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Soin S, Ibrahim R, Wig R, Mahmood N, Pham HN, Sainbayar E, Ferreira JP, Kim RY, Low SW. Lung cancer mortality trends and disparities: A cross-sectional analysis 1999-2020. Cancer Epidemiol 2024; 92:102652. [PMID: 39197399 PMCID: PMC11414020 DOI: 10.1016/j.canep.2024.102652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 07/02/2024] [Accepted: 08/15/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Lung cancer remains a leading cause of morbidity and mortality in the United States. Given the importance of epidemiological insight on lung cancer outcomes as the foundation for targeted interventions, we aimed to examine lung cancer death trends in the United States in the recent 22-year period, exploring demographic disparities and yearly mortality shifts. METHODS Mortality information was obtained from the CDC Wide-ranging Online Data for Epidemiologic Research database from the years 1999-2020. Demographic information included age, sex, race or ethnicity, and area of residence. We performed log-linear regression models to assess temporal mortality shifts and calculated average annual percentage change (AAPC) and compared age-adjusted mortality rates (AAMR) across demographic subpopulations. RESULTS A total of 3,380,830 lung cancer deaths were identified. The AAMR decreased from 55.4 in 1999-31.8 in 2020 (p<0.001). Males (AAMR 57.6) and non-Hispanic (NH) (AAMR 47.5) populations were disproportionately impacted compared to females (AAMR 36.0) and Hispanic (AAMR 19.1) populations, respectively. NH Black populations had the highest AAMR (48.5) despite an overall reduction in lung cancer deaths (AAPC -3.3 %) over the study period. Although non-metropolitan regions were affected by higher mortality rates, the annual decrease in mortality among metropolitan regions (AAPC -2.8 %, p<0.001) was greater compared to non-metropolitan regions (AAPC -1.7 %, p<0.001). Individuals living in the Western US (AAPC -3.4 %, p<0.001) experienced the greatest decline in lung cancer mortality compared to other US census regions. CONCLUSIONS Our findings revealed lung cancer mortality inequalities in the US. By contextualizing these mortality shifts, we provide a larger framework of data-driven initiatives for societal and health policy changes for improving access to care, minimizing healthcare inequalities, and improving outcomes.
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Affiliation(s)
- Sabrina Soin
- Department of Medicine, University of Arizona Tucson, Tucson, AZ, United States
| | - Ramzi Ibrahim
- Department of Medicine, University of Arizona Tucson, Tucson, AZ, United States
| | - Rebecca Wig
- Department of Medicine, University of Arizona Tucson, Tucson, AZ, United States
| | - Numaan Mahmood
- Department of Medicine, University of Arizona Tucson, Tucson, AZ, United States
| | - Hoang Nhat Pham
- Department of Medicine, University of Arizona Tucson, Tucson, AZ, United States
| | - Enkhtsogt Sainbayar
- Department of Medicine, University of Arizona Tucson, Tucson, AZ, United States
| | - João Paulo Ferreira
- Department of Medicine, University of Arizona Tucson, Tucson, AZ, United States
| | - Roger Y Kim
- Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA, United States
| | - See-Wei Low
- Division of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, United States.
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Chen Y, Yao L, Chen Q, Hu Y, Zhu X, Dai R, Chen X, Zeng Y, Zhu Y, Song D, Zhang Y. A retrospective study on the impact of radiotherapy on the survival outcomes of small cell lung cancer patients based on the SEER database. Sci Rep 2024; 14:15552. [PMID: 38969694 PMCID: PMC11226443 DOI: 10.1038/s41598-024-65314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 06/19/2024] [Indexed: 07/07/2024] Open
Abstract
Small cell lung cancer (SCLC) patients exhibit significant heterogeneity in tumor burden, physical condition, and responses to initial treatment. This diversity in treatment responses can result in varying treatment outcomes. The primary objective of this study was to explore the patient demographics associated with improved survival outcomes through radiotherapy. Based on the SEER database, we identified 42,824 SCLC patients enrolled between 2004 and 2015. These patients were stratified into radiotherapy (n = 20,360) and non-radiotherapy groups (n = 22,464). We controlled for confounding factors using propensity score matching (PSM) analysis. Subsequently, Kaplan-Meier (KM) analysis was employed to evaluate the impact of radiotherapy on patients' overall survival (OS) and cancer-specific survival (CSS). Cancer-specific mortality was further analyzed using competitive risk models. Cox analysis was also conducted to examine additional variables potentially affecting the survival of SCLC patients. We identified a total of 42,824 eligible patients, and following PSM, 13,329 patients were successfully matched in both the radiotherapy and non-radiotherapy groups. The KM analysis showed that the median OS was 9 months in the radiotherapy group and 6 months in the non-radiotherapy group. The median CSS was 10 months in the radiotherapy group and 7 months in the non-radiotherapy group. The 5-year OS and 10-year OS rates were 6.2% versus 1.6% in the radiotherapy group and 2.6% versus 0.8% in the non-radiotherapy group (P < 0.001). Competitive risk analysis showed that cancer-specific mortality was significantly higher in the non-radiotherapy group than in the radiotherapy group (P < 0.001). Multivariate Cox analysis showed that the radiotherapy group (relative non-radiotherapy group) showed a significant positive effect on survival outcomes (OS: HR 0.658 95% CI [0.642, 0.675] P < 0.001; CSS: HR 0.662 95% CI [0.645, 0.679], P < 0.001). In addition, age, gender, race, primary tumor site, T stage, N stage, M stage, chemotherapy, and surgery were also considered as important predictors of SCLC outcome. The results of the subgroup analysis showed that the radiotherapy group showed a significant survival advantage regardless of age, sex, race, primary tumor site, M stage, chemotherapy, and surgery (P < 0.001). Radiotherapy may improve both OS and CSS in SCLC patients. Patients with SCLC may benefit from radiotherapy regardless of age, sex, race, primary tumor site, M stage, chemotherapy, and surgery.
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Affiliation(s)
- Yao Chen
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian Province, China
- The School of Public Health, Fujian Medical University, Fuzhou, 350108, Fujian Province, China
| | - Ling Yao
- College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Children's Hospital, Fujian Medical University, Fuzhou, 350014, China
| | - Qingquan Chen
- The School of Public Health, Fujian Medical University, Fuzhou, 350108, Fujian Province, China
| | - Yiming Hu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Xi Zhu
- The School of Public Health, Fujian Medical University, Fuzhou, 350108, Fujian Province, China
| | - Rongrong Dai
- The School of Public Health, Fujian Medical University, Fuzhou, 350108, Fujian Province, China
| | - Xiaoyang Chen
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian Province, China
| | - Yifu Zeng
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian Province, China
- Cyberspace Institute of Advanced Technology, Guangzhou University, Guangzhou, China
| | - Yong Zhu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Duanhong Song
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian Province, China.
| | - Yixiang Zhang
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian Province, China.
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3
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Lim JU. Update on Adjuvant Treatment in Resectable Non-Small Cell Lung Cancer and Potential Biomarkers Predicting Postoperative Relapse. Tuberc Respir Dis (Seoul) 2023; 86:14-22. [PMID: 36594192 PMCID: PMC9816492 DOI: 10.4046/trd.2022.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022] Open
Abstract
A significant proportion of patients with non-small cell lung cancer (NSCLC) is diagnosed in the early and resectable stage. Despite the use of platinum-based adjuvant chemotherapy, there was only a marginal increase in overall survival and a 15% decrease in relapse. With the advents of immunotherapy and epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), the landscape of adjuvant treatment in completely resectable NSCLC is changing. Postoperative radiotherapy can be beneficial to patients who underwent surgical resection in certain clinical settings. In addition, new biomarkers that predict efficacy of EGFR TKI and immunotherapy as adjuvant treatment are also necessary. In this review, recent updates in adjuvant treatment in resectable NSCLC were briefly explained.
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Affiliation(s)
- Jeong Uk Lim
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,Address for correspondence Jeong Uk Lim, M.D., Ph.D. Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 10 63(yuksam)-ro, Yeongdeungpo-gu, Seoul 07345, Republic of Korea Phone 82-2-3779-1035 Fax 82-2-784-5458 E-mail
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Ning J, Ge T, Zhu S, Han Y, Ruan S, Ma Y, Liu R. The role of surgery in older patients with T1-2N0M0 small cell lung cancer: A propensity score matching analysis. Front Oncol 2022; 12:958187. [PMID: 36249007 PMCID: PMC9565197 DOI: 10.3389/fonc.2022.958187] [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: 05/31/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022] Open
Abstract
BackgroundSurgical resection could improve the survival of patients with early-stage small cell lung cancer (SCLC). However, there is a lack of dedicated studies concentrating on surgical treatment in older patients with T1-2N0M0 SCLC. Thus, we performed this population-based study to investigate whether older patients with T1-2N0M0 SCLC could benefit from surgery.MethodsWe collected the data of patients with SCLC between 2000 and 2015 from the Surveillance, Epidemiology, and End Results Program database. Older patients (≥ 65 years) with T1-2N0M0 SCLC were included, and we converted the staging information into those of the eighth edition. The propensity score matching (PSM) was used to balance the distribution of clinical characteristics between surgery and no-surgery groups.ResultsBefore PSM, the distribution proportions of clinical characteristics in 1,229 patients were unbalanced. The Kaplan–Meier curves of overall survival (OS) and cancer-specific survival (CSS) showed that the patients in the surgery group were better than those in the non-surgery group (all P < 0.001). After 1:2 PSM, the distribution proportions of clinical characteristics in 683 patients were balanced (all P > 0.05). The OS and CSS of patients in the surgery group were still better than that of patients in the no-surgery group (all P < 0.001), and subgroup analysis showed that the surgery was a protective factor for OS and CSS in all clinical characteristics subgroups (almost P < 0.001). The multivariate Cox analysis further confirmed this result (OS: HR, 0.33; 95% CI, 0.27–0.39; P < 0.001; CSS: HR, 0.29; 95% CI, 0.23–0.36; P < 0.001). The result of subgroup analysis based on age, T stage, and adjuvant therapy showed that surgery was related to better OS and CSS compared with non-surgery group (almost P < 0.001) and that lobectomy exhibited the longer survival than sublobectomy. Age, sex, and race were the independent prognostic factors for OS in patients undergoing surgery, whereas only the factor of age affects the CSS in patients with surgery.ConclusionsOlder patients with T1-2N0M0 SCLC can benefit significantly from surgical treatment, and lobectomy provides better prognosis than sublobectomy.
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Affiliation(s)
- Jing Ning
- Department of Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Tao Ge
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shuncang Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yingli Han
- Department of Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Suhong Ruan
- Department of Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Yuchen Ma
- Department of Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
- *Correspondence: Yuchen Ma, ; Rentao Liu,
| | - Rentao Liu
- Department of Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
- *Correspondence: Yuchen Ma, ; Rentao Liu,
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Çimen F, Aloglu M, Düzgün S, Şentürk A, Atikcan Ş, Özmen Ö. What is the effect of tumor diameter, lymph node metastases, and SUVmax value on prognosis in limited-stage small cell lung cancer? Rev Assoc Med Bras (1992) 2022; 68:1252-1258. [PMID: 36228257 PMCID: PMC9575018 DOI: 10.1590/1806-9282.20220325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/17/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study was designed to investigate the link between survival and prognostic factors such as tumor size, lymph node metastasis, and metabolic activity detected on positron emission tomography/computed tomography in patients with limited-stage small cell lung carcinoma. METHODS Patients who were admitted to our hospital with pathological diagnosis of limited-stage small cell lung cancer between January 2015 and December 2019 and were older than 18 years were retrospectively screened. RESULTS A total of 77 patients, including 10 females and 67 males, were included in the study. While there were 39 patients over 60 years of age, 38 patients were under 60.The ratios of male patients, N stage, multiple lymph nodes, distant metastasis, brain metastasis, and prophylactic cranial irradiation in the deceased patients' group were significantly (p=0.008, p=0.000, p=0.000, p=0.000, p=0.013, p=0.000, respectively) higher than those in the living patients' group.In the univariate model, we observed that gender, smoking, T stage, N stage, multiple lymph nodes, distant metastasis, brain metastasis, liver metastasis, sequential chemotherapy, sequential radiotherapy, concurrent chemoradiotherapy, and prophylactic cranial irradiation had significant effect (p=0.049, p=0.021, p=0.022, p=0.000, p=0.000, p=0.000 p=0.003, p=0.037, p=0.029, p=0.049, p=0.000, respectively) on survival time. In the multivariate model, smoking, N stage, liver metastasis, and prophylactic cranial irradiation demonstrated significant independent effect (p=0.010, p=0.003, p=0.004, p=0.000, respectively) on survival time. CONCLUSION Our findings provide useful information for better patient management, especially in terms of negative factors on the continuation of survival during and after the treatment of limited-stage small cell lung carcinoma patients.
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Affiliation(s)
- Filiz Çimen
- Ankara University, Faculty of Health Sciences, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Disease Department – Ankara, Turkish.,Corresponding author:
| | - Melike Aloglu
- Ankara University, Faculty of Health Sciences, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Disease Department – Ankara, Turkish
| | - Sevim Düzgün
- Ankara University, Faculty of Health Sciences, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Disease Department – Ankara, Turkish
| | - Ayşegül Şentürk
- Ankara University, Faculty of Health Sciences, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Disease Department – Ankara, Turkish
| | - Şükran Atikcan
- Ankara University, Faculty of Health Sciences, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Disease Department – Ankara, Turkish
| | - Özlem Özmen
- Ankara University, Faculty of Health Sciences, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Nuclear Medicine Department – Ankara, Turkish
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Skurla SE, Friedman ER, Park ER, Cannon S, Kilbourne GA, Pirl WF, Traeger L. Perceptions of somatic and affective symptoms and psychosocial care utilization in younger and older survivors of lung cancer. Support Care Cancer 2022; 30:5311-5318. [PMID: 35278137 DOI: 10.1007/s00520-022-06926-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/20/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Rates of depression identification in oncology settings and referral to psychosocial services remain low. Patients with lung cancer face an elevated risk of depression relative to patients with other cancers. This study explored perceptions of somatic and affective symptoms and psychosocial care utilization among younger and older lung cancer survivors. METHODS We conducted in-depth interviews with 20 adults at two academic medical centers in Boston, MA, who had received a lung cancer diagnosis in the past 24 months. A semi-structured interview guide was used to assess experiences with, and perceptions of, depression symptoms and psychosocial services. Interviews were audio-recorded, transcribed, and coded to identify themes. We also explored differences between younger (<65years; N=9) and older (>65years; N=11) patients. RESULTS Participants commonly described somatic symptoms (i.e., changes in appetite, sleep, or energy levels) and affective symptoms (i.e., worry, fear, sadness) as side effects of cancer treatment. Older participants more commonly contextualized these symptoms with information about how they impacted daily life. Both younger and older participants faced barriers to accessing psychosocial services, with older adults more commonly referencing stigma of service referral and utilization. DISCUSSION Patients with lung cancer associated both somatic and affective symptoms with their cancer and its treatment, with age differences in how symptoms were described and how psychosocial referrals may be perceived. More systematic integration of psychosocial care into cancer care may help to increase the identification of depression in lung cancer and reduce barriers to psychosocial service utilization.
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Affiliation(s)
- Sarah E Skurla
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor, MI, USA
| | - Emily R Friedman
- Cancer Outcomes Research and Education Program, Massachusetts General Hospital, Boston, MA, USA
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA
| | - Elyse R Park
- Cancer Outcomes Research and Education Program, Massachusetts General Hospital, Boston, MA, USA.
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Sheila Cannon
- School of Nursing, Fayetteville State University, Fayetteville, NC, USA
| | | | - William F Pirl
- Division of Adult Psychosocial Oncology and Palliative Care, Harvard Medical School, Boston, MA, USA
| | - Lara Traeger
- Cancer Outcomes Research and Education Program, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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BULUT S, ÇELİK D. THE EFFECTS OF TUMOR LOCALIZATION ON SMALL CELL LUNG CANCER AND ITS ASSOCIATION WITH PROGNOSIS. ACTA MEDICA ALANYA 2021. [DOI: 10.30565/medalanya.969705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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Kepka L, Socha J, Sas-Korczynska B. Radiotherapy for brain metastases from small-cell lung cancer in distinct clinical indications and scenarios. J Thorac Dis 2021; 13:3269-3278. [PMID: 34164219 PMCID: PMC8182529 DOI: 10.21037/jtd.2019.10.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/14/2019] [Indexed: 12/25/2022]
Abstract
Management of brain metastases (BM) from small-cell lung cancer (SCLC) is complex and not supported by a strong evidence from prospective clinical trials. Owing to the different clinical and pathological characteristics of SCLC, patients with this histology were not included in the prospective studies on the value of whole-brain radiotherapy (WBRT) and local surgical or ablative radiation treatment like stereotactic radiosurgery (SRS). Chemotherapy also represents a major part of the armamentarium against BM from SCLC due to the well-recognized chemoresponsiveness of this cancer and the frequent presentation of BM with extracranial progression. WBRT in combination with chemotherapy has long been a standard approach in this setting. However, data on the neurocognitive toxicity and the lack of documented impact on overall survival of WBRT in the management of BM from other solid tumors, as well as the increasing availability of the stereotactic radiotherapy technologies, has led to the increasing use of SRS with omission of WBRT also in SCLC. In the current review the use of different modalities of radiotherapy and ways of combining radiotherapy with chemotherapy for BM from SCLC will be presented for distinct clinical situations: presentation of BM synchronous with primary, metachronous presentation of BM-without previous prophylactic cranial irradiation (PCI) vs. after PCI, and asymptomatic BM found at the staging before PCI.
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Affiliation(s)
- Lucyna Kepka
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland
| | - Joanna Socha
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland
| | - Beata Sas-Korczynska
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland
- Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
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Zou J, Guo S, Xiong MT, Xu Y, Shao J, Tong Z, Zhang P, Pan L, Peng A, Li X. Ageing as key factor for distant metastasis patterns and prognosis in patients with extensive-stage Small Cell Lung Cancer. J Cancer 2021; 12:1575-1582. [PMID: 33613744 PMCID: PMC7890308 DOI: 10.7150/jca.49681] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Small cell lung cancer (SCLC) represents about 13% of lung cancer cases, which is highly invasive and has a high mortality rate, with the 5-year overall survival (OS) rate being only 6.3%. Age at diagnosis of advanced SCLC is much older, but studies describing the ageing factor for distant metastasis patterns and prognosis of extensive-stage SCLC (ES-SCLC) are limited. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) registry, we identified 18,682 patients with ES-SCLC (9,089 women and 9,053 men) who had complete clinical information between 2008 and 2015. Patients were classified into three groups (older group: ≥80 yrs, middle-aged group: 60-79 yrs, and younger group: ≤59 yrs). The role of different age at diagnosis of ES-SCLC (especially older group) in metastasis patterns was investigated, and OS and cancer-specific survival (CSS) of different age groups of metastatic ES-SCLC was assessed. Results: The most metastasis of ES-SCLC patients in the three groups was multiorgan metastases (MOM) metastasis (71.2%, 70.3% and 66.3%, respectively), the most single organ metastasis in the younger group was the lung (3.3%), the middle-aged group and the older group were the brain (3.5%, 3.1%, respectively). The analysis revealed that older patients were less likely to have MOM, but more likely to have all organs metastases than other two groups (p<0.001). Older group had the worst OS (p<0.001) and CSS (p<0.001). Furthermore, Radiotherapy and chemotherapy can improve survival (p<0.001), but the rate of radiotherapy and chemotherapy in older patients is lower than that in middle-aged and younger patients (50.4% vs 38.6% vs 20.7%, p<0.05). Compared with other two group, older group (odds ratios, ORs) for lung, all organ metastases, and MOM were 0.43 (95% CI 0.27-0.67), 1.77 (95% CI 1.55-2.03), 0.68 (95% CI 0.6-0.77), respectively. Conclusion: The mortality risk is highest with MOM and all organs metastasis followed by brain, lung, bone and liver metastases in elderly ES-SCLC patients. These results will be helpful for pre-treatment evaluation regarding the prognosis of ES-SCLC patients.
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Affiliation(s)
- Junyong Zou
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.,Department of Respiratory Medicine, Hwamei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences,Ningbo 315010, China
| | - Shijie Guo
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Meng Ting Xiong
- Department of Tuberculosis, Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Yingchun Xu
- Tongji University School of Medicine, Shanghai 200092, China
| | - Jiale Shao
- Department of Respiratory Medicine, Hwamei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, China
| | - Zhongkai Tong
- Department of Respiratory Medicine, Hwamei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, China
| | - Peng Zhang
- Department of Cardio-Thoracic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai200072, China
| | - Long Pan
- Department of Interventional and Vascular Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai200072, China
| | - Aimei Peng
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Xuan Li
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
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10
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Simone CB, Bogart JA, Cabrera AR, Daly ME, DeNunzio NJ, Detterbeck F, Faivre-Finn C, Gatschet N, Gore E, Jabbour SK, Kruser TJ, Schneider BJ, Slotman B, Turrisi A, Wu AJ, Zeng J, Rosenzweig KE. Radiation Therapy for Small Cell Lung Cancer: An ASTRO Clinical Practice Guideline. Pract Radiat Oncol 2020; 10:158-173. [PMID: 32222430 PMCID: PMC10915746 DOI: 10.1016/j.prro.2020.02.009] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/15/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Several sentinel phase III randomized trials have recently been published challenging traditional radiation therapy (RT) practices for small cell lung cancer (SCLC). This American Society for Radiation Oncology guideline reviews the evidence for thoracic RT and prophylactic cranial irradiation (PCI) for both limited-stage (LS) and extensive-stage (ES) SCLC. METHODS The American Society for Radiation Oncology convened a task force to address 4 key questions focused on indications, dose fractionation, techniques and timing of thoracic RT for LS-SCLC, the role of stereotactic body radiation therapy (SBRT) compared with conventional RT in stage I or II node negative SCLC, PCI for LS-SCLC and ES-SCLC, and thoracic consolidation for ES-SCLC. Recommendations were based on a systematic literature review and created using a consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS The task force strongly recommends definitive thoracic RT administered once or twice daily early in the course of treatment for LS-SCLC. Adjuvant RT is conditionally recommended in surgically resected patients with positive margins or nodal metastases. Involved field RT delivered using conformal advanced treatment modalities to postchemotherapy volumes is also strongly recommended. For patients with stage I or II node negative disease, SBRT or conventional fractionation is strongly recommended, and chemotherapy should be delivered before or after SBRT. In LS-SCLC, PCI is strongly recommended for stage II or III patients who responded to chemoradiation, conditionally not recommended for stage I patients, and should be a shared decision for patients at higher risk of neurocognitive toxicities. In ES-SCLC, radiation oncologist consultation for consideration of PCI versus magnetic resonance surveillance is strongly recommended. Lastly, the use of thoracic RT is strongly recommended in select patients with ES-SCLC after chemotherapy treatment, including a conditional recommendation in those responding to chemotherapy and immunotherapy. CONCLUSIONS RT plays a vital role in both LS-SCLC and ES-SCLC. These guidelines inform best clinical practices for local therapy in SCLC.
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Affiliation(s)
| | - Jeffrey A Bogart
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY
| | - Alvin R Cabrera
- Department of Radiation Oncology, Kaiser Permanente, Seattle, WA
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis, Sacramento, CA
| | - Nicholas J DeNunzio
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Frank Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT
| | - Corinne Faivre-Finn
- Division of Cancer Science, University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Elizabeth Gore
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers University, New Brunswick, NJ
| | - Tim J Kruser
- Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL
| | - Bryan J Schneider
- Department of Medical Oncology, University of Michigan, Ann Arbor, MI
| | - Ben Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands
| | - Andrew Turrisi
- Department of Radiation Oncology, James H. Quillen VA Medical Center, Mountain Home, TN
| | - Abraham J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, NY
| | - Jing Zeng
- Department of Radiation Oncology, University of Washington, Seattle, WA
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Abstract
PURPOSE OF REVIEW The current article reviews the state of art of prevention strategies for brain metastases from solid tumors and touches both old pivotal studies and new directions of personalized molecular approaches. RECENT FINDINGS Prophylactic cranial irradiation (PCI) has a definite role in the prevention of relapse into the brain for patients with small cell lung cancer (SCLC) responding to chemotherapy and radiotherapy as it prolongs overall survival (OS). However, the risk of late cognitive deficit following whole brain radiotherapy (WBRT) in this patient population is still not well known. Conversely, PCI significantly reduces the incidence of brain metastases and prolongs the disease-free interval in patients with non-SCLC (NSCLC), but does not improve OS thus far. Pharmacologic prevention is a new concept driven by the efficacy of targeted agents on macrometastases from specific molecular subgroups. SUMMARY The future challenges for prevention of brain metastases are represented by the identification of subgroups of patients at higher risk of relapse into the brain coupled with either new WBRT strategies to better preserve cognition or effective molecular agents to target micrometastases.
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Affiliation(s)
- Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
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12
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He J, Shao C, Hui SL, Zhang Z, Baker J, Dexter PR, Kachroo S, Jin F. Survival, Chemotherapy Treatments, and Health Care Utilization Among Patients with Advanced Small Cell Lung Cancer: An Observational Study. Adv Ther 2020; 37:552-565. [PMID: 31828610 DOI: 10.1007/s12325-019-01161-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Most cases of small cell lung cancer (SCLC) are diagnosed at an advanced stage. The objective of this study was to investigate patient characteristics, survival, chemotherapy treatments, and health care use after a diagnosis of advanced SCLC in subjects enrolled in a health system network. METHODS This was a retrospective cohort study of patients aged ≥ 18 years who either were diagnosed with stage III/IV SCLC or who progressed to advanced SCLC during the study period (2005-2015). Patients identified from the Indiana State Cancer Registry and the Indiana Network for Patient Care were followed from their advanced diagnosis index date until the earliest date of the last visit, death, or the end of the study period. Patient characteristics, survival, chemotherapy regimens, associated health care visits, and durations of treatment were reported. Time-to-event analyses were performed using the Kaplan-Meier method. RESULTS A total of 498 patients with advanced SCLC were identified, of whom 429 were newly diagnosed with advanced disease and 69 progressed to advanced disease during the study period. Median survival from the index diagnosis date was 13.2 months. First-line (1L) chemotherapy was received by 464 (93.2%) patients, most commonly carboplatin/etoposide, received by 213 (45.9%) patients, followed by cisplatin/etoposide (20.7%). Ninety-five (20.5%) patients progressed to second-line (2L) chemotherapy, where topotecan monotherapy (20.0%) was the most common regimen, followed by carboplatin/etoposide (14.7%). Median survival was 10.1 months from 1L initiation and 7.7 months from 2L initiation. CONCLUSION Patients in a regional health system network diagnosed with advanced SCLC were treated with chemotherapy regimens similar to those in earlier reports based on SEER-Medicare data. Survival of patients with advanced SCLC was poor, illustrating the lack of progress over several decades in the treatment of this lethal disease and highlighting the need for improved treatments.
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Affiliation(s)
| | | | - Siu L Hui
- Regenstrief Institute, Indianapolis, IN, USA
| | - Zuoyi Zhang
- Regenstrief Institute, Indianapolis, IN, USA
- Indiana University, Indianapolis, IN, USA
| | - Jarod Baker
- Regenstrief Institute, Indianapolis, IN, USA
| | | | | | - Fan Jin
- Merck & Co., Kenilworth, NJ, USA
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13
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Real-World Adherence to Guideline-Recommended Treatment for Small Cell Lung Cancer. Am J Clin Oncol 2019; 43:236-242. [DOI: 10.1097/coc.0000000000000657] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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14
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Shao C, He J, Kachroo S, Jin F. Chemotherapy treatments, costs of care, and survival for patients diagnosed with small cell lung cancer: A SEER-Medicare study. Cancer Med 2019; 8:7613-7622. [PMID: 31668011 PMCID: PMC6912057 DOI: 10.1002/cam4.2626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/09/2019] [Accepted: 10/09/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The effectiveness and costs of new treatments should be assessed in relation to existing practice. We describe treatments, survival and costs for advanced or metastatic small cell lung cancer (SCLC) patients receiving systemic therapy in the period preceding the introduction of immunotherapies. MATERIALS AND METHODS This was a retrospective cohort study of patients aged ≥65 years, identified using linked Surveillance, Epidemiology, and End Results and Medicare databases. Individuals with a new primary diagnosis of SCLC between January 2007 and December 2013 were followed until December 2014. Chemotherapy treatments, health care visits and costs (in 2016 USD), and survival were determined by line of therapy. RESULTS A total of 11 812 patients were identified with SCLC. First-line (1L) chemotherapy was received by 6509 (55.1%) patients, most (93.2%) with carboplatin- (71.0%) or cisplatin- (22.2%) based therapies, typically combined with etoposide (79.2%). Second- (2L) and third- (3L) line chemotherapies were received by 2238 (18.9%) and 679 (5.7%) patients, of which 48.4% and 30.9%, respectively, were platinum-based. The median durations of 1L, 2L, and 3L carboplatin-based therapies were 5.9, 4.8, and 5.4 months, respectively, and the corresponding durations of cisplatin-based therapies were 5.3, 4.2, and 5.3 months. During 1L, 2L, and 3L chemotherapies, patients averaged 8.2, 7.4, and 7.3 health care visits per month, respectively, and incurred total mean health care costs of $60 223, $42 636, and $35 903 per patient, respectively. Median survival from the start of 1L, 2L, and 3L chemotherapy was 9.2, 6.0, and 5.7 months, respectively. CONCLUSION First-line chemotherapy was primarily platinum-based, and a plethora of different regimens was used for 2L and 3L chemotherapies. Median survival from the start of 1L chemotherapy was 9 months, with an associated health care cost of $60 000. These data highlight an unmet medical need among SCLC patients receiving systemic therapy.
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Affiliation(s)
| | | | | | - Fan Jin
- Merck & Co., IncKenilworthNJUSA
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15
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Jørgensen N, Meline EL, Jeppesen SS, Hansen O, Nielsen M, Schytte T. The effect of tumor laterality on survival for non-small cell lung cancer patients treated with radiotherapy. Acta Oncol 2019; 58:1393-1398. [PMID: 31271075 DOI: 10.1080/0284186x.2019.1629011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: The treatment of choice for patients with locally advanced non-small cell lung cancer (LA-NSCLC) in good performance status is definitive radiotherapy (RT), the five-year survival being approximately 25-30%. Advances in the diagnostic procedures and treatment modalities in NSCLC have increased the overall survival, making identifying factors with impact on survival increasingly relevant. Recent research indicates that tumor laterality has impact on the survival of patients with LA-NSCLC treated with definitive RT. The aim of this study was to investigate whether tumor laterality impacted overall survival. Material and methods: All patients with stage IIa-IIIb NSCLC planned for curative intended RT from 2008 to 2013 at Odense University Hospital were analyzed to compare overall survival of patients with right-sided vs. left-sided tumors. Log-rank test was performed to test for differences in survival rates and Cox regression analyses to test for possible confounders. No patients were lost to follow-up. Results: In total, 164 patients had a tumor in the right lung and 118 had tumor in the left lung. All patients had at least 4.5 years' follow-up. Median overall survival was 19 months (right) and 22.5 months (left) p = .729. Three-year overall survival was 31% (right) and 35% (left). In Cox regression analyses age, performances status and total mean lung dose were statistically significant with a hazard ratio (HR) = 1.03 (95% Cl: 1.01-1.05), HR = 1.60 (95% Cl: 1.12-2.28), and HR = 1.11 (95% Cl: 1.06-1.16), respectively. Conclusion: This study did not verify that laterality has a significant impact on survival in LA-NSCLC patients treated with curative intended RT.
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Affiliation(s)
- Nicolai Jørgensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Eric Leif Meline
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Olfred Hansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Morten Nielsen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Tine Schytte
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
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A new small cell lung cancer biomarker identified by Cell-SELEX generated aptamers. Exp Cell Res 2019; 382:111478. [DOI: 10.1016/j.yexcr.2019.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/12/2019] [Accepted: 06/19/2019] [Indexed: 12/15/2022]
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17
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Effects of surgery on survival of elderly patients with stage I small-cell lung cancer: analysis of the SEER database. J Cancer Res Clin Oncol 2019; 145:2397-2404. [DOI: 10.1007/s00432-019-02976-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/06/2019] [Indexed: 12/12/2022]
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18
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Frega S, Dal Maso A, Ferro A, Bonanno L, Conte P, Pasello G. Heterogeneous tumor features and treatment outcome between males and females with lung cancer (LC): Do gender and sex matter? Crit Rev Oncol Hematol 2019; 138:87-103. [PMID: 31092389 DOI: 10.1016/j.critrevonc.2019.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 12/24/2022] Open
Abstract
Lung cancer (LC) is the leading cause of cancer-related death worldwide, despite a decreasing incidence rate in recent years, especially in men. Most risk factors for LC could be linked to an individual's reproductive system and secondary sex characteristics ('sex-related') and/or to some physical, behavioral and personality traits ('gender-related') peculiar to males rather than females or vice versa. An imbalance of these etiologic factors could explain why some LC features may differ between sexes. For this review, an extended literature data collection was performed, using keywords to identify 'sex/gender' and 'LC'. Differences between genders in LC epidemiology, pathological and molecular characteristics, loco-regional and/or systemic treatments outcome and prognosis were systematically analyzed. The possible predictive role of physio-pathological factors in males and females paves the way for a personalized therapeutic approach, emphasizing the need to include gender as a stratification factor in future clinical trials design.
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Affiliation(s)
- Stefano Frega
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Alessandro Dal Maso
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Alessandra Ferro
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Laura Bonanno
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy
| | - PierFranco Conte
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Giulia Pasello
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy.
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Chalian H, Khoshpouri P, Assari S. Patients' age and discussion with doctors about lung cancer screening; Diminished returns of Blacks. Aging Med (Milton) 2019; 2:35-41. [PMID: 31179418 PMCID: PMC6553649 DOI: 10.1002/agm2.12053] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/27/2019] [Accepted: 01/30/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND As age is one of the main risk factors for lung cancer, older adults are expected to receive more messages for lung cancer screening (LCS). It is, however, unclear whether age similarly increases patient's chance of discussing LCS across various racial groups. OBJECTIVE To determine racial differences in the effect of patients' age on patient-physician discussion about LCS. METHODS This cross-sectional study borrowed data from the Health Information National Trends Survey (HINTS 2017) which included 2,277 adults. Patients' demographic factors, socioeconomic characteristics, smoking status, possible LCS indication, and patient-physician discussion about LCS were measured. We ran logistic regression models for data analysis. RESULTS Independent of possible LCS indication, older patients were more likely to have patient-physician discussion about LCS. However, there is a significant interaction between race and age, suggesting a larger effect of age on the likelihood of discussing LCS with doctors for Whites than Blacks. In race-stratified models that controlled for possible LCS indication, higher age increased lung cancer discussion for Whites but not for Blacks. CONCLUSIONS Whether age increases the chance of discussing LCS or not depends on the patient's race, with Blacks receiving fewer messages regarding LCS as a result of their aging.
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Affiliation(s)
- Hamid Chalian
- Department of RadiologyDuke University Medical CenterDurhamNorth Carolina
| | - Pegah Khoshpouri
- Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Shervin Assari
- Department of Family MedicineCharles R. Drew University of Medicine and ScienceLos AngelesCalifornia
- Department of PsychiatryUniversity of MichiganAnn ArborMichigan
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20
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Ma W, Wang M, Li X, Huang H, Zhu Y, Song X, Dai D, Xu W. Quantitative 18F-FDG PET analysis in survival rate prediction of patients with non-small cell lung cancer. Oncol Lett 2018; 16:4129-4136. [PMID: 30214552 PMCID: PMC6126162 DOI: 10.3892/ol.2018.9166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 10/13/2017] [Indexed: 12/19/2022] Open
Abstract
The aim of the present study was to investigate the prognostic value of quantitative [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) parameters for patients with non-small cell lung cancer (NSCLC). The present study conducted a retrospective review of the medical records of 203 patients with NSCLC, of which 193 patients underwent baseline 18F-FDG PET/CT prior to initial therapy. Multivariate analyses using Cox's proportional hazards regression were performed for the assessment of the association between initial PET/CT measurements and overall survival (OS). The multivariate models were adjusted for sex, age, smoking status, disease stage, standardized uptake value (SUV), standardized uptake value corrected for lean body mass (SUL), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and standard deviation of SUV (SD). Kaplan-Meier (K-M) estimator curves were constructed following the formation of three approximately equal-sized groups using tertiles for each PET/CT measurement (n=65, 64 and 64). OS curves were plotted using K-M estimator curves. Results demonstrated significant associations between OS and MTVPET volume computerized assisted reporting (PETVCAR), MTV2.5, MTV25%, MTV42% and TLGPETVCAR; however, no significant associations were identified between OS and MTV50%, MTV75%, TLG2.5, all SUV and SUL. Subgroup analyses according to pathology demonstrated that there were statistically significant associations between OS and stage (P<0.001), MTV50% (P=0.002) and MTV42% (P=0.004) in the adenocarcinoma group, and SULmean (P=0.010), MTV25% (P=0.005) and MTV42% (P=0.001) in the squamous cell carcinoma group; however, no significant differences were identified between any other group. Furthermore, there was a significant association between OS and MTV42% (P=0.02) and MTV50% (P=0.04) in the early-stage group; however, no significant differences were identified in the advanced-stage group. K-M estimator curve analyses demonstrated that the pathology (P=0.01), stage (P<0.001) and all PET metabolic parameters with the exception of SD were significantly associated with OS (P<0.05). No significant associations were demonstrated between SD and OS. In conclusion, 18F-FDG PET/CT MTVPETVCAR, MTV2.5, MTV25%, MTV42% and TLGPETVCAR exhibit prognostic values with regard to OS. Overall, selection of appropriate metabolic parameters may predict NSCLC prognosis.
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Affiliation(s)
- Wenchao Ma
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
- Tianjin Clinical Research Center for Cancer, Hexi, Tianjin 300060, P.R. China
| | - Minshu Wang
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
- Tianjin Clinical Research Center for Cancer, Hexi, Tianjin 300060, P.R. China
| | - Xiaofeng Li
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
- Tianjin Clinical Research Center for Cancer, Hexi, Tianjin 300060, P.R. China
| | - Hui Huang
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
- Tianjin Clinical Research Center for Cancer, Hexi, Tianjin 300060, P.R. China
| | - Yanjia Zhu
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
- Tianjin Clinical Research Center for Cancer, Hexi, Tianjin 300060, P.R. China
| | - Xiuyu Song
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
- Tianjin Clinical Research Center for Cancer, Hexi, Tianjin 300060, P.R. China
| | - Dong Dai
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
- Tianjin Clinical Research Center for Cancer, Hexi, Tianjin 300060, P.R. China
| | - Wengui Xu
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
- Tianjin Clinical Research Center for Cancer, Hexi, Tianjin 300060, P.R. China
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Farrell MJ, Yahya JB, Degnin C, Chen Y, Holland JM, Henderson MA, Jaboin JJ, Harkenrider MM, Thomas CR, Mitin T. Radiation Dose and Fractionation for Limited-stage Small-cell Lung Cancer: Survey of US Radiation Oncologists on Practice Patterns. Clin Lung Cancer 2018; 20:13-19. [PMID: 30219240 DOI: 10.1016/j.cllc.2018.08.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/24/2018] [Accepted: 08/11/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Thoracic radiotherapy (TRT) with concurrent chemotherapy is standard for limited-stage small-cell lung cancer (LS-SCLC). However, the optimal dosing and fractionation remain unclear. The National Comprehensive Cancer Network guidelines have recommended either 45 Gy delivered twice daily (BID) or 60 to 70 Gy delivered once daily (QD). However, the current practice patterns among US radiation oncologists are unknown. MATERIALS AND METHODS We surveyed US radiation oncologists using an institutional review board-approved questionnaire. The questions covered demographic data, self-rated knowledge of key trials, and treatment recommendations. RESULTS We received 309 responses from radiation oncologists. Of the 309 radiation oncologists, 60% preferred TRT QD and 76% acknowledged QD to be more common in their practice. The respondents in academic settings were more likely to endorse BID treatment by both preference (P = .001) and actual practice (P = .009). The concordance between preferring QD and administering QD in practice was 100%. In contrast, 40% of respondents who preferred BID actually administered QD more often. Also, 15% of physicians would be unwilling to switch from QD to BID and 3% would be unwilling to switch from BID to QD, even on patient request. Most respondents (88%) recommended a dose of 45 Gy for BID treatment. For QD treatment, the division was greater, with 54% recommending 60 Gy, 30% recommending 63 to 66 Gy, and 10% recommending 70 Gy. CONCLUSION Substantial variation exists in how US radiation oncologists approach TRT dosing and fractionation for LS-SCLC. Three quarters of our respondents reported administering TRT QD most often. The most common doses were 60 Gy QD and 45 Gy BID. The results of the present survey have provided the most up-to-date information on US practice patterns for LS-SCLC.
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Affiliation(s)
- Matthew J Farrell
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - Jehan B Yahya
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - Catherine Degnin
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - Yiyi Chen
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - John M Holland
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - Mark A Henderson
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - Jerry J Jaboin
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - Matthew M Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - Timur Mitin
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR.
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Farrell MJ, Yahya JB, Degnin C, Chen Y, Holland JM, Henderson MA, Jaboin JJ, Harkenrider MM, Thomas CR, Mitin T. Timing of Thoracic Radiation Therapy With Chemotherapy in Limited-stage Small-cell Lung Cancer: Survey of US Radiation Oncologists on Current Practice Patterns. Clin Lung Cancer 2018; 19:e815-e821. [PMID: 29857969 DOI: 10.1016/j.cllc.2018.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/27/2018] [Accepted: 04/24/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION For limited-stage small-cell lung cancer (LS-SCLC), National Comprehensive Cancer Network guidelines recommend that thoracic radiotherapy (TRT) be delivered concurrently with chemotherapy and early in the regimen, with cycle 1 or 2. Evidence is conflicting regarding the benefit of early timing of TRT. A Korean randomized trial did not see a survival difference between early (cycle 1) and late (cycle 3) TRT. Current United States (US) practice patterns are unknown. MATERIALS AND METHODS We surveyed US radiation oncologists using an institutional review board-approved online questionnaire. Questions covered treatment recommendations, self-rated knowledge of trials, and demographics. RESULTS We received 309 responses from radiation oncologists. Ninety-eight percent recommend concurrent chemoradiotherapy over sequential. Seventy-one percent recommend starting TRT in cycle 1 of chemotherapy, and 25% recommend starting in cycle 2. In actual practice, TRT is started most commonly in cycle 2 (48%) and cycle 1 (44%). One-half of respondents (54%) believe starting in cycle 1 improves survival compared with starting in cycle 3. Knowledge of the Korean trial was associated with flexibility in delaying TRT to cycle 2 or 3 (P = .02). Over one-third (38%) treat based on pre-chemotherapy volume. CONCLUSION US radiation oncologists strongly align with National Comprehensive Cancer Network guidelines, which recommend early concurrent chemoradiotherapy. Nearly three-quarters of respondents prefer starting TRT with cycle 1 of chemotherapy. However, knowledge of a trial supporting a later start was associated with flexibility in delaying TRT. Treating based on pre-chemotherapy volume-endorsed by over one-third of respondents-may add unnecessary toxicity. This survey can inform development of future trials.
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Affiliation(s)
- Matthew J Farrell
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | - Jehan B Yahya
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | - Catherine Degnin
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | - Yiyi Chen
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | - John M Holland
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | - Mark A Henderson
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | - Jerry J Jaboin
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | - Matthew M Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | - Timur Mitin
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR.
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Jin K, Zhang K, Zhou F, Dai J, Zhang P, Jiang G. Selection of candidates for surgery as local therapy among early-stage small cell lung cancer patients: a population-based analysis. Cancer Commun (Lond) 2018; 38:5. [PMID: 29764484 PMCID: PMC5993140 DOI: 10.1186/s40880-018-0272-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 03/14/2018] [Indexed: 12/12/2022] Open
Abstract
Background Surgery and radiotherapy are considered local therapies for small cell lung cancer (SCLC). The present study aimed to select candidates for surgery as local therapy among patients with stage I or II SCLC, based on the eighth edition of the TNM classification for lung cancer. Methods Patients diagnosed with SCLC between 2004 and 2013 were selected from the Surveillance, Epidemiology, And End Results database. The TNM stage of SCLC in these patients was re-classified according to the eighth edition of the TNM classification for lung cancer. Patients with stage I or II SCLC were included in the present study. Overall survival (OS) and lung cancer-specific survival (LCSS) were separately compared in the different TNM stages between patients who received surgery and radiotherapy as local therapy. Multivariate analysis was applied to evaluate multiple factors associated with survival. Results Among the 2129 patients included in the present study, 387 (18.2%) received surgery, 1032 (48.5%) underwent radiotherapy as local therapy, 154 (7.2%) underwent surgery and radiotherapy, and 556 (26.1%) did not undergo either surgery or radiotherapy. Among patients with T1-2N0 (tumor size ≤ 50 mm without positive lymph nodes) disease, patients who underwent surgery had higher 5-year OS and LCSS rates than patients who received radiotherapy (T1N0: 46.0% vs. 23.8%, P < 0.001, and 58.4% vs. 36.4%, P < 0.001, respectively; T2N0: 42.6% vs. 24.7%, P = 0.004, and 48.8% vs. 31.3%, P = 0.011, respectively). Multivariate analysis results revealed that surgery was associated with low risk of death. However, among T3N0 or T1-2N1 (stage IIB) SCLC patients, patients who underwent surgery did not have higher 5-year OS and LCSS rates than patients who received radiotherapy (T3N0: 16.2% vs. 26.5%, P = 0.085, and 28.7% vs. 30.9%, P = 0.372, respectively; T1-2N1: 20.3% vs. 29.0%, P = 0.146, and 25.6% vs. 35.5%, P = 0.064, respectively). Conclusions Based on the assumption that the overwhelming majority of stage I or II SCLC patients who underwent surgery or radiotherapy also received certain types of systemic therapy, only patients with T1-2N0 SCLC may benefit from surgery as local therapy. Patients with T3N0 or T1-2N1 SCLC may consider radiotherapy as local therapy.
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Affiliation(s)
- Kaiqi Jin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, P. R. China
| | - Kaixuan Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, P. R. China
| | - Feng Zhou
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, P. R. China
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, P. R. China
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, P. R. China.
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, P. R. China.
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Sio TT, Prayongrat A, Zhang Y, Lin Q, Xu T, Liao Z, Yue J. The Road Less Traveled: Should We Omit Prophylactic Cranial Irradiation for Patients With Small Cell Lung Cancer? Clin Lung Cancer 2018; 19:289-293. [PMID: 29665993 DOI: 10.1016/j.cllc.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/07/2018] [Accepted: 03/10/2018] [Indexed: 01/29/2023]
Abstract
New randomized data from Japan have raised questions regarding the use of prophylactic cranial irradiation for patients with extensive-stage small-cell lung cancer but without detectable brain metastases on magnetic resonance imaging. In the present focused review, we examine the general role of prophylactic cranial irradiation in the management of small-cell lung cancer and present relevant controversies from both sides of the discussion. Future directions for clinical investigation and research are also highlighted. Strategies for neurocognitive protection, including memantine use and hippocampal sparing using modulated radiotherapy techniques, are also presented.
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Affiliation(s)
- Terence T Sio
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ
| | - Anussara Prayongrat
- Department of Radiation Oncology, King Chulalongkorn Memorial Hospital, Chulalongkorn University Bangkok, Bangkok, Thailand
| | - Yun Zhang
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China; Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Qin Lin
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Ting Xu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jinbo Yue
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong, China.
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25
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Glatzer M, Schmid S, Radovic M, Früh M, Putora PM. The role of radiation therapy in the management of small cell lung cancer. Breathe (Sheff) 2017; 13:e87-e94. [PMID: 29928456 PMCID: PMC6003267 DOI: 10.1183/20734735.009617] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Small cell lung cancer (SCLC) is a very aggressive form of lung cancer. SCLC treatment requires multidisciplinary management and timely treatment. Radiation therapy is an important part of management of all stages of SCLC, in the curative as well as in the palliative setting. The role of radiation therapy in all stages of SCLC has changed in recent years; this article describes these changes and highlights the role of radiation therapy in the management of SCLC.
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Affiliation(s)
- Markus Glatzer
- Dept of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Sabine Schmid
- Dept of Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marco Radovic
- Dept of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Martin Früh
- Dept of Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Paul Martin Putora
- Dept of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Lynch CM, van Berkel VH, Frieboes HB. Application of unsupervised analysis techniques to lung cancer patient data. PLoS One 2017; 12:e0184370. [PMID: 28910336 PMCID: PMC5598970 DOI: 10.1371/journal.pone.0184370] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/22/2017] [Indexed: 11/24/2022] Open
Abstract
This study applies unsupervised machine learning techniques for classification and clustering to a collection of descriptive variables from 10,442 lung cancer patient records in the Surveillance, Epidemiology, and End Results (SEER) program database. The goal is to automatically classify lung cancer patients into groups based on clinically measurable disease-specific variables in order to estimate survival. Variables selected as inputs for machine learning include Number of Primaries, Age, Grade, Tumor Size, Stage, and TNM, which are numeric or can readily be converted to numeric type. Minimal up-front processing of the data enables exploring the out-of-the-box capabilities of established unsupervised learning techniques, with little human intervention through the entire process. The output of the techniques is used to predict survival time, with the efficacy of the prediction representing a proxy for the usefulness of the classification. A basic single variable linear regression against each unsupervised output is applied, and the associated Root Mean Squared Error (RMSE) value is calculated as a metric to compare between the outputs. The results show that self-ordering maps exhibit the best performance, while k-Means performs the best of the simpler classification techniques. Predicting against the full data set, it is found that their respective RMSE values (15.591 for self-ordering maps and 16.193 for k-Means) are comparable to supervised regression techniques, such as Gradient Boosting Machine (RMSE of 15.048). We conclude that unsupervised data analysis techniques may be of use to classify patients by defining the classes as effective proxies for survival prediction.
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Affiliation(s)
- Chip M. Lynch
- Department of Computer Engineering and Computer Science, University of Louisville, Louisville, KY, United States of America
| | - Victor H. van Berkel
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, United States of America
| | - Hermann B. Frieboes
- Department of Bioengineering, University of Louisville, Louisville, KY, United States of America
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, United States of America
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Glatzer M, Rittmeyer A, Müller J, Opitz I, Papachristofilou A, Psallidas I, Früh M, Born D, Putora PM. Treatment of limited disease small cell lung cancer: the multidisciplinary team. Eur Respir J 2017; 50:50/2/1700422. [PMID: 28838979 DOI: 10.1183/13993003.00422-2017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 05/16/2017] [Indexed: 12/17/2022]
Abstract
Small cell lung cancer (SCLC) presents multiple interdisciplinary challenges with several paradigm shifts in its treatment in recent years. SCLC treatment requires multidisciplinary management and timely treatment. The aim of this review is to focus on the team management aspects in the treatment of limited disease SCLC and how this can contribute towards improving outcomes.
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Affiliation(s)
- Markus Glatzer
- Dept of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Achim Rittmeyer
- Dept of Thoracic Oncology, Lungenfachklinik Immenhausen, Immenhausen, Germany
| | - Joachim Müller
- Dept of Radiology and Nuclear Medicine, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Isabelle Opitz
- Dept of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | | | - Ioannis Psallidas
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK.,Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK
| | - Martin Früh
- Dept of Oncology and Haematology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Diana Born
- Institute of Pathology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Paul Martin Putora
- Dept of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland
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Evaluation of factors associated with platinum-sensitivity status and survival in limited-stage small cell lung cancer patients treated with chemoradiotherapy. Oncotarget 2017; 8:81405-81418. [PMID: 29113400 PMCID: PMC5655295 DOI: 10.18632/oncotarget.19073] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 06/27/2017] [Indexed: 01/05/2023] Open
Abstract
In this retrospective study, we analyzed the association of clinicopathological factors and therapeutic plans with platinum-sensitivity status and survival of limited-stage small cell lung cancer (LS-SCLC) patients. We enrolled 452 LS-SCLC patients with 279 platinum sensitive and 173 platinum refractory patients. The low serum neuro-specific enolase levels (NSE; p = 0.011), neutrophil-to-lymphocyte ratios (NLR; p = 0.013) and higher objective response rates (p = 0.003) were associated with sensitive group but not the refractory group. Multivariate analysis showed that treatment modality (HR = 0.267, p < 0.001), serum lactate dehydrogenase (LDH; HR = 1.894, p = 0.016), NLR (HR = 2.043, p = 0.043) and platinum-sensitivity status (HR = 0.561, p = 0.036) were independent prognostic factors for survival. We further showed that the numbers of chemotherapy cycles and response to first-line therapy were independent prognostic factors for refractory patients only. Our study demonstrates that platinum-sensitivity status is of prognostic importance, as it is strongly associated with survival in LS-SCLC patients.
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Wang S, Tang J, Sun T, Zheng X, Li J, Sun H, Zhou X, Zhou C, Zhang H, Cheng Z, Ma H, Sun H. Survival changes in patients with small cell lung cancer and disparities between different sexes, socioeconomic statuses and ages. Sci Rep 2017; 7:1339. [PMID: 28465554 PMCID: PMC5431017 DOI: 10.1038/s41598-017-01571-0] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 04/06/2017] [Indexed: 12/22/2022] Open
Abstract
Small cell lung cancer (SCLC), as a proportion, makes up only 15–17% of lung cancer cases. The development of treatments for SCLC has remained stagnant for decades, and SCLC is expected to persist as a threat to human health. To date, no publications based on large populations have been reported. We calculated survival changes in patients with SCLC during each decade between 1983 and 2012 to determine the roles of race, sex, age, and socioeconomic status (SES) on survival rates based on the Surveillance, Epidemiology, and End Results (SEER) registries. In total, 106,296 patients with SCLC were identified, with the overall incidence per 100,000 decreasing each decade from 9.6 to 7.8 to 5.8. The median survival for SCLC remained 7 months, and the 12-month relative survival rates (RSRs) remained relatively stable at 32.9%, 33.2% and 33.2% during each decade. The 5-year RSRs significantly improved from 4.9% to 5.9% to 6.4% during each decade, but remained extremely low. In addition, a narrowing of the survival gaps among SES groups and stable survival gaps between sexes were observed. Although the incidence of SCLC decreased during each decade, the overall survival remained relatively stable, highlighting the urgency of developing novel treatments and the importance of prevention and early detection.
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Affiliation(s)
- Shuncong Wang
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China
| | - Jianjun Tang
- Department of Gastroenterology, Cancer Hospital of Jiangxi Province, Nanchang, Jiangxi, 330029, China
| | - Tiantian Sun
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Xiaobin Zheng
- Department of Respiration, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China
| | - Jie Li
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Hongliu Sun
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48201, USA
| | - Xiuling Zhou
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China
| | - Cuiling Zhou
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China
| | - Hongyu Zhang
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China
| | - Zhibin Cheng
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China
| | - Haiqing Ma
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China.
| | - Huanhuan Sun
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 519000, China.
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TSPAN12 promotes chemoresistance and proliferation of SCLC under the regulation of miR-495. Biochem Biophys Res Commun 2017; 486:349-356. [DOI: 10.1016/j.bbrc.2017.03.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 03/12/2017] [Indexed: 01/10/2023]
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Farooqi AS, Holliday EB, Allen PK, Wei X, Cox JD, Komaki R. Prophylactic cranial irradiation after definitive chemoradiotherapy for limited-stage small cell lung cancer: Do all patients benefit? Radiother Oncol 2017; 122:307-312. [PMID: 28073578 DOI: 10.1016/j.radonc.2016.11.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/31/2016] [Accepted: 11/12/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE Prophylactic cranial irradiation (PCI) can improve overall survival (OS) and suppress brain metastases (BM) in patients with limited-stage small cell lung cancer (LS-SCLC) after complete response to primary therapy. However, PCI can be toxic. We sought to identify characteristics of patients who may not benefit from PCI. METHODS We identified 658 patients who received chemoradiotherapy at MD Anderson in 1986-2012; 364 received PCI and 294 did not. Median follow-up time was 21.2months (range 1.2-240.8months). Cox proportional hazards regression, competing-risk regression, and Kaplan-Meier analyses were used to identify factors influencing OS and BM. RESULTS PCI reduced risks of death [HR 0.73, 95% CI 0.61-0.88, P=0.001] and BM [HR 0.54, 95% CI 0.39-0.76, P<0.001]. Having tumors ⩾5cm increased the risk of BM [HR 1.77, 95% CI 1.22-2.55, P=0.002] but not death [HR 1.16, 95% CI 0.96-1.40, P=0.114]. Among patients ⩾70years with ⩾5-cm tumors, PCI did not improve OS [2-year rates 39.4% vs 40.9%, P=0.739]. CONCLUSIONS PCI remains standard therapy after complete response to chemoradiotherapy for LS-SCLC. However, older patients may be at risk from comorbidity or extracranial disease. Further work is warranted to identify patients who may not benefit from PCI.
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Affiliation(s)
- Ahsan S Farooqi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Emma B Holliday
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Pamela K Allen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Xiong Wei
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - James D Cox
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States.
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Prognostic role of patient gender in limited-disease small-cell lung cancer treated with chemoradiotherapy. Strahlenther Onkol 2016; 193:150-155. [PMID: 27853828 DOI: 10.1007/s00066-016-1073-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/19/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Previous studies have demonstrated that female gender could be a prognostic factor in limited-disease (LD) small-cell lung cancer (SCLC), but the correlation between patient gender and survival parameters remains unclear. PATIENTS AND METHODS Data from 179 LD SCLC patients treated with definitive chemoradiotherapy (CRT) were reviewed. Influence of patient gender on time to progression (TTP), local control (LC), brain metastasis-free (BMFS), distant metastasis-free (DMFS) and overall survival (OS) was analysed. RESULTS Definitive CRT was completed by 179 (110 men/69 women) patients. Of these, 68 (38%; 34 men/34 women) patients were treated in concurrent and 111 (62%; 76 men/35 women) in sequential mode. Prophylactic cranial irradiation (PCI) was subsequently applied in 70 (39%; 36 men/34 women) patients with partial or complete response after CRT. Median OS was 20 (95% confidence interval [CI] 10-22) and 14 (95% CI 10-18) months in female and male patients, respectively (p = 0.021). In subgroups defined by remission status (complete and partial response) after CRT, an OS benefit for females compared to males was also detected. There was no correlation between patient gender and TTP, LC or DMFS, and no difference in OS in the female and male subgroups treated with PCI. The incidence of metachronous brain metastases (BMs) in the male and female subgroups differed significantly (40/110 men vs. 18/69 women, p = 0.03). Also, mean BMFS was significantly longer in women (p = 0.023). Patient gender also significantly correlated with OS on multivariate analysis after adjustment for other prognostic factors (p = 0.04, HR 1.38, 95% CI 1.08-1.92). CONCLUSION In this heterogeneous LD SCLC patient cohort treated with definitive CRT, female gender was significantly associated with longer BMFS and OS, as well as with a lower incidence of metachronous brain failure.
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Sakaguchi M, Maebayashi T, Aizawa T, Ishibashi N, Saito T. Treatment outcomes of patients with small cell lung cancer without prophylactic cranial irradiation. J Thorac Dis 2016; 8:2571-2579. [PMID: 27747011 DOI: 10.21037/jtd.2016.08.73] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Prophylactic cranial irradiation (PCI) is indicated for limited disease (LD) in small cell lung cancer (SCLC) patients who achieve a complete or near-complete response; however, it is sometimes not administered because of possible adverse reactions or patient refusal. Here we assessed treatment outcomes among patients with SCLC who were not treated with PCI. METHODS The medical records of 60 patients (45 men, 15 women; mean age, 68 years; age range, 51-82 years) with SCLC were retrospectively reviewed. The tumors were staged by TNM classification. Two, 2, 5, 4, 32, and 15 patients had stage IA, IB, IIA, IIB, IIIA, and IIIB tumors, respectively. The patients were treated with thoracic radiotherapy (TRT) and four courses of chemotherapy. RESULTS Our subjects had a median survival of 25 months and 2- and 5-year survival rates of 52.6% and 25.3%, respectively. Univariate analysis revealed that the development of brain metastasis, performance status (PS), and T-stage were significant factors correlated with survival rate. Multivariate analysis identified only PS [hazard ratio (HR), 5.845, 95% confidence interval (CI), 2.333-14.63, P=0.002] and brain metastasis as independent prognostic variables (HR, 2.344, 95% CI, 1.071-5.128, P=0.033). CONCLUSIONS The results of our study demonstrated that the outcomes of treatment without PCI were improved, as compared with those of previously published data. Our findings may be used as reference data when PCI cannot be performed.
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Affiliation(s)
- Masakuni Sakaguchi
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiya Maebayashi
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Takuya Aizawa
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Naoya Ishibashi
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
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Fibroblast growth factor-inducible 14 regulates cell growth and multidrug resistance of small-cell lung cancer through the nuclear factor-κB pathway. Anticancer Drugs 2016; 25:1152-64. [PMID: 25054270 DOI: 10.1097/cad.0000000000000153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fibroblast growth factor-inducible 14 (Fn14) has been reported to play an oncogene role in many types of cancer. However, its biological functions in small-cell lung cancer (SCLC) remain unknown. The aim of this study is to investigate the roles of Fn14 in the cell growth and chemoresistance of SCLC and its possible molecular mechanism. Expression of Fn14 was examined in 51 cases of SCLC tissues by immunohistochemistry. Overexpression or knockdown of Fn14 was carried out in SCLC multidrug-resistant cell lines (H69AR and H446AR) and the parental cell lines (H69 and H446) to assess its influence on cell growth and chemoresistance. The results showed that Fn14 was expressed in 50.98% (26/51) of SCLC. Overexpression of Fn14 was associated with the poor pathologic stage of SCLC (P < 0.05 by the Fisher's exact test) and the shorter survival time (by the Kaplan-Meier method). Enforced expression of Fn14 in H69 and H446 cells promoted cell growth and enhanced multidrug resistance by decreasing cell apoptosis and increasing G2-phase cell accumulation. Inhibition of Fn14 expression using Fn14 shRNA in H69AR and H446AR cells inhibited cell growth and sensitized cancer cells to chemotherapeutic drugs by increasing drug-induced cell apoptosis accompanied by G1, S phase arrest. Furthermore, elevated expression of Fn14 in H69 and H446 cells can lead to increased expression of Bcl-xl and activity of nuclear factor-κB (NF-κB). Similar results were observed by Fn14 knockdown H69AR and H446AR cells. Bcl-xl expression regulated by Fn14 was dependent on NF-κB activation. Our results suggest that Fn14 modulates cell growth and drug resistance by upregulating Bcl-xl expression through the NF-κB pathway. All findings provide insight into the Fn14 signaling mechanism and Fn14 may be a potentially novel target for interfering with cancer growth and chemoresistance in SCLC.
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The Integration of Multimodality Care for the Treatment of Small Cell Lung Cancer in a Rural Population and Its Impact on Survival. Am J Clin Oncol 2016; 38:448-56. [PMID: 24064751 DOI: 10.1097/coc.0b013e3182a5346d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Many factors and disparities contribute to the multidisciplinary management of small cell lung cancer (SCLC). Our objective was to conduct a cancer registry analysis of patients with SCLC in Kentucky to identify factors affecting treatment choice and mortality. METHODS Database collection was done through the Kentucky Cancer Registry, which is part of the Surveillance, Epidemiology, and End Results program. Patients diagnosed between 1995 and 2008, diagnosed with SCLC, and AJCC stage I through IV were included. Statistical analyses were performed to identify variables affecting initial treatment choice and survival. RESULTS Analysis evaluated 4814 patients from the Kentucky Cancer Registry. For extensive stage, age (P<0.001) and urban versus rural county (P=0.03) were significantly associated with the type of treatment received. Age was the only variable impacting treatment choice in limited-stage patients. Limited stage patients were more likely to receive chemotherapy and radiation (chemoRT; 54.6% vs. 46.5%). On multivariate analysis, for extensive stage patients, age at diagnosis, male sex, and treatments other than chemoRT were variables associated for increased risk of death. In limited stage patients, increasing age, and treatments other than chemoRT were variables associated with increased risk of death. Survival was significantly improved in both limited stage and extensive stage patients that received chemoRT compared with chemotherapy only, radiation only, or no treatment. CONCLUSIONS Treatment with chemoRT was associated with improved survival in patients with limited and extensive stage SCLC. In these patients, socioeconomic, racial, or geographic factors did not impact the type of treatment received or survival.
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Nobashi T, Koyasu S, Nakamoto Y, Kubo T, Ishimori T, Kim YH, Yoshizawa A, Togashi K. Prognostic value of fluorine-18 fludeoxyglucose positron emission tomography parameters differs according to primary tumour location in small-cell lung cancer. Br J Radiol 2016; 89:20150618. [PMID: 26756811 DOI: 10.1259/bjr.20150618] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the prognostic value of fluorine-18 fludeoxyglucose (FDG) positron emission tomography (PET) parameters for small-cell lung cancer (SCLC), according to the primary tumour location, adjusted by conventional prognostic factors. METHODS From 2008 to 2013, we enrolled consecutive patients with histologically proven SCLC, who had undergone FDG-PET/CT prior to initial therapy. The primary tumour location was categorized into central or peripheral types. PET parameters and clinical variables were evaluated using univariate and multivariate analysis. RESULTS A total of 69 patients were enrolled in this study; 28 of these patients were categorized as having the central type and 41 patients as having the peripheral type. In univariate analysis, stage, serum neuron-specific enolase, whole-body metabolic tumour volume (WB-MTV) and whole-body total lesion glycolysis (WB-TLG) were found to be significant in both types of patients. In multivariate analysis, the independent prognostic factor was found to be stage in the central type, but WB-MTV and WB-TLG in the peripheral type. Kaplan-Meier analysis demonstrated that patients with peripheral type with limited disease and low WB-MTV or WB-TLG showed significantly better overall survival than all of the other groups (p < 0.0083). CONCLUSION The FDG-PET volumetric parameters were demonstrated to be significant and independent prognostic factors in patients with peripheral type of SCLC, while stage was the only independent prognostic factor in patients with central type of SCLC. ADVANCES IN KNOWLEDGE FDG-PET is a non-invasive method that could potentially be used to estimate the prognosis of patients, especially those with peripheral-type SCLC.
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Affiliation(s)
- Tomomi Nobashi
- 1 Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sho Koyasu
- 1 Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuji Nakamoto
- 1 Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kubo
- 1 Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayoshi Ishimori
- 1 Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Young H Kim
- 2 Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiko Yoshizawa
- 3 Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kaori Togashi
- 1 Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Kumar P, Gareen IF, Lathan C, Sicks JD, Perez GK, Hyland KA, Park ER. Racial Differences in Tobacco Cessation and Treatment Usage After Lung Screening: An Examination of the National Lung Screening Trial. Oncologist 2015; 21:40-9. [PMID: 26712960 DOI: 10.1634/theoncologist.2015-0325] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/24/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Black smokers have demonstrated greater lung cancer disease burden and poorer smoking cessation outcomes compared with whites. Lung cancer screening represents a unique opportunity to promote cessation among smokers; however, little is known about the differential impact of screening on smoking behaviors among black and white smokers. Using data from the National Lung Screening Trial (NLST), we examined the racial differences in smoking behaviors after screening. METHODS We examined racial differences in smoking behavior and cessation activity among 6,316 white and 497 black (median age, 60 and 59 years, respectively) NLST participants who were current smokers at screening using a follow-up survey on 24-hour and 7-day quit attempts, 6-month continuous abstinence, and the use of smoking cessation programs and aids at 12 months after screening. Using multiple regression analyses, we examined the predictors of 24-hour and 7-day quit attempts and 6-month continuous abstinence. RESULTS At 12 months after screening, blacks were more likely to report a 24-hour (52.7% vs. 41.2%, p < .0001) or 7-day (33.6% vs. 27.2%, p = .002) quit attempt. However, no significant racial differences were found in 6-month continuous abstinence (5.6% blacks vs. 7.2% whites). In multiple regression, black race was predictive of a higher likelihood of a 24-hour (odds ratio [OR], 1.6, 95% confidence interval [CI], 1.2-2.0) and 7-day (OR, 1.5, 95% CI, 1.1-1.8) quit attempt; however, race was not associated with 6-month continuous abstinence. Only a positive screening result for lung cancer was significantly predictive of successful 6-month continuous abstinence (OR, 2.3, 95% CI, 1.8-2.9). CONCLUSION Although blacks were more likely than whites to have 24-hour and 7-day quit attempts, the rates of 6-month continuous abstinence did not differ. Targeted interventions are needed at the time of lung cancer screening to promote abstinence among all smokers. IMPLICATIONS FOR PRACTICE Among smokers undergoing screening for lung cancer, blacks were more likely than whites to have 24-hour and 7-day quit attempts; however, these attempts did not translate to increased rates of 6-month continuous abstinence among black smokers. Targeted interventions are needed at the time of lung cancer screening to convert quit attempts to sustained smoking cessation among all smokers.
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Affiliation(s)
- Pallavi Kumar
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ilana F Gareen
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island, USA and Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Christopher Lathan
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - JoRean D Sicks
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island, USA and
| | - Giselle K Perez
- Mongan Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kelly A Hyland
- Mongan Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA University of South Florida and Moffitt Cancer Center, Tampa, Florida, USA
| | - Elyse R Park
- Mongan Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Silva M, Galeone C, Sverzellati N, Marchianò A, Calareso G, Sestini S, La Vecchia C, Sozzi G, Pelosi G, Pastorino U. Screening with Low-Dose Computed Tomography Does Not Improve Survival of Small Cell Lung Cancer. J Thorac Oncol 2015; 11:187-93. [PMID: 26845115 DOI: 10.1016/j.jtho.2015.10.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/16/2015] [Accepted: 10/21/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Small cell lung cancer (SCLC) constitutes a distinct component of symptomatic or advanced-stage lung cancers in clinical practice and in lung cancer screening trials. The purpose of this study was to describe the outcome of SCLC in lung cancer screening trials and compare the frequency of SCLC in our cohort with that in the major lung cancer screening trials. METHODS Subjects with a diagnosis of SCLC were selected from two lung cancer screening trials by low-dose computed tomography (LDCT), and their demographic characteristics, clinical parameters, tumor stage at diagnosis, therapy, and survival times were recorded. Survival curves were estimated using the Kaplan-Meier method. RESULTS Ten cases of SCLC were reported in 45,141 person-years (22 in 100,000 person-years), representing the 6% of all lung cancer cases. Cumulative tobacco consumption was 82 pack-years compared with 39 and 46 pack-years for the overall study population and subjects with non-SCLC, respectively. Most of the neoplasms were in an advanced stage (seven in stage IV and one each in stages IIIb, IIIa, and Ia). Two subjects were treated with lobectomy for curative purposes and died of diffuse metastasis within 2 years of diagnosis. The median overall survival time in the LDCT arms was 20.6 months, with no survivors remaining at 3 years. CONCLUSIONS Subjects in whom SCLC develops are a subgroup of smokers with extremely high cumulative tobacco consumption. Consequently, the frequency of SCLC in our population was lower than in other screening populations, with higher cumulative tobacco consumption. Screening for lung cancer by LDCT does not improve survival of SCLC, with no survivors remaining at 3 years after diagnosis.
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Affiliation(s)
- Mario Silva
- Section of Radiology, Department of Surgical Sciences, University Hospital of Parma, Parma, Italy; Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Nicola Sverzellati
- Section of Radiology, Department of Surgical Sciences, University Hospital of Parma, Parma, Italy; Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alfonso Marchianò
- Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Stefano Sestini
- Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Gabriella Sozzi
- Tumor Genomics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Pelosi
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ugo Pastorino
- Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Patel MI, Wang A, Kapphahn K, Desai M, Chlebowski RT, Simon MS, Bird CE, Corbie-Smith G, Gomez SL, Adams-Campbell LL, Cote ML, Stefanick ML, Wakelee HA. Racial and Ethnic Variations in Lung Cancer Incidence and Mortality: Results From the Women's Health Initiative. J Clin Oncol 2015; 34:360-8. [PMID: 26700122 DOI: 10.1200/jco.2015.63.5789] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE This study aimed to evaluate racial/ethnic differences in lung cancer incidence and mortality in the Women's Health Initiative Study, a longitudinal prospective cohort evaluation of postmenopausal women recruited from 40 clinical centers. METHODS Lung cancer diagnoses were centrally adjudicated by pathology review. Baseline survey questionnaires collected sociodemographic and health information. Logistic regression models estimated incidence and mortality odds by race/ethnicity adjusted for age, education, calcium/vitamin D, body mass index, smoking (status, age at start, duration, and pack-years), alcohol, family history, oral contraceptive, hormones, physical activity, and diet. RESULTS The cohort included 129,951 women--108,487 (83%) non-Hispanic white (NHW); 10,892 (8%) non-Hispanic black (NHB); 4,882 (4%) Hispanic; 3,696 (3%) Asian/Pacific Islander (API); 534 (< 1%) American Indian/Alaskan Native; and 1,994 (1%) other. In unadjusted models, Hispanics had 66% lower odds of lung cancer compared with NHW (odds ratio [OR], 0.34; 95% CI, 0.2 to 0.5), followed by API (OR, 0.45; 95% CI, 0.27 to 0.75) and NHB (OR, 0.75; 95% CI, 0.59 to 0.95). In fully adjusted multivariable models, the decreased lung cancer risk for Hispanic compared with NHW women attenuated to the null (OR, 0.59; 95% CI, 0.35 to 0.99). In unadjusted models Hispanic and API women had decreased risk of death compared with NHW women (OR, 0.30 [95% CI, 0.15 to 0.62] and 0.34 [95% CI, 0.16 to 0.75, respectively); however, no racial/ethnic differences were found in risk of lung cancer death in fully adjusted models. CONCLUSION Differences in lung cancer incidence and mortality are associated with sociodemographic, clinical, and behavioral factors. These findings suggest modifiable exposures and behaviors may contribute to differences in incidence of and mortality by race/ethnicity for postmenopausal women. Interventions focused on these factors may reduce racial/ethnic differences in lung cancer incidence and mortality.
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Affiliation(s)
- Manali I Patel
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC.
| | - Ange Wang
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Kristopher Kapphahn
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Manisha Desai
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Rowan T Chlebowski
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Michael S Simon
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Chloe E Bird
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Giselle Corbie-Smith
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Scarlett Lin Gomez
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Lucile L Adams-Campbell
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Michele L Cote
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Marcia L Stefanick
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Heather A Wakelee
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
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Radiosensitization by a novel Bcl-2 and Bcl-XL inhibitor S44563 in small-cell lung cancer. Cell Death Dis 2014; 5:e1423. [PMID: 25232677 PMCID: PMC4540189 DOI: 10.1038/cddis.2014.365] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/06/2014] [Accepted: 06/26/2014] [Indexed: 12/14/2022]
Abstract
Radiotherapy has a critical role in the treatment of small-cell lung cancer (SCLC). The effectiveness of radiation in SCLC remains limited as resistance results from defects in apoptosis. In the current study, we investigated whether using the Bcl-2/Bcl-XL inhibitor S44563 can enhance radiosensitivity of SCLC cells in vitro and in vivo. In vitro studies confirmed that S44563 caused SCLC cells to acquire hallmarks of apoptosis. S44563 markedly enhanced the sensitivity of SCLC cells to radiation, as determined by a clonogenic assay. The combination of S44563 and cisplatin-based chemo-radiation showed a significant tumor growth delay and increased overall survival in mouse xenograft models. This positive interaction was greater when S44563 was given after the completion of the radiation, which might be explained by the radiation-induced overexpression of anti-apoptotic proteins secondary to activation of the NF-κB pathway. These data underline the possibility of combining IR and Bcl-2/Bcl-XL inhibition in the treatment of SCLC as they underscore the importance of administering conventional and targeted therapies in an optimal sequence.
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Okamoto K, Okamoto I, Takeda M, Kobayashi S, Takeda K, Nakamatsu K, Nishimura Y, Nakagawa K. A Phase I Study of Split-dose Cisplatin and Etoposide with Concurrent Accelerated Hyperfractionated Thoracic Radiotherapy in Elderly Patients with Limited-disease Small Cell Lung Cancer. Jpn J Clin Oncol 2014; 44:743-748. [DOI: 10.1093/jjco/hyu071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Sculier JP, Berghmans T, Meert AP. Small cell lung cancer: what are the treatment results in routine management? Lung Cancer 2014; 84:101-2. [PMID: 24767173 DOI: 10.1016/s0169-5002(14)00175-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/07/2014] [Indexed: 01/15/2023]
Affiliation(s)
- Jean-Paul Sculier
- Service des Soins Intensifs et Urgences Oncologiques, Unité de recherche en oncologie thoracique, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium.
| | - Thierry Berghmans
- Service des Soins Intensifs et Urgences Oncologiques, Unité de recherche en oncologie thoracique, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Anne-Pascale Meert
- Service des Soins Intensifs et Urgences Oncologiques, Unité de recherche en oncologie thoracique, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
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Sullivan DR, Ganzini L, Lopez-Chavez A, Slatore CG. Association of patient characteristics with chemotherapy receipt among depressed and non-depressed patients with non-small cell lung cancer. Psychooncology 2014; 23:1318-22. [PMID: 24771684 DOI: 10.1002/pon.3528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 02/11/2014] [Accepted: 02/28/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Donald R Sullivan
- Health Services Research & Development, Portland VA Medical Center, Portland, OR, USA; Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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Parsons HM, Harlan LC, Stevens JL, Ullmann CD. Treatment of small cell lung cancer in academic and community settings: factors associated with receiving standard therapy and survival. Cancer J 2014; 20:97-104. [PMID: 24667952 PMCID: PMC3999900 DOI: 10.1097/ppo.0000000000000039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Small cell lung cancer (SCLC) historically has had poor prognosis. Clinical trials have demonstrated improved survival among patients receiving standard platinum-/etoposide-based chemotherapy. Whereas treatment patterns and outcomes have been evaluated for patients with SCLC in clinical trials, population-based practice patterns are not well known. METHODS The National Cancer Institute's Patterns of Care study was used to evaluate patient and provider factors associated with standard treatment, clinical trial enrollment, and 12-month relative hazard of death. RESULTS Among 931 patients with SCLC diagnosed in 2007 in academic and community settings, 72.2% of patients with limited-stage (LS) disease received chemoradiation and 42.2% of patients with extensive-stage (ES) disease received chemotherapy only; the expected treatment scenarios by stage. Less than 1% of the patients enrolled in clinical trials and 2.1% of the patients with LS disease and 3.4% of the patients with ES disease refused any type of treatment. Patients 80 years or older at diagnosis and those with pneumonia/lung collapse were less likely to receive chemoradiation for LS disease. Patients treated in hospitals with residency programs were more likely to receive chemotherapy for ES disease, and patients 80 years or older were less likely to receive chemotherapy for ES disease. Finally, female patients with LS disease, black patients with ES disease, and all patients who received chemotherapy compared to receiving radiation alone or no therapy experienced significantly lower mortality. DISCUSSION Despite the demonstrated lower mortality, a relatively large proportion of patients with SCLC are not treated with a standard treatment regimen. Future studies should evaluate efforts to promote use of appropriate treatment regimens and encourage clinical trial participation.
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Affiliation(s)
- Helen M. Parsons
- Applied Research Program, National Cancer Institute, Bethesda, MD
| | - Linda C. Harlan
- Applied Research Program, National Cancer Institute, Bethesda, MD
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Janssen-Heijnen MLG. How safe is chemotherapy and chemoradiation in elderly patients with small-cell lung cancer? Lung Cancer Manag 2014. [DOI: 10.2217/lmt.13.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Maryska LG Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands and Department of Epidemiology, Maastricht University Medical Center, GROW School for Oncology & Developmental Biology, Maastricht, The Netherlands
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Eaton BR, Kim S, Marcus DM, Prabhu R, Chen Z, Ramalingam SS, Curran WJ, Higgins KA. Effect of prophylactic cranial irradiation on survival in elderly patients with limited-stage small cell lung cancer. Cancer 2013; 119:3753-60. [PMID: 23921891 DOI: 10.1002/cncr.28267] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 06/05/2013] [Accepted: 06/06/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prophylactic cranial irradiation (PCI) improves survival in patients with limited-stage small cell lung cancer (SCLC) who have a complete response to chemotherapy and radiotherapy, yet to the best of the authors' knowledge, data specific to the elderly population are lacking. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) database, the authors identified 1926 patients aged ≥ 70 years who were diagnosed with limited-stage SCLC between 1988 and 1997. Overall survival (OS) for patients who received PCI versus those who did not were estimated using the Kaplan-Meier method and compared with the log-rank test. A Cox proportional hazards model was further fitted to estimate the effect of PCI on OS after adjusting for age, race, sex, tumor size, lymph node status, stage of disease, and receipt of thoracic radiotherapy and surgery. RESULTS The median age of the patients was 75 years (range, 70 years-94 years) and 138 patients (7.2 %) received PCI. The 2-year and 5-year OS rates were 33.3% (95% confidence interval [95% CI], 25.6%-41.2%) and 11.6% (95% CI, 6.9%-17.6%), respectively, among patients who received PCI versus 23.1% (95% CI, 21.2%-25.1%) and 8.6% (95% CI, 7.3%-9.9%), respectively, among patients who did not receive PCI (P = .028). On multivariable analysis, PCI was found to be an independent predictor of OS (hazards ratio, 0.72; 95% CI, 0.54-0.97 [P = .032]). On subgroup analysis, PCI remained an independent predictor of OS among patients aged ≥ 75 years, but not among patients aged ≥ 80 years. CONCLUSIONS The receipt of PCI is associated with improved OS in patients aged ≥ 70 years with SCLC, suggesting that the benefit of PCI is maintained in the elderly population.
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Affiliation(s)
- Bree R Eaton
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
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Komaki R, Khalid N, Langer CJ, Kong FMS, Owen JB, Crozier CL, Wilson JF, Wei X, Movsas B. Penetration of recommended procedures for lung cancer staging and management in the United States over 10 years: a quality research in radiation oncology survey. Int J Radiat Oncol Biol Phys 2013; 85:1082-9. [PMID: 23273996 PMCID: PMC3897271 DOI: 10.1016/j.ijrobp.2012.10.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 10/10/2012] [Accepted: 10/11/2012] [Indexed: 12/25/2022]
Abstract
PURPOSE To document the penetration of clinical trial results, practice guidelines, and appropriateness criteria into national practice, we compared the use of components of staging and treatment for lung cancer among patients treated in 2006-2007 with those used in patients treated in 1998-1999. METHODS AND MATERIALS Patient, staging work-up, and treatment characteristics were extracted from the process survey database of the Quality Research in Radiation Oncology (QRRO), consisting of records of 340 patients with locally advanced non-small cell lung cancer (LA-NSCLC) at 44 institutions and of 144 patients with limited-stage small cell lung cancer (LS-SCLC) at 39 institutions. Data were compared for patients treated in 2006-2007 versus those for patients treated in 1998-1999. RESULTS Use of all recommended procedures for staging and treatment was more common in 2006-2007. Specifically, disease was staged with brain imaging (magnetic resonance imaging or computed tomography) and whole-body imaging (positron emission tomography or bone scanning) in 66% of patients with LA-NSCLC in 2006-2007 (vs 42% in 1998-1999, P=.0001) and in 84% of patients with LS-SCLC in 2006-2007 (vs 58.3% in 1998-1999, P=.0011). Concurrent chemoradiation was used for 77% of LA-NSCLC patients (vs 45% in 1998-1999, P<.0001) and for 90% of LS-SCLC patients (vs 62.5% in 1998-1999, P<.0001). Use of the recommended radiation dose (59-74 Gy for NSCLC and 60-70 Gy as once-daily therapy for SCLC) did not change appreciably, being 88% for NSCLC in both periods and 51% (2006-2007) versus 43% (1998-1999) for SCLC. Twice-daily radiation for SCLC was used for 21% of patients in 2006-2007 versus 8% in 1998-1999. Finally, 49% of patients with LS-SCLC received prophylactic cranial irradiation (PCI) in 2006-2007 (vs 21% in 1998-1999). CONCLUSIONS Although adherence to all quality indicators improved over time, brain imaging and recommended radiation doses for stage III NSCLC were used in <90% of cases. Use of full thoracic doses and PCI for LS-SCLC also requires improvement.
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Affiliation(s)
- Ritsuko Komaki
- Departmentof Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030-4009, USA.
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Nagy-Mignotte H, Guillem P, Vignoud L, Coudurier M, Vesin A, Bonneterre V, Toffart AC, Sakhri L, Brambilla C, Brambilla E, Timsit JF, Moro-Sibilot D. Outcomes in recurrent small-cell lung cancer after one to four chemotherapy lines: A retrospective study of 300 patients. Lung Cancer 2012; 78:112-20. [DOI: 10.1016/j.lungcan.2012.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 05/31/2012] [Accepted: 06/09/2012] [Indexed: 12/23/2022]
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Wainer Z, Daniels MG, Callahan J, Binns D, Hicks RJ, Antippa P, Russell PA, Alam NZ, Conron M, Solomon B, Wright GM. Sex and SUVmax: sex-dependent prognostication in early non-small cell lung cancer. J Nucl Med 2012; 53:1676-85. [PMID: 22984219 DOI: 10.2967/jnumed.112.105197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
UNLABELLED The identification of robust prognostic factors for patients with early-stage non-small cell lung cancer (NSCLC) is clinically important. The International Association for the Study of Lung Cancer has identified both sex and the maximum standardized uptake value (SUVmax) of (18)F-FDG in the primary tumor as measured by PET as potential prognostic variables. We examined the prognostic value of SUVmax in a surgical cohort of patients with NSCLC and disaggregated the findings by sex. METHODS Patients who had undergone a preoperative PET/CT scan and surgical resection with curative intent from 2001 to 2009 were identified from a prospective database. An SUVmax cutoff was calculated using receiver-operating-characteristic curves. Overall survival was correlated with SUVmax for the whole cohort and disaggregated by sex. RESULTS Inclusion criteria were met by 189 patients: 127 (67%) men and 62 (33%) women. Five-year survival was 54.6% for the whole cohort, 47.7% for men, and 68.2% for women. SUVmax correlated negatively with survival in a univariate analysis for the whole cohort (hazard ratio [HR], 2.51; 95% confidence interval [CI], 1.54-4.09; P < 0.001) and men (HR, 3.42; 95% CI, 1.94-6.05; P < 0.001) but not for women (HR, 1.61; 95% CI, 0.43-3.12; P = 0.77), using 8 as a cutoff. In multivariate analysis, SUVmax correlated with overall survival for the whole cohort (HR, 1.70; 95% CI, 1.05-2.99; P = 0.05) and men (HR, 2.40; 95% CI, 1.32-4.37; P = 0.004) but not for women (HR, 0.80; 95% CI, 0.15-4.47; P = 0.80). CONCLUSION SUVmax independently predicted overall survival for men but not for women in this surgical cohort. Our results suggest that SUVmax is an independent prognostic variable in men with surgically treated early NSCLC.
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Affiliation(s)
- Zoe Wainer
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
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