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Ergen SA, Dincbas FO, Yücel B, Altınok P, Akyurek S, Korkmaz Kıraklı E, Ulger S, Etiz D, Yilmaz U, Kılıc D, Bozcuk H. Risk factors of radiation pneumonitis in patients with NSCLC treated with concomitant chemoradiotherapy--Are we underestimating diabetes?--Turkish oncology group (TOG)/Lung cancer study group. CLINICAL RESPIRATORY JOURNAL 2020; 14:871-879. [PMID: 32470205 DOI: 10.1111/crj.13220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 12/03/2019] [Accepted: 05/12/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION To evaluate the clinical and dosimetric parameters that increase the risk of radiation pneumonitis (RP) in locally advanced non-small cell lung cancer (NSCLC) patients treated with concomitant chemoradiotherapy of nationwide multicentric data analysis. METHODS All data of 268 patients who underwent definitive chemoradiotherapy were retrospectively collected from eight institutes participating in this study. Patient, tumor and treatment-related factors and dosimetric parameters were analyzed for grade ≥2 RP. The toxicity scoring system of The Radiation Therapy Oncology Group used for grading the severity of pneumonitis. A relationship with the risk of RP with potential predictive factors were evaluated by univariate and multivariate analyses. A recursive partition analysis (RPA) was applied to stratify patients according to the risk of developing RP. RESULTS There were 90 (33.6%) patients who had grade ≥2 RP. The median time to pneumonitis after treatment was 4 months (range:1-6 months). In univariate analysis, diabetes mellitus (DM), use of cisplatin/etoposide, total and daily radiotherapy (RT) fraction dose, the planning target volume (PTV) size, mean lung dose, V5, V10 and RT technique were associated with the development of pneumonitis. In multivariate analysis, only DM (P = 0.008) was found to be independent risk factors for RP. According to RPA, the risk of developing RP was highest in patients with DM. CONCLUSIONS In our study, besides the known dosimetric factors, DM was found to be the most important risk factor causing RP development in multivariate analysis and RPA. The risk is tripled compared to patients without DM.
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Affiliation(s)
- Sefika A Ergen
- Department of Radiation Oncology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Fazilet O Dincbas
- Department of Radiation Oncology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Birsen Yücel
- Department of Radiation Oncology, Cumhuriyet University Medical Faculty, Sivas, Turkey
| | - Pelin Altınok
- Department of Radiation Oncology, Bezmialem Foundation University Medical Faculty Hospital, Istanbul, Turkey
| | - Serap Akyurek
- Department of Radiation Oncology, Ankara University Medical Faculty, Ankara, Turkey
| | - Esra Korkmaz Kıraklı
- Department of Radiation Oncology, Dr. Suat Seren Chest Disease and Surgery Training Hospital, Izmir, Turkey
| | - Sukran Ulger
- Department of Radiation Oncology (retired), Gazi University Medical Faculty, Ankara, Turkey
| | - Durmus Etiz
- Department of Radiation Oncology, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - Ufuk Yilmaz
- Department of Pulmonology, Dr. Suat Seren Chest Disease and Surgery Training Hospital, Izmir, Turkey
| | - Diclehan Kılıc
- Department of Radiation Oncology, Gazi University Medical Faculty, Ankara, Turkey
| | - Hakan Bozcuk
- Department of Medical Oncology, Medical Park Hospital, Antalya, Turkey
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Radiographic patterns of symptomatic radiation pneumonitis in lung cancer patients: Imaging predictors for clinical severity and outcome. Lung Cancer 2020; 145:132-139. [PMID: 32447116 DOI: 10.1016/j.lungcan.2020.03.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Investigate the spectrum of radiographic patterns of radiation pneumonitis (RP) in lung cancer patients and identify imaging markers for high-grade RP and RP-related death. METHODS Eighty-two patients with lung cancer treated with conventional chest radiotherapy who had symptomatic RP were identified from the radiation oncology database. The imaging features of RP were studied for association with high-grade RP (Grade ≥3) and RP-related death (Grade 5). RESULTS RP was Grade 2 in 60 (73%), Grade 3 in 15 (18%), and Grade 5 in 7 patients (9%). Lower performance status (p = 0.04), squamous cell histology (p = 0.03), and FEV1 ≤ 2 (p = 0.009) were associated with high-grade pneumonitis. Older age (p = 0.03) and squamous cell histology (p = 0.03) were associated with RP-related death. The CT findings included ground-glass and reticular opacities in all patients, with traction bronchiectasis in 77 (94%) and consolidation in 74 (90%). The most common radiographic pattern of RP was cryptogenic organizing pneumonia (COP) pattern (n = 54), followed by acute interstitial pneumonia (AIP)/acute respiratory distress syndrome (ARDS) pattern (n = 10). Higher extent of lung involvement, diffuse distribution, and AIP/ARDS pattern were associated with high-grade pneumonitis and RP-related death. AIP/ARDS pattern was a significant factor for high-grade pneumonitis (OR:12.62, p = 0.01) in multivariable analyses adjusting for clinical variables. CONCLUSION COP pattern was the most common radiographic pattern for symptomatic RP in lung cancer patients. AIP/ARDS pattern was significantly associated with high-grade RP and RP-related deaths, and was an independent marker for high-grade RP. The recognition of the radiographic patterns of RP can help to effectively contribute to patient management.
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Iijima M, Gombodorj N, Tachibana Y, Tachibana K, Yokobori T, Honma K, Nakano T, Asao T, Kuwahara R, Aoyama K, Yasuda H, Kelly M, Kuwano H, Yamanouchi D. Development of single nanometer-sized ultrafine oxygen bubbles to overcome the hypoxia-induced resistance to radiation therapy via the suppression of hypoxia-inducible factor‑1α. Int J Oncol 2018; 52:679-686. [PMID: 29393397 PMCID: PMC5807044 DOI: 10.3892/ijo.2018.4248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/12/2018] [Indexed: 02/06/2023] Open
Abstract
Radiation therapy can result in severe side-effects, including the development of radiation resistance. The aim of this study was to validate the use of oxygen nanobubble water to overcome resistance to radiation in cancer cell lines via the suppression of the hypoxia-inducible factor 1-α (HIF-1α) subunit. Oxygen nanobubble water was created using a newly developed method to produce nanobubbles in the single-nanometer range with the ΣPM-5 device. The size and concentration of the oxygen nanobubbles in the water was examined using a cryo-transmission electron microscope. The nanobubble size was ranged from 2 to 3 nm, and the concentration of the nanobubbles was calculated at 2×1018 particles/ml. Cell viability and HIF-1α levels were evaluated in EBC-1 lung cancer and MDA-MB-231 breast cancer cells treated with or without the nanobubble water and radiation under normoxic and hypoxic conditions in vitro. The cancer cells grown in oxygen nanobubble-containing media exhibited a clear suppression of hypoxia-induced HIF-1α expression compared to the cells grown in media made with distilled water. Under hypoxic conditions, the EBC-1 and MDA-MB231 cells displayed resistance to radiation compared to the cells cultured under normoxic cells. The use of oxygen nanobubble medium significantly suppressed the hypoxia-induced resistance to radiation compared to the use of normal medium at 2, 6, 10 and 14 Gy doses. Importantly, the use of nanobubble media did not affect the viability and radiation sensitivity of the cancer cell lines, or the non-cancerous cell line, BEAS-2B, under normoxic conditions. This newly created single-nanometer range oxygen nanobubble water, without any additives, may thus prove to be a promising agent which may be used to overcome the hypoxia-induced resistance of cancer cells to radiation via the suppression of HIF-1α.
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Affiliation(s)
- Misaki Iijima
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan
| | - Navchaa Gombodorj
- Department of Molecular Pharmacology and Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan
| | | | | | - Takehiko Yokobori
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan
| | - Kyoko Honma
- Sigma Technology Inc., Hitachinaka, Ibaraki 312-0053, Japan
| | - Takashi Nakano
- Department of Molecular Pharmacology and Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan
| | - Takayuki Asao
- Big Data Center for Integrative Analysis, Gunma University Initiative for Advance Research (GIAR), Maebashi, Gunma 371-8511, Japan
| | - Ryusuke Kuwahara
- Research Center for Ultra-High Voltage Electron Microscopy, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - Kazuhiro Aoyama
- Research Center for Ultra-High Voltage Electron Microscopy, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - Hidehiro Yasuda
- Research Center for Ultra-High Voltage Electron Microscopy, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - Matthew Kelly
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan
| | - Dai Yamanouchi
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
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Villela-Ma LM, Velez-Ayal AK, Lopez-Sanc RDC, Martinez-C JA, Hernandez- JA. Advantages of Drug Selective Distribution in Cancer Treatment: Brentuximab Vedotin. INT J PHARMACOL 2017. [DOI: 10.3923/ijp.2017.785.807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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An open source solution for an in-house built dynamic platform for the validation of stereotactic ablative body radiotherapy for VMAT and IMRT. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2016; 39:957-964. [DOI: 10.1007/s13246-016-0484-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 08/31/2016] [Indexed: 01/20/2023]
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Kumar S, Liney G, Rai R, Holloway L, Moses D, Vinod SK. Magnetic resonance imaging in lung: a review of its potential for radiotherapy. Br J Radiol 2016; 89:20150431. [PMID: 26838950 DOI: 10.1259/bjr.20150431] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
MRI has superior soft-tissue definition compared with existing imaging modalities in radiation oncology; this has the added benefit of functional as well as anatomical imaging. This review aimed to evaluate the current use of MRI for lung cancer and identify the potential of a MRI protocol for lung radiotherapy (RT). 30 relevant studies were identified. Improvements in MRI technology have overcome some of the initial limitations of utilizing MRI for lung imaging. A number of commercially available and novel sequences have shown image quality to be adequate for the detection of pulmonary nodules with the potential for tumour delineation. Quantifying tumour motion is also feasible and may be more representative than that seen on four-dimensional CT. Functional MRI sequences have shown correlation with flu-deoxy-glucose positron emission tomography (FDG-PET) in identifying malignant involvement and treatment response. MRI can also be used as a measure of pulmonary function. While there are some limitations for the adoption of MRI in RT-planning process for lung cancer, MRI has shown the potential to compete with both CT and PET for tumour delineation and motion definition, with the added benefit of functional information. MRI is well placed to become a significant imaging modality in RT for lung cancer.
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Affiliation(s)
- Shivani Kumar
- 1 South Western Clinical School, School of Medicine, University of New South Wales, Liverpool, NSW, Australia.,2 Liverpool and Macarthur Cancer Therapy Centres, Liverpool Hospital, Liverpool, NSW, Australia.,3 Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Gary Liney
- 1 South Western Clinical School, School of Medicine, University of New South Wales, Liverpool, NSW, Australia.,2 Liverpool and Macarthur Cancer Therapy Centres, Liverpool Hospital, Liverpool, NSW, Australia.,3 Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia.,4 Centre for Medical Radiation Physics, University of Wollongong, Liverpool, NSW, Australia
| | - Robba Rai
- 2 Liverpool and Macarthur Cancer Therapy Centres, Liverpool Hospital, Liverpool, NSW, Australia.,3 Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Lois Holloway
- 1 South Western Clinical School, School of Medicine, University of New South Wales, Liverpool, NSW, Australia.,2 Liverpool and Macarthur Cancer Therapy Centres, Liverpool Hospital, Liverpool, NSW, Australia.,3 Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia.,4 Centre for Medical Radiation Physics, University of Wollongong, Liverpool, NSW, Australia.,5 Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia
| | - Daniel Moses
- 1 South Western Clinical School, School of Medicine, University of New South Wales, Liverpool, NSW, Australia.,6 Department of Medical Imaging, Northern Hospital Network, Sydney, NSW, Australia.,7 Western Sydney University, Penrith, NSW, Australia
| | - Shalini K Vinod
- 1 South Western Clinical School, School of Medicine, University of New South Wales, Liverpool, NSW, Australia.,2 Liverpool and Macarthur Cancer Therapy Centres, Liverpool Hospital, Liverpool, NSW, Australia.,7 Western Sydney University, Penrith, NSW, Australia
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Simeonova AO, Fleckenstein K, Wertz H, Frauenfeld A, Boda-Heggemann J, Lohr F, Wenz F. Are three doses of stereotactic ablative radiotherapy (SABR) more effective than 30 doses of conventional radiotherapy? Transl Lung Cancer Res 2015; 1:45-53. [PMID: 25806154 DOI: 10.3978/j.issn.2218-6751.10.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 10/24/2011] [Indexed: 12/29/2022]
Abstract
In early stage non-small cell lung cancer (NSCLC) definitive radiation therapy is an appropriate alternative to surgery. Recent studies show, that in such patients hypofractionation schedules (for example 3 times 18 Gy or 5 times 12 Gy), can be safely applied, without causing severe toxicities and achieving high local control rates of up to 90% and more. In the last couple of years a lot of knowledge about the cancer biology, technical aspects, clinical outcomes and toxicities has been accumulated from different clinical trials. The purpose of this review is to summarize recent outcomes and developments in stereotactic radiation therapy for patients with early stage NSCLC.
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Affiliation(s)
- Anna O Simeonova
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Katharina Fleckenstein
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hansjörg Wertz
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Anian Frauenfeld
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frank Lohr
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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Angus SD, Piotrowska MJ. A matter of timing: identifying significant multi-dose radiotherapy improvements by numerical simulation and genetic algorithm search. PLoS One 2014; 9:e114098. [PMID: 25460164 PMCID: PMC4252029 DOI: 10.1371/journal.pone.0114098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/01/2014] [Indexed: 12/25/2022] Open
Abstract
Multi-dose radiotherapy protocols (fraction dose and timing) currently used in the clinic are the product of human selection based on habit, received wisdom, physician experience and intra-day patient timetabling. However, due to combinatorial considerations, the potential treatment protocol space for a given total dose or treatment length is enormous, even for relatively coarse search; well beyond the capacity of traditional in-vitro methods. In constrast, high fidelity numerical simulation of tumor development is well suited to the challenge. Building on our previous single-dose numerical simulation model of EMT6/Ro spheroids, a multi-dose irradiation response module is added and calibrated to the effective dose arising from 18 independent multi-dose treatment programs available in the experimental literature. With the developed model a constrained, non-linear, search for better performing cadidate protocols is conducted within the vicinity of two benchmarks by genetic algorithm (GA) techniques. After evaluating less than 0.01% of the potential benchmark protocol space, candidate protocols were identified by the GA which conferred an average of 9.4% (max benefit 16.5%) and 7.1% (13.3%) improvement (reduction) on tumour cell count compared to the two benchmarks, respectively. Noticing that a convergent phenomenon of the top performing protocols was their temporal synchronicity, a further series of numerical experiments was conducted with periodic time-gap protocols (10 h to 23 h), leading to the discovery that the performance of the GA search candidates could be replicated by 17-18 h periodic candidates. Further dynamic irradiation-response cell-phase analysis revealed that such periodicity cohered with latent EMT6/Ro cell-phase temporal patterning. Taken together, this study provides powerful evidence towards the hypothesis that even simple inter-fraction timing variations for a given fractional dose program may present a facile, and highly cost-effecitive means of significantly improving clinical efficacy.
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Affiliation(s)
- Simon D. Angus
- Department of Economics, Monash University, Melbourne, Victoria, Australia
| | - Monika Joanna Piotrowska
- Faculty of Mathematics Informatics and Mechanics, Institute of Applied Mathematics and Mechanics, University of Warsaw, Warsaw, Mazowieckie, Poland
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Rwigema JCM, Chen AM, Wang PC, Lee JM, Garon E, Lee P. Incidental Mediastinal Dose Does Not Explain Low Mediastinal Node Recurrence Rates in Patients With Early-Stage NSCLC Treated With Stereotactic Body Radiotherapy. Clin Lung Cancer 2014; 15:287-93. [DOI: 10.1016/j.cllc.2014.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 01/19/2014] [Accepted: 01/21/2014] [Indexed: 12/25/2022]
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Griffioen GH, Dahele M, de Haan PF, van de Ven PM, Slotman BJ, Senan S. High-dose, conventionally fractionated thoracic reirradiation for lung tumors. Lung Cancer 2014; 83:356-62. [DOI: 10.1016/j.lungcan.2013.12.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/11/2013] [Accepted: 12/16/2013] [Indexed: 12/25/2022]
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Ishida K, Hirose T, Yokouchi J, Oki Y, Kusumoto S, Sugiyama T, Ishida H, Shirai T, Nakashima M, Yamaoka T, Ohnishi T, Ohmori T, Kagami Y. Phase II study of concurrent chemoradiotherapy with carboplatin and vinorelbine for locally advanced non-small-cell lung cancer. Mol Clin Oncol 2014; 2:405-410. [PMID: 24772308 DOI: 10.3892/mco.2014.252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 01/01/2014] [Indexed: 11/05/2022] Open
Abstract
Patients with non-small cell lung cancer (NSCLC) have locally advanced disease with poor prognosis. Although concurrent chemoradiotherapy is the standard treatment, more effective regimens are required. The aim of this study was to assess the safety and efficacy of concurrent chemoradiotherapy with a divided schedule of carboplatin and vinorelbine in patients with locally advanced NSCLC. Patients with unresectable, stage IIIA or IIIB NSCLC were eligible for enrollment if they exhibited a performance status of 0-2 and were ≤75 years of age. Patients were treated with carboplatin at an area under the plasma concentration vs. time curve of 2.5 mg/ml/min and vinorelbine at 20 mg/m2 on days 1 and 8 every 3 weeks. Thoracic radiotherapy at a total dose of 60 Gy was concurrently administered (2 Gy per fraction). Twenty-eight patients (23 men and 5 women; median age, 67 years; range 47-75 years) were enrolled in the present study. The overall response rate was 85.7% [95% confidence interval (CI), 67.3-96.0%] and the disease control rate was 96.4% (95% CI, 81.7-99.9%). The median survival time (MST) was 23 months and the median progression-free survival (PFS) time was 8 months. Grade 3-4 toxicities included neutropenia, thrombocytopenia, anemia and infection in 100, 14, 46 and 36% of patients, respectively. One patient (4%) developed grade 3 radiation esophagitis that resolved completely without residual dilation. Grade 3 radiation pneumonitis occurred in 2 patients (7%); however, the symptoms and radiographic abnormalities subsided with corticosteroid therapy. In conclusion, concurrent chemoradiotherapy with a divided schedule of carboplatin and vinorelbine is well-tolerated and effective in patients with locally advanced NSCLC.
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Affiliation(s)
- Koko Ishida
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Showa University School of Medicine, Shinagawa, Tokyo 142-8666
| | - Takashi Hirose
- Department of Respirology, National Hospital Organization, Tokyo Hospital, Tokyo 204-8585
| | - Junichi Yokouchi
- Department of Radiology, Showa University School of Medicine, Shinagawa, Tokyo 142-8666, Japan
| | - Yasunari Oki
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Showa University School of Medicine, Shinagawa, Tokyo 142-8666
| | - Sojiro Kusumoto
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Showa University School of Medicine, Shinagawa, Tokyo 142-8666
| | - Tomohide Sugiyama
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Showa University School of Medicine, Shinagawa, Tokyo 142-8666
| | - Hiroo Ishida
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Showa University School of Medicine, Shinagawa, Tokyo 142-8666
| | - Takao Shirai
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Showa University School of Medicine, Shinagawa, Tokyo 142-8666
| | - Masanao Nakashima
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Showa University School of Medicine, Shinagawa, Tokyo 142-8666
| | - Toshimitsu Yamaoka
- Institute of Molecular Oncology, Showa University School of Medicine, Shinagawa, Tokyo 142-8666, Japan
| | - Tsukasa Ohnishi
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Showa University School of Medicine, Shinagawa, Tokyo 142-8666
| | - Tohru Ohmori
- Institute of Molecular Oncology, Showa University School of Medicine, Shinagawa, Tokyo 142-8666, Japan
| | - Yoshikazu Kagami
- Department of Radiology, Showa University School of Medicine, Shinagawa, Tokyo 142-8666, Japan
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The efficacy of oral glutamine in prevention of acute radiotherapy-induced esophagitis in patients with lung cancer. Contemp Oncol (Pozn) 2013; 17:520-4. [PMID: 24592140 PMCID: PMC3934034 DOI: 10.5114/wo.2013.38912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 05/06/2013] [Accepted: 10/16/2013] [Indexed: 11/24/2022] Open
Abstract
Aim of the study This study explores the efficacy of oral glutamine in the prevention of acute radiotherapy-induced esophagitis in patients with lung cancer who are treated with thoracic radiotherapy. Material and methods This study was planned as a retrospective randomized experimental study. Forty-six patients with lung cancer, who were treated and kept under control between January 2008 and January 2010, were included in the study by the Department of Radiation Oncology, Faculty of Medicine, Dicle University. The patients were divided into two groups. The first group (n = 21) was given prophylactic oral powder glutamine (daily 30 g), while the second group (n = 25) was not given oral glutamine. Results There were 21 patients in Group 1 (45.7%) and 25 patients in Group 2 (54.3%). No significant statistical difference was observed between the two groups in terms of age, gender, stage, histopathological type, treatment choice, received radiation doses, esophagus length in RT field, or location of the tumor (p > 0.05). A significant statistical difference was observed between the glutamine-supplemented group (first group) and the glutamine-free group (second group) according to the grade of esophagitis (p < 0.0001). Conclusions In our retrospective randomized experimental study, we determined that the severity of acute radiotherapy-induced esophagitis might be decreased with oral glutamine in patients with lung cancer who were treated with thoracic radiotherapy.
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Abstract
Approximately one third of patients with non-small cell lung cancer have unresectable stage IIIA or stage IIIB disease; combined cytotoxic chemotherapy and radiation therapy delivered concurrently has been established as the standard treatment for such patients. Despite many clinical trials that tested several different radiochemotherapy combinations, it seems that a plateau of efficiencies at the acceptable risk of complications has been reached. Clinical studies indicate that the improved efficacy of radiochemotherapy is associated with the radiosensitizing effects of chemotherapy. Improvement of outcomes of this combined modality by developing novel radiosensitizers is a viable therapeutic strategy. In addition to causing cell death, ionizing radiation also induces a many-faceted signaling response, which activates numerous prosurvival pathways that lead to enhanced proliferation in the endothelial cells and increased vascularization in tumors. Radiation at doses used in the clinic activates cytoplasmic phospholipase A2, leading to increased production of arachidonic acid and lysophosphatidylcholine. The former is the initial step in the generation of eicosanoids, while the later is the initial step in the formation of lysophosphatidic acid, leading to the activation of inflammatory pathways. The echinoderm microtubule-associated protein-like 4 anaplastic lymphoma kinase (EML4-ALK) is member of the insulin superfamily of receptor tyrosine kinases. The EML4-ALK fusion gene appears unique to lung cancer and signals through extracellular signal regulated kinase and phosphoinositide 3-kinase. Heat shock protein 90 (Hsp90) is often overexpressed and present in an activated multichaperone complex in cancer cells, and it is now regarded as essential for malignant transformation and progression. In this review we focus on radiosensitizing strategies involving the targeting of membrane phospholipids, EML4-ALK, and Hsp90 with specific inhibitors and briefly discuss the combination of radiation with antivascular agents.
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Wang W, Xu Y, Schipper M, Matuszak MM, Ritter T, Cao Y, Ten Haken RK, Kong FMS. Effect of normal lung definition on lung dosimetry and lung toxicity prediction in radiation therapy treatment planning. Int J Radiat Oncol Biol Phys 2013; 86:956-63. [PMID: 23845844 DOI: 10.1016/j.ijrobp.2013.05.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 04/14/2013] [Accepted: 05/01/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE This study aimed to compare lung dose-volume histogram (DVH) parameters such as mean lung dose (MLD) and the lung volume receiving ≥20 Gy (V20) of commonly used definitions of normal lung in terms of tumor/target subtraction and to determine to what extent they differ in predicting radiation pneumonitis (RP). METHODS AND MATERIALS One hundred lung cancer patients treated with definitive radiation therapy were assessed. The gross tumor volume (GTV) and clinical planning target volume (PTVc) were defined by the treating physician and dosimetrist. For this study, the clinical target volume (CTV) was defined as GTV with 8-mm uniform expansion, and the PTV was defined as CTV with an 8-mm uniform expansion. Lung DVHs were generated with exclusion of targets: (1) GTV (DVHG); (2) CTV (DVHC); (3) PTV (DVHP); and (4) PTVc (DVHPc). The lung DVHs, V20s, and MLDs from each of the 4 methods were compared, as was their significance in predicting radiation pneumonitis of grade 2 or greater (RP2). RESULTS There are significant differences in dosimetric parameters among the various definition methods (all Ps<.05). The mean and maximum differences in V20 are 4.4% and 12.6% (95% confidence interval 3.6%-5.1%), respectively. The mean and maximum differences in MLD are 3.3 Gy and 7.5 Gy (95% confidence interval, 1.7-4.8 Gy), respectively. MLDs of all methods are highly correlated with each other and significantly correlated with clinical RP2, although V20s are not. For RP2 prediction, on the receiver operating characteristic curve, MLD from DVHG (MLDG) has a greater area under curve of than MLD from DVHC (MLDC) or DVHP (MLDP). Limiting RP2 to 30%, the threshold is 22.4, 20.6, and 18.8 Gy, for MLDG, MLDC, and MLDP, respectively. CONCLUSIONS The differences in MLD and V20 from various lung definitions are significant. MLD from the GTV exclusion method may be more accurate in predicting clinical significant radiation pneumonitis.
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Affiliation(s)
- Weili Wang
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
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15
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Verstegen NE, Lagerwaard FJ, Senan S. Developments in early-stage NSCLC: advances in radiotherapy. Ann Oncol 2013; 23 Suppl 10:x46-51. [PMID: 22987992 DOI: 10.1093/annonc/mds301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
An increase in the number of predominantly elderly patients with early-stage non-small-cell lung cancer is anticipated in many Western populations. Patients often have major co-morbidities and are at increased risk for surgical morbidity and mortality. In the past decade, the use of stereotactic ablative radiotherapy (SABR) has achieved excellent results, with only mild toxicity in such vulnerable patient groups, leading to SABR becoming accepted as a standard of care for unfit patients in several countries. The planning and delivery of SABR has rapidly improved in recent years, particularly with the use of 'on-board' imaging at treatment units, and shortened treatment delivery times. Increasingly, more central tumors are being treated using lower doses per fraction (so-called risk-adapted schemes). It is also becoming clear that long-term follow-up should take place at specialist centers in order to distinguish the evolving fibrosis that is frequently observed from the relatively infrequent local recurrences. Given the high local control rates and limited toxicity, increasing attention is being paid to the use of SABR in the subgroup of so-called borderline operable patients, and clinical trials comparing surgery and SABR in these patients are ongoing.
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Affiliation(s)
- N E Verstegen
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
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16
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Senthi S, Haasbeek CJA, Lagerwaard FJ, Verbakel WF, de Haan PF, Slotman BJ, Senan S. Radiotherapy for a second primary lung cancer arising post-pneumonectomy: planning considerations and clinical outcomes. J Thorac Dis 2013; 5:116-22. [PMID: 23585935 DOI: 10.3978/j.issn.2072-1439.2013.02.07] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 02/27/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Second primary non-small cell lung cancer (SPLC) is a significant cause of death amongst lung cancer survivors. As subsequent surgery is seldom feasible post-pneumonectomy, we studied the long-term clinical outcomes achieved with curative radiotherapy using modern delivery techniques. METHODS Retrospective review of an institutional database between 2003-2011 identified 27 patients who had received curative radiotherapy for SPLC arising post-pneumonectomy. Treatments included; stereotactic ablative radiotherapy (SABR, n=20, dose 54-60 Gy in 3-8 fractions), hypofractionated radiotherapy (HFR, n=6, dose 39-60 Gy in 12-23 fractions) and conventional radiotherapy (RT, n=1, 60 Gy in 30 fractions). Clinical follow-up with a CT scan at 3, 6 and 12 months, then yearly was performed. Toxicities were scored using the common toxicity criteria for adverse events (version 4.0). RESULTS The median overall survival was 39 months (95% CI, 33-44 months). After a median follow-up of 52 months (95% CI, 37-67 months), any recurrence was observed in four (15%) patients. Actuarial 3-year rates of local, regional and distant recurrences were 8% (95% CI, 0-21 months), 10% (95% CI, 0-23%) and 9% (95% CI, 0-20%), respectively. Patients receiving HFR or RT all had centrally located tumors. Of the patients treated with HFR delivered 12 fractions, 75% (3/4) developed grade 3 or higher radiation pneumonitis (RP), including one probable grade 5 toxicity. Of those receiving RT or HFR in 13 or more fractions no (0/3) grade 3 or worse RP was observed, despite such treatment being used for larger tumors and resulting in worse lung dose-volume histogram metrics. All the patients who developed RP had radiotherapy plans, which prioritized the sparing of central structures over lung sparing. No non-RP grade 3 or higher toxicities were observed. CONCLUSIONS Curative radiotherapy is an effective treatment for SPLC arising post-pneumonectomy. For larger central tumors, our data suggests that plans should prioritize reducing lung doses above the sparing of central structures.
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Affiliation(s)
- Sashendra Senthi
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
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Automatic Segmentation of Lung Carcinoma Using 3D Texture Features in 18-FDG PET/CT. INTERNATIONAL JOURNAL OF MOLECULAR IMAGING 2013; 2013:980769. [PMID: 23533750 PMCID: PMC3600349 DOI: 10.1155/2013/980769] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 01/06/2013] [Accepted: 01/07/2013] [Indexed: 11/17/2022]
Abstract
Target definition is the largest source of geometric uncertainty in radiation therapy. This is partly due to a lack of contrast between tumor and healthy soft tissue for computed tomography (CT) and due to blurriness, lower spatial resolution, and lack of a truly quantitative unit for positron emission tomography (PET). First-, second-, and higher-order statistics, Tamura, and structural features were characterized for PET and CT images of lung carcinoma and organs of the thorax. A combined decision tree (DT) with K-nearest neighbours (KNN) classifiers as nodes containing combinations of 3 features were trained and used for segmentation of the gross tumor volume. This approach was validated for 31 patients from two separate institutions and scanners. The results were compared with thresholding approaches, the fuzzy clustering method, the 3-level fuzzy locally adaptive Bayesian algorithm, the multivalued level set algorithm, and a single KNN using Hounsfield units and standard uptake value. The results showed the DTKNN classifier had the highest sensitivity of 73.9%, second highest average Dice coefficient of 0.607, and a specificity of 99.2% for classifying voxels when using a probabilistic ground truth provided by simultaneous truth and performance level estimation using contours drawn by 3 trained physicians.
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Patterns of disease recurrence after stereotactic ablative radiotherapy for early stage non-small-cell lung cancer: a retrospective analysis. Lancet Oncol 2012; 13:802-9. [DOI: 10.1016/s1470-2045(12)70242-5] [Citation(s) in RCA: 344] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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19
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Palma DA, Senan S. Improving outcomes for high-risk patients with early-stage non-small-cell lung cancer: insights from population-based data and the role of stereotactic ablative radiotherapy. Clin Lung Cancer 2012; 14:1-5. [PMID: 22846581 DOI: 10.1016/j.cllc.2012.06.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 06/07/2012] [Accepted: 06/11/2012] [Indexed: 12/25/2022]
Affiliation(s)
- David A Palma
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
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20
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Li X, Zhang H, Xing L, Ma H, Xie P, Zhang L, Xu X, Yue J, Sun X, Hu X, Chen M, Xu W, Chen L, Yu J. Mediastinal lymph nodes staging by 18F-FDG PET/CT for early stage non-small cell lung cancer: a multicenter study. Radiother Oncol 2011; 102:246-50. [PMID: 22100657 DOI: 10.1016/j.radonc.2011.10.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 10/19/2011] [Accepted: 10/20/2011] [Indexed: 12/13/2022]
Abstract
PURPOSE Accurate staging of mediastinal lymph nodes metastases is critical for determining the application of stereotactic body radiation therapy (SBRT) for patients with early stage non-small cell lung cancer (NSCLC). In this multicenter study the accuracy of (18)F-FDG PET/CT to detect lymph node metastases was evaluated for early stage NSCLC. MATERIALS AND METHODS The data from the patients with stage1 NSCLC who received preoperative (18)F-FDG PET/CT staging and radical surgery was retrospectively reviewed of five centers from February 2004 to August 2010. The lymph node metastases were confirmed histopathologically after radical surgery. And the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for PET/CT staging. RESULTS Two hundred patients were enrolled. The sensitivity, specificity, accuracy, PPV and NPV for lymph node metastases on PET/CT were 44%, 83%, 78%, 29% and 91%, respectively. There were eight and 19 cases positive for lymph node metastases with central (n=62) and peripheral (n=138) NSCLC (P>0.05), respectively. CONCLUSION (18)F-FDG PET/CT was specific in N(0) staging for T(1-2) NSCLC. The NPV was about 91% in clinical N(0) patients, suggested that (18)F-FDG PET/CT may help to accurately stage N(0) patients and thus identify patients for SBRT.
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Affiliation(s)
- Xiaolin Li
- Department of Radiation Oncology, Key Laboratory of Radiation Oncology of Shandong Province, Jinan, China.
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Mehta HJ, Ross C, Silvestri GA, Decker RH. Evaluation and treatment of high-risk patients with early-stage lung cancer. Clin Chest Med 2011; 32:783-97. [PMID: 22054886 DOI: 10.1016/j.ccm.2011.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Standard therapy for early-stage non-small cell lung cancer is lobectomy for patients who are able to tolerate such surgery. However, the risk of postoperative morbidity is not trivial, with a 30% to 40% incidence of postoperative complications and a 1% to 5% incidence of operative mortality. Some patients, though technically resectable, refuse surgery or are considered medically inoperable because of insufficient respiratory reserve, cardiovascular disease, or general frailty. This group is considered either "high risk" or "medically inoperable."
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Affiliation(s)
- Hiren J Mehta
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
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22
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Larici AR, del Ciello A, Maggi F, Santoro SI, Meduri B, Valentini V, Giordano A, Bonomo L. Lung abnormalities at multimodality imaging after radiation therapy for non-small cell lung cancer. Radiographics 2011; 31:771-89. [PMID: 21571656 DOI: 10.1148/rg.313105096] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Three-dimensional (3D) conformal radiation therapy (CRT) and stereotactic body radiation therapy (SBRT) are designed to deliver the maximum therapeutic radiation dose to the tumor, allowing improved local disease control, while minimizing irradiation of surrounding normal structures. The complex configuration of the multiple beams that deliver the radiation dose to the tumor in 3D CRT and SBRT produces patterns of lung injury that differ in location and extent from those seen after conventional radiation therapy. Radiation-induced changes in lung tissue after 3D CRT and SBRT occur within the radiation portals. The imaging appearance of irradiated tissues varies according to the time elapsed after the completion of therapy, with acute-phase changes of radiation pneumonitis represented by ground-glass opacities and consolidation and with late-phase changes of radiation fibrosis manifesting as volume loss, consolidation, and traction bronchiectasis. Knowledge of treatment timelines and radiation field locations, as well as familiarity with the full spectrum of possible radiation-induced lung injuries after 3D CRT and SBRT, is important to correctly interpret the abnormalities that may be seen at computed tomography (CT). Differential diagnoses in this context might include infections, lymphangitic carcinomatosis, local recurrence of malignancy, and radiation-induced tumors. The integration of morphologic information obtained at CT with metabolic information obtained at positron emission tomography is helpful in distinguishing radiation-induced parenchymal abnormalities from residual, recurrent, and new cancers. Thus, multimodality follow-up imaging may lead to substantial changes in disease management.
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Affiliation(s)
- Anna Rita Larici
- Department of Bioimaging and Radiological Sciences, Catholic University, A. Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy.
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Tomatis S, Carrara M, Massafra E, Naldi G, Palazzi M, Orlandi E, Marchesini R. Geometry of volumes in radiotherapy planning. A new method for a quantitative assessment. TUMORI JOURNAL 2011; 97:503-9. [DOI: 10.1177/030089161109700415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background The purpose of the study was to develop a general method able to quantify the mutual disposition in the 3D space of critical organs with respect to the target when these structures are designed for a radiotherapy treatment plan. To that end, we introduce the “expansion intersection histogram”, a function defined as the intersection between an organ at risk and the target volume, while the target is expanded in 3D. Methods and study design A software was developed to calculate the expansion intersection histogram of anatomical structures exported in a DICOM format from a commercial treatment planning system. A virtual phantom with spherical and cylindrical objects arranged in different dispositions in the 3D space was created for testing the software under known conditions. Results and conclusions Expansion intersection histogram computation was tested against reference data derived analytically for spherical volumes, with a resulting maximum error of 0.5%. Specific geometric features derived from the expansion intersection histogram, such as the distance between a selected target and each different ideal volume included in the virtual phantom, well matched the corresponding theoretical expected values. The expansion intersection histogram was evaluated also for the anatomical structures of a real patient. Data show this method as a tool to effectively take into account the mutual disposition of each critical organ with respect to the target, summarized in characteristics of distance, shape and orientation. The expansion intersection histogram method integrates and extends other preexisting modalities for evaluating the geometrical relationships among radiotherapy volumes and could be used to improve planning optimization.
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Affiliation(s)
- Stefano Tomatis
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - Mauro Carrara
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | | | | | - Mauro Palazzi
- Radiotherapy Unit, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan
| | - Ester Orlandi
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
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Muirhead R, van der Weide L, van Sornsen de Koste JR, Cover KS, Senan S. Use of megavoltage cine-images for studying intra-thoracic motion during radiotherapy for locally advanced lung cancer. Radiother Oncol 2011; 99:155-60. [PMID: 21621867 DOI: 10.1016/j.radonc.2011.05.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 05/17/2011] [Accepted: 05/17/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Use of planning 4-dimensional CT (4DCT) scans often permits use of smaller target volumes for thoracic tumors but this assumes a reproducible pattern of motion during radiotherapy. We compared cranio-caudal (CC) motion on MV cine-images acquired during treatment with that seen on planning 4DCT. METHODS AND MATERIALS A pre-programmable respiratory motion phantom and a software tool for motion assessment were used to validate the use of MV cine-images for motion detection. MV cine-images acquired in 20 patients with node-positive lung cancer were analyzed using the same software. Intra-fraction CC motion on 6 MV cine-images from each patient was compared with CC motion on their planning 4DCT. RESULTS Software-based motion measurement on MV cine-images from the phantom corresponded to actual motion. Mean CC motion of primary tumor, carina and hilus on 4DCT was 7.3mm (range 2-13.8mm), 6.8mm (1.8-21.2) and 11.0mm (4.2-15.1), respectively. Corresponding intra-fraction motion on MV cine was 4.1mm (0.6-13.6mm); 2.7mm (0-10mm) and 6.0mm (1.8-14.4mm), respectively. The tumor, hilus and carina could be tracked in 95%, 88% and 38% of the MV cine-images, respectively. CONCLUSIONS Intra-fraction motion can be reliably measured using MV-cine images from a phantom. Motion discrepancies identified on MV cine-images can identify patients in whom planning 4DCT scans are not representative.
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Affiliation(s)
- Rebecca Muirhead
- Department of Radiation Oncology, VU Medical Centre, Amsterdam, The Netherlands.
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Stereotactic radiation therapy: changing treatment paradigms for stage I nonsmall cell lung cancer. Curr Opin Oncol 2011; 23:133-9. [DOI: 10.1097/cco.0b013e328341ee11] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Choi YJ, Rho JK, Back DH, Kim HR, Lee JC, Kim CH. Enhanced Sensitivity to Gefitinib after Radiation in Non-Small Cell Lung Cancer Cells. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.71.4.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yun Jung Choi
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Kyung Rho
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Hyun Back
- Division of Pulmonology, Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Hye-Ryoun Kim
- Division of Pulmonology, Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Jae Cheol Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheol Hyeon Kim
- Division of Pulmonology, Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
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Phernambucq E, Spoelstra F, Verbakel W, Postmus P, Melissant C, Maassen van den Brink K, Frings V, van de Ven P, Smit E, Senan S. Outcomes of concurrent chemoradiotherapy in patients with stage III non-small-cell lung cancer and significant comorbidity. Ann Oncol 2011; 22:132-138. [DOI: 10.1093/annonc/mdq316] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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28
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De Ruysscher D, Faivre-Finn C, Nestle U, Hurkmans CW, Le Péchoux C, Price A, Senan S. European Organisation for Research and Treatment of Cancer Recommendations for Planning and Delivery of High-Dose, High-Precision Radiotherapy for Lung Cancer. J Clin Oncol 2010; 28:5301-10. [DOI: 10.1200/jco.2010.30.3271] [Citation(s) in RCA: 203] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose To derive recommendations for routine practice and clinical trials for techniques used in high-dose, high-precision thoracic radiotherapy for lung cancer. Methods A literature search was performed to identify published articles considered both clinically relevant and practical to use. Recommendations were categorized under the following headings: patient selection, patient positioning and immobilization, tumor motion, computed tomography and [18F]fluorodeoxyglucose–positron emission technology scanning, generating target volumes, radiotherapy treatment planning, treatment delivery, and scoring of response and toxicity. The American College of Chest Physicians grading of recommendations was used. Results Recommendations were identified for each of the recommendation categories. Although most of the recommended techniques have not been evaluated in multicenter clinical trials, their use in high-precision thoracic radiotherapy and stereotactic body radiotherapy (SBRT) appears to be justified on the basis of available evidence. Conclusion Recommendations to facilitate the clinical implementation of high-precision conformal radiotherapy and SBRT for lung tumors were identified from the literature. Some techniques that are considered investigational at present were also highlighted.
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Affiliation(s)
- Dirk De Ruysscher
- From the Maastricht University Medical Center, GROW Research Institute, Maastricht; Free University Medical Center, Amsterdam; and Catharina Hospital, Eindhoven, the Netherlands; the Christie, Manchester; and Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom; Freiburg University Medical Center, Freiburg, Germany; and Gustave Roussy Institute, Villejuif, France
| | - Corinne Faivre-Finn
- From the Maastricht University Medical Center, GROW Research Institute, Maastricht; Free University Medical Center, Amsterdam; and Catharina Hospital, Eindhoven, the Netherlands; the Christie, Manchester; and Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom; Freiburg University Medical Center, Freiburg, Germany; and Gustave Roussy Institute, Villejuif, France
| | - Ursula Nestle
- From the Maastricht University Medical Center, GROW Research Institute, Maastricht; Free University Medical Center, Amsterdam; and Catharina Hospital, Eindhoven, the Netherlands; the Christie, Manchester; and Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom; Freiburg University Medical Center, Freiburg, Germany; and Gustave Roussy Institute, Villejuif, France
| | - Coen W. Hurkmans
- From the Maastricht University Medical Center, GROW Research Institute, Maastricht; Free University Medical Center, Amsterdam; and Catharina Hospital, Eindhoven, the Netherlands; the Christie, Manchester; and Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom; Freiburg University Medical Center, Freiburg, Germany; and Gustave Roussy Institute, Villejuif, France
| | - Cécile Le Péchoux
- From the Maastricht University Medical Center, GROW Research Institute, Maastricht; Free University Medical Center, Amsterdam; and Catharina Hospital, Eindhoven, the Netherlands; the Christie, Manchester; and Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom; Freiburg University Medical Center, Freiburg, Germany; and Gustave Roussy Institute, Villejuif, France
| | - Allan Price
- From the Maastricht University Medical Center, GROW Research Institute, Maastricht; Free University Medical Center, Amsterdam; and Catharina Hospital, Eindhoven, the Netherlands; the Christie, Manchester; and Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom; Freiburg University Medical Center, Freiburg, Germany; and Gustave Roussy Institute, Villejuif, France
| | - Suresh Senan
- From the Maastricht University Medical Center, GROW Research Institute, Maastricht; Free University Medical Center, Amsterdam; and Catharina Hospital, Eindhoven, the Netherlands; the Christie, Manchester; and Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom; Freiburg University Medical Center, Freiburg, Germany; and Gustave Roussy Institute, Villejuif, France
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Radiotherapy for lung cancer in the elderly. Lung Cancer 2010; 68:129-36. [DOI: 10.1016/j.lungcan.2009.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 11/30/2009] [Accepted: 12/07/2009] [Indexed: 12/25/2022]
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30
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van Baardwijk A, Wanders S, Boersma L, Borger J, Ollers M, Dingemans AMC, Bootsma G, Geraedts W, Pitz C, Lunde R, Lambin P, De Ruysscher D. Mature results of an individualized radiation dose prescription study based on normal tissue constraints in stages I to III non-small-cell lung cancer. J Clin Oncol 2010; 28:1380-6. [PMID: 20142596 DOI: 10.1200/jco.2009.24.7221] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE We previously showed that individualized radiation dose escalation based on normal tissue constraints would allow safe administration of high radiation doses with low complication rate. Here, we report the mature results of a prospective, single-arm study that used this individualized tolerable dose approach. PATIENTS AND METHODS In total, 166 patients with stage III or medically inoperable stage I to II non-small-cell lung cancer, WHO performance status 0 to 2, a forced expiratory volume at 1 second and diffusing capacity of lungs for carbon monoxide >or= 30% were included. Patients were irradiated using an individualized prescribed total tumor dose (TTD) based on normal tissue dose constraints (mean lung dose, 19 Gy; maximal spinal cord dose, 54 Gy) up to a maximal TTD of 79.2 Gy in 1.8 Gy fractions twice daily. Only sequential chemoradiation was administered. The primary end point was overall survival (OS), and the secondary end point was toxicity according to Common Terminology Criteria of Adverse Events (CTCAE) v3.0. RESULTS The median prescribed TTD was 64.8 Gy (standard deviation, +/- 11.4 Gy) delivered in 25 +/- 5.8 days. With a median follow-up of 31.6 months, the median OS was 21.0 months with a 1-year OS of 68.7% and a 2-year OS of 45.0%. Multivariable analysis showed that only a large gross tumor volume significantly decreased OS (P < .001). Both acute (grade 3, 21.1%; grade 4, 2.4%) and late toxicity (grade 3, 4.2%; grade 4, 1.8%) were acceptable. CONCLUSION Individualized prescribed radical radiotherapy based on normal tissue constraints with sequential chemoradiation shows survival rates that come close to results of concurrent chemoradiation schedules, with acceptable acute and late toxicity. A prospective randomized study is warranted to further investigate its efficacy.
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Affiliation(s)
- Angela van Baardwijk
- Department of RadiationOncology (MAASTRO), GROWResearch Institute, Maastricht UniversityMedical Center, Maastricht.
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