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Ohtaki Y, Nagashima T, Okano N, Kubo N, Ohtaka T, Sunaga N, Sakurai R, Miura Y, Nakazawa S, Kawatani N, Yazawa T, Yoshikawa R, Narusawa E, Shirabe K. Prognosis of non-small cell lung cancer with postoperative regional lymph node recurrence. Thorac Cancer 2024; 15:859-866. [PMID: 38414316 PMCID: PMC11016435 DOI: 10.1111/1759-7714.15265] [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: 01/03/2024] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Regional lymph node recurrence after radical surgery for non-small cell lung cancer (NSCLC) is an oligo-recurrent disease; however, no treatment strategy has been established. In the present study we aimed to determine the clinical outcomes of postoperative regional lymph node recurrence and identify prognostic predictors in the era of molecular-targeted therapy. METHODS We retrospectively analyzed data on clinical characteristics and outcomes of patients with regional lymph node recurrence after surgery who underwent treatment for NSCLC between 2002 and 2022. RESULTS A total of 53 patients were included in this study. The median time between surgery and detection of recurrence was 1.21 years. Radiotherapy (RT) alone and chemoradiotherapy (CRT) were performed in 38 and six patients, respectively. Driver gene alterations were detected in eight patients (EGFR: 6, ROS1:1, and BRAF: 1) and programmed death-ligand 1 (PD-L1) expression was examined in 22 patients after 2016. Median progression-free survival (PFS) and overall survival (OS) after lymph node recurrences were 1.32 and 4.34 years, respectively. Multiple lymph node recurrence was an independent prognostic factor for PFS, whereas driver gene alteration was the only prognostic factor for OS. There was no significant difference in the OS between patients stratified according to the initial treatment modality for lymph node recurrence. CONCLUSION Our results suggest that the number of tumor recurrences may correlate with PFS, while detection of driver gene alterations could guide decision-making for the appropriate molecular-targeted therapy to achieve longer OS.
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Affiliation(s)
- Yoichi Ohtaki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Division of General Thoracic SurgeryIntegrative Center of General Surgery, Gunma University HospitalMaebashiJapan
| | - Toshiteru Nagashima
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Division of General Thoracic SurgeryIntegrative Center of General Surgery, Gunma University HospitalMaebashiJapan
| | - Naoko Okano
- Gunma University Heavy Ion Medical CenterMaebashiJapan
| | - Nobuteru Kubo
- Gunma University Heavy Ion Medical CenterMaebashiJapan
| | - Takeru Ohtaka
- Department of Radiation OncologyGunma University Graduate School of MedicineMaebashiJapan
| | - Noriaki Sunaga
- Division of Allergy and Respiratory MedicineIntegrative Center of Internal Medicine, Gunma University HospitalMaebashiJapan
| | - Reiko Sakurai
- Division of Allergy and Respiratory MedicineIntegrative Center of Internal Medicine, Gunma University HospitalMaebashiJapan
| | - Yosuke Miura
- Division of Allergy and Respiratory MedicineIntegrative Center of Internal Medicine, Gunma University HospitalMaebashiJapan
| | - Seshiru Nakazawa
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Division of General Thoracic SurgeryIntegrative Center of General Surgery, Gunma University HospitalMaebashiJapan
| | - Natsuko Kawatani
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Division of General Thoracic SurgeryIntegrative Center of General Surgery, Gunma University HospitalMaebashiJapan
| | - Tomohiro Yazawa
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Division of General Thoracic SurgeryIntegrative Center of General Surgery, Gunma University HospitalMaebashiJapan
| | - Ryohei Yoshikawa
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Division of General Thoracic SurgeryIntegrative Center of General Surgery, Gunma University HospitalMaebashiJapan
| | - Eiji Narusawa
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Division of General Thoracic SurgeryIntegrative Center of General Surgery, Gunma University HospitalMaebashiJapan
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Division of General Thoracic SurgeryIntegrative Center of General Surgery, Gunma University HospitalMaebashiJapan
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Takenaka T, Yano T, Yamazaki K, Okamoto T, Hamatake M, Shimokawa M, Mori M. Survival after recurrence following surgical resected non-small cell lung cancer: A multicenter, prospective cohort study. JTCVS OPEN 2022; 10:370-381. [PMID: 36004269 PMCID: PMC9390543 DOI: 10.1016/j.xjon.2022.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/04/2022] [Indexed: 11/27/2022]
Abstract
Objectives The optimal treatment for recurrent non–small cell lung cancer (NSCLC) has not been standardized. In this prospective cohort study, we evaluated post-recurrence survival (PRS) after treatment of recurrent NSCLC and identified prognostic factors after recurrence. Methods This multicenter prospective cohort study was conducted in 14 hospitals. The inclusion criteria for this study were patients with recurrence after radical resection for NSCLC. Information about the patient characteristics at recurrence, tumor-related variables, primary surgery, and treatment for recurrence was collected. After registration, follow-up data, such as treatment and survival outcomes, were obtained every 3 months. Results From 2010 to 2015, 505 cases were enrolled, and 495 cases were analyzed. As initial treatment for recurrence, 263 patients (53%) received chemotherapy, 46 (9%) received chemoradiotherapy, 98 (20%) had definitive radiotherapy, 14 (3%) received palliative radiotherapy, and 31 (6%) underwent surgical resection. The remaining 43 patients (9%) received supportive care. The median PRS and 5-year survival rates for all cases were 30 months and 31.9%, respectively. The median PRS according to the initial treatment was as follows: supportive care, 8 months; palliative radiotherapy, 16 months; definitive radiotherapy, 30 months; chemotherapy, 31 months; chemoradiotherapy, 35 months; and surgery, not reached. A multivariate analysis showed that the age, gender, performance status, histology presence of symptoms, duration from primary surgery to recurrence, and number of recurrent foci were independent prognostic factors for PRS. Conclusions The PRS of patients with recurrent NSCLC was different depending on the patient's background characteristics and initial treatment for recurrence.
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Sonoda D, Matsuura Y, Kondo Y, Ichinose J, Nakao M, Ninomiya H, Nishio M, Okumura S, Satoh Y, Mun M. A Reasonable Definition of Oligo-Recurrence in Non-Small-Cell Lung Cancer. Clin Lung Cancer 2021; 23:82-90. [PMID: 34836824 DOI: 10.1016/j.cllc.2021.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The concept of oligo-recurrence in non-small-cell lung cancer (NSCLC) has been suggested to describe the possibility of achieving long-term survival or even cure with local therapy for recurrence despite having recurrent disease. Oligo-recurrence involves a limited number of metachronous recurrences that can be treated with local therapy. However, the number of recurrences that constitutes an oligo-recurrence has varied among studies and remains to be defined. The aim of this study was to elucidate the number of recurrences that constitutes an oligo-recurrence in NSCLC. PATIENTS AND METHODS We retrospectively reviewed 577 patients with NSCLC who had underwent complete resection and developed recurrence between 1990 and 2009, and these patients were evaluated. Patients were categorized according to the number of recurrences, and postrecurrence survival (PRS) was compared between groups. RESULTS Altogether, 270 patients underwent local therapy for all recurrent lesions. In these patients, sex (female), histological type (adenocarcinoma), gene mutation status, recurrence-free interval <1 year, and presence of 1 or 2 recurrences were factors associated with prolonged PRS. Additionally, all patients who maintained a cancer-free status for at least 5 years after treatment for recurrence and were considered possibly cured, had 1 or 2 recurrences. CONCLUSION Among patients receiving radical local therapy, the PRS was particularly longer among those with 1 or 2 recurrences, and these patients were able to aim for postrecurrence cure. Thus, a reasonable threshold to define oligo-recurrence in NSCLC is 1 or 2 recurrences that can be treated with local therapy.
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Affiliation(s)
- Dai Sonoda
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yosuke Matsuura
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Yasuto Kondo
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Junji Ichinose
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayuki Nakao
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hironori Ninomiya
- Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Makoto Nishio
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yukitoshi Satoh
- Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Jo YY, Kim SS, Song SY, Choi EK. Salvage radiation therapy for postoperative locoregionally recurrent non-small cell lung cancer: a single-center experience. Radiat Oncol J 2021; 39:210-218. [PMID: 34610660 PMCID: PMC8497866 DOI: 10.3857/roj.2021.00696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To determine the effectiveness of salvage radiation therapy (RT) in patients with locoregional recurrence (LRR) following initial curative resection of non-small cell lung cancer (NSCLC) and identify the prognostic factors affecting survival. Materials and Methods Between January 2009 and January 2019, 54 patients with LRR after NSCLC surgery were treated with salvage RT (83.3%) or concurrent chemoradiation therapy (16.7%). Twenty-three (42.6%), 21 (38.9%), and 10 (18.5%) patients had local, regional, and both recurrences, respectively. The median RT dose was 66 Gy (range, 37.5 to 70 Gy). The radiation target volume included recurrent lesions with or without regional lymphatics depending on the location and recurrence type. Results The median follow-up time from the start of RT was 28.3 months (range, 2.4 to 112.4 months) and disease-free interval (DFI) from surgery to recurrence was 21.0 months (range, 0.5 to 92.3 months). Tumor response after RT was complete response, partial response, stable disease, and progressive disease in 17, 29, 5, and 3 patients, respectively. The rates of freedom from local progression at 1 and 2 years were 77.2% and 66.0%, respectively. The median survival duration after RT was 24.8 months, and the 2-year overall survival (OS) rate was 51.1%. On univariate analysis, initial stage, recurrence site, DFI, and tumor response after RT were significant prognostic factors for OS. DFI ≥12 months and tumor response after RT were statistically significant factors on multivariate Cox analysis for OS. Conclusion Our results demonstrated the effectiveness of salvage RT for LRR of NSCLC following curative surgery.
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Affiliation(s)
- Yoon Young Jo
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Si Yeol Song
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Kyung Choi
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Seo YS, Park WY, Kim SW, Kim D, Min BJ, Kim WD. Virtual randomized study comparing lobectomy and particle beam therapy for clinical stage IA non-small cell lung cancer in operable patients. JOURNAL OF RADIATION RESEARCH 2021; 62:884-893. [PMID: 34218277 PMCID: PMC8438263 DOI: 10.1093/jrr/rrab060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/30/2021] [Indexed: 06/13/2023]
Abstract
To the best of our knowledge there have been no randomized controlled trials comparing lobectomy-a standard treatment for patients with early-stage non-small cell lung cancer (NSCLC)-and particle beam therapy (PBT), the best performing existing radiotherapy. We conducted a virtual randomized trial in medically operable patients with stage IA NSCLC to compare lobectomy and PBT effectiveness. A Markov model was developed to predict life expectancy after lobectomy and PBT in a cohort of patients with stage IA NSCLC. Ten thousand virtual patients were randomly assigned to each group. Sensitivity analyses were performed as model variables and scenarios changed to determine which treatment strategy was best for improving life expectancy. All estimated model parameters were determined using variables extracted from a systematic literature review of previously published articles. The preferred strategy differed depending on patient age. In young patients, lobectomy showed better life expectancy than that of PBT. The difference in life expectancy between lobectomy and PBT was statistically insignificant in older patients. Our model predicted lobectomy as the preferred strategy when operative mortality was under 5%. However, the preferred strategy changed to PBT if operative mortality post lobectomy was over 5%. For medically operable patients with stage IA NSCLC, our Markov model revealed the preferred strategy of lobectomy or PBT regarding operative mortality changed with varying age and comorbidity. Until randomized controlled trial results become available, we hope the current results will provide a rationale background for clinicians to decide treatment modalities for patients with stage IA NSCLC.
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Affiliation(s)
- Young-Seok Seo
- Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju 28644, Korea
| | - Woo-Yoon Park
- Department of Radiation Oncology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea
| | - Si-Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea
| | - Dohun Kim
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea
| | - Byung Jun Min
- Corresponding authors: Byung Jun Min, PhD, Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju 28644, Korea. Phone: +82-43-269-6213, Fax: +82-43-269-6208, E-mail: ; Won-Dong Kim, MD, PhD, Department of Radiation Oncology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea. Phone: +82-43-269-6212, Fax: +82-43-269-6208, E-mail:
| | - Won-Dong Kim
- Corresponding authors: Byung Jun Min, PhD, Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju 28644, Korea. Phone: +82-43-269-6213, Fax: +82-43-269-6208, E-mail: ; Won-Dong Kim, MD, PhD, Department of Radiation Oncology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea. Phone: +82-43-269-6212, Fax: +82-43-269-6208, E-mail:
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Nakamura M, Ohnishi K, Ishikawa H, Nakazawa K, Shiozawa T, Okumura T, Sekine I, Sato Y, Hizawa N, Sakurai H. Salvage Photon or Proton Radiotherapy for Oligo-recurrence in Regional Lymph Nodes After Surgery for Non-small Cell Lung Cancer. In Vivo 2021; 34:1883-1892. [PMID: 32606159 DOI: 10.21873/invivo.11984] [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: 03/08/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To evaluate the outcome of definitive salvage radiotherapy (RT) in non-small cell lung cancer (NSCLC) patients with oligo-recurrence in regional lymph nodes after surgery. PATIENTS AND METHODS Between January 2003 and December 2016, 33 patients with NSCLC were reviewed from radiotherapy database at our hospital. All patients received photon or proton salvage RT for metastases in the regional lymph nodes. RESULTS The median follow-up from salvage RT was 35.2 (range=5.9-89.6) months. Recurrences occurred in 18 (55%) patients, and the 3-year overall and progression-free survival rates were 63.8% and 45.1%, respectively. Regional and local control improved patients' survival and these control rates were increased by use of concurrent chemotherapy (p=0.039) and proton RT (p=0.084). No grade 4 acute or late non-hematologic toxicities were observed. CONCLUSION Salvage RT is an effective treatment for NSCLC patients with oligo-recurrence at regional lymph nodes.
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Affiliation(s)
- Masatoshi Nakamura
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kayoko Ohnishi
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hitoshi Ishikawa
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kensuke Nakazawa
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Toshihiro Shiozawa
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Ikuo Sekine
- Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yukio Sato
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Nobuyuki Hizawa
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Moore S, Leung B, Wu J, Ho C. Survival Outcomes of Salvage Therapy for Local and Regionally Recurrent NSCLC. JTO Clin Res Rep 2020; 1:100083. [PMID: 34589962 PMCID: PMC8474440 DOI: 10.1016/j.jtocrr.2020.100083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/27/2020] [Accepted: 08/08/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction The treatment of locally recurrent NSCLC after initial curative therapy is variable. We sought to perform a real-world analysis of curative and palliative therapeutic strategies used in locally recurrent NSCLC and explore the impact of baseline factors and the previous and recurrent treatment on outcomes. Methods A retrospective cohort study was done including all patients with stage I to III NSCLC who were referred to BC Cancer and received curative-intent therapy between 2005 and 2012. Patients were followed up to determine whether they developed locoregional recurrence. Two cohorts were created: curative-intent treatment at recurrence (surgery, radiotherapy with ≥50Gy ± chemotherapy, stereotactic radiosurgery) and palliative treatment. The primary outcome was overall survival (OS). Results A total of 1571 patients received curative-intent therapy during the study period. Of these, 179 (11%) developed a local and regional recurrence. A total of 51 patients (28%) were treated with curative intent at recurrence (12 surgery, 39 radiotherapy ± chemotherapy), and 128 (72%) received palliative treatment only. Patients receiving curative-intent therapy were more likely to have an Eastern Cooperative Oncology Group performance status of 0 to 1 (90% versus 58%), earlier stage at diagnosis (51% stage I) and receive more aggressive staging investigations at recurrence, pathologic confirmation (75% versus 27%) and positron emission tomography (77% versus 27%). OS was longer in the cohort receiving curative-intent therapy, with an OS of 34.3 months versus 9.8 months (p < 0.001) in palliative treatment. Conclusions In this real-world population, isolated locoregional recurrences occurred in 11% of patients. Curative-intent treatment at recurrence is associated with a reasonable chance of long-term survival, making aggressive therapy of locoregional recurrences an important treatment consideration.
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Affiliation(s)
- Sara Moore
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Bonnie Leung
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Jonn Wu
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Radiation Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Cheryl Ho
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
- Corresponding author. Address for correspondence: Cheryl Ho, MD, FRCPC, BC Cancer, 600 W 10th Avenue, Vancouver, BC V5Z 4E6, Canada.
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Tjong MC, Malik NH, Chen H, Boldt RG, Li G, Cheung P, Poon I, Ung YC, Tsao M, Louie AV. Stereotactic ablative radiotherapy for malignant mediastinal and hilar lymphadenopathy: a systematic review. J Thorac Dis 2020; 12:2280-2287. [PMID: 32642133 PMCID: PMC7330368 DOI: 10.21037/jtd.2020.03.112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Stereotactic ablative radiotherapy (SABR) safety and efficacy for mediastinal and hilar lymphadenopathy (MHL) is not yet established, given its potential for toxicity due to the proximity to esophagus and proximal bronchial tree (PBT). This review summarized current reported outcomes of MHL SABR. Methods This systematic review, based on the PRISMA guidelines, was performed using MEDLINE® (PubMed®), EMBASE and Cochrane Library databases from inception until December 2018. Studies reporting outcomes from SABR specifically for MHL from all primary malignancies were included. Non- English studies, guidelines, reviews, non-peer reviewed correspondences were excluded. Only the most recent publication and/or largest cohort from a single institution would be included for analysis. Results From the 222 studies identified, 4 retrospective studies totaling 196 patients were included in the analysis. One study included a small number of patients receiving non-ablative doses of stereotactic radiotherapy (RT). Non-small cell lung cancer (NSCLC) was the most common primary (65%), followed by breast (8%). Median follow-up ranged between 12 and 32 months. Reported dose and fractionation ranged from 21 to 60 Gy in 3–11 fractions, with median BED10 ranged from 46–106 Gy10. Three studies reported local control (LC) rates: study 1, 97% (1-year) and 77% (5-year); study 4, 88% (2-year); and study 2, 69% (6-month) and 66% (16-month). Pooled grade 3–5 toxicity rate according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0 was 6% (n=11). Pooled SABR-related mortality (grade 5 toxicity) rate was 2% (n=4). Three SABR-related deaths from esophageal fistulae (2 to trachea, 1 to mediastinum) were reported, with all 3 having prior RT to the subcarinal nodes. Conclusions Our review suggested SABR for MHL to be feasible and effective, though there is a potential for serious toxicity especially in the re-irradiation scenario. Multi-institutional and/or prospective studies will help determine the therapeutic benefit of SABR in this high-risk treatment scenario.
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Affiliation(s)
- Michael C Tjong
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Nauman H Malik
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.,Department of Radiation Oncology, London Health Sciences Centre, London, ON N6A 4L6, Canada
| | - R Gabriel Boldt
- Department of Radiation Oncology, London Health Sciences Centre, London, ON N6A 4L6, Canada
| | - George Li
- Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON M5S 1A8, Canada
| | - Patrick Cheung
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Yee C Ung
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - May Tsao
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
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Shirai K, Kubota Y, Ohno T, Saitoh JI, Abe T, Mizukami T, Mori Y, Kawamura H, Akahane K, Nakano T. Carbon-ion Radiotherapy for Isolated Lymph Node Metastasis After Surgery or Radiotherapy for Lung Cancer. Front Oncol 2019; 9:731. [PMID: 31448233 PMCID: PMC6692658 DOI: 10.3389/fonc.2019.00731] [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] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/22/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose: Mediastinal and hilar lymph node metastasis is one of the recurrence patterns after definitive treatment of lung cancer. Salvage radiotherapy (RT) can be a treatment option for lymph node metastasis. However, the usefulness of additional RT remains unclear after surgery or RT for the primary lung tumor. We retrospectively evaluated the efficacy and safety of hypofractionated carbon-ion RT for isolated lymph node metastasis. Methods and Materials: Between April 2013 and August 2016, 15 consecutive patients with isolated lymph node metastasis underwent carbon-ion RT. The pretreatment evaluations confirmed the isolated lymph node metastasis and the absence of local recurrence or distant metastasis, which was oligometastatic disease. The median age was 72 (range, 51-83) years, with 11 male patients. The first treatments for primary lung tumors were carbon-ion RT for 8 patients and surgery for 7 patients. There were 9 adenocarcinomas, 4 squamous cell carcinomas, 1 adenosquamous cell carcinoma, and 1 mucoepidermoid carcinoma. Most patients (93%) were irradiated with 52.8 Gy relative biological effectiveness in 12 fractions for 3 weeks. There were no patients treated with concurrent or adjuvant therapy such as chemotherapy, molecular-targeted therapy, or immunotherapy. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Events (version 4.0). Results: The median follow-up for surviving patients was 28 months. One patient experienced local lymph node recurrence, and the 2-year local control rate was 92% for all patients. Distant metastasis was observed in 7 patients, and 2-year progression-free survival rate was 47%. During follow-up, there were 4 deaths from lung cancer, and the 2-year overall survival rate was 75%. There were 2 patients with acute grade 2 esophagitis and 2 with late grade 2 cough, which were improved by conservative therapy. There were no other grade 2 or higher adverse events. Conclusions: Hypofractionated carbon-ion RT showed excellent local control and overall survival without severe toxicities in lung cancer patients with isolated lymph node metastasis after surgery or carbon-ion RT for primary lung tumors. A multi-institutional prospective study is required to establish the efficacy and safety of carbon-ion RT.
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Affiliation(s)
- Katsuyuki Shirai
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.,Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Yoshiki Kubota
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Jun-Ichi Saitoh
- Department of Radiation Oncology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Takanori Abe
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Tatsuji Mizukami
- Department of Radiation Oncology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yasumasa Mori
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | | | - Keiko Akahane
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takashi Nakano
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
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Seo YS, Kim HJ, Wu HG, Choi SM, Park S. Lobectomy versus stereotactic ablative radiotherapy for medically operable patients with stage IA non-small cell lung cancer: A virtual randomized phase III trial stratified by age. Thorac Cancer 2019; 10:1489-1499. [PMID: 31124275 PMCID: PMC6558457 DOI: 10.1111/1759-7714.13103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although the choice between stereotactic ablative radiotherapy (SABR) and lobectomy for early-stage non-small cell lung cancer (NSCLC) has been debated for years, the two procedures have not yet been directly compared in a randomized trial. We conducted a virtual randomized phase III trial stratified by age to compare the effectiveness of lobectomy and SABR for medically operable patients with stage IA (AJCC eighth) NSCLC using the Markov model analysis. METHODS A Markov model was developed to simulate a cohort of patients aged 45-85 years with stage IA NSCLC who had undergone either lobectomy or SABR and were followed up for their remaining lifetime. Each virtual patient was randomly assigned to undergo lobectomy or SABR, and 10 000 patients were allocated to each group. All estimates of the variables were obtained by a systematic review of published articles. RESULTS The lobectomy group showed a better life expectancy than the SABR group, in patients under 75 years of age. However, no statistically significant difference was seen in patients 75 years or older. The predicted life expectancy was 9.43 and 8.70 years in 75-year-old patients in the lobectomy and SABR groups, respectively. However, the 95%CI for the difference in life expectancy between the two groups was - 0.06-1.50 years (P = 0.0689). CONCLUSIONS The Markov model showed no statistically significant difference in the expected overall survival in stage IA NSCLC patients who were older than 75 years and had undergone SABR or lobectomy.
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Affiliation(s)
- Young-Seok Seo
- Department of Radiation Oncology, ChungBuk National University Hospital, Chungcheongbuk-do, Republic of Korea.,Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiation Oncology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hong Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiation Oncology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Mi Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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11
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Nicosia L, Agolli L, Reverberi C, De Sanctis V, Marinelli L, Minniti G, Di Muzio J, Valeriani M, Osti MF. Salvage radiotherapy with simultaneous integrated boost in non small-cell lung cancer patients with mediastinal relapse after surgery: a pilot study. Radiat Oncol 2018; 13:207. [PMID: 30352607 PMCID: PMC6199747 DOI: 10.1186/s13014-018-1155-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 10/11/2018] [Indexed: 12/25/2022] Open
Abstract
Background The aim of our study was to evaluate feasibility, toxicity profile and local control of salvage intensity modulated radiotherapy (IMRT) delivered with simultaneous integrated boost (SIB) associated or not to concomitant weekly cisplatin in patients affected by NSCLC with mediastinal nodal recurrence after surgery. Patterns of recurrence, outcomes and prognostic factors were assessed. Methods Fourteen consecutive patients received 25 fractions of 50Gy/2Gy to the elective nodal stations and boost up to 62.5Gy/2.5Gy to the macroscopic lymph node metastases. Concomitant weekly cisplatin (40 mg/m2) was administered to 8 (57.1%) patients. Results Five (35.7%) patients experienced grade 2 pneumonitis and 5 (35.7%) patients had grade 2 esophagitis. One case of grade 3 pneumonitis occurred and was successfully treated with antibiotics and steroids with no sequelae. No patient recurred locally in the boost volume (local control 100%). Loco-regional control was 79% with 3 patients that developed nodal recurrence principally marginal to the elective volume. Seven patients developed distant metastases. Median PFS was 7 months. The nodal involvement of station 7 was associated to a significantly lower median metastasis-free survival (4 months vs. not reached, p = 0.036). Conclusions Salvage radiotherapy with IMRT-SIB is a feasible and a well-tolerated treatment option for mediastinal recurrent NSCLC after surgery. The role of more intensified radiation regimens and association to systemic therapy remain to be evaluated in larger cohorts.
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Affiliation(s)
- L Nicosia
- Department of Radiation Oncology, Sant'Andrea Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
| | - L Agolli
- Department of Radiation Oncology, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - C Reverberi
- Department of Radiation Oncology, Sant'Andrea Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - V De Sanctis
- Department of Radiation Oncology, Sant'Andrea Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - L Marinelli
- Department of Radiation Oncology, Sant'Andrea Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - G Minniti
- Radiation Oncology Unit, UPMC Hillman Cancer Center, San Pietro Hospital, Rome, Italy.,IRCCS Neuromed, Pozzilli (IS), Italy
| | - J Di Muzio
- Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy
| | - M Valeriani
- Department of Radiation Oncology, Sant'Andrea Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - M F Osti
- Department of Radiation Oncology, Sant'Andrea Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy
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12
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Manabe Y, Shibamoto Y, Baba F, Yanagi T, Iwata H, Miyakawa A, Murai T, Okuda K. Definitive radiotherapy for hilar and/or mediastinal lymph node metastases after stereotactic body radiotherapy or surgery for stage I non-small cell lung cancer: 5-year results. Jpn J Radiol 2018; 36:719-725. [DOI: 10.1007/s11604-018-0776-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/10/2018] [Indexed: 12/25/2022]
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13
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Lee KH, Ahn YC, Pyo H, Noh JM, Park SG, Kim TG, Lee E, Nam H, Lee H, Sun JM, Ahn JS, Ahn MJ, Park K. Salvage Concurrent Chemo-radiation Therapy for Loco-regional Recurrence Following Curative Surgery of Non-small Cell Lung Cancer. Cancer Res Treat 2018; 51:769-776. [PMID: 30205417 PMCID: PMC6473287 DOI: 10.4143/crt.2018.366] [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: 06/17/2018] [Accepted: 09/05/2018] [Indexed: 12/15/2022] Open
Abstract
Purpose This study is to report clinical outcomes of salvage concurrent chemo-radiation therapy (CCRT) in treating patients with loco-regional recurrence (LRR) following initial complete resection of non-small cell lung cancer. Materials and Methods Between February 2004 and December 2016, 127 patients underwent salvage CCRT for LRR. The median radiation therapy (RT) dose was 66 Gy and clinical target volume was to cover recurrent lesion with margin without elective inclusion of regional lymphatics. Majority of patients (94.5%) received weekly platinum-based doublet chemotherapy during RT course. Results The median follow-up time from the start of CCRT was 25 months. The median survival duration was 49 months, and overall survival (OS) rates at 2 and 5 years were 72.9% and 43.9%. The 2- and 5-year rates of in-field failure-free survival, distant metastasis free survival, and progression free survival were 82.4% and 73.8%, 50.4% and 39.9%, and 34.6% and 22.3%, respectively. Grade ≥ 3 radiation-related esophagitis and pneumonitis occurred in 14 (11.0%) and six patients (4.7%), respectively. On both univariate and multivariate analysis, higher biologically equivalent dose (BED10) (≥ 79.2 Gy10 vs. < 79.2 Gy10; hazard ratio [HR], 0.431), smaller CTV (≤ 80 cm3 vs. > 80 cm3; HR, 0.403), and longer disease-free interval (> 1 year vs. ≤ 1 year; HR, 0.489) were significantly favorable factors for OS. Conclusion The current study has demonstrated that high dose salvage CCRT focused to the involved lesion only was highly effective and safe. In particular, higher BED10, smaller CTV, and longer disease-free interval were favorable factors for improved survival.
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Affiliation(s)
- Kyung Hwa Lee
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hongryull Pyo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Gyu Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Gyu Kim
- Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Eonju Lee
- Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Heerim Nam
- Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyebin Lee
- Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Mu Sun
- Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keunchil Park
- Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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