L.P.)
| | - Rubén Osuna-Gómez
- Inflammatory Diseases, Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain; (M.M.); (R.O.-G.); (C.Z.); (J.C.N.); (L.P.)
| | - Carlos Zamora
- Inflammatory Diseases, Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain; (M.M.); (R.O.-G.); (C.Z.); (J.C.N.); (L.P.)
| | - José M. Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Hospital Universitari Arnau de Vilanova, IRBLleida, University of Lleida, 25003 Lleida, Spain;
| | - Juan C. Nieto
- Inflammatory Diseases, Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain; (M.M.); (R.O.-G.); (C.Z.); (J.C.N.); (L.P.)
| | - Lídia Perea
- Inflammatory Diseases, Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain; (M.M.); (R.O.-G.); (C.Z.); (J.C.N.); (L.P.)
| | - Virginia Pajares
- Department of Pneumology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (V.P.); (A.M.M.-F.)
| | - Ana M. Muñoz-Fernandez
- Department of Pneumology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (V.P.); (A.M.M.-F.)
| | - Nuria Calvo
- Department of Oncology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
| | | | - Silvia Vidal
- Inflammatory Diseases, Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain; (M.M.); (R.O.-G.); (C.Z.); (J.C.N.); (L.P.)
- Correspondence:
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Zhai T, Li Y, Brown R, Lanuti M, Gainor JF, Christiani DC. Spirometry at diagnosis and overall survival in non-small cell lung cancer patients. Cancer Med 2022; 11:4796-4805. [PMID: 35545892 PMCID: PMC9761088 DOI: 10.1002/cam4.4808] [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: 11/20/2021] [Revised: 04/11/2022] [Accepted: 04/26/2022] [Indexed: 02/03/2023] Open
Abstract
Pulmonary function can predict all-cause mortality, and chronic obstructive pulmonary disease (COPD) is associated with worse overall survival (OS) in non-small cell lung cancer (NSCLC) patients. Though pre-operative lung function is predictive of in-hospital mortality following lung cancer surgery, its predictive utility for long-term survival is unclear. The prognostic role of commonly used spirometry tests in survival of lung cancer also remains uncertain. This study evaluates the role of spirometry at lung cancer diagnosis in predicting OS of NSCLC patients. This was a retrospective study using data from the Boston Lung Cancer Study on newly diagnosed NSCLC patients with spirometry tests performed before cancer therapy (n = 2805). Spirometric test values, after being categorized using quartiles, were analyzed for association with OS using univariate and risk-adjusted multiple regression models. Further, we analyzed OS by the status of COPD determined by spirometry, and, among those with COPD, by its stage defined by the Global Initiative for Chronic Obstructive Lung Disease criteria. Both univariate and multiple regression models demonstrated that lower quartiles of actual and percent predicted forced expiratory volume in 1 second and forced vital capacity at lung cancer diagnosis were significantly associated with worse OS. Spirometry-determined COPD, and more advanced stage of COPD at lung cancer diagnosis were associated with worse lung cancer OS. The findings provide evidence that a good pulmonary function at diagnosis may help improve OS in NSCLC patients.
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Affiliation(s)
- Ting Zhai
- Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Yi Li
- Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Robert Brown
- Pulmonary and Critical Care Division, Department of MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Michael Lanuti
- Division of Thoracic Surgery, Department of SurgeryMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Justin F. Gainor
- Massachusetts General Hospital Cancer Center and Department of Hematology & OncologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - David C. Christiani
- Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA,Pulmonary and Critical Care Division, Department of MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
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Chen JLY, Pan CK, Lin YL, Tsai CY, Huang YS, Yang WC, Hsu FM, Kuo SH, Shieh MJ. Preclinical evaluation of PEGylated liposomal doxorubicin as an effective radiosensitizer in chemoradiotherapy for lung cancer. Strahlenther Onkol 2021; 197:1131-1142. [PMID: 34476531 DOI: 10.1007/s00066-021-01835-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 08/01/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Development of a safe and effective systemic chemotherapeutic agent for concurrent administration with definitive thoracic radiotherapy remains a major goal of lung cancer management. The synergistic effect of PEGylated liposomal doxorubicin and irradiation was evaluated in lung cancer cell lines both in vitro and in vivo. METHODS In vitro radiosensitization of A549 and LLC cell lines was evaluated by colony formation assay, γH2AX fluorescent staining and western blot assay, and annexin V staining. A radiosensitization study with healthy human lung-derived cell line BEAS-2B was performed for comparative purposes. In vivo radiosensitization was evaluated by tumor ectopic growth, cell survival, pharmacokinetics, and biodistribution analyses. Cleaved caspase‑3, the marker for apoptosis, was assessed immunohistochemically in A549 xenograft tumors. RESULTS Treatment with PEGylated liposomal doxorubicin decreased A549 and LLC cell proliferation in a dose-dependent manner. In vitro studies revealed comparable radiosensitizer advantages of PEGylated liposomal doxorubicin and free doxorubicin, showing equivalent DNA double-strand breaks according to γH2AX fluorescent staining and western blot assays, similar numbers of apoptotic cells in the annexin‑V staining assay, and moderately decreased clonogenic survival. In vivo studies demonstrated markedly slow ectopic tumor growth with prolonged survival following treatment with PEGylated liposomal doxorubicin plus irradiation in both A549 and LLC mouse models, suggesting that PEGylated liposomal doxorubicin is more effective as a radiosensitizer than free doxorubicin in vivo. Pharmacokinetics evaluation showed a longer half-life of approximately 40 h for PEGylated liposomal doxorubicin, confirming that the liposomal carrier achieved controlled release. Biodistribution evaluation of PEGylated liposomal doxorubicin confirmed high accumulation of doxorubicin in tumors, indicating the promising drug delivery attributes of PEGylated liposomal doxorubicin. Although free doxorubicin caused histopathologic myocarditis with the cardiac muscle fibers showing varying degrees of damage, PEGylated liposomal doxorubicin caused no such effects. The immunohistochemical expression of cleaved caspase-3-positive cells was greatest expressed in the irradiation and PEGylated liposomal doxorubicin combined treatment group, indicating prolonged tumoricidal effects. CONCLUSIONS Our study provides preclinical in vitro and in vivo evidence of the effectiveness of PEGylated liposomal doxorubicin as a radiosensitizer, supporting its potential clinical development as a component of chemoradiotherapy.
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Affiliation(s)
- Jenny Ling-Yu Chen
- Department of Radiology, National Taiwan University College of Medicine, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan
- Cancer Center, College of Medicine, National Taiwan University, No. 57, Lane 155, Section 3, Keelung Road, Taipei, Taiwan
| | - Chun-Kai Pan
- Department of Radiology, National Taiwan University College of Medicine, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan
- Department of Medical Research, National Taiwan University Hospital, No. 7, Chung-Shan South Road, 100, Taipei, Taiwan
| | - Yu-Li Lin
- Department of Medical Research, National Taiwan University Hospital, No. 7, Chung-Shan South Road, 100, Taipei, Taiwan.
| | - Ching-Yi Tsai
- Department of Medical Research, National Taiwan University Hospital, No. 7, Chung-Shan South Road, 100, Taipei, Taiwan
- Institute of Toxicology, National Taiwan University College of Medicine, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan
| | - Yu-Sen Huang
- Department of Radiology, National Taiwan University College of Medicine, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan
| | - Wen-Chi Yang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan
- Cancer Center, College of Medicine, National Taiwan University, No. 57, Lane 155, Section 3, Keelung Road, Taipei, Taiwan
| | - Feng-Ming Hsu
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan
- Cancer Center, College of Medicine, National Taiwan University, No. 57, Lane 155, Section 3, Keelung Road, Taipei, Taiwan
| | - Sung-Hsin Kuo
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan
- Cancer Center, College of Medicine, National Taiwan University, No. 57, Lane 155, Section 3, Keelung Road, Taipei, Taiwan
| | - Ming-Jium Shieh
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan
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Utsumi N, Takahashi T, Hatanaka S, Hariu M, Saito M, Kondo S, Soda R, Nishimura K, Yamano T, Watanabe W, Shimbo M, Honda N. VMAT Planning With Xe-CT Functional Images Enables Radiotherapy Planning With Consideration of Lung Function. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:193-200. [PMID: 35399314 PMCID: PMC8962790 DOI: 10.21873/cdp.10026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/25/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM The most severe adverse event of radiotherapy in lung cancer is radiation pneumonitis (RP). Some indices commonly used to prevent RP are evaluated based on the anatomical lung volume. The irradiation dose may be more accurately assessed by using functional lung volume. We evaluated the usefulness of computed tomography (CT) incorporating functional ventilation images acquired by the inhalation of xenon (Xe) gas (Xe-CT functional images). PATIENTS AND METHODS Two plans were created for twelve patients: volumetric modulated arc therapy (VMAT) planning using conventional chest CT images (anatomical plans) and VMAT planning using Xe-CT functional images (functional plans), and the dosimetric parameters were compared. RESULTS Compared to the anatomical plans, the functional plans had significantly reduced V 20Gy in the high-functional lungs (p=0.005), but significant differences were not seen in the moderate-functional and low-functional lungs. CONCLUSION The incorporation of Xe-CT functional images into VMAT plans enables radiotherapy planning with consideration of lung function.
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Affiliation(s)
- Nobuko Utsumi
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
- Department of Radiation Therapy, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Takeo Takahashi
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shogo Hatanaka
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Masatsugu Hariu
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Mio Saito
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shuichi Kondo
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Rikana Soda
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Keiichiro Nishimura
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Takafumi Yamano
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Wataru Watanabe
- Department of Radiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Munefumi Shimbo
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Norinari Honda
- Department of Radiology, Saitama Sekishinkai Hospital, Saitama, Japan
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Goussault H, Gendarme S, Assié JB, Bylicki O, Chouaïd C. Factors associated with early lung cancer mortality: a systematic review. Expert Rev Anticancer Ther 2021; 21:1125-1133. [PMID: 34121578 DOI: 10.1080/14737140.2021.1941888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Despite recent therapeutic advances, lung cancer remains the primary cause of cancer deaths worldwide, and early lung mortality was poorly studied.Area covered: Early lung-cancer mortality reflects local therapy (surgery or radiotherapy) impact (localized forms), and metastatic disease evolution, comorbidities and healthcare-system accessibility. The definition of early lung cancer mortality is not consensual; thresholds range from 1 to 12 months post-diagnosis. This systematic review was undertaken to identify and analyze factors significantly associated with early lung cancer mortality. Age, male sex, non-adenocarcinoma histology, advanced stage at diagnosis and ECOG performance status are the main clinical factors of early lung cancer mortality. Active/ex-smoking also seems to favor early mortality, despite heterogeneous definitions of smoker status. For radio-chemotherapy treated locally advance disease, the early mortality rate increases according to tumor volume. Less well studied, socioeconomic characteristics (rurality and social deprivation index) yielded contradictory results, partially because definitions vary over studies. However, early lung cancer mortality is significantly higher for lower socioeconomic class patients.Expert opinion: Prospective, observational, general population studies are needed to better evaluate early lung-cancer mortality. International consensus concerning the patient-, disease- or healthcare system-linked factors of interest to be collected would facilitate comparisons among countries.
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Affiliation(s)
- Helene Goussault
- Respiratory Medicine, Centre Hospitalier Intercommunal De Créteil, Creteil, France.,INSERM U955, Creteil, Île-de-france, France
| | - Sebastien Gendarme
- Respiratory Medicine, Centre Hospitalier Intercommunal De Créteil, Creteil, France.,INSERM U955, Creteil, Île-de-france, France
| | - Jean Baptiste Assié
- Respiratory Medicine, Centre Hospitalier Intercommunal De Créteil, Creteil, France.,Centre De Recherche Des Cordeliers, Paris, Île-de-france, France
| | - Olivier Bylicki
- Hopital D'instruction Des Armées De Saint-Anne, Toulon, France
| | - Christos Chouaïd
- Respiratory Medicine, Centre Hospitalier Intercommunal De Créteil, Creteil, France.,INSERM U955, Creteil, Île-de-france, France
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Associations between pretreatment physical performance tests and treatment complications in patients with non-small cell lung cancer: A systematic review. Crit Rev Oncol Hematol 2021; 158:103207. [PMID: 33383208 DOI: 10.1016/j.critrevonc.2020.103207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 12/25/2022] Open
Abstract
This systematic review evaluated which outcome variables and cut-off values of pretreatment exercise tests are associated with treatment complications in patients with stage I-III non-small cell lung cancer (NSCLC). PRISMA and Cochrane guidelines were followed. A total of 38 studies with adult patients undergoing treatment for stage I-III NSCLC who completed pretreatment exercise tests, and of whom treatment-related complications were recorded were included. A lower oxygen uptake at peak exercise amongst several other variables on the cardiopulmonary exercise test and a lower performance on field tests, such as the incremental shuttle walk test, stair-climb test, and 6-minute walk test, were associated with a higher risk for postoperative complications and/or postoperative mortality. Cut-off values were reported in a limited number of studies and were inconsistent. Due to the variety in outcomes, further research is needed to evaluate which outcomes and cut-off values of physical exercise tests are most clinically relevant.
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Guo M, Li W, Li B, Zou B, Wang S, Fan B, Sun X, Wang L. Multiple Immune Features-Based Signature for Predicting Recurrence and Survival of Inoperable LA-NSCLC Patients. Front Oncol 2020; 10:571380. [PMID: 33154945 PMCID: PMC7591766 DOI: 10.3389/fonc.2020.571380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/21/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction The immune status of the tumor microenvironment is extremely complex. One single immune feature cannot reflect the integral immune status, and its prognostic value was limited. We postulated that the immune signature based on multiple immuno-features could markedly improve the prediction of post-chemoradiotherapeutic survival in inoperable locally advanced non-small-cell lung cancer (LA-NSCLC) patients. Methods In this study, 100 patients who were diagnosed as having inoperable LA-NSCLC between January 2005 and January 2016 were analyzed. A five immune features-based signature was then constructed using the nested repeat 10-fold cross validation with least absolute shrinkage and selection operator (LASSO) Cox regression model. Nomograms were then established for predicting prognosis. Results The immune signature combining five immuno-features was significantly associated with overall survival (OS) and progression-free survival (PFS) (P = 0.002 and P = 0.014, respectively) in patients with inoperable LA-NSCLC, and at a cutoff of −0.05 stratified patients into two groups with 5-year OS rates of 39.8 and 8.8%, and 2-year PFS rates of 22.2 and 5.5% for the high- and low-immune signature groups, respectively. Integrating immune signature, we proposed predictive nomograms that were better than the traditional TNM staging system in terms of discriminating ability (OS: 0.692 vs. 0.588; PFS: 0.672 vs. 0.586, respectively) or net weight classification (OS: 32.96%; PFS: 9.22%), suggesting that the immune signature plays a significant role in improving the prognostic value. Conclusion Multiple immune features-based immune signature could effectively predict recurrence and survival of inoperable LA-NSCLC patients and complemented the prognostic value of the TNM staging system.
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Affiliation(s)
- Meiying Guo
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Wanlong Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Butuo Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.,Key Laboratory of Cancer Prevention and Therapy, Department of Radiation Oncology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Bing Zou
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Shijiang Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Bingjie Fan
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xindong Sun
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Linlin Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Prognostic factors for overall survival of stage III non-small cell lung cancer patients on computed tomography: A systematic review and meta-analysis. Radiother Oncol 2020; 151:152-175. [PMID: 32710990 DOI: 10.1016/j.radonc.2020.07.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Prognosis prediction is central in treatment decision making and quality of life for non-small cell lung cancer (NSCLC) patients. However, conventional computed tomography (CT) related prognostic factors may not apply to the challenging stage III NSCLC group. The aim of this systematic review was therefore to identify and evaluate CT-related prognostic factors for overall survival (OS) of stage III NSCLC. METHODS The Medline, Embase, and Cochrane electronic databases were searched. After study selection, risk of bias was estimated for the included studies. Meta-analysis of univariate results was performed when sufficient data were available. RESULTS 1595 of the 11,996 retrieved records were selected for full text review, leading to inclusion of 65 studies that reported data of 144,513 stage III NSCLC patients andcompromising 26 unique CT-related prognostic factors. Relevance and validity varied substantially, few studies had low relevance and validity. Only four studies evaluated the added value of new prognostic factors compared with recognized clinical factors. Included studies suggested gross tumor volume (meta-analysis: HR = 1.22, 95%CI: 1.05-1.42), tumor diameter, nodal volume, and pleural effusion, are prognostic in patients treated with chemoradiation. Clinical T-stage and location (right/left) were likely not prognostic within stage III NSCLC. Inconclusive are several radiomic features, tumor volume, atelectasis, location (pulmonary lobes, central/peripheral), interstitial lung abnormalities, great vessel invasion, pit-fall sign, and cavitation. CONCLUSIONS Tumor-size and nodal size-related factors are prognostic for OS in stage III NSCLC. Future studies should carefully report study characteristics and contrast factors with guideline recognized factors to improve evidence evaluation and validation.
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Outcomes of Hypofractional Tomotherapy in Patients with Stage III Nonsmall Cell Lung Cancer Who Are Not Eligible for Surgery or Concurrent Chemoradiation. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9168424. [PMID: 32685544 PMCID: PMC7345954 DOI: 10.1155/2020/9168424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/21/2020] [Indexed: 12/04/2022]
Abstract
Purpose We assessed the clinical outcomes and toxicities following hypofractionation with helical tomographic intensity-modulated radiotherapy technology (tomotherapy) in patients with stage III non-small cell lung cancer (NSCLC) who were not candidates for surgery or concurrent chemoradiation. Methods Forty-three patients with stage III NSCLC who were treated between 2011 and 2017 were enrolled. The prescription doses for gross target volume and clinical target volume were 70 Gy and 60 Gy (respectively) delivered in 15–25 fractions over 3–5 weeks. Results The median overall survival (OS) time was 34.23 (range 11.33–99.33) months. The estimated 1-, 2-, and 3-year OS rates were 97.7%, 74.4%, and 55.9%, respectively; the corresponding progression-free survival (PFS) rates were 79.1%, 53.5%, and 36.1%, respectively. The local disease recurrence, regional disease recurrence, and distant metastasis rates at 3 years were 4.7%, 11.62%, and 55.81%, respectively. On multivariate analysis, dose regimen (<19 f vs. ≥19 f) was an independent prognostic factor affecting OS, PFS, and DM (p < 0.05). Seven patients developed grade 1-2 acute radiation pneumonia (RP), 5 patients developed grade 1-2 late RP, while 3 patients developed grade 3 late RP. None of the patients developed grade 4-5 radiation lung injury. Conclusion Tomotherapy may be an effective treatment option for patients with stage III NSCLC. It may be a viable alternative to surgery with lower incidence of side effects.
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Stervik L, Pettersson N, Scherman J, Behrens CF, Ceberg C, Engelholm S, Gunnarsson K, Hallqvist A, Nyman J, Persson GF, Pøhl M, Wahlstedt I, Vogelius IR, Bäck A. Analysis of early respiratory-related mortality after radiation therapy of non-small-cell lung cancer: feasibility of automatic data extraction for dose-response studies. Acta Oncol 2020; 59:628-635. [PMID: 32202189 DOI: 10.1080/0284186x.2020.1739331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose: To examine the feasibility of automatic data extraction from clinical radiation therapy (RT) databases at four hospitals to investigate the impact of mean lung dose (MLD) and age on the risk of early respiratory-related death and early overall death for patients treated with RT for non-small-cell lung cancer (NSCLC).Material and methods: We included adult patients with NSCLC receiving curatively intended RT between 2002 and 2017 at four hospitals. A script was developed to automatically extract RT-related data. The cause of death for patients deceased within 180 days of the start of RT was retrospectively assessed. Using logistic regression, the risks of respiratory-related death and of overall death within 90 and 180 days were investigated using MLD and age as variables.Results: Altogether, 1785 patients were included in the analysis of early overall mortality and 1655 of early respiratory-related mortality. The respiratory-related mortalities within 90 and 180 days were 0.9% (15/1655) and 3.6% (60/1655). The overall mortalities within 90 and 180 days were 2.5% (45/1785) and 10.6% (190/1785). Higher MLD and older age were associated with an increased risk of respiratory-related death within 180 days and overall death within 90 and 180 days (all p<.05). For example, the risk of respiratory-related death within 180 days and their 95% confidence interval for patients aged 65 and 75 years with MLDs of 20 Gy was according to our logistic model 3.8% (2.6-5.0%) and 7.7% (5.5-10%), respectively.Conclusions: Automatic data extraction was successfully used to pool data from four hospitals. MLD and age were associated with the risk of respiratory-related death within 180 days of the start of RT and with overall death within 90 and 180 days. A model quantifying the risk of respiratory-related death within 180 days was formulated.
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Affiliation(s)
- Louise Stervik
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Niclas Pettersson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonas Scherman
- Department of Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Claus F. Behrens
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Crister Ceberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Silke Engelholm
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Kerstin Gunnarsson
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Hallqvist
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Nyman
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gitte F. Persson
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Pøhl
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Isak Wahlstedt
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ivan R. Vogelius
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna Bäck
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Kwint M, Stam B, Proust-Lima C, Philipps V, Hoekstra T, Aalbersberg E, Rossi M, Sonke JJ, Belderbos J, Walraven I. The prognostic value of volumetric changes of the primary tumor measured on Cone Beam-CT during radiotherapy for concurrent chemoradiation in NSCLC patients. Radiother Oncol 2020; 146:44-51. [DOI: 10.1016/j.radonc.2020.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/05/2019] [Accepted: 02/05/2020] [Indexed: 02/09/2023]
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Ni L, Koshy M, Connell P, Pitroda S, Golden DW, Al-Hallaq H, Hubert G, Kauffman G, McCall A, Malik R. Heart V5 predicts cardiac events in unresectable lung cancer patients undergoing chemoradiation. J Thorac Dis 2019; 11:2229-2239. [PMID: 31372260 DOI: 10.21037/jtd.2019.06.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Recent studies incorporating dose escalated radiation identified heart dose as a predictor of cardiac toxicity in unresectable lung cancer patients. Whether conventionally dosed radiation impacts cardiac events remains unclear. Methods Stage III lung cancer patients undergoing definitive chemoradiation to 60-70 Gy were analyzed. Clinical and dosimetric factors (mean heart dose, heart V5-60 in 5 Gy increments) were analyzed against freedom from ≥ grade 3 cardiac events and overall survival (OS) by log-rank test. Multivariable analysis (MVA) for factors significant on univariate analysis was performed by Cox proportional hazards. Results A total of 108 patients were identified. Median follow-up was 18.0 months. One- and two-year OS were 79% and 61%, respectively. On MVA, gross tumor volume (GTV) ≥98.6 cm3 [hazard ratio (HR): 2.11, 95% confidence interval (CI): 1.15-3.93, P=0.02] and female gender (HR: 2.01, 95% CI: 1.09-3.73, P=0.03) predicted for worse survival. Twelve patients (11%) developed ≥ grade 3 cardiac events. One- and two-year freedom from cardiac events (FFCE) was 94% and 84% respectively. On MVA, heart V5 ≥49% predicted for cardiac events (HR: 11.44, 95% CI: 1.31-111.60, P=0.03) while female gender was nearly significant (HR: 3.49, 95% CI: 0.97-16.80, P=0.06). Females presented with similar comorbidity scores, GTVs, and relapse rates but experienced higher heart doses than their male counterparts. Conclusions Heart V5 ≥49% predicted for cardiac events after chemoradiation. However, cardiac dosimetry was not associated with survival. Rather, female gender and GTV ≥98.6 cm3 led to worse survival. This study corroborates emerging data that low-dose radiation to the heart impacts cardiac toxicity.
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Affiliation(s)
- Lisa Ni
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Matthew Koshy
- University of Chicago Department of Radiation and Cellular Oncology, Chicago, IL, USA
| | - Philip Connell
- University of Chicago Department of Radiation and Cellular Oncology, Chicago, IL, USA
| | - Sean Pitroda
- University of Chicago Department of Radiation and Cellular Oncology, Chicago, IL, USA
| | - Daniel W Golden
- University of Chicago Department of Radiation and Cellular Oncology, Chicago, IL, USA
| | - Hania Al-Hallaq
- University of Chicago Department of Radiation and Cellular Oncology, Chicago, IL, USA
| | - Greg Hubert
- University of Chicago Department of Radiation and Cellular Oncology, Chicago, IL, USA
| | - Greg Kauffman
- University of Chicago Department of Radiation and Cellular Oncology, Chicago, IL, USA
| | - Anne McCall
- University of Chicago Department of Radiation and Cellular Oncology, Chicago, IL, USA
| | - Renuka Malik
- University of Chicago Department of Radiation and Cellular Oncology, Chicago, IL, USA
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Urbanic JJ, McGarry RC, Daly ME, Palma DA. Locally Advanced Lung Cancer: Is It Time to Take Cardiac Protection Seriously in Radiation Planning? Int J Radiat Oncol Biol Phys 2019; 100:1091-1094. [PMID: 29722650 DOI: 10.1016/j.ijrobp.2017.09.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 09/22/2017] [Indexed: 12/25/2022]
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The role of tumour volume as a prognostic factor in non-small cell lung cancer (NSCLC) patients treated with definitive radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2019. [DOI: 10.1017/s1460396919000037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractBackgroundIt has been shown that patients with a greater tumour volume have poorer outcomes following definitive radiotherapy but its exact role remains unclear. The purpose of this study is to investigate the role of tumour volume as a prognostic indicator in non-small cell lung cancer (NSCLC) patients treated with definitive radiotherapy in a single institution over 10 years.MethodsIn total, 167 patients with NSCLC treated by definitive (chemo)radiotherapy were retrospectively reviewed between 2006 and 2015. Patient demographics, disease characteristics and tumour volume parameters were collected. Univariate analyses were carried out using Kaplan–Meier survival curves to assess the association of potential prognostic factors with the primary endpoints of overall survival (OS) rates and locoregional recurrence rates. Multivariate analyses were carried out using a Cox regression method.ResultsThe median total tumour volume (TTV), defined as the gross tumour volume plus the volume of involved nodes, was 103 cm3. Patients were divided into small and large tumour groups based on this median. OS rates at 1, 3 and 5 years for smaller volumes were 69%, 24% and 13% and for larger volumes 48%, 14% and 8%, respectively. On univariate survival analyses larger TTV was significantly associated with poorer OS (p= 0·019). The concurrent use of chemotherapy significantly improved survival (p= 0·026). Nodal involvement (p= 0·03) and Eastern Cooperative Oncology Group performance status (p< 0·001) were also significant independent prognostic factors of OS. On multivariate analysis TTV was strongly predictive of survival (p= 0·03; hazard ratio 1·702, 95% confidence interval 1·198–2·415). There was no association between nodal volume, tumour stages, overall stage, age, histology and radiation dose with any of the primary endpoints.ConclusionTTV is a significant prognostic factor in patients with advanced NSCLC treated by radical radiotherapy. In this cohort of patients TTV is more reliable at predicting survival than T stage and overall stage.
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Guberina M, Eberhardt W, Stuschke M, Gauler T, Aigner C, Schuler M, Stamatis G, Theegarten D, Jentzen W, Herrmann K, Pöttgen C. Pretreatment metabolic tumour volume in stage IIIA/B non-small-cell lung cancer uncovers differences in effectiveness of definitive radiochemotherapy schedules: analysis of the ESPATUE randomized phase 3 trial. Eur J Nucl Med Mol Imaging 2019; 46:1439-1447. [PMID: 30710323 DOI: 10.1007/s00259-019-4270-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/10/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE According to the ACRIN 6668/RTOG 0235 trial, pretreatment metabolic tumour volume (MTV) as detected by 18F-fluorodeoxyglucose PET/CT is a prognostic factor in patients with stage III non-small-cell lung cancer (NSCLC) after definitive radiochemotherapy (RCT). To validate the prognostic value of MTV in patients with stage III NSCLC after RCT, we analysed mature survival data from the German phase III trial ESPATUE. METHODS This analysis included patients who were staged by PET/CT and who were enrolled in the ESPATUE trial, a randomized study comparing definitive RCT (arm A) with surgery (arm B) after induction chemotherapy and RCT in patients with resectable stage IIIA/IIIB NSCLC. Patients refusing surgery and those with nonresectable disease were scheduled to receive definitive RCT. MTV was measured using a fixed threshold-based approach and a model-based iterative volume thresholding approach. Data were analysed using proportional hazards models and Kaplan-Meier survival functions. RESULTS MTV as a continuous variable did not reveal differences in survival between the 117 patients scheduled to receive definitive RCT and all 169 enrolled patients who underwent pretreatment PET/CT (p > 0.5). Five-year survival rates were 33% (95% CI 17-49%) in patients scheduled for definitive RCT with a high MTV (>95.4 ml) and 32% (95% CI: 22-42%) in those with a low MTV. The hazard ratio for survival was 0.997 (95% CI 0.973-1.022) per 10-ml increase in MTV and the slope was significantly shallower than that in the ACRIN 6668/RTOG 0235 trial (random effects model, p = 0.002). There were no differences in MTV size distributions between the ACRIN and ESPATUE trials (p = 0.97). CONCLUSION Patients with stage III NSCLC and a large MTV in whom definitive RCT had a particularly good survival in the ESPATUE trial. Treatment individualization according to MTV is not supported by this study. The ESPATUE and ACRIN trials differed by the use of cisplatin-containing induction chemotherapy and an intensified radiotherapy regimen that were particularly effective in patients with large MTV disease.
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Affiliation(s)
- Maja Guberina
- Department of Radiation Oncology, West German Cancer Center, University of Duisburg-Essen Medical School, Hufelandstr. 55, 45122, Essen, Germany
| | - Wilfried Eberhardt
- Department of Medical Oncology, West German Cancer Center, University of Duisburg-Essen Medical School, 45122, Essen, Germany
| | - Martin Stuschke
- Department of Radiation Oncology, West German Cancer Center, University of Duisburg-Essen Medical School, Hufelandstr. 55, 45122, Essen, Germany. .,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45122, Essen, Germany.
| | - Thomas Gauler
- Department of Radiation Oncology, West German Cancer Center, University of Duisburg-Essen Medical School, Hufelandstr. 55, 45122, Essen, Germany
| | - Clemens Aigner
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45122, Essen, Germany.,Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen Medical School, 45239, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University of Duisburg-Essen Medical School, 45122, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45122, Essen, Germany
| | - Georgios Stamatis
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen Medical School, 45239, Essen, Germany
| | - Dirk Theegarten
- Department of Pathology, West German Cancer Center, University of Duisburg-Essen Medical School, 45122, Essen, Germany
| | - Walter Jentzen
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen Medical School, 45122, Essen, Germany
| | - Ken Herrmann
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45122, Essen, Germany.,Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen Medical School, 45122, Essen, Germany
| | - Christoph Pöttgen
- Department of Radiation Oncology, West German Cancer Center, University of Duisburg-Essen Medical School, Hufelandstr. 55, 45122, Essen, Germany
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Predicting tumor responses and patient survival in chemoradiotherapy-treated patients with non-small-cell lung cancer using dynamic contrast-enhanced integrated magnetic resonance-positron-emission tomography. Strahlenther Onkol 2019; 195:707-718. [PMID: 30610356 DOI: 10.1007/s00066-018-1418-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/14/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE We investigated whether radiologic parameters by dynamic contrast-enhanced (DCE) integrated magnetic resonance-positron-emission tomography (MR-PET) predicts tumor response to treatment and survival in non-metastatic non-small-cell lung cancer (NSCLC) patients receiving chemoradiotherapy (CRT). METHODS Patients underwent DCE integrated MR-PET imaging 1 week before CRT. The following parameters were analyzed: primary tumor size, gross tumor volume, maximal standardized uptake value (SUVmax), total lesion glycolysis (TLG), apparent diffusion coefficient (ADC), volume transfer constant (Ktrans), reverse reflux rate constant (kep), extracellular extravascular volume fraction (ve), blood plasma volume fraction (vp), and initial area under the time-concentration curve defined over the first 60 s post-enhancement (iAUC60). CRT responses were defined using the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1). RESULTS Thirty patients were included. Non-responders demonstrated higher baseline TLG (p = 0.012), and lower baseline Ktrans (p = 0.020) and iAUC60 (p = 0.016) compared to responders, indicating the usefulness of DCE integrated MR-PET to predict treatment responses. Receiver operating characteristic curve indicated that TLG has the best differentiation capability to predict responders. By setting the threshold of TLG to 277, the sensitivity, specificity, and accuracy were 66.7%, 83.3%, and 75.0%, respectively, with an area under the curve of 0.776. The median follow-up time was 19.6 (range 7.8-32.0) months. In univariate analyses, baseline TLG >277 (p = 0.005) and baseline Ktrans <254 (10-3 min-1; p = 0.015) correlated with poor survival after CRT. In multivariate analysis, baseline TLG >277 remained the significant factor in predicting progression (p = 0.012) and death (p = 0.031). CONCLUSIONS The radiologic parameters derived from DCE integrated MR-PET scans are useful for predicting treatment response in NSCLC patients treated with CRT; furthermore, these parameters are correlated with clinical and survival outcomes including tumor progression and death.
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Greater reduction in mid-treatment FDG-PET volume may be associated with worse survival in non-small cell lung cancer. Radiother Oncol 2018; 132:241-249. [PMID: 30389239 DOI: 10.1016/j.radonc.2018.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 09/17/2018] [Accepted: 10/08/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE This study tested the hypotheses that 1) changes in mid-treatment fluorodeoxyglucose (FDG)-positron emission tomography (PET) parameters are predictive of overall survival (OS) and 2) mid-treatment FDG-PET-adapted treatment has the potential to improve survival in patients with non-small cell lung cancer (NSCLC). MATERIAL AND METHODS Patients with stage I-III NSCLC requiring daily fractionated radiation were eligible. FDG-PET-CT scans were obtained prior to and mid-treatment with radiotherapy at 40-50 Gy. The normalized maximum standardized uptake value (NSUVmax), normalized mean SUV (NSUVmean), PET-metabolic tumor volume (MTV), total lesion glycolysis (TLG), and computed tomography-based gross tumor volume (CT-GTV) were consistently measured for all patients. The primary study endpoint was OS. RESULTS The study is comprised of 102 patients who received 3-dimensional conformal radiotherapy, among whom 30 patients who received mid-treatment PET-adapted dose escalation radiotherapy. All PET-CT parameters decreased significantly (P < 0.001) mid-treatment, with greater reductions in FDG-volumetric parameters compared to FDG-activity factors. Mid-treatment changes in MTV (P = 0.053) and TLG (P = 0.021) were associated with OS, while changes in NSUVmax, NSUVmean, and CT-GTV were not (all Ps>0.1). Patients receiving conventional radiation (60-70 Gy) with MTV reductions greater than the mean had a median survival of 14 months, compared to those with MTV reductions less than the mean who had a median survival of 22 months. By contrast, patients receiving mid-treatment PET-adapted radiation with MTV reductions greater than the mean had a median survival of 33 months, compared to those with MTV reductions less than the mean who had a median survival of 19 months. Overall, PET-adapted treatment resulted in a 19% better 5-year survival than conventional radiation. CONCLUSION Changes in mid-treatment PET-volumetric parameters were significantly associated with survival in NSCLC. A greater reduction in the mid-treatment MTV was associated with worse survival in patients treated with standard radiation, but with better survival in patients who received mid-treatment PET-adapted treatment.
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Tong YS, Tan J, Zhou XL, Song YQ, Song YJ. Systemic immune-inflammation index predicting chemoradiation resistance and poor outcome in patients with stage III non-small cell lung cancer. J Transl Med 2017; 15:221. [PMID: 29089030 PMCID: PMC5664920 DOI: 10.1186/s12967-017-1326-1] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/26/2017] [Indexed: 12/11/2022] Open
Abstract
Background There is increasing evidence that the existence of systemic inflammation response is correlated with poor prognosis in several solid tumors. The aim of this retrospective study was to investigate the association between systemic immune-inflammation index (SII) and therapy response and overall survival in patients with stage III non-small cell lung cancer (NSCLC). The prognostic values of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and prognostic nutritional index (PNI) were also evaluated. Methods In total, 332 patients with new diagnosis of stage III NSCLC were included in this retrospective analysis. SII was defined as platelet counts × neutrophil counts/lymphocyte counts. Receiver operating characteristic (ROC) curve was used to evaluate the optimal cut-off value for SII, NLR, PLR and PNI. Univariate and multivariate survival analysis were performed to identify the factors correlated with overall survival. Results Applying cut-offs of ≥ 660 (SII), ≥ 3.57 (NLR), ≥ 147 (PLR), ≤ 52.95 (PNI), SII ≥ 660 was significantly correlated with worse ECOG PS (< 0.001), higher T stage (< 0.001), advanced clinical stage (p = 0.019), and lower response rate (p = 0.018). In univariate analysis, SII ≥ 660, NLR ≥ 3.57, PLR ≥ 147, and PNI ≤ 52.95 were significantly associated with worse overall survival (pall < 0.001). Patients with SII ≥ 660 had a median overall survival of 10 months, and patients with SII < 660 showed a median overall survival of 30 months. In multivariate analysis only ECOG PS (HR, 1.744; 95% CI 1.158–2.626; p = 0.008), T stage (HR, 1.332; 95% CI 1.032–1.718; p = 0.028), N stage (HR, 1.848; 95% CI 1.113–3.068; p = 0.018), SII (HR, 2.105; 95% CI 1.481–2.741; p < 0.001) and NLR ≥ 3.57 (HR, 1.934; 95% CI 1.448–2.585; p < 0.001) were independently correlated with overall survival. Conclusions This study demonstrates that the SII is an independent prognostic indicator of poor outcomes for patients with stage III NSCLC and is superior to other inflammation-based factors in terms of prognostic ability.
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Affiliation(s)
- Yu-Suo Tong
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China
| | - Juan Tan
- Department of Gerontology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China
| | - Xi-Lei Zhou
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China
| | - Ya-Qi Song
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China
| | - Ying-Jian Song
- Department of Respiratory Medicine, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China.
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21
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Tong YS, Tan J, Zhou XL, Song YQ, Song YJ. Systemic immune-inflammation index predicting chemoradiation resistance and poor outcome in patients with stage III non-small cell lung cancer. J Transl Med 2017. [PMID: 29089030 DOI: 10.7150/jca.2569110.1186/s12967-017-1326-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There is increasing evidence that the existence of systemic inflammation response is correlated with poor prognosis in several solid tumors. The aim of this retrospective study was to investigate the association between systemic immune-inflammation index (SII) and therapy response and overall survival in patients with stage III non-small cell lung cancer (NSCLC). The prognostic values of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and prognostic nutritional index (PNI) were also evaluated. METHODS In total, 332 patients with new diagnosis of stage III NSCLC were included in this retrospective analysis. SII was defined as platelet counts × neutrophil counts/lymphocyte counts. Receiver operating characteristic (ROC) curve was used to evaluate the optimal cut-off value for SII, NLR, PLR and PNI. Univariate and multivariate survival analysis were performed to identify the factors correlated with overall survival. RESULTS Applying cut-offs of ≥ 660 (SII), ≥ 3.57 (NLR), ≥ 147 (PLR), ≤ 52.95 (PNI), SII ≥ 660 was significantly correlated with worse ECOG PS (< 0.001), higher T stage (< 0.001), advanced clinical stage (p = 0.019), and lower response rate (p = 0.018). In univariate analysis, SII ≥ 660, NLR ≥ 3.57, PLR ≥ 147, and PNI ≤ 52.95 were significantly associated with worse overall survival (p all < 0.001). Patients with SII ≥ 660 had a median overall survival of 10 months, and patients with SII < 660 showed a median overall survival of 30 months. In multivariate analysis only ECOG PS (HR, 1.744; 95% CI 1.158-2.626; p = 0.008), T stage (HR, 1.332; 95% CI 1.032-1.718; p = 0.028), N stage (HR, 1.848; 95% CI 1.113-3.068; p = 0.018), SII (HR, 2.105; 95% CI 1.481-2.741; p < 0.001) and NLR ≥ 3.57 (HR, 1.934; 95% CI 1.448-2.585; p < 0.001) were independently correlated with overall survival. CONCLUSIONS This study demonstrates that the SII is an independent prognostic indicator of poor outcomes for patients with stage III NSCLC and is superior to other inflammation-based factors in terms of prognostic ability.
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Affiliation(s)
- Yu-Suo Tong
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China
| | - Juan Tan
- Department of Gerontology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China
| | - Xi-Lei Zhou
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China
| | - Ya-Qi Song
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China
| | - Ying-Jian Song
- Department of Respiratory Medicine, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China.
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Xiao HF, Zhang BH, Liao XZ, Yan SP, Zhu SL, Zhou F, Zhou YK. Development and validation of two prognostic nomograms for predicting survival in patients with non-small cell and small cell lung cancer. Oncotarget 2017; 8:64303-64316. [PMID: 28969072 PMCID: PMC5610004 DOI: 10.18632/oncotarget.19791] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/18/2017] [Indexed: 12/29/2022] Open
Abstract
Purpose This study aimed to construct two prognostic nomograms to predict survival in patients with non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) using a novel set of clinical parameters. Patients and Methods Two nomograms were developed, using a retrospective analysis of 5384 NSCLC and 647 SCLC patients seen during a 10-year period at Xiang Ya Affiliated Cancer Hospital (Changsha, China). The patients were randomly divided into training and validation cohorts. Univariate and multivariate analyses were used to identify the prognostic factors needed to establish nomograms for the training cohort. The model was internally validated via bootstrap resampling and externally certified using the validation cohort. Predictive accuracy and discriminatory capability were estimated using concordance index (C-index), calibration curves, and risk group stratification. Results The largest contributor to overall survival (OS) prognosis in the NSCLC nomogram was the therapeutic regimen and diagnostic method parameters, and in the SCLC nomogram was the therapeutic regimen and health insurance plan parameters. Calibration curves for the nomogram prediction and the actual observation were in optimal agreement for the 3-year OS and acceptable agreement for the 5-year OS in both training datasets. The C-index was higher for the NSCLC cohort nomogram than for the TNM staging system (0.67 vs. 0.64, P = 0.01) and higher for the SCLC nomogram than for the clinical staging system (limited vs. extensive) (0.60 vs. 0.53, P = 0.12). Conclusion Treatment regimen parameter made the largest contribution to OS prognosis in both nomograms, and these nomograms might provide clinicians and patients a simple tool that improves their ability to accurately estimate survival based on individual patient parameters rather than using an averaged predefined treatment regimen.
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Affiliation(s)
- Hai-Fan Xiao
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.,The Department of Cancer Prevention, Hunan Cancer Hospital, Changsha 410006, China
| | - Bai-Hua Zhang
- The Department of Thoracic Surgery, Hunan Cancer Hospital, Changsha 410006, China
| | - Xian-Zhen Liao
- The Department of Cancer Prevention, Hunan Cancer Hospital, Changsha 410006, China
| | - Shi-Peng Yan
- The Department of Cancer Prevention, Hunan Cancer Hospital, Changsha 410006, China
| | - Song-Lin Zhu
- The Department of Cancer Prevention, Hunan Cancer Hospital, Changsha 410006, China
| | - Feng Zhou
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yi-Kai Zhou
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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Postmus PE, Kerr KM, Oudkerk M, Senan S, Waller DA, Vansteenkiste J, Escriu C, Peters S. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28:iv1-iv21. [PMID: 28881918 DOI: 10.1093/annonc/mdx222] [Citation(s) in RCA: 1212] [Impact Index Per Article: 173.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- P E Postmus
- The Clatterbridge Cancer Centre and Liverpool Heart and Chest Hospital, Liverpool
| | - K M Kerr
- University of Aberdeen, Aberdeen, UK
| | - M Oudkerk
- Center for Medical Imaging, University of Groningen, Groningen
| | - S Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - D A Waller
- Department of Thoracic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - C Escriu
- The Clatterbridge Cancer Centre and Liverpool Heart and Chest Hospital, Liverpool
| | - S Peters
- Oncology Department, Service d'Oncologie Médicale, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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24
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Bowden JCS, Williams LJ, Simms A, Price A, Campbell S, Fallon MT, Fearon KCH. Prediction of 90 Day and Overall Survival after Chemoradiotherapy for Lung Cancer: Role of Performance Status and Body Composition. Clin Oncol (R Coll Radiol) 2017; 29:576-584. [PMID: 28652093 DOI: 10.1016/j.clon.2017.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/17/2017] [Accepted: 05/23/2017] [Indexed: 01/26/2023]
Abstract
AIMS If appropriate patients are to be selected for lung cancer treatment, an understanding of who is most at risk of adverse outcomes after treatment is needed. The aim of the present study was to identify predictive factors for 30 and 90 day mortality after chemoradiotherapy (CRT), and factors that were prognostic for overall survival. MATERIALS AND METHODS A retrospective cohort study of 194 patients with lung cancer who had undergone CRT in South East Scotland from 2008 to 2010 was undertaken. Gender, age, cancer characteristics, weight loss, body mass index (BMI), performance status (Eastern Cooperative Oncology Group; ECOG) and computed tomography-derived body composition variables were examined for prognostic significance using Cox's proportional hazards model and logistic regression. RESULTS The median overall survival was 19 months (95% confidence interval 16.3, 21.7). Four of 194 patients died within 30 days of treatment completion, for which there were no independent predictive variables; 22/194 (11%) died within 90 days of treatment completion. BMI < 20 and ECOG performance status ≥2 were independent predictors of death within 90 days of treatment completion (P = 0.001 and P = 0.004, respectively). Patients with either BMI < 20 or ECOG performance status ≥ 2 had an odds ratio of death within 90 days of 5.97 (95% confidence interval 2.20, 16.19), rising to an odds ratio of 13.27 (1.70, 103.47) for patients with both BMI < 20 and ECOG performance status ≥ 2. Patients with low muscle attenuation had significantly reduced overall survival (P = 0.004); individuals with low muscle attenuation had a median survival of 15.2 months (95% confidence interval 12.7, 17.7) compared with 23.0 months (95% confidence interval 18.3, 27.8) for those with high muscle attenuation, equating to a hazard ratio of death of 1.62 (95% confidence interval 1.17, 2.23, P = 0.003). CONCLUSION Poor performance status, low BMI and low muscle attenuation identify patients at increased risk of premature death after CRT. Risk factors for adverse outcomes should inform personalised discussions with patients about the potential harms as well as the intended benefits of treatment.
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Affiliation(s)
- J C S Bowden
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK; University of St Andrews, St Andrews, UK; NHS Fife, Kirkcaldy, UK.
| | - L J Williams
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - A Price
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK; NHS Lothian, Edinburgh, UK
| | | | - M T Fallon
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK; NHS Lothian, Edinburgh, UK
| | - K C H Fearon
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK; NHS Lothian, Edinburgh, UK
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25
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Baker S, Dahele M, Lagerwaard FJ, Senan S. A critical review of recent developments in radiotherapy for non-small cell lung cancer. Radiat Oncol 2016; 11:115. [PMID: 27600665 PMCID: PMC5012092 DOI: 10.1186/s13014-016-0693-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/02/2016] [Indexed: 02/07/2023] Open
Abstract
Lung cancer is the leading cause of cancer mortality, and radiotherapy plays a key role in both curative and palliative treatments for this disease. Recent advances include stereotactic ablative radiotherapy (SABR), which is now established as a curative-intent treatment option for patients with peripheral early-stage NSCLC who are medically inoperable, or at high risk for surgical complications. Improved delivery techniques have facilitated studies evaluating the role of SABR in oligometastatic NSCLC, and encouraged the use of high-technology radiotherapy in some palliative settings. Although outcomes in locally advanced NSCLC remain disappointing for many patients, future progress may come about from an improved understanding of disease biology and the development of radiotherapy approaches that further reduce normal tissue irradiation. At the moment, the benefits, if any, of radiotherapy technologies such as proton beam therapy remain unproven. This paper provides a critical review of selected aspects of modern radiotherapy for lung cancer, highlights the current limitations in our understanding and treatment approaches, and discuss future treatment strategies for NSCLC.
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Affiliation(s)
- Sarah Baker
- Department of Radiation Oncology, Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, Canada, T6G 1Z2
| | - Max Dahele
- Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, Postbox 7057, 1007 MD, Amsterdam, The Netherlands
| | - Frank J Lagerwaard
- Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, Postbox 7057, 1007 MD, Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, Postbox 7057, 1007 MD, Amsterdam, The Netherlands.
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26
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de Boer P, Dahele MR, Senan S. Is radical chemo-radiotherapy appropriate in patients with stage IV non-small-cell lung cancer due to cervical lymph node metastases? Ann Oncol 2016; 27:1973. [PMID: 27543275 DOI: 10.1093/annonc/mdw267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- P de Boer
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - M R Dahele
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - S Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
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27
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Rodrigues G. Cons: concurrent chemo-radiotherapy remains the ideal treatment in fit patients with inoperable large volume stage III non-small cell lung cancer. Transl Lung Cancer Res 2016; 5:195-7. [PMID: 27186514 DOI: 10.21037/tlcr.2016.04.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- George Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
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