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Van Houtte P, Moretti L, Charlier F, Roelandts M, Van Gestel D. Preoperative and postoperative radiotherapy (RT) for non-small cell lung cancer: still an open question. Transl Lung Cancer Res 2021; 10:1950-1959. [PMID: 34012805 PMCID: PMC8107767 DOI: 10.21037/tlcr-20-472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Preoperative and postoperative radiotherapy (PORT) with or without chemotherapy has been used in non-small cell lung cancer (NSCLC) for decades. Numerous trials have investigated the potential survival benefit of this strategy, but despite greater knowledge of the disease, considerable technological developments in imaging and radiotherapy, and significant progress in surgery, many questions remain unsolved. In this review, we summarize the current knowledge on this problem and discuss issues which still require elucidation.
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Affiliation(s)
- Paul Van Houtte
- Department of Radiation Oncology, Institut Jules Bordet, Université Libre Bruxelles, Brussels, Belgium
| | - Luigi Moretti
- Department of Radiation Oncology, Institut Jules Bordet, Université Libre Bruxelles, Brussels, Belgium
| | - Florian Charlier
- Department of Radiation Oncology, Institut Jules Bordet, Université Libre Bruxelles, Brussels, Belgium
| | - Martine Roelandts
- Department of Radiation Oncology, Institut Jules Bordet, Université Libre Bruxelles, Brussels, Belgium
| | - Dirk Van Gestel
- Department of Radiation Oncology, Institut Jules Bordet, Université Libre Bruxelles, Brussels, Belgium
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Zazuli Z, Kos R, Veltman JD, Uyterlinde W, Longo C, Baas P, Masereeuw R, Vijverberg SJH, Maitland-van der Zee AH. Comparison of Myelotoxicity and Nephrotoxicity Between Daily Low-Dose Cisplatin With Concurrent Radiation and Cyclic High-Dose Cisplatin in Non-Small Cell Lung Cancer Patients. Front Pharmacol 2020; 11:975. [PMID: 32670072 PMCID: PMC7332698 DOI: 10.3389/fphar.2020.00975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/15/2020] [Indexed: 12/25/2022] Open
Abstract
Aim Antineoplastic effect of cisplatin, the first line treatment in non-small cell lung cancer (NSCLC), is hindered by its nephrotoxicity and myelotoxicity. Both low-dose and high-dose regimens are used in the management of NSCLC. The aim of this study is to assess the risk on myelotoxicity and nephrotoxicity from the daily low-dose cisplatin (DLD) treatment as compared to cyclic high-dose cisplatin (CHD). Methods A retrospective cohort study was conducted. NSCLC patients treated with cisplatin between 2011 and 2018 in the Amsterdam UMC or Antoni van Leeuwenhoek cancer hospital were studied. Myelotoxicity and nephrotoxicity were defined based on common terminology criteria (CTCAE v4.03) and categorized as ≥grade 1 and ≥grade 2. Modified Poisson regression and Cox proportional hazards model were used to estimate relative risks and cumulative hazard respectively. Results Of the 115 NSCLC patients receiving DLD (N=62) and CHD (N=53), 60% had ≥grade 1 anemia, 33.9% leukopenia, 31.3% neutropenia, 27.8% thrombocytopenia, 32.2% acute nephrotoxicity with combined definition (Cr-electrolyte nephrotoxicity), and 58.3% chronic nephrotoxicity. The DLD group was older, had an earlier cancer stage, had more comorbidities, and had higher baseline albumin levels. In the DLD group less ≥grade 2 toxicities were reported compared to the CHD group except for Cr-electrolyte nephrotoxicity. However, there was a stronger association in the DLD group with ≥grade 1 leukopenia, thrombocytopenia, and Cr-electrolyte nephrotoxicity. The DLD group developed significantly more ≥grade 1 leukopenia [adjusted relative risk (adjRR)=1.83, 95% CI 1.02-3.27], thrombocytopenia (adjRR=3.43, 95% CI 1.64-7.15), and ≥grade 2 Cr-electrolyte nephrotoxicity (adjRR=3.02, 95% CI 1.20-7.56). The DLD group had a lower adjusted cumulative hazard for developing ≥grade 2 myelotoxicity and chronic nephrotoxicity but not for Cr-electrolyte nephrotoxicity [adjusted hazard ratio (adjHR)=3.90, 95% CI 1.35-11.23]. In contrast, DLD showed protective effect to ≥grade 2 nephrotoxicity when definition was restricted to the traditional creatinine-based definition (adjRR=0.07, 95% CI 0.01-0.86; adjHR=0.05, 95% CI 0.01-0.56). Conclusions Overall, the DLD regimen was safer than the CHD regimen when assessing the risk of ≥grade 2 myelotoxicity and nephrotoxicity. However, this might not be the case in patients with a higher risk of electrolyte abnormalities.
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Affiliation(s)
- Zulfan Zazuli
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Pharmacology-Clinical Pharmacy, School of Pharmacy, Bandung Institute of Technology, Bandung, Indonesia
| | - Renate Kos
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Joris D Veltman
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Wilma Uyterlinde
- Department of Thoracic Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Cristina Longo
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Paul Baas
- Department of Thoracic Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Rosalinde Masereeuw
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, Netherlands
| | - Susanne J H Vijverberg
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Metformin enhances the radiosensitizing effect of cisplatin in non-small cell lung cancer cell lines with different cisplatin sensitivities. Sci Rep 2019; 9:1282. [PMID: 30718758 PMCID: PMC6361966 DOI: 10.1038/s41598-018-38004-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/18/2018] [Indexed: 12/11/2022] Open
Abstract
Cisplatin is an extensively used chemotherapeutic drug for lung cancer, but the development of resistance decreases its effectiveness in the treatments of non-small cell lung cancer (NSCLC). In this study, we examined the effects of metformin, a widely used antidiabetic drug, on cisplatin radiosensitization in NSCLC cell lines. Human NSCLC cell lines, A549 (cisplatin-resistant) and H460 (cisplatin-sensitive), were treated with metformin, cisplatin or a combination of both drugs before ionizing radiation. Cell proliferation, clonogenic assays, western blotting, cisplatin-DNA adduct formation and immunocytochemistry were used to characterize the treatments effects. Metformin increased the radiosensitivity of NSCLC cells. Metformin showed additive and over-additive effects in combination with cisplatin and the radiation response in the clonogenic assay in H460 and A549 cell lines (p = 0.018 for the interaction effect between cisplatin and metformin), respectively. At the molecular level, metformin led to a significant increase in cisplatin-DNA adduct formation compared with cisplatin alone (p < 0.01, ANOVA-F test). This was accompanied by a decreased expression of the excision repair cross-complementation 1 expression (ERCC1), a key enzyme in nucleotide excision repair pathway. Furthermore, compared with each treatment alone metformin in combination with cisplatin yielded the lowest level of radiation-induced Rad51 foci, an essential protein of homologous recombination repair. Ionizing radiation-induced γ-H2AX and 53BP1 foci persisted longer in both cell lines in the presence of metformin. Pharmacological inhibition of AMP-activated protein kinase (AMPK) demonstrated that metformin enhances the radiosensitizing effect of cisplatin through an AMPK-dependent pathway only in H460 but not in A549 cells. Our results suggest that metformin can enhance the effect of combined cisplatin and radiotherapy in NSCLC and can sensitize these cells to radiation that are not sensitized by cisplatin alone.
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Radiation Therapy in Non-small-Cell Lung Cancer. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-52619-5_34-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Park B, Cho JH, Kim HK, Choi YS, Zo JI, Shim YM, Kim J. Long-term survival in locally advanced non-small cell lung cancer invading the great vessels and heart. Thorac Cancer 2018; 9:598-605. [PMID: 29602232 PMCID: PMC5928382 DOI: 10.1111/1759-7714.12625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study was to analyze the surgical outcomes of locally advanced lung cancer invading the great vessels or heart, according to the extension of cancer invasion. Methods From 1995 to 2015, 59 patients who were surgically treated and pathologically diagnosed with T4N0–1 non‐small cell lung cancer with invasion to the great vessels or heart were enrolled. Surgical outcomes were compared between patient groups with and without intrapericardial invasion. Results The median age was 64 years (interquartile range [IQR] 57–68) and 56 patients (95%) were male. In‐hospital mortality was 9% and median overall survival was 30 months (IQR 12–83). One and five‐year overall survival rates were 75% and 44%, respectively. The median overall survival in patients with lung cancer invasion to the intrapericardial space (n = 45) was 27 months (IQR 10–63), while it was 42 months (IQR 18–104) in patients without intrapericardial invasion (n = 14). Median disease‐free survival was significantly poorer in patients with intrapericardial invasion (12 months; IQR 6–55), especially in patients with heart invasion (n = 11, 7 months, IQR 5–27), than in patients without intrapericardial invasion (30 months, IQR 13–103). Conclusion Patients with lung cancer invading the intrapericardial space showed worse surgical outcomes in both overall and disease‐free survival. Therefore, surgical management should be carefully considered in patients with intrapericardial invasion.
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Affiliation(s)
- Byungjoon Park
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Seoul, South Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Il Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Trimodality Therapy for Lung Cancer With Chest Wall Invasion: Initial Results of a Phase II Study. Ann Thorac Surg 2014; 98:1184-91. [DOI: 10.1016/j.athoracsur.2014.05.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 04/16/2014] [Accepted: 05/05/2014] [Indexed: 11/20/2022]
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Surgical management of locally advanced lung cancer. Gen Thorac Cardiovasc Surg 2014; 62:522-30. [DOI: 10.1007/s11748-014-0425-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Indexed: 11/25/2022]
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Cisplatin-mediated radiosensitization of non-small cell lung cancer cells is stimulated by ATM inhibition. Radiother Oncol 2014; 111:228-36. [DOI: 10.1016/j.radonc.2014.04.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 03/23/2014] [Accepted: 04/09/2014] [Indexed: 01/01/2023]
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Reymen B, van Baardwijk A, Wanders R, Borger J, Dingemans AMC, Bootsma G, Pitz C, Lunde R, Geraedts W, Lambin P, De Ruysscher D. Long-term survival of stage T4N0-1 and single station IIIA-N2 NSCLC patients treated with definitive chemo-radiotherapy using individualised isotoxic accelerated radiotherapy (INDAR). Radiother Oncol 2014; 110:482-7. [PMID: 24444527 DOI: 10.1016/j.radonc.2013.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 12/10/2013] [Accepted: 12/18/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) stage T4N0-1 or single nodal station IIIA-N2 are two stage III sub-groups for which the outcome of non-surgical therapy is not well known. We investigated the results of individualised isotoxic accelerated radiotherapy (INDAR) and chemotherapy in this setting. METHODS Analysis of NSCLC patients included in 2 prospective trials (NCT00573040 and NCT00572325) stage T4N0-1 or IIIA-N2 with 1 pathologic nodal station, treated with chemo-radiotherapy (CRT) using INDAR with concurrent or sequential platinum-based chemotherapy. Overall survival (OS) was updated and calculated from date of diagnosis (Kaplan-Meier). Toxicity was scored following CTCAEv3.0. To allow comparison with other articles the subgroups were also analysed separately for toxicity, progression free and overall survival. RESULTS 83 patients (42 T4N0-1 and 41 IIIA-N2) were identified: the median radiotherapy dose was 65Gy. Thirty-seven percent of patients received sequential CRT and 63% received concurrent CRT. At a median follow-up of 48 months the median OS for T4N0-1 patients was 34 months with 55% 2-year survival and 25% 5-year survival. For stage IIIA-N2 at a median follow-up of 50 months the median OS was 26 months with 2- and 5-year survival rates of 53% and 24%, respectively. CONCLUSION Chemo-radiation using INDAR yields promising survival results in patients with single-station stage IIIA-N2 or T4N0-1 NSCLC.
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Affiliation(s)
- Bart Reymen
- Department of Radiation Oncology (MAASTRO Clinic), The Netherlands.
| | | | - Rinus Wanders
- Department of Radiation Oncology (MAASTRO Clinic), The Netherlands
| | - Jacques Borger
- Department of Radiation Oncology (MAASTRO Clinic), The Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonology, University Medical Centre Maastricht, GROW-School for Oncology and Developmental Biology, The Netherlands
| | - Gerben Bootsma
- Department of Pulmonology, Atrium Medical Centre, Heerlen, The Netherlands
| | - Cordula Pitz
- Department of Pulmonology, Laurentius Hospital, Roermond, The Netherlands
| | - Ragnar Lunde
- Department of Pulmonology, St. Jansgasthuis, Weert, The Netherlands
| | - Wiel Geraedts
- Department of Pulmonology, Orbis Medical Centre, Sittard, The Netherlands
| | - Philippe Lambin
- Department of Radiation Oncology (MAASTRO Clinic), The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO Clinic), The Netherlands; University Hospital Leuven/KU Leuven, Belgium
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Wang YY, Lin SX, Yang GQ, Liu HC, Sun DN, Wang YS. Clinical efficacy of CyberKnife combined with chemotherapy and hyperthermia for advanced non-small cell lung cancer. Mol Clin Oncol 2013; 1:527-530. [PMID: 24649205 DOI: 10.3892/mco.2013.95] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 02/27/2013] [Indexed: 11/06/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is responsible for at least 80% of all lung tumors and has a poor prognosis, since 75% of NSCLCs are first diagnosed at an advanced stage. This study was conducted to evaluate the therapeutic efficacy of CyberKnife in combination with chemotherapy and hyperthermia for selected patients with advanced non-small cell lung cancer (NSCLC). Clinical charts, imaging and pathology reports of patients with advanced NSCLC who underwent CyberKnife therapy in our Tumor Therapy Center were retrospectively reviewed. Clinical efficacy was evaluated for local control, Karnofsky performance status scale (KPS) and toxicity analysis. A total of 119 patients with 136 target areas were evaluated. A prescribed dose of 24-51 Gy to the gross tumor volume was delivered in 3-6 fractions. The median prescription dose was 35 Gy (mean, 34.73±4.80 Gy), with an average of five fractions. Patients, who voluntarily participated in the study, were assigned to one of three groups, which were as follows: CyberKnife therapy alone, CyberKnife combined with chemotherapy and CyberKnife combined with chemotherapy and hyperthermia. The median follow-up period was 6 months and curative efficiencies were 62.16, 71.79 and 90.70%, respectively, as determined by radiographic and clinical re-examinations. Patients treated by CyberKnife combined with chemotherapy and hyperthermia achieved optimal improvement in the aspect of KPS, which was statistically different compared to the other two groups (P<0.05). In conclusion, our results indicated that CyberKnife combined with chemotherapy and hyperthermia achieved favorable short-term outcomes and may be a more viable option for patients with advanced NSCLC. However, further investigations are required to evaluate long-term outcomes.
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Affiliation(s)
- Yuan-Yuan Wang
- School of Integration of Traditional and Western Medicine, Binzhou Medical University
| | - Si-Xiang Lin
- School of Integration of Traditional and Western Medicine, Binzhou Medical University; ; Center for Tumor Treatment, The People's Liberation Army 107th Hospital, Yantai, Shandong 264002, P.R. China
| | - Gui-Qing Yang
- School of Integration of Traditional and Western Medicine, Binzhou Medical University
| | - Han-Chen Liu
- Center for Tumor Treatment, The People's Liberation Army 107th Hospital, Yantai, Shandong 264002, P.R. China
| | - Dong-Ning Sun
- School of Integration of Traditional and Western Medicine, Binzhou Medical University
| | - Yi-Shan Wang
- Center for Tumor Treatment, The People's Liberation Army 107th Hospital, Yantai, Shandong 264002, P.R. China
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van Elmpt W, De Ruysscher D, van der Salm A, Lakeman A, van der Stoep J, Emans D, Damen E, Öllers M, Sonke JJ, Belderbos J. The PET-boost randomised phase II dose-escalation trial in non-small cell lung cancer. Radiother Oncol 2012; 104:67-71. [DOI: 10.1016/j.radonc.2012.03.005] [Citation(s) in RCA: 179] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 01/06/2012] [Accepted: 03/10/2012] [Indexed: 12/25/2022]
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Gomez DR, Komaki R. Postoperative radiation therapy for non-small cell lung cancer and thymic malignancies. Cancers (Basel) 2012; 4:307-22. [PMID: 24213242 PMCID: PMC3712677 DOI: 10.3390/cancers4010307] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 02/21/2012] [Accepted: 03/06/2012] [Indexed: 12/25/2022] Open
Abstract
For many thoracic malignancies, surgery, when feasible, is the preferred upfront modality for local control. However, adjuvant radiation plays an important role in minimizing the risk of locoregional recurrence. Tumors in the thoracic category include certain subgroups of non-small cell lung cancer (NSCLC) as well as thymic malignancies. The indications, radiation doses, and treatment fields vary amongst subtypes of thoracic tumors, as does the level of data supporting the use of radiation. For example, in the setting of NSCLC, postoperative radiation is typically reserved for close/positive margins or N2/N3 disease, although such diseases as superior sulcus tumors present unique cases in which the role of neoadjuvant vs. adjuvant treatment is still being elucidated. In contrast, for thymic malignancies, postoperative radiation therapy is often used for initially resected Masaoka stage III or higher disease, with its use for stage II disease remaining controversial. This review provides an overview of postoperative radiation therapy for thoracic tumors, with a separate focus on superior sulcus tumors and thymoma, including a discussion of acceptable radiation approaches and an assessment of the current controversies involved in its use.
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Affiliation(s)
- Daniel R Gomez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1840 Old Spanish Trail, Houston, TX 77054, USA.
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