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Lucia F, Antoni D, Vaugier L, Duvergé L, Thureau S, Bourbonne V. Role of stereotactic radiotherapy in the management of small-cell lung cancer. Cancer Radiother 2024:S1278-3218(24)00142-2. [PMID: 39358196 DOI: 10.1016/j.canrad.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 10/04/2024]
Abstract
Small-cell lung cancer is the most aggressive form of lung neoplasia, treated in recent decades with chemoradiotherapy in case of limited stage and chemotherapy alone at the metastatic stage. In the last few years, the advent of immunotherapy has changed the landscape in the treatment of non-small-cell lung cancer, and to a lesser degree in small-cell lung cancer. Despite the recent advances in research, small-cell lung cancer is still considered an aggressive and lethal disease characterized by high recurrence or metastatic potential. As stereotactic radiotherapy has established itself as the standard of care in the early stage of inoperable non-small-cell lung cancer and in metastatic disease to treat brain and extracranial metastases, these same issues now arise in the management of small-cell lung cancer. This article aims to review the current knowledge and the potential of stereotactic radiotherapy in small-cell lung cancer.
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Affiliation(s)
- François Lucia
- Radiation Oncology Department, CHU de Brest, 2, avenue Foch, 29609 Brest cedex, France; LaTIM, UMR 1101, Inserm, université de Bretagne occidentale, Brest, France.
| | - Delphine Antoni
- Radiation Oncology Department, institut de cancérologie Strasbourg Europe, Strasbourg, France
| | - Loïg Vaugier
- Radiation Oncology Department, institut de cancérologie de l'Ouest - centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - Loïg Duvergé
- Radiation Oncology Department, centre Eugène-Marquis, avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - Sébastien Thureau
- Radiation Oncology Department, centre Henri-Becquerel, Rouen, France; QuantIf-Litis EA4108, université de Rouen, Rouen, France
| | - Vincent Bourbonne
- Radiation Oncology Department, CHU de Brest, 2, avenue Foch, 29609 Brest cedex, France; LaTIM, UMR 1101, Inserm, université de Bretagne occidentale, Brest, France
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2
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Fang M, Wang L, Gu Q, Wu H, Du X, Lai X. Efficacy and safety of thoracic radiotherapy for extensive stage small cell lung cancer after immunotherapy in real world. Clin Exp Metastasis 2023; 40:423-429. [PMID: 37584783 DOI: 10.1007/s10585-023-10227-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/24/2023] [Indexed: 08/17/2023]
Abstract
The immunotherapy combined chemotherapy has been the standard treatment strategy for extensive-stage small lung cancer (ES-SCLC). The CREST trial reported consolidative thoracic radiotherapy (cTRT) improved overall survival (OS) for ES-SCLC with intrathoracic residual after chemotherapy. In this study, patients with ES-SCLC who received immunotherapy were assigned to receive either TRT or no TRT. TRT significantly improved progression-free survival (PFS), local recurrence-free survival (LRFS) and OS with well tolerated toxicity. Further sub-cohort analysis, TRT significantly improved LRFS in patients with oligo-metastasis and without liver metastasis.
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Affiliation(s)
- Min Fang
- Department of Thoracic Radiotherapy, Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, 310022, China.
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310018, China.
- Department of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou, 310022, China.
| | - Le Wang
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310018, China
- Department of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Qing Gu
- Department of Thoracic Radiotherapy, Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, 310022, China
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310018, China
| | - Huiwen Wu
- Department of Thoracic Radiotherapy, Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Xianghui Du
- Department of Thoracic Radiotherapy, Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, 310022, China
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310018, China
| | - Xiaojing Lai
- Department of Thoracic Radiotherapy, Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, 310022, China.
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310018, China.
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Rim CH, Cho WK, Lee JH, Kim YS, Suh YG, Kim KH, Chie EK, Ahn YC. Role of Local Treatment for Oligometastasis: A Comparability-Based Meta-Analysis. Cancer Res Treat 2022; 54:953-969. [PMID: 35989655 PMCID: PMC9582460 DOI: 10.4143/crt.2022.329] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/13/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE We intend to investigate the oncological efficacy and feasibility of local consolidative therapy (LCT) through a meta-analysis method. MATERIALS AND METHODS Four databases including PubMed, MEDLINE, Embase, and Cochrane library were searched. Target studies are controlled trials comparing outcomes of LCT versus a control group. Primary endpoints are overall survival (OS) and progression-free survival (PFS). RESULTS A total of 54 studies involving 7,242 patients were included. Pooled analyses showed that the LCT arm could achieve improved OS with pooled odds ratio of 2.896 (95% confidence interval [CI], 2.377 to 3.528; p < 0.001). Regarding PFS, pooled analyses showed pooled odds ratio of 3.045 (95% CI, 2.356 to 3.937; p < 0.001) in favor of the LCT arm. In the subgroup analyses including the studies with reliable comparability (e.g. randomized studies or intentionally matched studies without significant favorable prognosticator in LCT arms), pooled odds ratio was 2.548 (95% CI, 1.808 to 3.591; p < 0.001) favoring the LCT arm regarding OS. Regarding PFS, pooled OR was 2.656 (95% CI, 1.713 to 4.120; p < 0.001) which also favored the LCT arm. Subgroup analyses limited to the randomized controlled trials (RCT) were also performed and pooled odds ratios on OS and PFS were 1.535 (95% CI, 1.082 to 2.177; p=0.016) and 1.668 (95% CI, 1.187 to 2.344; p=0.003). The rates of grade ≥ 3 complications related to LCT was mostly low (< 10%) and not significantly higher compared to the control arm. CONCLUSION Pooled analyses results of all included studies, selected studies with reliable comparability, and RCT's demonstrated the survival benefit of LCT. These consistent results suggest that LCT was beneficial to the patients with oligometastasis.
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Affiliation(s)
- Chai Hong Rim
- Department of Radiation Oncology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan,
Korea
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon,
Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, Ulsan University College of Medicine, Seoul,
Korea
| | - Yang-Gun Suh
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang,
Korea
| | - Kyung Hwan Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul,
Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul,
Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
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Stokes M, Berfeld N, Gayle A, Descoteaux A, Rohrmoser O, Franks A. A systematic literature review of real-world treatment outcomes of small cell lung cancer. Medicine (Baltimore) 2022; 101:e29783. [PMID: 35777024 PMCID: PMC9239604 DOI: 10.1097/md.0000000000029783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Robust evidence from real-world studies is needed to aid decision-makers and other stakeholders in choosing the best treatment options for patients. The objective of this work was to assess real-world outcomes of treatment strategies for limited- and extensive-stage small cell lung cancer (SCLC) prior to the global introduction of immunotherapies for this disease. METHODS Searches were conducted in MEDLINE and Embase to identify articles published in English from October 1, 2015, through May 20, 2020. Searches were designed using a combination of Medical Subject Heading (Medline), Emtree (Embase subject headings), and free-text terms such as SCLC. Observational studies reporting data on outcomes of initial treatment strategies in patients with limited- and extensive-stage SCLC were included. Studies with limited sample sizes (<100 patients), enrolled all patients prior to 2010, or did not report outcomes for limited- and extensive-stage SCLC separately were excluded. Data were extracted into a predesigned template by a single researcher. All extractions were validated by a second researcher, with disagreements resolved via consensus. RESULTS Forty articles were included in this review. Most enrolled patients from the United States (n = 18 articles) or China (n = 12 articles). Most examined limited-stage (n = 27 articles) SCLC. All studies examined overall survival as the primary outcome. Articles investigating limited-stage SCLC reported outcomes for surgery, chemotherapy and/or radiotherapy, and adjuvant prophylactic cranial irradiation. In studies examining multiple treatment strategies, chemoradiotherapy was the most commonly utilized therapy (56%-82%), with chemotherapy used in 18% to 44% of patients. Across studies, median overall survival was generally higher for chemoradiotherapy (15-45 months) compared with chemotherapy alone (6.0-15.6 months). Studies of extensive-stage SCLC primarily reported on chemotherapy alone, consolidative thoracic radiotherapy, and radiotherapy for patients presenting with brain metastases. Overall survival was generally lower for patients receiving chemotherapy alone (median: 6.4-16.5 months; 3 years, 5%-14.9%) compared with chemotherapy in combination with consolidative thoracic radiotherapy (median: 12.1-18.0 months; 3 years, 15.0%-18.1%). Studies examining whole-brain radiotherapy for brain metastases reported lower median overall survival (5.6-8.7 months) compared with stereotactic radiosurgery (10.0-14.5 months). CONCLUSIONS Under current standard of care, which has remained relatively unchanged over the past few decades, prognosis remains poor for patients with SCLC.
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Affiliation(s)
| | | | - Alicia Gayle
- AstraZeneca, Cambridge, United Kingdom
- *Correspondence: Alicia Gayle, Epidemiology, AstraZeneca, OBU, Global Medical Affairs, Global Real World Evidence Generation, City House, 126–130 Hills Road, Cambridge CB2 1RY, United Kingdom (e-mail: )
| | | | | | - April Franks
- AstraZeneca, Gaithersburg, Maryland, United States
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Radiation therapy for extensive-stage small-cell lung cancer in the era of immunotherapy. Cancer Lett 2022; 541:215719. [PMID: 35597478 DOI: 10.1016/j.canlet.2022.215719] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 12/23/2022]
Abstract
Unlike non-small-cell lung cancer (NSCLC), the progression of small-cell lung cancer (SCLC) is slow. Extensive-stage SCLC (ES-SCLC) is a serious threat to human health, with a 5-year survival rate of <7%. Chemotherapy has been the first-line treatment for the past 30 years. The anti-PD-L1 checkpoint blockades durvalumab and atezolizumab have greatly prolonged overall survival and have become the standard first-line therapy for ES-SCLC since the CASPIAN and IMpower133 trials. In the era of chemotherapy, radiation therapy (RT), including thoracic radiation therapy (TRT) and brain radiation therapy (BRT), has shown clinical effects in randomized and retrospective studies on ES-SCLC. RT-immunotherapy has shown exciting synergistic effects in NSCLC. For ES-SCLC, the clinical effects of combining TRT/BRT with immunotherapy have not yet been systematically explored. In this review, we found that studies on RT-immunotherapy in ES-SCLC are relatively few and limited to early phase studies focusing on toxicity. The efficacy and safety profiles of early phase studies encourage prospective clinical trials. In this review, we discuss the best population, optimum TRT dose, proper TRT time, and strategies for reducing radiation-induced neurotoxicity. Furthermore, we suggest that biomarkers and patient performance status should be fully assessed before RT-immunotherapy treatment. Prospective trials are needed to provide more evidence for RT-immunotherapy applications in ES-SCLC.
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Wang X, Lu Z, Zeng Z, Cai J, Xu P, Liu A. Thoracic stereotactic body radiation therapy plus first-line tyrosine kinase inhibitors for patients with epidermal growth factor receptor-mutant polymetastatic non-small-cell lung cancer: A propensity-matched retrospective study. Medicine (Baltimore) 2021; 100:e27279. [PMID: 34664886 PMCID: PMC8448028 DOI: 10.1097/md.0000000000027279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/31/2021] [Indexed: 02/07/2023] Open
Abstract
The role of thoracic stereotactic body radiation therapy (SBRT) in addition to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in EGFR-mutant polymetastatic non-small-cell lung cancer (NSCLC) has not been well established. This retrospective study aimed to evaluate the efficacy and safety of EGFR-TKIs with thoracic SBRT for the treatment of this patient group.Polymetastatic NSCLC was defined as having >5 metastatic lesions. Patients with polymetastatic NSCLC harboring positive EGFR mutations after initial TKI therapy for at least 8 weeks were eligible for SBRT between August 2016and August 2019. Eligible patients were treated with thoracic SBRT, and TKIs were administered for the duration of SBRT and continued after SBRT until they were considered ineffective. The control group was treated with TKI monotherapy. Propensity score matching (ratio of 1:4) was used to account for differences in baseline characteristics. Progression-free survival (PFS), overall survival, and treatment safety were evaluated.In total, 136 patients were included in the study population. Among them, 120 patients received TKIs alone, and 16 patients received TKIs with thoracic SBRT. The baseline characteristics did not significantly differ between the two cohorts after propensity score matching. The median PFS was 17.8 months in the thoracic SBRT group and 10.8 months in the control group (P = .033). In the multivariate analysis, a Cox regression model showed that thoracic SBRT was an independent statistically significant positive predictor of improved survival, with a hazard ratio of 0.54 (P = .046). We recorded no severe toxic effects or grade 4 to 5 toxicities.Real-world data demonstrate that thoracic SBRT significantly extends PFS in EGFR-mutant polymetastatic NSCLC patients with tolerable toxicity. Given these results, randomized studies are warranted.
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Affiliation(s)
- Xia Wang
- Department of Oncology, The Second Affiliated Hospital of Nanchang University
| | - Zhiqin Lu
- Department of Oncology, The Second Affiliated Hospital of Nanchang University
| | - Zhimin Zeng
- Department of Oncology, The Second Affiliated Hospital of Nanchang University
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, China
| | - Jing Cai
- Department of Oncology, The Second Affiliated Hospital of Nanchang University
| | - Peng Xu
- Department of Oncology, The Second Affiliated Hospital of Nanchang University
| | - Anwen Liu
- Department of Oncology, The Second Affiliated Hospital of Nanchang University
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, China
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Li AM, Zhou H, Xu YY, Ji XQ, Wu TC, Yuan X, Jiang CC, Zhu XX, Zhan P, Shen ZT. Role of thoracic radiotherapy in extensive stage small cell lung cancer: a systemic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:299. [PMID: 33708926 PMCID: PMC7944300 DOI: 10.21037/atm-20-5765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The role of thoracic consolidation radiotherapy in patients with extensive stage small cell lung cancer (ES-SCLC) remains controversial. This study aimed to evaluate the efficacy of thoracic radiotherapy (TRT) in these patients. Methods A systematic literature search was performed in PubMed, Embase, and the Cochrane library to identify qualified clinical studies. The hazard ratios (HRs) and 95% confidence intervals (CIs) of overall survival (OS), progression-free survival (PFS) and local recurrence-free survival (LRFS) were extracted, and toxicity of the TRT group versus non-TRT group was analyzed. Results A total of 12 studies were included in this meta-analysis, including 936 patients in the TRT group and 1,059 patients in the non-TRT group. The combined results showed that TRT significantly improved OS (HR =0.65; 95% CI: 0.55–0.77, P<0.00001), PFS (HR =0.64; 95% CI: 0.56–0.72, P<0.00001) and LRFS (HR =0.38, 95% CI: 0.26–0.53, P<0.00001). Subgroup analysis showed that OS benefits were observed in patients receiving sequential TRT (HR =0.67; 95% CI: 0.54–0.84, P=0.0006). The addition of TRT significantly improved OS in patients over 65 years of age (HR =0.55; 95% CI: 0.40–0.74, P=0.0001). For patients with only one organ metastasis, there was no significant difference in OS between the two groups (HR =0.61; 95% CI: 0.36–1.01, P=0.06). There was no statistical difference in hematologic toxicity (leukopenia, thrombocytopenia, anemia) and non-hematologic toxicity (nausea or vomiting) between the two groups. The incidence of grade ≥3 esophageal toxicity was 4.6% in the TRT group and 0% in the non-TRT group (P=0.0001). Grade ≥3 bronchopulmonary toxicity was 2.9% in the TRT group and 0.8% in the non-TRT group (P=0.02). Conclusions TRT improves OS, PFS and LRFS in patients with ES-SCLC, with a low increase in esophageal and bronchopulmonary toxicity. More randomized controlled trials (RCTs) are expected to confirm our conclusions. PROSPERO registration number CRD42020190575.
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Affiliation(s)
- Ao-Mei Li
- Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Han Zhou
- Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yang-Yang Xu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Qin Ji
- Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Tian-Cong Wu
- Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xi Yuan
- Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chang-Chen Jiang
- Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xi-Xu Zhu
- Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ping Zhan
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Ze-Tian Shen
- Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Rim CH, Shin IS, Park S, Lee HY. Benefits of local consolidative treatment in oligometastases of solid cancers: a stepwise-hierarchical pooled analysis and systematic review. NPJ Precis Oncol 2021; 5:2. [PMID: 33479481 PMCID: PMC7820397 DOI: 10.1038/s41698-020-00141-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/01/2020] [Indexed: 01/29/2023] Open
Abstract
We conducted a meta-analysis of articles published in PubMed, MEDLINE, EMBASE, and Cochrane library to investigate the effectiveness of local consolidative therapy (LCT) against oligometastases. Data from randomized controlled trials (RCTs), balanced studies, and all studies combined were analyzed in a hierarchical manner. Pooled analyses of 31 studies (including seven randomized trials) investigating the effectiveness of LCT on overall survival revealed odds ratios of 3.04, 2.56, and 1.41 for all studies, balanced studies, and RCTs, respectively (all p < 0.05). The benefit of LCT was more prominent in patients with non-small cell lung and colorectal cancers than in those with prostate and small cell lung cancers. Moreover, the benefit of LCT was smaller in patients with high metastatic burdens (p = 0.054). In four of 12 studies with available information, additional grade ≥3 toxicities due to LCTs were reported. Overall, LCT is beneficial for patients with oligometastases, although such benefits are less evident in RCTs than in observational studies. Appropriate LCTs should be carefully selected considering their feasibility, disease type, and metastatic burden.
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Affiliation(s)
- Chai Hong Rim
- grid.222754.40000 0001 0840 2678Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Gyeonggi-do Republic of Korea
| | - In-Soo Shin
- grid.255168.d0000 0001 0671 5021Graduate school of Education, Dongguk University, Seoul, Korea
| | - Sunmin Park
- grid.222754.40000 0001 0840 2678Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Gyeonggi-do Republic of Korea
| | - Hye Yoon Lee
- grid.222754.40000 0001 0840 2678Department of General Surgery, Ansan Hospital, Korea University Medical College, Ansan, Gyeonggi-do Republic of Korea
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Tsutsui T, Yamaki H, Kumagai T, Omori C, Kobayashi H, Kakizaki Y, Miyashita Y. Small cell lung cancer with thyroid gland oligometastasis: A case report. Thorac Cancer 2020; 12:387-390. [PMID: 33319473 PMCID: PMC7862780 DOI: 10.1111/1759-7714.13740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 12/29/2022] Open
Abstract
Extensive disease small cell lung cancer (ED-SCLC) is a systemic disease characterized by diffuse metastases and a poor prognosis. Oligometastatic cases in ED-SCLC are rare. This study reports the case of a 72-year-old Japanese male. A mass lesion was identified on chest computed tomography (CT). Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) revealed a solitary thyroid gland lesion with high FDG uptake as an extrapulmonary finding, suggesting thyroid cancer or a goiter. Upon confirmation of diagnosis, treatment of SCLC was prioritized, and chemoradiotherapy for limited disease SCLC was initiated without further examination of the thyroid gland. The thyroid nodule disappeared after treatment. Two years later, the disease recurred, and a thyroid nodule was found to have reappeared. Upon fine needle aspiration cytology of the thyroid, small cell carcinoma was detected. Therefore, in cases of SCLC, it is necessary to carefully investigate the thyroid for solitary lesions to consider the possibility of oligometastasis. KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: Manifesting as a solitary lesion, oligometastasis, particularly in the thyroid, is rare in cases of ED-SCLC. WHAT THIS STUDY ADDS: In SCLC cases, it is necessary to carefully investigate the thyroid for solitary lesions to consider the possibility of oligometastasis.
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Affiliation(s)
- Toshiharu Tsutsui
- Lung Cancer and Respiratory Disease Center, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Haruna Yamaki
- Lung Cancer and Respiratory Disease Center, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Takashi Kumagai
- Lung Cancer and Respiratory Disease Center, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Chisa Omori
- Lung Cancer and Respiratory Disease Center, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Hiroaki Kobayashi
- Lung Cancer and Respiratory Disease Center, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Yumiko Kakizaki
- Lung Cancer and Respiratory Disease Center, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Yoshihiro Miyashita
- Lung Cancer and Respiratory Disease Center, Yamanashi Prefectural Central Hospital, Kofu, Japan
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Consolidation radiotherapy for patients with extended disease small cell lung cancer in a single tertiary institution: impact of dose and perspectives in the era of immunotherapy. Radiol Oncol 2020; 54:353-363. [PMID: 32726294 PMCID: PMC7409599 DOI: 10.2478/raon-2020-0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/04/2020] [Indexed: 12/22/2022] Open
Abstract
Background Consolidation radiotherapy (cRT) in extended disease small cell lung cancer (ED-SCLC) showed improved 2-year overall survival in patients who responded to chemotherapy (ChT) in CREST trial, however results of two meta - analysis were contradictive. Recently, immunotherapy was introduced to the treatment of ED-SCLC, making the role of cRT even more unclear. The aim of our study was to access if consolidation thoracic irradiation improves survival of ED-SCLC patients treated in a routine clinical practice and to study the impact of cRT dose on survival. We also discuss the future role of cRT in the era of immunotherapy. Patients and methods We retrospectively reviewed 704 consecutive medical records of patients with small cell lung cancer treated at the Institute of Oncology Ljubljana from January 2010 to December 2014 with median follow up of 65 months. We analyzed median overall survival (mOS) of patients with ED-SCLC treated with ChT only and those treated with ChT and cRT. We also compared mOS of patients treated with different consolidation doses and performed univariate and multivariate analysis of prognostic factors. Results Out of 412 patients with ED-SCLC, ChT with cRT was delivered to 74 patients and ChT only to 113 patients. Patients with cRT had significantly longer mOS compared to patients with ChT only, 11.1 months (CI 10.1-12.0) vs. 7.6 months (CI 6.9-8.5, p < 0.001) and longer 1-year OS (44% vs. 23%, p = 0.0025), while the difference in 2-year OS was not significantly different (10% vs. 5%, p = 0.19). The cRT dose was not uniform. Higher dose with 45 Gy (in 18 fractions) resulted in better mOS compared to lower doses 30-36 Gy (in 10-12 fractions), 17.2 months vs. 10.3 months (p = 0.03) and statistically significant difference was also seen for 1-year OS (68% vs. 30%, p = 0.01) but non significant for 2-year OS (18% vs. 5%, p = 0.11). Conclusions Consolidation RT improved mOS and 1-year OS in ED-SCLC as compared to ChT alone. Higher dose of cRT resulted in better mOS and 1-year OS compared to lower dose. Consolidation RT, higher number of ChT cycles and prophylactic cranial irradiation (PCI) were independent prognostic factors for better survival in our analysis. For patients who received cRT, only higher doses and PCI had impact on survival regardless of number of ChT cycles received. Role of cRT in the era of immunotherapy is unknown and should be exploited in further trials.
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Fujita N, Hatakeyama S, Momota M, Tobisawa Y, Yoneyama T, Yamamoto H, Imai A, Ito H, Yoneyama T, Hashimoto Y, Yoshikawa K, Mariya Y, Ohyama C. Safety and Feasibility of Radiation Therapy to the Primary Tumor in Patients With Metastatic Castration-resistant Prostate Cancer. Clin Genitourin Cancer 2020; 18:e523-e530. [PMID: 32278839 DOI: 10.1016/j.clgc.2020.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The objective of this study was to evaluate the safety and feasibility of radiation therapy (RT) to the primary tumor in patients with metastatic castration-resistant prostate cancer (mCRPC). PATIENTS AND METHODS This retrospective study included 105 patients with mCRPC who were treated between April 2004 and May 2019. We divided the patients into 2 groups: patients treated with RT to the primary tumor after they developed CRPC (RT group) and without (non-RT group). The primary purpose was safety assessed using the Common Terminology Criteria for Adverse Events. The secondary purpose included prostate-specific antigen (PSA) response, cancer-specific survival (CSS), and overall survival (OS). Background-adjusted multivariate analyses, with the inverse probability of treatment weighting (IPTW) method, were performed to evaluate impact of RT on CSS and OS. RESULTS The median age at CRPC diagnosis was 75 years, and the median follow-up period after CRPC diagnosis was 21 months. The adverse events rates related to RT in any grade and grade ≥ 3 were 55% and 23%, respectively. Nine (29%) patients achieved ≥ 30% PSA decline with RT. In multivariate analyses with the IPTW method, the CSS and OS in the RT group were significantly longer than those in the non-RT group. In subgroup analyses with the IPTW method, RT was significantly associated with improved OS in patients aged ≥ 75 years and patients with initial PSA ≥ 500 ng/mL, cT4, Gleason score ≥ 8, and high-volume metastatic burden. CONCLUSIONS RT to the primary tumor is safe and feasible, and it has potential benefits on oncologic outcomes in patients with mCRPC.
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Affiliation(s)
- Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Masaki Momota
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Atsushi Imai
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroyuki Ito
- Department of Urology, Aomori Rosai Hospital, Hachinohe, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Yasushi Mariya
- Department of Radiology, Mutsu General Hospital, Mutsu, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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12
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Makhlin I, Fox K. Oligometastatic Breast Cancer: Is This a Curable Entity? A Contemporary Review of the Literature. Curr Oncol Rep 2020; 22:15. [PMID: 32025905 PMCID: PMC7219961 DOI: 10.1007/s11912-020-0867-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Oligometastatic breast cancer (OMBC) remains a poorly understood entity for which no standard of care exists at this time. This review will focus on our biologic understanding of OMBC and provide an update on current treatment strategies. RECENT FINDINGS The introduction of micro RNA expression profiling has advanced our understanding of the biologic underpinnings of OMBC. Although most of the data regarding treatment have come from retrospective studies, there are now prospective randomized trials reporting progression-free survival and overall survival improvements with stereotactic ablative radiotherapy (SABR). Ongoing studies designed to evaluate addition of SABR as well as other novel agents will further develop this field and provide new treatment options. A "cure" for OMBC remains elusive. With further basic research coupled with novel prospective trials, patients will hopefully enjoy increased progression-free survival and overall survival, and ideally a delay to more toxic systemic therapy.
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Affiliation(s)
- Igor Makhlin
- Division of Hematology & Oncology, Department of Medicine, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin Fox
- Division of Hematology & Oncology, Department of Medicine, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA, USA.
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13
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Qi J, Xu L, Sun J, Wang X, Zhao L. Thoracic Radiotherapy Benefits Elderly Extensive-Stage Small Cell Lung Cancer Patients with Distant Metastasis. Cancer Manag Res 2019; 11:10767-10775. [PMID: 31920386 PMCID: PMC6935272 DOI: 10.2147/cmar.s221225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 12/12/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose Thoracic radiotherapy (TRT) is the recommended therapeutic regimen for extensive-stage small cell lung cancer (ES-SCLC). Little is known about TRT benefits in elderly populations. The aim of this study was to evaluate TRT effects on the prognosis of elderly patients with ES-SCLC. Patients and methods This retrospective analysis reviewed the records of patients over 65 years of age with metastatic ES-SCLC treated between 2010 and 2016. Enrolled patients received standard chemotherapy regimens (etoposide plus cisplatin or carboplatin). A total of 93 eligible patients were subjected to propensity score matching, which led to 40 patients being assigned to the TRT group and 40 to the no thoracic radiotherapy (noTRT) group. The cohort of 80 patients (67 males) had the median age of 69 years (range, 65–85 years), with a median of 4 chemotherapy cycle (range, 1–8 cycles), and a median chest irradiation dose of 50 Gy (range, 30–60 Gy). We analyzed overall survival (OS), progression-free survival (PFS), and local recurrence-free survival (LRFS) as endpoints; survival rates were determined by the Kaplan–Meier method and compared across groups with log-rank tests. Multivariate prognostic analysis was performed with Cox regression modeling, and categorical variables were analyzed with Chi-square tests. Results In all patients, the 1-year OS, PFS, and LRFS rates were 38.3%, 16%, and 17.9%, respectively. The TRT group had superior survival outcomes compared to the noTRT group: their 1-year OS, PFS, and LRFS rates were 55% vs. 25% (P < 0.001), 32.1% vs. 0% (P < 0.001), and 31% vs. 2.6% (P < 0.001), respectively. TRT did not increase the incidence of adverse reactions (P = 0.431). Conclusion TRT can improve chest tumor control and survival time in elderly ES-SCLC patients. Large-scale studies to further assess the benefits of TRT are warranted.
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Affiliation(s)
- Jing Qi
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, People's Republic of China
| | - Liming Xu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, People's Republic of China
| | - Jian Sun
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, People's Republic of China
| | - Xin Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, People's Republic of China
| | - Lujun Zhao
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, People's Republic of China
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14
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Hermans BCM, Derks JL, Groen HJM, Stigt JA, van Suylen RJ, Hillen LM, van den Broek EC, Speel EJM, Dingemans AMC. Large cell neuroendocrine carcinoma with a solitary brain metastasis and low Ki-67: a unique subtype. Endocr Connect 2019; 8:1600-1606. [PMID: 31751303 PMCID: PMC6933830 DOI: 10.1530/ec-19-0372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/14/2019] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Stage IV large cell neuroendocrine carcinoma (LCNEC) of the lung generally presents as disseminated and aggressive disease with a Ki-67 proliferation index (PI) 40-80%. LCNEC can be subdivided in two main subtypes: the first harboring TP53/RB1 mutations (small-cell lung carcinoma (SCLC)-like), the second with mutations in TP53 and STK11/KEAP1 (non-small-cell lung carcinoma (NSCLC)-like). Here we evaluated 11 LCNEC patients with only a solitary brain metastasis and evaluate phenotype, genotype and follow-up. METHODS Eleven LCNEC patients with solitary brain metastases were analyzed. Clinical characteristics and survival data were retrieved from medical records. Pathological analysis included histomorphological analysis, immunohistochemistry (pRB and Ki-67 PI) and next-generation sequencing (TP53, RB1, STK11, KEAP1 and MEN1). RESULTS All patients had N0 or N1 disease. Median overall survival (OS) was 12 months (95% confidence interval (CI) 5.5-18.5 months). Mean Ki-67 PI was 59% (range 15-100%). In 6/11 LCNEC Ki-67 PI was ≤40%. OS was longer for Ki-67 ≤40% compared to >40% (17 months (95% CI 11-23 months) vs 5 months (95% CI 0.7-9 months), P = 0.007). Two patients were still alive at follow-up after 86 and 103 months, both had Ki-67 ≤40%. 8/11 patients could be subclassified, and both SCLC-like (n = 6) and NSCLC-like (n = 2) subtypes were present. No MEN1 mutation was found. CONCLUSION Stage IV LCNEC with a solitary brain metastasis and N0/N1 disease show in the majority of cases Ki-67 PI ≤40% and prolonged survival, distinguishing them from general LCNEC. This unique subgroup can be both of the SCLC-like and NSCLC-like subtype.
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Affiliation(s)
- B C M Hermans
- Department of Pulmonary Diseases, GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J L Derks
- Department of Pulmonary Diseases, GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - H J M Groen
- Department of Pulmonary Diseases, University of Groningen and University Medical Centre, Groningen, The Netherlands
| | - J A Stigt
- Department of Pulmonary Diseases, Isala Hospital, Zwolle, The Netherlands
| | - R J van Suylen
- Pathology-DNA, Jeroen Bosch Hospital, ‘s Hertogenbosch, The Netherlands
| | - L M Hillen
- Department of Pathology, GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - E J M Speel
- Department of Pathology, GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A-M C Dingemans
- Department of Pulmonary Diseases, GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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15
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Radiotherapy Improves the Survival of Patients With Metastatic Cervical Cancer: A Propensity-Matched Analysis of SEER Database. Int J Gynecol Cancer 2019; 28:1360-1368. [PMID: 30036221 DOI: 10.1097/igc.0000000000001313] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To demonstrate whether radiotherapy has an effect on the survival of patients with stage IVb (M1) cervical cancer, as it has not been adequately clarified. METHODS We analyzed International Federation of Gynecology and Obstetrics (FIGO) stage M1 cervical cancer diagnosed in patients between 1992 and 2013 using population-based data from the Surveillance, Epidemiology, and End Results registry. Propensity score (PS) analysis with 1:1 matching and the nearest neighbor matching method was performed to ensure well-balanced characteristics of comparison groups. Data were analyzed by Kaplan-Meier and Cox proportional hazards regression models to evaluate the overall survival (OS) and cancer-specific survival (CSS) months with corresponding 95% confidence intervals (95% CIs). RESULTS In general, receiving radiotherapy significantly improved OS and CSS both before and after PS matching (PSM) (P < 0.001), with significantly improved OS (hazard ratio, 0.69; 95% CI, 0.62-0.76) and CSS (hazard ratio, 0.79; 95% CI, 0.70-0.89) after PSM in patients with stage M1 cervical cancer. Before PSM, radiotherapy was found to be associated with improved survival even for the patients with stage M1 cervical cancer with extensive metastasis (≥2 metastatic sites) (P < 0.001). Although P value was not significant for brain metastasis, the survival month was numerically improved before PSM (OS and CSS, 1 month vs 4 months). Overall, radiotherapy still significantly improved survival for patients with one metastatic site (ie, oligometastases) either before or after PSM (P < 0.05), with the survival month improved more than 6 months. CONCLUSIONS The large Surveillance, Epidemiology, and End Results results support that radiotherapy might improve the survival of patients with metastatic cervical cancer. It might be prudent to carefully select suitable patients for radiation therapy for metastatic cervical cancer.
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Hong JC, Boyer MJ, Spiegel DY, Williams CD, Tong BC, Shofer SL, Moravan MJ, Kelley MJ, Salama JK. Increasing PET Use in Small Cell Lung Cancer: Survival Improvement and Stage Migration in the VA Central Cancer Registry. J Natl Compr Canc Netw 2019; 17:127-139. [PMID: 30787126 DOI: 10.6004/jnccn.2018.7090] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 09/17/2018] [Indexed: 11/17/2022]
Abstract
Background: Accurate staging for small cell lung cancer (SCLC) is critical for determining appropriate therapy. The clinical impact of increasing PET adoption and stage migration is well described in non-small cell lung cancer but not in SCLC. The objective of this study was to evaluate temporal trends in PET staging and survival in the Veterans Affairs Central Cancer Registry and the impact of PET on outcomes. Patients and Methods: Patients diagnosed with SCLC from 2001 to 2010 were identified. PET staging, overall survival (OS), and lung cancer-specific survival (LCSS) were assessed over time. The impact of PET staging on OS and LCSS was assessed for limited-stage (LS) and extensive-stage (ES) SCLC. Results: From 2001 to 2010, PET use in a total of 10,135 patients with SCLC increased from 1.1% to 39.2%. Median OS improved for all patients (from 6.2 to 7.9 months), those with LS-SCLC (from 10.9 to 13.2 months), and those with ES-SCLC (from 5.0 to 7.0 months). Among staged patients, the proportion of ES-SCLC increased from 63.9% to 65.7%. Among 1,536 patients with LS-SCLC treated with concurrent chemoradiotherapy, 397 were staged by PET. In these patients, PET was associated with longer OS (median, 19.8 vs 14.3 months; hazard ratio [HR], 0.78; 95% CI, 0.68-0.90; P<.0001) and LCSS (median, 22.9 vs 16.7 months; HR, 0.74; 95% CI, 0.63-0.87; P<.0001) with multivariate adjustment and propensity-matching. In the 6,143 patients with ES-SCLC, PET was also associated with improved OS and LCSS. Conclusions: From 2001 to 2010, PET staging increased in this large cohort, with a corresponding relative increase in ES-SCLC. PET was associated with greater OS and LCSS for LS-SCLC and ES-SCLC, likely reflecting stage migration and stage-appropriate therapy. These findings emphasize the importance of PET in SCLC and support its routine use.
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Affiliation(s)
- Julian C Hong
- aDepartment of Radiation Oncology, Duke University, Durham, North Carolina
| | - Matthew J Boyer
- aDepartment of Radiation Oncology, Duke University, Durham, North Carolina
- bDepartment of Radiation Oncology, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Daphna Y Spiegel
- aDepartment of Radiation Oncology, Duke University, Durham, North Carolina
| | - Christina D Williams
- cCooperative Studies Program Epidemiology Center-Durham, Durham Veterans Administration Medical Center, Durham, North Carolina; Divisions of
| | - Betty C Tong
- dCardiovascular and Thoracic Surgery, Department of Surgery
| | - Scott L Shofer
- ePulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | - Michael J Moravan
- aDepartment of Radiation Oncology, Duke University, Durham, North Carolina
| | - Michael J Kelley
- fMedical Oncology, Department of Medicine, Duke University, Durham, North Carolina; and
- gDivision of Hematology-Oncology, Medical Service, Durham Veterans Administration Medical Center, Durham, North Carolina
| | - Joseph K Salama
- aDepartment of Radiation Oncology, Duke University, Durham, North Carolina
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17
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Zhang R, Li P, Li Q, Qiao Y, Xu T, Ruan P, Song Q, Fu Z. Radiotherapy improves the survival of patients with extensive-disease small-cell lung cancer: a propensity score matched analysis of Surveillance, Epidemiology, and End Results database. Cancer Manag Res 2018; 10:6525-6535. [PMID: 30555258 PMCID: PMC6278721 DOI: 10.2147/cmar.s174801] [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] [Indexed: 12/21/2022] Open
Abstract
Background The survival advantage of radiotherapy for patients with extensive-disease small-cell lung cancer (ED-SCLC) has not been adequately evaluated. Methods We analyzed stage IV SCLC patients enrolled from the Surveillance, Epidemiology, and End Results (SEER) registry through January 2010 and December 2012. Propensity score analysis with 1:1 matching was performed to ensure well-balanced characteristics of all comparison groups. Kaplan-Meier and Cox proportional hazardous model were used to evaluate the overall survival (OS), cancer-specific survival (CSS), and corresponding 95% CI. Results Overall, for all metastatic ED-SCLC, receiving radiotherapy was associated with both improved OS and CSS. Radiotherapy for thoracic lesion and any metastatic sites could significantly improve the OS and CSS, except for brain metastasis. For M1a-SCLC patient, radiotherapy, most likely to the primary site, significantly improved the survival (P<0.001). Furthermore, for those ED-SCLC patients with ≥ 2 metastatic sites, that is, polymetastatic ED-SCLC patients, radiation also significantly improved the median OS from 6.0 to 8.0 months (P=0.015) and the median CSS from 7.0 to 8.0 months (P=0.020). Conclusion The large SEER results support that radiotherapy in addition to chemotherapy might improve the survival of patients with metastatic ED-SCLC.
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Affiliation(s)
- Rui Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China,
| | - Ping Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China,
| | - Qin Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China,
| | - Yunfeng Qiao
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China,
| | - Tangpeng Xu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China,
| | - Peng Ruan
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China,
| | - Qibin Song
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China,
| | - Zhenming Fu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China,
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Frost N, Tessmer A, Schmittel A, van Laak V, Raspe M, Ruwwe-Glösenkamp C, Brunn M, Senger C, Böhmer D, Ochsenreither S, Temmesfeld-Wollbrück B, Furth C, Schmidt B, Neudecker J, Rückert JC, Suttorp N, Witzenrath M, Grohé C. Local ablative treatment for synchronous single organ oligometastatic lung cancer-A propensity score analysis of 180 patients. Lung Cancer 2018; 125:164-173. [PMID: 30429016 DOI: 10.1016/j.lungcan.2018.09.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/12/2018] [Accepted: 09/23/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Local ablative treatment (LAT) improves outcome in lung cancer with oligometastatic disease (OMD) and potentially leads to long term survival. The aim of this retrospective study was to evaluate and quantify the additional benefit of LAT in synchronous OMD and to further identify prognostic factors for survival. PATIENTS AND METHODS A propensity score-matched pairs analysis was performed on a set of patient and disease variables in 180 patients, treated for synchronous single organ OMD including non small-cell and neuroendocrine lung cancer with ≤4 metastases between 2000 and 2016 in 3 lung cancer centers in Berlin, Germany. Patients either received LAT for all sites of disease (intervention group) by means of surgery or stereotactic radiotherapy, or standard chemotherapy, if necessary combined with a local treatment with palliative intent (control group). RESULTS Median follow-up time was 32.2 and 18.8 months for the intervention and control group, respectively. Substantial benefits in median progression-free survival (PFS, 25.1 vs. 8.2 months; HR, 0.30; 95% CI, 0.21-0.43; p < 0.001) and overall survival (OS, 60.4 vs. 22.5 months; HR, 0.42; 95% CI, 0.28-0.62; p < 0.001) were associated with LAT. Histology of adenocarcinoma and T1a primaries also predicted a favorable prognosis concerning PFS and OS. More favorable nodal stage (N0-2 vs. 3) and solitary metastases were associated with an extended PFS, whereas initial ECOG-PS (0-1 vs. 2) predicted OS. CONCLUSIONS LAT was the strongest predictor for PFS and OS in OMD with ≤4 metastases. Survival in the control group identifies OMD as a subset of lung cancer with a generally more favorable prognosis.
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Affiliation(s)
- Nikolaj Frost
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Berlin, Germany.
| | - Antje Tessmer
- Klinik für Pneumologie - Evangelische Lungenklinik Berlin Buch, Berlin, Germany
| | | | | | - Matthias Raspe
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Berlin, Germany
| | - Christoph Ruwwe-Glösenkamp
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Berlin, Germany
| | | | - Carolin Senger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, Germany
| | - Dirk Böhmer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, Germany
| | - Sebastian Ochsenreither
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Hematology, Oncology and Tumorimmunology, Germany
| | - Bettina Temmesfeld-Wollbrück
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Berlin, Germany
| | - Christian Furth
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, Germany
| | - Bernd Schmidt
- DRK hospital Berlin-Mitte, Department of Pneumonology, Germany
| | - Jens Neudecker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of General, Visceral, Vascular and Thoracic Surgery, Germany
| | - Jens-Carsten Rückert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of General, Visceral, Vascular and Thoracic Surgery, Germany
| | - Norbert Suttorp
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Berlin, Germany
| | - Martin Witzenrath
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Division of Pulmonary Inflammation, Berlin, Germany
| | - Christian Grohé
- Klinik für Pneumologie - Evangelische Lungenklinik Berlin Buch, Berlin, Germany
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Dose escalation and associated predictors of survival with consolidative thoracic radiotherapy in extensive stage small cell lung cancer (SCLC): A National Cancer Database (NCDB) propensity-matched analysis. Lung Cancer 2018; 124:283-290. [PMID: 30268474 DOI: 10.1016/j.lungcan.2018.08.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/16/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE Randomized studies have demonstrated a survival benefit for consolidative thoracic radiotherapy (TRT) in extensive stage (ES) small cell lung cancer (SCLC), however the radiation dose and optimal selection criteria are often debated. METHODS We analyzed 3280 stage IV SCLC treated with double-agent chemotherapy and TRT within the National Cancer Data Base (NCDB) and evaluated the differences in selection patterns and survival outcomes for patients who received at least 45 Gy of TRT and those who received <45 Gy. Univariable and multivariable analyses identified characteristics predictive of overall survival. Propensity-adjusted Cox proportional hazard ratios for survival were used to account for indication bias between the two dose arms. RESULTS There were 1621 patients in the <45 Gy group (most common 30 Gy) and 1659 patients in the 45 Gy or higher group (most common 45 Gy). White patients, T1-T3 lesions, an absence of brain/liver/bone metastases, and starting TRT after 12 weeks of chemotherapy were associated with the higher dose group. With multivariable analysis, TRT to at least 45 Gy was an independent predictor of improved survival (HR = 0.78, P < 0.001) along with female gender, age <65, lower comorbidity score, starting TRT 12 weeks after chemotherapy, and the absence of brain/liver/bone metastases (P < 0.01). Propensity adjusted regression model showed a persistent correlation between a higher dose and survival (HR = 0.74, P < 0.001). Survival at 1 and 2 years for the 45 Gy or higher arm was 58.1% and 25.2% compared to 43.8% and 15.1% for the <45 Gy arm (P < 0.001). CONCLUSION In the largest analysis of consolidative thoracic radiotherapy in ES-SCLC to date, dose escalation to at least 45 Gy was an independent predictor for increased survival. These findings may be validated in ongoing prospective studies.
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Li-Ming X, Zhao LJ, Simone CB, Cheng C, Kang M, Wang X, Gong LL, Pang QS, Wang J, Yuan ZY, Wang P. Receipt of thoracic radiation therapy and radiotherapy dose are correlated with outcomes in a retrospective study of three hundred and six patients with extensive stage small-cell lung cancer. Radiother Oncol 2017; 125:331-337. [PMID: 29079309 DOI: 10.1016/j.radonc.2017.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/06/2017] [Accepted: 10/03/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND The importance of the thoracic radiation therapy (TRT) dose has not been clearly defined in extensive stage small-cell lung cancer (ES-SCLC) and it is unclear whether improved TRT dose translates into a survival benefit. METHODS 306 patients with ES-SCLC were retrospectively reviewed, of which 170 received IMRT/CRT fractionation RT after ChT, and 136 received chemotherapy (ChT) alone. We adopted the time-adjusted BED (tBED) for effective dose fractionation calculation. Due to the nonrandomized nature of this study, we compared the ChT+RT with ChT groups that matched on possible confounding variables. RESULTS Patients achieved 2-year OS, PFS and LC rates of 19.7%, 10.7% and 28.4%, respectively. After propensity score matching, (113 cases for each group), the rates of OS, PFS and LC at 2 years were 21.4%, 7.7% and 34.5% for ChT+TRT, and 10.3% (p<0.001), 4.6% (p<0.001) and 6.3% for ChT only (p<0.001), respectively. Among propensity score matching patients, 56 cases for each group received the high dose (tBED>50 Gy) TRT and received low dose (tBED≤50 Gy) TRT. Two-year OS, PFS and LC rates were 32.3%, 15.3% and 47.1% for the high dose compared with 17.0% (p<0.001), 12.9% (p=0.097) and 34.7% (p=0.029) for low dose radiotherapy. CONCLUSIONS TRT added to ChT improved ES-SCLC patient OS. High dose TRT improved OS over lower doses. Our results suggest that high-dose thoracic radiation therapy may be a reasonable consideration in select patients with ES-SCLC.
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Affiliation(s)
- Xu Li-Ming
- Departments of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China
| | - Lu-Jun Zhao
- Departments of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China.
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, USA
| | - Chingyun Cheng
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Minglei Kang
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA; Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, USA
| | - Xin Wang
- Departments of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China
| | - Lin-Lin Gong
- Departments of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China
| | - Qing-Song Pang
- Departments of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China
| | - Jun Wang
- Departments of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China
| | - Zhi-Yong Yuan
- Departments of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China
| | - Ping Wang
- Departments of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China.
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