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Qi RZ, He SL, Li Y, Zhao YW, Geng L, He J, Cheng MQ, Hu JQ, Li CH, Hua BJ. Retrospective Clinical Study on Integrated Chinese and Western Medicine in Treatment of Limited-Stage Small Cell Lung Cancer. Chin J Integr Med 2023:10.1007/s11655-022-3682-9. [PMID: 36607585 DOI: 10.1007/s11655-022-3682-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate the efficacy of integrated Chinese and Western medicine extending the progression-free survival (PFS) and overall survival (OS) of limited-stage small cell lung cancer (LS-SCLC) patients after the first-line chemoradiotherapy. METHODS The data of 67 LS-SCLC patients who received combined treatment of CM and Western medicine (WM) between January 2013 and May 2020 at the outpatient clinic of Guang'anmen Hospital were retrospectively analyzed. Thirty-six LS-SCLC patients who received only WM treatment was used as the WM control group. The medical data of the two groups were statistically analyzed. Survival analysis was performed using the product-limit method (Kaplan-Meier analysis). The median OS and PFS were calculated, and survival curves were compared by the Log rank test. The cumulative survival rates at 1, 2, and 5 years were estimated by the life table analysis. Stratified survival analysis was performed between patients with different CM administration time. RESULTS The median PFS in the CM and WM combination treatment group and the WM group were 19 months (95% CI: 12.357-25.643) vs. 9 months (95% CI: 5.957-12.043), HR=0.43 (95% CI: 0.27-0.69, P<0.001), respectively. The median OS in the CM and WM combination group and the WM group were 34 months (95% CI could not be calculated) vs. 18.63 months (95% CI: 16.425-20.835), HR=0.40 (95% CI: 0.24-0.66, P<0.001), respectively. Similar results were obtained in the further stratified analysis of whether the duration of CM administration exceeded 18 and 24 months (P<0.001). CONCLUSION The combination treatment of CM and WM with continuing oral administration of CM treatment after the first-line chemoradiotherapy for LS-SCLC patients produced better prognosis, lower risks of progression, and longer survival than the WM treatment alone. (Registration No. ChiCTR2200056616).
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Affiliation(s)
- Run-Zhi Qi
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing, 100053, China
| | - Shu-Lin He
- Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yue Li
- Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yu-Wei Zhao
- Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Liang Geng
- Department of Integrated Traditional Chinese and Western Medicine Oncology, Henan Cancer Hospital, Zhengzhou, 100053, China
| | - Jie He
- Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Meng-Qi Cheng
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing, 100053, China
| | - Jia-Qi Hu
- Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Cong-Huang Li
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing, 100053, China.
| | - Bao-Jin Hua
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing, 100053, China
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Qiu J, Ke D, Yu Y, Lin H, Zheng Q, Li H, Zheng H, Liu L, Wang Z, Wu Y, Liu T, Li J. A New Nomogram and Risk Stratification of Brain Metastasis by Clinical and Inflammatory Parameters in Stage III Small Cell Lung Cancer Without Prophylactic Cranial Irradiation. Front Oncol 2022; 12:882744. [PMID: 35875127 PMCID: PMC9300937 DOI: 10.3389/fonc.2022.882744] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background This study was conducted to determine risk factors for developing brain metastasis (BM) and to predict brain metastasis free survival (BMFS) and overall survival (OS) by combining several clinical parameters and inflammatory indexes. Materials and Methods A nomogram and risk stratification were developed based on multivariate analysis results. The prognostic index (PI) predicting the high risk of BM was calculated by multiplying the weighted factor (β coefficient) with each variable. Results Thirty-two of one hundred patients (32.0%) developed BM. Multivariate cox regression analysis revealed that concurrent chemoradiotherapy (CCRT; hazard ratio (HR), 3.356; p = 0.020), monocyte–lymphocyte ratio (MLR; HR, 4.511; p = 0.002), neutrophil–lymphocyte ratio (NLR; HR, 4.023; p = 0.033), and prognostic-nutrition index (PNI; HR, 2.902; p = 0.018) were independent prognostic factors of BMFS. The nomogram has good accuracy in predicting BMFS, and the C-index was 0.73. The ROC curve showed that these risk factors have good discriminant ability. Similarly, tumor location (HR, 1.675; p = 0.035) and MLR (HR, 2.076; p = 0.013) were independent prognostic factors of OS. In the subgroup analysis of OS, the good group had a better prognosis than the other groups. Risk stratification by PI: the high-risk group had worse BMFS than the low-risk group, which also has certain practical significance for clinical practice in OS. Conclusion We developed a nomogram and corresponding risk stratification in stage III SCLC patients who developed BM. This model and risk stratification can help clinicians improve patient treatment management and better deliver personalized therapy.
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Li L, Pi C, Yan X, Lu J, Yang X, Wang C, Li X, Zhang S, Zhang Z, Sun Y, Hu Y. Prognostic Value of the Pretreatment Lung Immune Prognostic Index in Advanced Small Cell Lung Cancer Patients Treated With First-Line PD-1/PD-L1 Inhibitors Plus Chemotherapy. Front Oncol 2021; 11:697865. [PMID: 34692478 PMCID: PMC8531596 DOI: 10.3389/fonc.2021.697865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/20/2021] [Indexed: 01/11/2023] Open
Abstract
Background Lung immune prognostic index (LIPI) refers to a biomarker combining derived neutrophil-to-lymphocyte ratio (dNLR) and lactate dehydrogenase (LDH). Its prognostic effect on advanced small cell lung cancer (SCLC) patients receiving programmed cell death 1/programmed cell death ligand-1 (PD-1/PD-L1) inhibitors plus chemotherapy as first-line treatment remains unclear. Our research investigated the relationship between pretreatment LIPI and the prognosis of patients receiving first-line PD-1/PD-L1 inhibitors plus chemotherapy. Methods Advanced SCLC patients receiving PD-1/PD-L1 inhibitors plus chemotherapy as first-line treatment from Jan 2015 to Oct 2020 were included. Based on the values of dNLR and LDH, the study population was divided into two groups: LIPI good and LIPI intermediate/poor. The Kaplan-Meier method was used to compute the median survival time and the log-rank test was used to compare the two groups. Univariate and multivariate analyses were used to examine the correlation between the pretreatment LIPI and clinical outcomes. Results One hundred patients were included in this study, of which, 64% were LIPI good (dNLR < 4.0 and LDH < 283 U/L), 11% were LIPI poor (dNLR ≥ 4.0 and LDH ≥ 283 U/L), and the remaining 25% were LIPI intermediate. The LIPI good group had better progression-free survival (PFS) (median: 8.4 vs 4.7 months, p = 0.02) and overall survival (OS) (median: 23.8 vs 13.3 months, p = 0.0006) than the LIPI intermediate/poor group. Multivariate analysis showed that pretreatment LIPI intermediate/poor was an independent risk factor for OS (HR: 2.34; 95%CI, 1.13, 4.86; p = 0.02). Subgroup analysis showed that pretreatment LIPI good was associated with better PFS and OS in males, extensive disease (ED), PD-1 inhibitor treatment, smokers, and liver metastasis (p < 0.05). Conclusions Pretreatment LIPI could serve as a prognostic biomarker for advanced SCLC patients receiving first-line PD-1/PD-L1 inhibitors plus chemotherapy.
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Affiliation(s)
- Lingling Li
- School of Medicine, Nankai University, Tianjin, China.,Department of Oncology, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Chenghui Pi
- School of Medicine, Nankai University, Tianjin, China
| | - Xin Yan
- School of Medicine, Nankai University, Tianjin, China
| | - Jiangyue Lu
- Department of Further Education, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xuhui Yang
- Department of Oncology, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Chunyu Wang
- Department of Oncology, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xiaoyan Li
- Department of Oncology, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Sujie Zhang
- Department of Oncology, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhibo Zhang
- Department of Cardiothoracic Surgery, The 78th Group Army Hospital of Chinese PLA, Mudanjiang, China
| | - Yi Sun
- State Key Laboratory of Transducer Technology, Shanghai Institute of Microsystem and Information Technology, Chinese Academy of Sciences, Shanghai, China
| | - Yi Hu
- School of Medicine, Nankai University, Tianjin, China.,Department of Oncology, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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Sonehara K, Tateishi K, Komatsu M, Yamamoto H, Hanaoka M. Lung immune prognostic index as a prognostic factor in patients with small cell lung cancer. Thorac Cancer 2020; 11:1578-1586. [PMID: 32286017 PMCID: PMC7262905 DOI: 10.1111/1759-7714.13432] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/24/2022] Open
Abstract
Background The lung immune prognostic index (LIPI) is a marker that combines the derived neutrophil‐to‐lymphocyte ratio (dNLR) and serum lactate dehydrogenase (LDH) level and is a recently reported prognostic factor of immune checkpoint inhibitor therapy for non‐small cell lung cancer (NSCLC). However, there are no reports regarding the prognostic value of LIPI in small cell lung cancer (SCLC). Methods We retrospectively enrolled 171 patients diagnosed with SCLC and treated at Shinshu University School of Medicine between January 2003 and November 2019. Progression‐free survival (PFS) and overall survival (OS) were compared according to LIPI, and we investigated whether LIPI could be a prognostic factor in SCLC using the Kaplan‐Meier method and univariate and multivariate Cox models. Results The median OS of the LIPI 0 group was significantly longer than that of the LIPI 1 plus 2 group (21.0 vs. 11.6 months, P < 0.001). The multivariate analysis associated with OS indicated that LIPI 1 plus 2 was an independent unfavorable prognostic factor in addition to poor performance status (2–3), old age (≥ 75 years) and stage (extensive disease [ED]). However, PFS of the LIPI 0 group was not significantly different from that of the LIPI 1 plus 2 group. In ED‐SCLC patients, the median PFS and OS of the LIPI 0 group were significantly longer than those of the LIPI 2 group (6.6 vs. 4.0 months, P = 0.006 and 17.1 vs. 5.9 months, P < 0.001, respectively). Conclusions We confirmed the prognostic value of LIPI in SCLC, especially ED‐SCLC. Key points Significant findings of the study: The present study is the first to demonstrate that pretreatment lung immune prognostic index is an independent prognostic factor associated with overall survival for small cell lung cancer. What this study adds: The utility of the lung immune prognostic index as a prognostic factor for small cell lung cancer.
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Affiliation(s)
- Kei Sonehara
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan
| | - Kazunari Tateishi
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan
| | - Masamichi Komatsu
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan
| | - Hiroshi Yamamoto
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan
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Guan Y, Zhang X. Determination of Risk Factors Related to Supraclavicular Recurrence for Limited-Stage Small Cell Lung Cancer (SCLC) Patients. Med Sci Monit 2019; 25:4968-4973. [PMID: 31273183 PMCID: PMC6626499 DOI: 10.12659/msm.916279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This research aimed to determine high-risk factors of supraclavicular recurrence for limited-stage small cell lung cancer (LS-SCLC) patients to discover a potential subpopulation that can benefit from prophylactic supraclavicular irradiation (PSCI). MATERIAL AND METHODS Between July 2006 and July 2011, LS-SCLC patients without supraclavicular lymph node (SCLN) involvement consecutively treated with concurrent chemo-radiation but without PSCI in the Radiotherapy Department of the Cancer Institute and Hospital of Tianjin Medical University, were retrospectively analyzed. SCLN recurrence rate, overall survival (OS), and distant metastasis-free survival (DMFS) were assessed. Binary logistic regression analysis was conducted to discover the high-risk factors related to the SCLN recurrence. The receiver operating characteristic (ROC) curves were drawn to evaluate logistic regression model prediction performance. RESULTS Eighty-eight LS-SCLC patients were analyzed in this study. During 99 months (ranging from 72 months to 124 months) for survivors, 28 (31.8%) had SCLN recurrence. There were significant differences for median DMFS and OS between LS-SCLC patients with and without SCLN recurrence. The logistic regression model revealed that lymphadenopathy at mediastinal level 2 and level 3 prior to chemotherapy were significantly associated with SCLN recurrence, which was validated by ROC. CONCLUSIONS Lymphadenopathy at mediastinal level 2 and level 3 prior to chemotherapy were the high-risk factors associated with SCLN recurrence for patients with LS-SCLC. Further work is needed to determine whether patients with these factors can benefit from PSCI.
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Affiliation(s)
- Yong Guan
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin Clinical Research Center for Cancer, Tianjin, China (mainland)
| | - Ximei Zhang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin Clinical Research Center for Cancer, Tianjin, China (mainland)
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Manoharan P, Salem A, Mistry H, Gornall M, Harden S, Julyan P, Locke I, McAleese J, McMenemin R, Mohammed N, Snee M, Woods S, Westwood T, Faivre-Finn C. 18F-Fludeoxyglucose PET/CT in SCLC: Analysis of the CONVERT Randomized Controlled Trial. J Thorac Oncol 2019; 14:1296-1305. [PMID: 31002954 PMCID: PMC6616906 DOI: 10.1016/j.jtho.2019.03.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/14/2019] [Accepted: 03/17/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION We used phase-3 CONVERT trial data to investigate the impact of fludeoxyglucose F 18 (18F-FDG) positron emission tomography (PET)/computed tomography (CT) in SCLC. METHODS CONVERT randomized patients with limited-stage SCLC to twice-daily (45 Gy in 30 fractions) or once-daily (66 Gy in 33 fractions) chemoradiotherapy. Patients were divided into two groups in this unplanned analysis: those staged with conventional imaging (contrast-enhanced thorax and abdomen CT and brain imaging with or without bone scintigraphy) and those staged with 18F-FDG PET/CT in addition. RESULTS Data on a total of 540 patients were analyzed. Compared with patients who underwent conventional imaging (n = 231), patients also staged with 18F-FDG PET/CT (n = 309) had a smaller gross tumor volume (p = 0.003), were less likely to have an increased pretreatment serum lactate dehydrogenase level (p = 0.035), and received more chemotherapy (p = 0.026). There were no significant differences in overall (hazard ratio = 0.87, 95% confidence interval: 0.70-1.08, p = 0.192) and progression-free survival (hazard ratio = 0.87, 95% confidence interval: 0.71-1.07], p = 0.198) between patients staged with or without 18F-FDG PET/CT. In the conventional imaging group, we found no survival difference between patients staged with or without bone scintigraphy. Although there were no differences in delivered radiotherapy dose, 18F-FDG PET/CT-staged patients received lower normal tissue (lung, heart, and esophagus) radiation doses. Apart from a higher incidence of late esophagitis in patients staged with conventional imaging (for grade ≥1, 19% versus 11%; [p = 0.012]), the incidence of acute and late radiotherapy-related toxicities was not different between the two groups. CONCLUSION In CONVERT, survival outcomes were not significantly different in patients staged with or without 18F-FDG PET/CT. However, this analysis cannot support the use or omission of 18F-FDG PET/CT owing to study limitations.
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Affiliation(s)
- Prakash Manoharan
- Department of Radiology, The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Department of Nuclear Medicine, The Christie National Health Service Foundation Trust, Manchester, United Kingdom.
| | - Ahmed Salem
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom; Department of Clinical Oncology, The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Hitesh Mistry
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom; Division of Pharmacy, University of Manchester, Manchester, United Kingdom
| | - Michael Gornall
- Department of Nuclear Medicine, The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Susan Harden
- Department of Clinical Oncology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Peter Julyan
- Department of Nuclear Medicine, The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Imogen Locke
- Department of Clinical Oncology, The Royal Marsden National Health Service Foundation Trust, Surrey, United Kingdom
| | - Jonathan McAleese
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, United Kingdom
| | - Rhona McMenemin
- Department of Clinical Oncology, Northern Centre for Cancer Care, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Nazia Mohammed
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Michael Snee
- Department of Clinical Oncology, Leeds Cancer Centre, St James's Hospital, Leeds, United Kingdom
| | - Sarah Woods
- Department of Nuclear Medicine, Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Thomas Westwood
- Department of Radiology, The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Department of Nuclear Medicine, The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom; Department of Clinical Oncology, The Christie National Health Service Foundation Trust, Manchester, United Kingdom
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Shirasawa M, Fukui T, Kusuhara S, Hiyoshi Y, Ishihara M, Kasajima M, Nakahara Y, Otani S, Igawa S, Yokoba M, Mitsufuji H, Kubota M, Katagiri M, Sasaki J, Naoki K. Prognostic significance of the 8th edition of the TNM classification for patients with extensive disease small cell lung cancer. Cancer Manag Res 2018; 10:6039-6047. [PMID: 30538553 PMCID: PMC6252783 DOI: 10.2147/cmar.s181789] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Small cell lung cancer (SCLC) is typically categorized according to disease extent as limited or extensive, and utility of the 8th TNM classification, recommended for lung cancer staging, which demonstrates a strong association with non-small-cell lung cancer (NSCLC) management, remains unclear. Methods This retrospective study included 277 consecutive SCLC patients treated at a single institution between 2008 and 2016. Results According to the currently used two-stage system, 186 (65.7%) of the patients were classified as having extensive disease (ED)-SCLC. Among the ED-SCLC patients, ten (5.3%), 38 (20.4%), 32 (17.2%), and 106 (57.0%) were categorized into stages M0, M1a, M1b, and M1c, respectively, according to the 8th TNM classification. There was a significant difference in overall survival based on the M descriptors: 15.8 (95% CI 9.4–22.2) months in the M1b group vs 7.3 (95% CI 5.7–8.9) months in the M1c group (P<0.001). Multivariate analysis showed that in addition to the known prognostic factors such as performance status, serum albumin, and lactate dehydrogenase, M descriptor was a prognostic factor (HR 1.95, 95% CI 1.38–2.77; P<0.001). Conclusion The 8th TNM classification has a prognostic value in SCLC. Similarly to NSCLC, treatment approaches should be considered on the basis of the 8th TNM classification, especially stage IVA separate from stage IVB in ED-SCLC patients.
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Affiliation(s)
- Masayuki Shirasawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Tomoya Fukui
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Seiichiro Kusuhara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Yasuhiro Hiyoshi
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Mikiko Ishihara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Masashi Kasajima
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Yoshiro Nakahara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Sakiko Otani
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Satoshi Igawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Masanori Yokoba
- Department of Medical Laboratory, Kitasato University School of Allied Health Sciences, Kanagawa, Japan
| | - Hisashi Mitsufuji
- Fundamental Nursing, Kitasato University School of Nursing, Kanagawa, Japan
| | - Masaru Kubota
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Masato Katagiri
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kanagawa, Japan
| | - Katsuhiko Naoki
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
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Zhao S, Zhou T, Ma S, Zhao Y, Zhan J, Fang W, Yang Y, Hou X, Zhang Z, Chen G, Zhang Y, Huang Y, Zhang L. Effects of thoracic radiotherapy timing and duration on progression-free survival in limited-stage small cell lung cancer. Cancer Med 2018; 7:4208-4216. [PMID: 30019533 PMCID: PMC6143999 DOI: 10.1002/cam4.1616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/23/2018] [Accepted: 05/25/2018] [Indexed: 12/22/2022] Open
Abstract
Concurrent chemoradiotherapy (CRT) has been recommended and applied widely as the standard treatment for limited‐stage small cell lung cancer (LS‐SCLC). However, controversies remain regarding the optimal timing and treatment duration of thoracic radiotherapy (TRT), and their effects on patient survival. To evaluate prognostic values of TRT timing and duration on progression‐free survival (PFS) in LS‐SCLC and their dependence on TRT fractionation and clinicopathological characteristics, we retrospectively analyzed 197 LS‐SCLC patients receiving CRT from 2000 to 2016 at Sun Yat‐sen University Cancer Center. Based on the optimal cut‐off values of TRT timing and duration generated by Cutoff Finder, patients were divided into early TRT/late TRT group and short TRT/long TRT group respectively. Univariate and multivariate Cox analysis were performed to assess correlations of TRT timing, duration, fractionation, and clinicopathological characteristics with PFS. Univariate analysis revealed that early‐initiated TRT (P = 2.54 × 10−4) and short TRT (P = .001) significantly correlated with longer PFS. Their PFS benefits persisted in patients receiving hyperfractionated TRT and etoposide‐cisplatin (EP) chemotherapy, but were less prominent in those receiving once‐daily TRT and non‐EP chemotherapy. Multivariate analysis further identified early initiated TRT (P = .004) and short TRT (P = .017) as independent prognostic factors for longer PFS in LS‐SCLC. Our study confirmed that early‐initiated TRT and short TRT had positive prognostic roles in LS‐SCLC, especially in patients receiving hyperfractionated TRT and etoposide‐cisplatin chemotherapy. TRT fractionation was not an independent prognostic factor in LS‐SCLC.
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Affiliation(s)
- Shen Zhao
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Ting Zhou
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shuxiang Ma
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yuanyuan Zhao
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jianhua Zhan
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wenfeng Fang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yunpeng Yang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xue Hou
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhonghan Zhang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Gang Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yaxiong Zhang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yan Huang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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9
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Chen Y, Li J, Zhang Y, Hu Y, Zhang G, Yan X, Lin Z, Zhao Z, Jiao S. Early versus late prophylactic cranial irradiation in patients with extensive small cell lung cancer. Strahlenther Onkol 2018; 194:876-885. [DOI: 10.1007/s00066-018-1307-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 04/23/2018] [Indexed: 01/08/2023]
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10
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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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Aktan M, Koc M, Kanyilmaz G, Yavuz BB. Prognostic value of pre-treatment 18F-FDG-PET uptake in small-cell lung cancer. Ann Nucl Med 2017; 31:462-468. [PMID: 28516335 DOI: 10.1007/s12149-017-1178-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/12/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Small-cell lung cancer (SCLC) is an aggressive disease, despite an initially favorable response to treatment, and its prognosis is still poor. Multiple parameters have been studied as possible prognostic factors, but none of them are reliable enough to change the treatment approach. 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) is a novel imaging technique for staging of SCLC. The aim of this study was to evaluate the prognostic value of pre-treatment FDG-PET parameters on clinical outcome in limited stage (LS) SCLC patients treated with curative thoracic radiotherapy (RT) and chemotherapy. METHODS Clinical records of 46 LS-SCLC patients with pre-treatment FDG-PET imaging were retrospectively reviewed. Patients were treated with definitive RT for a total dose of 50-60 Gy and chemotherapy. The clinical endpoints were progression-free survival (PFS) and overall survival (OS). RESULTS The median age was 59 (range 30-82) years, and median follow-up time was 23.2 months (range 5-82.8 months). Median OS was 30.9 months for pre-treatment tumor maximum standardized uptake value (SUVmax) <9.3 and 20.6 months for SUVmax ≥9.3 (p = 0.027) and PFS was 55.6 months for SUVmax <9.3 and 38.6 months for SUVmax ≥9.3 (p = 0.16). Median OS was 73 months for pre-treatment lymph node SUVmax <5.8 and 21 months for ≥5.8 (p = 0.01) and PFS was 38.6 months (range 6.8-70.3 months) for SUVmax-LN ≥5.8; all patients with SUVmax-LN <5.8 were alive (p = 0.07). Median survival time was 28.2 months (range 21.7-34.7 months) for patients younger than 65 and 8.7 months (range 5.7-11.8 months) for those ≥65 years (p = 0.00). CONCLUSIONS Pre-treatment FDG-PET uptake may be a valuable tool to evaluate prognosis in SCLC patients. Patients with a higher pre-treatment FDG uptake may be considered at increased risk of failure and may benefit from more aggressive treatment approaches.
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Affiliation(s)
- Meryem Aktan
- Department of Radiation Oncology, Faculty of Medicine, Necmettin Erbakan University, 42090, Konya, Turkey.
| | - Mehmet Koc
- Department of Radiation Oncology, Faculty of Medicine, Necmettin Erbakan University, 42090, Konya, Turkey
| | - Gul Kanyilmaz
- Department of Radiation Oncology, Faculty of Medicine, Necmettin Erbakan University, 42090, Konya, Turkey
| | - Berrin Benli Yavuz
- Department of Radiation Oncology, Faculty of Medicine, Necmettin Erbakan University, 42090, Konya, Turkey
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12
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Peng Y, Wang Y, Li J, Hao X, Hu X. [Utility of NSE, ProGRP and LDH in Diagnosis and Treatment
in Patients with Small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 19:590-4. [PMID: 27666548 PMCID: PMC5972956 DOI: 10.3779/j.issn.1009-3419.2016.09.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Small cell lung cancer (SCLC) is a rapidly growing tumor with characteristic of neuroendocrine cellular function. Neuron specific enolase (NSE), pro-gastrin-releasing peptide (ProGRP) and lactic dehydrogenase (LDH) are valuable in diagnosis and treatment of SCLC. By analyzing the variation of NSE, ProGRP and LDH before and after treatment, the aim of this study is to investigate the efficacy of tumor markers in diagnostic staging, therapeutic evaluation and prediction of disease relapsing. METHODS Patients with SCLC who receiving the first line chemotherapy in Cancer Hospital, Chinese Academy of Medical Sciences were enrolled and retrospectively analyzed. Clinical characteristic (includes NSE, ProGRP and LDH level before and after 2 cycles chemotherapy), efficacy evaluation, progression-free survival (PFS) were analyzed. RESULTS Before treatment, Serum NSE, ProGRP and LDH in patients with extensive disease (ED) were significantly higher than those with limited disease (LD)(all P<0.005); NSE level increased obviously accompanied by increase of lymph nodes stage in LD group (P=0.010); Patients with weight reduction when diagnosis had higher NSE and LDH than those without loss of weight (P=0.032, P=0.014). After 2 cycles chemotherapy, decrease of NSE and ProGRP in effective group was higher than which in stable and ineffective groups (P=0.015, P=0.002). The relapse risk was lower in patients who accepted >4 cycles chemotherapy and with obvious decrease of ProGRP than those who accepted ≤4 cycles chemotherapy and with less obvious decrease of ProGRP in LD group; ED patients with no more than 2 distant metastasis, normal LDH level before treatment and obvious decrease of ProGRP after chemotherapy had lower short term relapse risk. In addition, the types of relapse (sensitive relapse, drug resistance relapse and refractory relapse) were negatively correlated with decrease of ProGRP (P=0.044). By multivariate analysis, numbers of chemotherapy cycle was independent prognostic factor for PFS in LD SCLC; numbers of distant metastasis and decrease of ProGRP were independent prognostic factors for PFS in ED SCLC. CONCLUSIONS Increase level of serum tumor markers is related to tumor burden. Decrease level of ProGRP after treatment may prognose efficacy and relapse risk.
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Affiliation(s)
- Yan Peng
- Department of Medical Oncology, Beijing Chaoyang Sanhuan Cancer Hospital, Beijing 100021, China
| | - Yan Wang
- Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Junling Li
- Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Xuezhi Hao
- Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Xingsheng Hu
- Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
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13
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Prelaj A, Rebuzzi SE, Del Bene G, Giròn Berrìos JR, Emiliani A, De Filippis L, Prete AA, Pecorari S, Manna G, Ferrara C, Rossini D, Longo F. Evaluation of the efficacy of cisplatin-etoposide and the role of thoracic radiotherapy and prophylactic cranial irradiation in LCNEC. ERJ Open Res 2017; 3:00128-2016. [PMID: 28382303 PMCID: PMC5370316 DOI: 10.1183/23120541.00128-2016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/12/2017] [Indexed: 01/29/2023] Open
Abstract
In small-cell lung cancer (SCLC), the role of chemotherapy and radiotherapy is well established. Large-cell neuroendocrine carcinoma (LCNEC) shares several clinicopathological features with SCLC, but its optimal therapy is not defined. We evaluated clinical response and survival outcomes of advanced LCNEC treated in first-line therapy compared with SCLC. 72 patients with stage III–IV LCNEC (n=28) and extensive-stage SCLC (ES-SCLC) (n=44) received cisplatin–etoposide with/without thoracic radiotherapy (TRT) and prophylactic cranial irradiation (PCI). Comparing LCNEC with SCLC, we observed similar response rates (64.2% versus 59.1%), disease control rates (82.1% versus 88.6%), progression-free survival (mPFS) (7.4 versus 6.1 months) and overall survival (mOS) (10.4 versus 10.9 months). TRT and PCI in both histologies showed a benefit in mOS (34 versus 7.8 months and 34 versus 8.6 months, both p=0.0001). LCNEC patients receiving TRT showed an improvement in mPFS and mOS (12.5 versus 5 months, p=0.02 and 28.3 versus 5 months, p=0.004), similarly to ES-SCLC. PCI in LCNEC showed an increase in mPFS (20.5 versus 6.4 months, p=0.09) and mOS (33.4 versus 8.6 months, p=0.05), as in ES-SCLC. Advanced LCNEC treated with SCLC first-line therapy has a similar clinical response and survival outcomes to ES-SCLC. Cisplatin–etoposide is an efficient treatment for large-cell neuroendocrine carcinoma. RT and PCI improve survival.http://ow.ly/sBJo309HG8s
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Affiliation(s)
- Arsela Prelaj
- Dept of Medical Oncology Unit A, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | - Gabriella Del Bene
- Dept of Medical Oncology Unit A, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | - Alessandra Emiliani
- Dept of Medical Oncology Unit A, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Lucilla De Filippis
- Dept of Medical Oncology Unit A, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Alessandra Anna Prete
- Dept of Medical Oncology Unit A, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Silvia Pecorari
- Dept of Medical Oncology Unit A, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Gaia Manna
- Dept of Medical Oncology Unit A, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Carla Ferrara
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Daniele Rossini
- Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy University of Pisa, Pisa, Italy
| | - Flavia Longo
- Dept of Medical Oncology Unit A, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
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Timing of thoracic radiotherapy in the treatment of extensive-stage small-cell lung cancer: important or not? Radiat Oncol 2017; 12:42. [PMID: 28245874 PMCID: PMC5331725 DOI: 10.1186/s13014-017-0779-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/08/2017] [Indexed: 12/12/2022] Open
Abstract
Background This study evaluated the prognosis of patients with extensive-stage small-cell lung cancer (ES-SCLC) that may be associated with timing of thoracic radiotherapy (TRT). Methods ES-SCLC patients (n = 232) without progression were retrospectively analyzed after first-line induction chemotherapy. Patients in the TRT group were stratified as early-TRT (ERT; ≤3 cycles of induction chemotherapy received prior to TRT, n = 65) or late-TRT (LRT; >3 cycles, n = 122). To avoid selection bias, we conducted Propensity Score Matching (PSM) for patients. Overall survival (OS), progression-free survival (PFS), and locoregional recurrence-free survival (LRRFS) were assessed and compared. Results Overall, the median survival time, PFS, and LRRFS were 13.2, 8.7, and 14.6 months, respectively. After matching by PSM, there were 45 patients total in the TRT/non-TRT groups, and 56 patients total in the ERT/LRT groups. OS, PFS, and LRRFS were significantly longer in the TRT group than the non-TRT group (P < 0.001, all). However, between the ERT and LRT groups these survival parameters were similar (P > 0.05, all). Conclusion For ES-SCLC patients without progression, the addition of TRT after first-line chemotherapy benefited survival greatly. Early TRT showed no significant benefit over late TRT.
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15
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Xiao XG, Wang SJ, Hu LY, Chu Q, Wei Y, Li Y, Mei Q, Chen Y. Relationship between the SER treatment period and prognosis of patients with small cell lung cancer. Asian Pac J Cancer Prev 2017; 15:6415-9. [PMID: 25124635 DOI: 10.7314/apjcp.2014.15.15.6415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To explore the relationship between SER (time between the start of any treatment and the end of radiation therapy) and the survival of patients with limited-stage small cell lung cancer. MATERIALS AND METHODS Between 2008 and 2013, 135 cases of limited-stage small cell lung cancer (LS-SCLC) treated with consecutively curative chemoradiotherapy were included in this retrospective analysis. In terms of SER, patients were divided into early radiotherapy group (SER<30 days, n=76) and late radiotherapy group (SER≥30 days, n=59) with a cut- off of SER 30 days. Outcomes of the two groups were compared for overall survival. RESULTS For all analyzable patients, median follow-up time was 23.8 months and median overall survival time was 16.8 months. Although there was no significant differences in distant metastasis free survival between the two groups, patients in early radiotherapy group had a significantly better PFS (p=0.003) and OS (p=0.000). CONCLUSIONS A short SER may be a good prognostic factor for LD-SCLC patients treated with concurrent chemoradiotherapy.
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Affiliation(s)
- Xiao-Guang Xiao
- Department of Oncology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China E-mail :
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16
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Abstract
Radiotherapy for small cell lung carcinoma has known significant improvements over the past 10 years especially through routine use of PET-CT in the initial work-up and contouring before treatment. Prophylactic cranial irradiation remains a standard of care for locally advanced disease and is a subject of controversy for metastatic disease. A new indication for thoracic radiotherapy may soon arise for metastatic disease, still confirmation studies are ongoing.
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Affiliation(s)
- N Pourel
- Département de radiothérapie, institut Sainte-Catherine, 250, chemin de Baigne-Pieds, CS80005, 84918 Avignon cedex 9, France.
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Chen Y, Li J, Hu Y, Zhang Y, Lin Z, Zhao Z, Jiao S. Prophylactic cranial irradiation could improve overall survival in patients with extensive small cell lung cancer. Strahlenther Onkol 2016; 192:905-912. [DOI: 10.1007/s00066-016-1038-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 08/11/2016] [Indexed: 11/24/2022]
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A phase II study of topotecan and cisplatin with sequential thoracic radiotherapy in elderly patients with small-cell lung cancer: Okayama Lung Cancer Study Group 0102. Cancer Chemother Pharmacol 2016; 78:769-74. [PMID: 27544764 DOI: 10.1007/s00280-016-3135-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The treatment outcome in elderly patients with limited-disease small-cell lung cancer (LD-SCLC) remains poor. We carried out a phase II trial of split topotecan and cisplatin (TP) therapy and sequential thoracic radiotherapy for elderly LD-SCLC patients as a follow-up to our previous phase I trial. METHODS In total, 30 patients aged 76 years or older, with untreated LD-SCLC were enrolled. Four courses of topotecan (1.0 mg/m(2), days 1-3) and cisplatin (20 mg/m(2), days 1-3) were administered, followed by thoracic radiotherapy (1.8 Gy/day, total of 45 Gy). The primary end point was the overall response rate (ORR). RESULTS The trial was terminated early with 22 patients because of slow accrual. Their median age was 79 years. The median number of courses of chemotherapy administered was three, and the actual completion rate of the entire treatment course was 41 %. The ORR was 68 % with a 95 % confidence interval of 47-89 % (15/22 cases). The median progression-free survival and overall survival were 9.1 and 22.2 months, respectively. The main toxicity was myelosuppression, with grades 3-4 neutropenia (96 %), thrombocytopenia (50 %), and febrile neutropenia (32 %). CONCLUSIONS This regimen produced a favorable survival outcome, despite moderate-to-severe toxicity profiles. Further efforts are necessary to define an optimal regimen for elderly patients with limited SCLC.
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Nomograms Predict Overall Survival for Patients with Small-Cell Lung Cancer Incorporating Pretreatment Peripheral Blood Markers. J Thorac Oncol 2016. [PMID: 26200277 DOI: 10.1097/jto.0000000000000585] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND We sought to build prognostic nomograms and identify novel prognostic factors in small-cell lung cancer (SCLC) incorporating both clinical data and peripheral blood markers. METHODS We analyzed 938 patients with SCLC (555 extensive stage SCLC [ES-SCLC] and 383 limited stage SCLC [LS-SCLC]) diagnosed between 1997 and 2012 from a single institution. We investigated the prognostic value of pretreatment neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, red cell distribution width, hemoglobin, and other clinicopathological factors. Cox proportional hazards models determined the effects of multiple factors on overall survival (OS). Two nomograms were developed to predict median survival and 6- and 12-month OS for ES-SCLC, and 1- and 2-year OS for LS-SCLC. RESULTS In ES-SCLC, the multivariate Cox model identified neutrophil to lymphocyte ratio and red cell distribution width as significant prognostic factors for OS independent of age, Eastern Cooperative Oncology Group performance score, chest radiation, chemotherapy, liver metastases, and numbers of metastatic sites. In LS-SCLC, significant prognostic variables included platelet to lymphocyte ratio, age, smoking cessation, chest radiation, chemotherapy, surgery, and prophylactic cranial irradiation. The two nomograms show good accuracy in predicting OS, with a concordance index of 0.73 in both ES- and LS-SCLC. CONCLUSION The two nomograms incorporating hematological markers could more accurately predict individualized survival probability of SCLC than the existing models.
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Prognostic factors affecting the risk of thoracic progression in extensive-stage small cell lung cancer. BMC Cancer 2016; 16:197. [PMID: 26955807 PMCID: PMC4782389 DOI: 10.1186/s12885-016-2222-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/28/2016] [Indexed: 12/21/2022] Open
Abstract
Background The efficacy of combined modality therapy is evaluated for patients with extensive-stage (ES) small cell lung cancer (SCLC). This study evaluated prognostic factors affecting the risk of thoracic progression in ES-SCLC patients likely to undergo thoracic radiotherapy combined chemotherapy. Methods A retrospective review of ES-SCLC patients who had received systemic chemotherapy at our hospital was performed. Tumor size, metastatic sites, and laboratory data at diagnosis were evaluated as potential prognostic factors. In ES-SCLC patients without pleural dissemination, the rate of thoracic progression after initial chemotherapy was assessed. Results Eighty-three of 96 consecutive ES-SCLC patients were analyzed. The overall response rate was 55 %, median progression free survival was 5.0 months (mo), and overall survival (OS) was 9.2 mo. Tumor size (19.4 mo for ≤3 cm vs. 8.5 mo for >3 cm, p = 0.017) and the number of metastatic sites (12.9 mo for single sites vs. 7.1 mo for multiple sites, p = 0.015) were prognostic factors, in addition to known prognostic factors such as performance status and the levels of LDH and sodium. Cox proportional hazard model showed that the OS was significantly worse in patients with large (>3 cm) primary tumor size {HR 2.44 [95 % confidential interval (CI) 1.05–5.68], p = 0.038} and multiple metastatic sites [HR 1.81 (95 % CI 1.08–3.04), p = 0.026]. In 51 cases without pleural dissemination, the number of metastatic sites was associated with thoracic progression after initial chemotherapy (65 % for single sites vs. 36 % for multiple sites, p = 0.036). Conclusion Large tumor size and multiple metastatic sites at diagnosis significantly predicted poor survival in ES-SCLC patients. Based on the high rate of thoracic progression in ES-SCLC patients with single site of distant metastasis, we should consider thoracic radiotherapy combined with chemotherapy for this population. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2222-4) contains supplementary material, which is available to authorized users.
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Sekine I, Sumi M, Satouchi M, Tsujino K, Nishio M, Kozuka T, Niho S, Nihei K, Yamamoto N, Harada H, Ishikura S, Tamura T. Feasibility study of chemoradiotherapy followed by amrubicin and cisplatin for limited-disease small cell lung cancer. Cancer Sci 2016; 107:315-9. [PMID: 26748638 PMCID: PMC4814250 DOI: 10.1111/cas.12875] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/19/2015] [Accepted: 12/26/2015] [Indexed: 12/11/2022] Open
Abstract
To evaluate the feasibility of amrubicin plus cisplatin (AP) following chemoradiotherapy for limited‐disease small‐cell lung cancer, chemo‐naïve patients aged 20–70 years with a performance status of 0 or 1 and normal organ functions were treated with etoposide 100 mg/m2 on days 1–3, cisplatin 80 mg/m2 on day 1 and concurrent thoracic radiotherapy at 45 Gy/30 fractions (EP‐TRT), followed by three cycles of amrubicin 40 mg/m2 on days 1–3 and cisplatin 60 mg/m2 on day 1 every 3 weeks. The EP‐TRT could be completed in 21 patients (15 male and 6 female patients with a median age of 62 years). Of these, 2, 1 and 18 (86%) patients received one, two and three cycles of AP, respectively. Sixteen (76%) patients required granulocyte‐colony stimulating factor (G‐CSF) support. Grade 3/4 neutropenia occurred in all patients. Grade 3 febrile neutropenia was observed in 9 patients, lasting for 1 day in 5 patients. The incidences of grade 3/4 thrombocytopenia and anemia were 43 and 24%, respectively. Grade 3 infection and anorexia occurred in 2 and 3 patients, respectively. The response rate was 95%. The median (95% confidence interval [CI]) progression‐free survival (PFS) was 41.9 (0–102) months, and the 5‐year PFS rate (CI) was 41.9% (20.4–63.4%). The median overall survival (OS) has not been reached yet, and the 5‐year OS rate (CI) was 57.8% (35.2–80.4%). In conclusion, EP‐TRT followed by AP therapy was well‐tolerated, although a large number of patients required G‐CSF support.
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Affiliation(s)
- Ikuo Sekine
- Division of Internal Medicine and Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Minako Sumi
- Division of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Miyako Satouchi
- Department of Thoracic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Kayoko Tsujino
- Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Makoto Nishio
- Thoracic Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takuyo Kozuka
- Department of Radiation Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Seiji Niho
- Division of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Keiji Nihei
- Division of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | | | - Hideyuki Harada
- Radiotherapy Division, Shizuoka Cancer Center, Shizuoka, Japan
| | - Satoshi Ishikura
- Department of Radiology, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Tomohide Tamura
- Division of Internal Medicine and Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
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Kwon SH, Hyun SH, Yoon JK, An YS, Oh YT, Choi JH, Park KJ, Lee SJ. The Highest Metabolic Activity on FDG PET Is Associated With Overall Survival in Limited-Stage Small-Cell Lung Cancer. Medicine (Baltimore) 2016; 95:e2772. [PMID: 26844524 PMCID: PMC4748941 DOI: 10.1097/md.0000000000002772] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We evaluated the prognostic value of F-fluorodeoxyglucose positron emission tomography (FDG PET) parameters for limited-stage small-cell lung cancer (LS-SCLC).We retrospectively enrolled 59 LS-SCLC patients who underwent pretreatment FDG PET/CT. Various PET parameters were measured in all malignant lesions, and we recorded the highest maximum standardized uptake value (SUVmax), and sum of metabolic tumor volume (MTVsum) and total lesion glycolysis (TLGsum). The relationship between the highest SUVmax and volumetric PET parameters was evaluated. The prognostic significances of PET parameters and clinical variables were assessed using Cox's proportional hazard regression analysis. Overall survival (OS) and progression-free survival (PFS) were assessed by the Kaplan-Meier method.The SUVmax of the highest metabolic lesion had a significant positive correlation with MTVsum and TLGsum (P < 0.001). Upon multivariate analysis, the highest SUVmax was an independent predictor of OS (1 unit increase, hazard ratio [HR]: 1.133, P = 0.003) and MTVsum was a significant prognostic factor of PFS (10-cm increase, HR: 1.027, P = 0.034) after adjusting for age, sex, performance status, tumor stage, and treatment modality. The highest SUVmax was a prognostic factor for PFS with marginal significance (1 unit increase, HR: 1.078, P = 0.053). Patients with higher SUVmax (≥11) were also characterized by a significantly shorter median OS (P < 0.001) and PFS (P = 0.002) compared with patients with lower SUVmax.The highest SUVmax is an independent prognostic factor for survival in LS-SCLC patients. Therefore, the highest SUVmax might be a possible imaging biomarker for risk stratification in LS-SCLC. A further study in a large cohort is needed to validate the prognostic significance of the parameter.
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Affiliation(s)
- Soo Hyun Kwon
- From the Department of Nuclear Medicine, Ajou University School of Medicine, Suwon (SHK, J-KY, Y-SA, SJL); Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (SHH); Department of Radiation Oncology (Y-TO); and Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea (J-HC, KJP)
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Stish BJ, Hallemeier CL, Olivier KR, Harmsen WS, Allen MS, Garces YI. Long-Term Outcomes and Patterns of Failure After Surgical Resection of Small-Cell Lung Cancer. Clin Lung Cancer 2015; 16:e67-73. [PMID: 25823413 DOI: 10.1016/j.cllc.2015.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/12/2015] [Accepted: 02/17/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of surgical resection as a treatment option for early-stage small-cell lung cancer (SCLC) is controversial, and few data exist regarding the patterns of treatment failure in these patients. PATIENTS AND METHODS The medical records of all patients receiving definitive surgical management of SCLC at Mayo Clinic (Rochester, MN) from January 1, 1985 to December 31, 2012 were reviewed. Estimates of survival and recurrence risk were recorded using the Kaplan-Meier method, and comparative analyses were performed with Cox regression analysis. RESULTS A total of 54 patients were identified. The median follow-up period was 5.9 years. At 5 years, overall survival was 37% and recurrence-free survival 44%. Intrathoracic recurrence, the most frequent treatment failure, occurred in 14 patients, with an estimated intrathoracic recurrence-free survival at 3 years of 64.4%. Patients undergoing wedge resection or segmentectomy, rather than lobectomy or pneumonectomy, had an increased risk of intrathoracic recurrence (hazard ratio, 3.5; P = .01). Overall survival was improved at 5 years after lobectomy or pneumonectomy compared with wedge resection or segmentectomy (48% vs. 15%, respectively; P = .03). CONCLUSION Surgical resection of SCLC can achieve reasonable treatment outcomes and can be considered for well-selected patients with clinical early-stage disease. Intrathoracic recurrence is the most common site of treatment failure. Caution should be taken with patients who are unable to tolerate at least lobectomy, because they are at a high risk of local recurrence.
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Affiliation(s)
- Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | | | - William S Harmsen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Mark S Allen
- Department of General Thoracic Surgery, Mayo Clinic, Rochester, MN
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Wang P, Liu W, Zhao L, Wang P. Does the response to induction chemotherapy impact the timing of thoracic radiotherapy for limited-stage small-cell lung cancer? Thorac Cancer 2015; 6:605-12. [PMID: 26445609 PMCID: PMC4567006 DOI: 10.1111/1759-7714.12229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/14/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To investigate whether the response to induction chemotherapy (IC) would impact the timing of thoracic radiotherapy (TRT) in limited-stage small-cell lung cancer (LS-SCLC). METHODS A total of 146 patients with LS-SCLC who had received two to six cycles of IC followed by TRT from January 2009 to December 2011 at our hospital were included in this study. Patients were divided into two groups based on the time TRT was administered: early TRT (administered after 2-3 cycles of chemotherapy) or late TRT (administered after 4-6 cycles). Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method. Multivariate Cox regression analysis was performed to evaluate the independent factors affecting survival. RESULTS The median OS for patients who received early TRT and late TRT was 29.0 and 19.9 months, respectively, (P = 0.018) and the median PFS was 18.5 and 13.8 months, respectively (P = 0.049). In patients who achieved complete remission (CR) or partial remission (PR) after two to three cycles of IC, the median OS was 36.1 and 22.5 months in the early and late TRT subgroups, respectively (P = 0.009); the corresponding median PFS was 20.2 and 13.8 months, respectively (P = 0.038). In the patients who did not achieve CR or PR, no statistic difference was found in OS or PFS between the two subgroups. CONCLUSION Patients who received early TRT had more favorable outcomes than those who received late TRT. Patients who achieved CR or PR after two to three cycles of IC obtained more benefit from early TRT.
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Affiliation(s)
- Peng Wang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy Tianjin, China
| | - Weishuai Liu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy Tianjin, China
| | - Lujun Zhao
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy Tianjin, China
| | - Ping Wang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy Tianjin, China
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Stereotactic body radiotherapy with concurrent chemotherapy extends survival of patients with limited stage small cell lung cancer: a single-center prospective phase II study. Med Oncol 2014; 31:369. [DOI: 10.1007/s12032-014-0369-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/25/2022]
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Li Y, He Y, Qiu Z, Zhou B, Shi S, Zhang K, Luo Y, Huang Q, Li W. CRTC2 and PROM1 expression in non-small cell lung cancer: analysis by Western blot and immunohistochemistry. Tumour Biol 2014; 35:11719-26. [PMID: 25256670 DOI: 10.1007/s13277-014-2011-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/23/2014] [Indexed: 02/05/2023] Open
Abstract
Accumulating evidence supports that genetic factors are another risk factors for lung cancer. Previously, we used whole exome sequencing with sanger sequencing to search for genetic-related mutations in one of four individuals from a pedigree with lung cancer history. Then, we used PCR-RFLP and direct-sequence in the sample size of 318 individuals with lung cancer (cases) and 272 controls. Recently, we detected two new genes including CRTC2 (CREB regulated transcription coactivator 2) and PROM1(human prominin-1,CD133). We investigated the CRTC2 mutation and PROM1 mutation of surgically resected NSCLC tissues (n=200). The presence or absence of CRTC2 and PROM1 mutation was analyzed by direct sequencing. The expression of CRTC2 and PROM1 was studied by western blot and immunohistochemical analysis of the lung cancer tissues which had the mutation of the two genes(cases), the samples without mutations(controls) and the normal lung tissue(controls). CRTC2 and PROM1 mutations in 5 NSCLC tissues and 3 NSCLC tissues out of the samples were identified. The positive results were closely correlated with clinicopathological features, such as male gender, adenocarcinoma, smoker status, and older age (≥55). We found that the CRTC2 and PROM1 expression were significantly higher in tissues of NSCLS with mutations than that without mutations and the normal lung tissue. The results imply that the high expression of CRTC2 and PROM1 may play an important role in the development and hereditary of NSCLC.
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Affiliation(s)
- Yalun Li
- Department of Respiratory Medicine, West China Hospital of Sichuan University, 37 Guoxue Xiang, Chengdu, Sichuan, 610041, China
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Okamoto K, Okamoto I, Takeda M, Kobayashi S, Takeda K, Nakamatsu K, Nishimura Y, Nakagawa K. A Phase I Study of Split-dose Cisplatin and Etoposide with Concurrent Accelerated Hyperfractionated Thoracic Radiotherapy in Elderly Patients with Limited-disease Small Cell Lung Cancer. Jpn J Clin Oncol 2014; 44:743-748. [DOI: 10.1093/jjco/hyu071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Kenmotsu H. Efficacy of chemotherapy in limited-disease small-cell lung cancer. Lung Cancer Manag 2013. [DOI: 10.2217/lmt.13.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Small-cell lung cancer (SCLC) accounts for approximately 13% of all lung cancers, and limited-disease SCLC is defined as a disease that can be encompassed within a tolerable radiation field. Concurrent chemoradiotherapy is considered to be the standard treatment for limited-disease SCLC. In both concurrent and consolidation chemoradiotherapies, the combination of etoposide and cisplatin is considered to be a standard chemotherapy regimen. To develop novel treatment for SCLC, several clinical trials of molecular-targeted therapy or immunotherapy have been reported. However, no molecular-targeted drug has shown clinical activity in limited-disease SCLC. In future studies, understanding the molecular profile of SCLC will be necessary for the development of molecular-targeted therapies for SCLC. This review provides an overview of chemotherapy regimens for limited-disease SCLC.
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Affiliation(s)
- Hirotsugu Kenmotsu
- Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan
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Coe BP, Thu KL, Aviel-Ronen S, Vucic EA, Gazdar AF, Lam S, Tsao MS, Lam WL. Genomic deregulation of the E2F/Rb pathway leads to activation of the oncogene EZH2 in small cell lung cancer. PLoS One 2013; 8:e71670. [PMID: 23967231 PMCID: PMC3744458 DOI: 10.1371/journal.pone.0071670] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 07/02/2013] [Indexed: 01/15/2023] Open
Abstract
Small cell lung cancer (SCLC) is a highly aggressive lung neoplasm with extremely poor clinical outcomes and no approved targeted treatments. To elucidate the mechanisms responsible for driving the SCLC phenotype in hopes of revealing novel therapeutic targets, we studied copy number and methylation profiles of SCLC. We found disruption of the E2F/Rb pathway was a prominent feature deregulated in 96% of the SCLC samples investigated and was strongly associated with increased expression of EZH2, an oncogene and core member of the polycomb repressive complex 2 (PRC2). Through its catalytic role in the PRC2 complex, EZH2 normally functions to epigenetically silence genes during development, however, it aberrantly silences genes in human cancers. We provide evidence to support that EZH2 is functionally active in SCLC tumours, exerts pro-tumourigenic functions in vitro, and is associated with aberrant methylation profiles of PRC2 target genes indicative of a “stem-cell like” hypermethylator profile in SCLC tumours. Furthermore, lentiviral-mediated knockdown of EZH2 demonstrated a significant reduction in the growth of SCLC cell lines, suggesting EZH2 has a key role in driving SCLC biology. In conclusion, our data confirm the role of EZH2 as a critical oncogene in SCLC, and lend support to the prioritization of EZH2 as a potential therapeutic target in clinical disease.
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Affiliation(s)
- Bradley P. Coe
- Integrative Oncology Department, BC Cancer Research Centre, Vancouver, Canada
| | - Kelsie L. Thu
- Integrative Oncology Department, BC Cancer Research Centre, Vancouver, Canada
- * E-mail:
| | | | - Emily A. Vucic
- Integrative Oncology Department, BC Cancer Research Centre, Vancouver, Canada
| | - Adi F. Gazdar
- Hamon Center for Therapeutic Oncology Research and Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Stephen Lam
- Integrative Oncology Department, BC Cancer Research Centre, Vancouver, Canada
| | - Ming-Sound Tsao
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Department of Pathology, Princess Margaret Hospital University Health Network, Toronto, Canada
| | - Wan L. Lam
- Integrative Oncology Department, BC Cancer Research Centre, Vancouver, Canada
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Rationale for Chemotherapy, Immunotherapy, and Checkpoint Blockade in SCLC: Beyond Traditional Treatment Approaches. J Thorac Oncol 2013; 8:587-98. [DOI: 10.1097/jto.0b013e318286cf88] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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31
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Sun JM, Ahn YC, Choi EK, Ahn MJ, Ahn JS, Lee SH, Lee DH, Pyo H, Song SY, Jung SH, Jo JS, Jo J, Sohn HJ, Suh C, Lee JS, Kim SW, Park K. Phase III trial of concurrent thoracic radiotherapy with either first- or third-cycle chemotherapy for limited-disease small-cell lung cancer. Ann Oncol 2013; 24:2088-92. [PMID: 23592701 DOI: 10.1093/annonc/mdt140] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We compared late thoracic radiotherapy (TRT) with early TRT in the treatment of limited-disease small-cell lung cancer (LD-SCLC). PATIENTS AND METHODS Patients with LD-SCLC received four cycles of etoposide plus cisplatin every 21 days. Patients were randomly assigned to receive either TRT administered concurrently with the first cycle (early TRT) or the third cycle (late TRT) of chemotherapy. The primary end point was complete response rate. RESULTS Two hundred twenty-two patients were randomly assigned.Late TRT was not inferior to early TRT in terms of the complete response rate (early v late; 36.0% v 38.0%). Other efficacy measures including overall survival [median, 24.1 v 26.8 months;hazard ratio (HR) 0.93; 95% CI = 0.67–1.29] and progression free survival (median, 12.4 v 11.2 months; HR 1.09; 95%CI = 0.80–1.48) were not different between two arms. No statistical difference was noted in the pattern of treatment failures.However, neutropenic fever occurred more commonly in the early TRT arm than the late TRT arm (21.6% v 10.2%; P = 0.02) [corrected]. CONCLUSION In LD-SCLC treatment, TRT starting in the third cycle of chemotherapy seemed to be noninferior to early TRT, and had a more favorable profile with regard to neutropenic fever.
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Affiliation(s)
- J-M Sun
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sas-Korczynska B, Sokolowski A, Korzeniowski S. The influence of time of radio-chemotherapy and other therapeutic factors on treatment results in patients with limited disease small cell lung cancer. Lung Cancer 2013; 79:14-9. [DOI: 10.1016/j.lungcan.2012.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 09/25/2012] [Accepted: 10/04/2012] [Indexed: 11/16/2022]
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Sundaresan P, Hruby G, Hamilton A, Hong A, Boyer M, Chatfield M, Thompson J. Definitive Radiotherapy or Chemoradiotherapy in the Treatment of Merkel Cell Carcinoma. Clin Oncol (R Coll Radiol) 2012; 24:e131-6. [DOI: 10.1016/j.clon.2012.04.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 03/15/2012] [Accepted: 04/27/2012] [Indexed: 10/28/2022]
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Manapov F, Klöcking S, Niyazi M, Levitskiy V, Belka C, Hildebrandt G, Fietkau R, Klautke G. Primary tumor response to chemoradiotherapy in limited-disease small-cell lung cancer correlates with duration of brain-metastasis free survival. J Neurooncol 2012; 109:309-14. [PMID: 22610939 DOI: 10.1007/s11060-012-0894-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 04/27/2012] [Indexed: 10/28/2022]
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Park KS, Liang MC, Raiser DM, Zamponi R, Roach RR, Curtis SJ, Walton Z, Schaffer BE, Roake CM, Zmoos AF, Kriegel C, Wong KK, Sage J, Kim CF. Characterization of the cell of origin for small cell lung cancer. Cell Cycle 2011; 10:2806-15. [PMID: 21822053 DOI: 10.4161/cc.10.16.17012] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Small cell lung carcinoma (SCLC) is a neuroendocrine subtype of lung cancer that affects more than 200,000 people worldwide every year with a very high mortality rate. Here, we used a mouse genetics approach to characterize the cell of origin for SCLC; in this mouse model, tumors are initiated by the deletion of the Rb and p53 tumor suppressor genes in the lung epithelium of adult mice. We found that mouse SCLCs often arise in the lung epithelium, where neuroendocrine cells are located, and that the majority of early lesions were composed of proliferating neuroendocrine cells. In addition, mice in which Rb and p53 are deleted in a variety of non-neuroendocrine lung epithelial cells did not develop SCLC. These data indicate that SCLC likely arises from neuroendocrine cells in the lung.
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Affiliation(s)
- Kwon-Sik Park
- Department of Genetics, Stanford University, Palo Alto, CA, USA
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Huntingtin-interacting protein 1: a Merkel cell carcinoma marker that interacts with c-Kit. J Invest Dermatol 2011; 131:2113-20. [PMID: 21697888 PMCID: PMC3174286 DOI: 10.1038/jid.2011.171] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Merkel cell carcinoma (MCC) is a neoplasm thought to originate from the neuroendocrine Merkel cells of the skin. Although the prevalence of MCC has been increasing, treatments for this disease remain limited because of a paucity of information regarding MCC biology. We have found that the endocytic oncoprotein Huntingtin-interacting protein 1 (HIP1) is expressed at high levels in ∼90% of MCC tumors and serves as a more reliable histological cytoplasmic stain than the gold standard, cytokeratin 20. Furthermore, high anti-HIP1 antibody reactivity in the sera of a cohort of MCC patients predicts the presence of metastases. Another protein that is frequently expressed at high levels in MCC tumors is the stem cell factor (SCF) receptor tyrosine kinase, c-Kit. In working toward an understanding of how HIP1 might contribute to MCC tumorigenesis, we have discovered that HIP1 interacts with SCF-activated c-Kit. These data not only identify HIP1 as a molecular marker for management of MCC patients but also show that HIP1 interacts with and slows the degradation of c-Kit.
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Hu X, Bao Y, Zhang L, Guo Y, Chen YY, Li KX, Wang WH, Liu Y, He H, Chen M. Omitting elective nodal irradiation and irradiating postinduction versus preinduction chemotherapy tumor extent for limited-stage small cell lung cancer: interim analysis of a prospective randomized noninferiority trial. Cancer 2011; 118:278-87. [PMID: 21598237 DOI: 10.1002/cncr.26119] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 02/15/2011] [Accepted: 02/15/2011] [Indexed: 12/27/2022]
Abstract
BACKGROUND Controversies exist with regard to thoracic radiotherapy volumes for limited-stage small cell lung cancer (SCLC). This study compared locoregional progression and overall survival between limited-stage SCLC patients who received thoracic radiotherapy to different target volumes after induction chemotherapy. METHODS Chemotherapy consisted of 6 cycles of etoposide and cisplatin. After 2 cycles of etoposide and cisplatin, patients were randomly assigned to receive thoracic radiotherapy to either the postchemotherapy or prechemotherapy tumor extent as study arm or control. Elective nodal irradiation was omitted for both arms. Forty-five Gy/30Fx/19 days thoracic radiotherapy was administered concurrently with cycle 3 chemotherapy. Prophylactic cranial irradiation was administered to patients who achieved complete remission. An interim analysis was planned when the first 80 patients had been followed for at least 6 months, for consideration of potential inferiority in the study arm. RESULTS Forty-two and 43 patients were randomly assigned to a study arm and a control, respectively. The local recurrence rates were 31.6% (12 of 38) and 28.6% (12 of 42), respectively (P = .81). The isolated nodal failure rates were 2.6% (1 of 38) and 2.4% (1 of 42), respectively (P = 1.00). All isolated nodal failure sites were in the ipsilateral supraclavicular fossa. Mediastinal N3 was the only factor to predict isolated nodal failure (P = .004; odds ratio [OR], 29.33; 95% CI, 2.94-292.38). One-year and 3-year overall survival rates were 80.6%, 36.2%, and 78.9%, 36.4%, respectively (P = .54). CONCLUSIONS Preliminary results indicated that irradiated postchemotherapy tumor extent and omitted elective nodal irradiation did not decrease locoregional control in the study arm, and the overall survival difference was not statistically significant between the 2 arms. Further investigation is warranted.
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Affiliation(s)
- Xiao Hu
- Department of Radiation Oncology, Cancer Center, Sun Yat Sen University, Guangzhou, People's Republic of China
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Mediastinal radiotherapy after multidrug chemotherapy and prophylactic cranial irradiation in patients with SCLC – treatment results after long-term follow-up and literature overview. Cancer Radiother 2011; 15:81-8. [DOI: 10.1016/j.canrad.2010.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 03/12/2010] [Accepted: 03/21/2010] [Indexed: 11/22/2022]
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Phase II study of the histone deacetylase inhibitor Romidepsin in relapsed small cell lung cancer (Cancer and Leukemia Group B 30304). J Thorac Oncol 2011; 5:1644-8. [PMID: 20871263 DOI: 10.1097/jto.0b013e3181ec1713] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Treatment of small cell lung cancer (SCLC) is initially gratifying with most patients responding to platinum-based chemotherapy. Treatment of relapsed disease gives much lower response rates of short duration. We undertook this study of the protein deacetylase inhibitor Romidepsin in chemosensitive recurrent SCLC based on preclinical data that suggested this to be an active target. METHODS Patients had recurrent chemosensitive SCLC (relapse ≥90 days since completion of platinum-based chemotherapy). Treatment was administered as weekly infusions of Romidepsin at 13 mg/m(2) for 3 of 4 weeks. We designed a two-stage phase II study targeting a response rate of 30% (<10% response would be uninteresting and ≥30% worthy of further study). RESULTS Sixteen patients (10 male, 6 female) were accrued to the first stage of this study. Most (11 patients, 69%) presented with extensive-stage SCLC, and all had received prior chemotherapy, with 11 having received prior radiation. Eastern Cooperative Oncology Group performance status was excellent with 0 in 6 patients (38%) and 1 in 10 patients. No objective responses were seen, and stable disease was the best response seen in 3 patients (19%). Toxicity was modest with 3 patients suffering grade 3 toxicity (lymphopenia, insomnia, nausea, vomiting, and hyponatremia) and one patient with grade 4 thrombocytopenia. Median progression-free survival was 1.8 months, and median overall survival was 6 months. CONCLUSION Romidepsin given on a weekly schedule in patients with chemosensitive, recurrent SCLC was inactive and will not be pursued further in this setting.
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Hsu HS, Huang PI, Chang YL, Tzao C, Chen YW, Shih HC, Hung SC, Chen YC, Tseng LM, Chiou SH. Cucurbitacin I inhibits tumorigenic ability and enhances radiochemosensitivity in nonsmall cell lung cancer-derived CD133-positive cells. Cancer 2011; 117:2970-85. [DOI: 10.1002/cncr.25869] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 11/05/2010] [Accepted: 11/22/2010] [Indexed: 01/16/2023]
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Janssen-Heijnen ML, Szerencsi K, van de Schans SA, Maas HA, Widdershoven JW, Coebergh JWW. Cancer patients with cardiovascular disease have survival rates comparable to cancer patients within the age-cohort of 10 years older without cardiovascular morbidity. Crit Rev Oncol Hematol 2010; 76:196-207. [DOI: 10.1016/j.critrevonc.2009.11.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 11/19/2009] [Accepted: 11/26/2009] [Indexed: 11/26/2022] Open
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Kurebayashi J, Kanomata N, Moriya T, Kozuka Y, Watanabe M, Sonoo H. Preferential antitumor effect of the Src inhibitor dasatinib associated with a decreased proportion of aldehyde dehydrogenase 1-positive cells in breast cancer cells of the basal B subtype. BMC Cancer 2010; 10:568. [PMID: 20959018 PMCID: PMC2967550 DOI: 10.1186/1471-2407-10-568] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 10/20/2010] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Recent studies have suggested that the Src inhibitor dasatinib preferentially inhibits the growth of breast cancer cells of the basal-like subtype. To clarify this finding and further investigate combined antitumor effects of dasatinib with cytotoxic agents, a panel of breast cancer cell lines of various subtypes was treated with dasatinib and/or chemotherapeutic agents. METHODS Seven human breast cancer cell lines were treated with dasatinib and/or seven chemotherapeutic agents. Effects of the treatments on c-Src activation, cell growth, cell cycle, apoptosis and the proportion of aldehyde dehydrogenase (ALDH) 1-positive cells were examined. RESULTS The 50%-growth inhibitory concentrations (IC50s) of dasatinib were much lower in two basal B cell lines than those in the other cell lines. The IC50s of chemotherapeutic agents were not substantially different among the cell lines. Dasatinib enhanced antitumor activity of etoposide in the basal B cell lines. Dasatinib induced a G1-S blockade with a slight apoptosis, and a combined treatment of dasatinib with etoposide also induced a G1-S blockade in the basal B cell lines. Dasatinib decreased the expression levels of phosphorylated Src in all cell lines. Interestingly, dasatinib significantly decreased the proportion of ALDH1-positive cells in the basal B cell lines but not in the other cell lines. CONCLUSIONS The present study indicates that dasatinib preferentially inhibits the growth of breast cancer cells of the basal B subtype associated with a significant loss of putative cancer stem cell population. A combined use of dasatinib with etoposide additively inhibits their growth. Further studies targeting breast cancers of the basal B subtype using dasatinib with cytotoxic agents are warranted.
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Affiliation(s)
- Junichi Kurebayashi
- Department of Breast and Thyroid Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Naoki Kanomata
- Department of Pathology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Takuya Moriya
- Department of Pathology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Yuji Kozuka
- Department of Pathology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Mika Watanabe
- Department of Pathology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Hiroshi Sonoo
- Department of Breast and Thyroid Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
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Hu X, Bao Y, Zhang L, Cheng Y, Li K, Wang W, Liu Y, He H, Sun Z, Zhuang T, Wang Y, Chen J, Liang Y, Zhang Y, Zhao H, Wang F, Chen M. [A prospective randomized study of the radiotherapy volume for limited-stage small cell lung cancer: a preliminary report]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2010; 13:691-9. [PMID: 20673485 PMCID: PMC6000379 DOI: 10.3779/j.issn.1009-3419.2010.07.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 05/25/2010] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE Controversies exists with regard to target volumes as far as thoracic radiotherapy (TRT) is concerned in the multimodality treatment for limited-stage small cell lung cancer (LSCLC). The aim of this study is to prospectively compare the local control rate, toxicity profiles, and overall survival (OS) between patients received different target volumes irradiation after induction chemotherapy. METHODS LSCLC patients received 2 cycles of etoposide and cisplatin (EP) induction chemotherapy and were randomly assigned to receive TRT to either the post- or pre-chemotherapy tumor extent (GTV-T) as study arm and control arm, CTV-N included the positive nodal drainage area for both arms. One to 2 weeks after induction chemotherapy, 45 Gy/30 Fx/19 d TRT was administered concurrently with the third cycle of EP regimen. After that, additional 3 cycles of EP consolidation were administered. Prophylactic cranial irradiation (PCI) was administered to patients with a complete response. RESULTS Thirty-seven and 40 patients were randomly assigned to study arm and control arm. The local recurrence rates were 32.4% and 28.2% respectively (P = 0.80); the isolated nodal failure (INF) rates were 3.0% and 2.6% respectively (P = 0.91); all INF sites were in the ipsilateral supraclavicular fossa. Medastinal N3 disease was the risk factor for INF (P = 0.02, OR = 14.13, 95% CI: 1.47-136.13). During radiotherapy, grade I, II weight loss was observed in 29.4%, 5.9% and 56.4%, 7.7% patients respectively (P = 0.04). Grade 0-I and II-III late pulmonary injury was developed in 97.1%, 2.9% and 86.4%, 15.4% patients respectively (P = 0.07). Median survival time was 22.1 months and 26.9 months respectively. The 1 to 3-year OS were 77.9%, 44.4%, 37.3% and 75.8%, 56.3%, 41.7% respectively (P = 0.79). CONCLUSIONS The preliminary results of this study indicate that irradiant the post-chemotherapy tumor extent (GTV-T) and positive nodal drainage area did not decrease local control and overall survival while radiation toxicity was reduced. But the current sample size has not met designed requirements, and further investigation is warranted before final conclusions could be drawn.
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Affiliation(s)
- Xiao Hu
- State Key Laboratory of Oncology in Southern China, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
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Comparison of the Effectiveness of “Late” and “Early” Prophylactic Cranial Irradiation in Patients with Limited-Stage Small Cell Lung Cancer. Strahlenther Onkol 2010; 186:315-9. [DOI: 10.1007/s00066-010-2088-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 03/05/2010] [Indexed: 10/19/2022]
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Abstract
Although the incidence of small cell lung cancer (SCLC) has declined during the past 30 years, it remains a significant cause of cancer mortality in the United States and across the world. With appropriate treatment, about 20% of patients who present with limited stage SCLC can be cured of their disease. Unfortunately, the outcome for the remainder of patients is extremely poor. The only significant advance in extensive stage SCLC in the past 2 decades is the recent discovery that prophylactic cranial irradiation improves survival in those patients whose disease has responded to initial chemotherapy. Numerous attempts to enhance the antitumor effects of traditional chemotherapy for SCLC have not been successful. As the understanding of the biology of SCLC increased, a number of rational molecular targets for therapy have been identified. Although initial attempts at "targeted therapy" in SCLC have been unsuccessful, several newly identified targets hold promise and give hope that significant improvements in therapy for this challenging disease are not far away.
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The role of higher thoracic irradiation doses in patients with limited stage of small-cell lung cancer: Retrospective study. ARCHIVE OF ONCOLOGY 2010. [DOI: 10.2298/aoo1002008s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Small-cell lung cancer is highly chemo- and radiosensitive tumor. We evaluated two different radiotherapy doses applied sequentially with chemotherapy in relation to time to progression, progression free survival, and overall survival in patients with limited disease of small cell lung cancer. Methods: From 1998 to 2003, 81 patients were treated for small-cell lung carcinoma. Median age was 57 years (range, 36-77 years) and female: male ratio was 1:4. Patients were initially treated with four cycles of chemotherapy during three weeks (cisplatin 80mg/m2 IV, day 1 and etoposide 100 mg/m2 IV, days 1 - 3). One month later, patients received up to 44 Gy, 2 Gy per day, 5 days per week (group I, 41 patients) or above 44 Gy, standard fractionation (group II, 40 patients), to mediastinum and tumor. Range of higher radiotherapy doses was 54 Gy to 64 Gy, standard fractionation. We evaluated if different radiotherapy doses had any influence on time to progression, progression free survival, and overall survival. Results: The median follow up time was 23 months (range, 12-72 months) for both groups of patients (81). The median time to progression in group I of patients (41) was 13 months (range, 11-29 months) while median time to progression in group II of patients (40) was 20 months (min=9, max=60). There was no statistically significant difference in relapse rate between two groups of patients (p>0.05, Fisher test). However, there was difference but not statistically significant in one-year progression free survival (p=0.05, chi square test) between groups, while there was statistically significant difference in two-year progression free survival favoring higher doses of radiotherapy (p<0.05, chi-square test). The median overall survival was 18 months (range, 12-35 months) for group I of patients and 28 months (range, 15-72 months) for group II of patients. There was no statistically significant advantage between two groups of patients for one-year overall survival (p>0.05, chi-square test). However, there was statistically significant difference in overall survival favoring higher radiotherapy doses for two-year overall survival (p<0.05, chi-square test). Conclusion: We found that higher radiotherapy doses had an impact on long-term time to progression, progression free survival, and overall survival (2 years) of patients.
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Casas F, Kepka L, Agarwal JP, Dawotola D, Gaye P, Abdel-Wahab S, Vashkevitch L, Saghatelyan T, Perin B, Jeremic B. Radiochemotherapy in the elderly with lung cancer. Expert Rev Anticancer Ther 2009; 9:1405-11. [PMID: 19827999 DOI: 10.1586/era.09.110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lung cancer is the leading cause of cancer mortality with the median age of incidence being 69 years in males and 67 years in females. Radiochemotherapy (RT-CHT) is indicated in locally advanced non-small-cell lung cancer and limited-stage small-cell lung cancer; however, a significant under-representation of the elderly has been observed in patient recruitment in cancer treatment trials. In the last decades of the 20th Century, studies showed that elderly patients achieved the best quality-adjusted survival with radiotherapy alone, but recent trials have found that fit elderly patients benefit from concurrent RT-CHT, although with more short-term toxicity. Age alone should not exclude fit patients and deprive them of the standard treatment. Using tools, such as comprehensive geriatric assessment, a patient's tolerance to therapy can be assessed and monitoring can be performed. This review will focus on RT-CHT treatment in elderly patients with nonoperable stage III non-small-cell lung cancer and limited-stage small-cell lung cancer exclusively.
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Affiliation(s)
- Francesc Casas
- Radiation Oncology Department, Hospital Clinic Barcelona, Villaroel 170, 08036 Barcelona, Spain.
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Okamoto K, Okamoto I, Takezawa K, Tachibana I, Fukuoka M, Nishimura Y, Nakagawa K. Cisplatin and Etoposide Chemotherapy Combined with Early Concurrent Twice-daily Thoracic Radiotherapy for Limited-disease Small Cell Lung Cancer in Elderly Patients. Jpn J Clin Oncol 2009; 40:54-9. [DOI: 10.1093/jjco/hyp137] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tomita N, Kodaira T, Hida T, Tachibana H, Nakamura T, Nakahara R, Inokuchi H. The impact of radiation dose and fractionation on outcomes for limited-stage small-cell lung cancer. Int J Radiat Oncol Biol Phys 2009; 76:1121-6. [PMID: 19665321 DOI: 10.1016/j.ijrobp.2009.03.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 02/04/2009] [Accepted: 03/09/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To review the treatment outcomes of limited-stage small-cell lung cancer (LS-SCLC) patients and to compare the outcomes among three groups in which the total radiation doses were 45 Gy with accelerated hyperfractionation (AHF), <54 Gy with standard fractionation (SF), and > or =54 Gy with SF. METHODS AND MATERIALS LS-SCLC patients that had been treated with chemoradiotherapy between 1997 and 2007 at Aichi Cancer Center Hospital were reviewed in this study. Of the 127 eligible patients, there were 37 patients in the AHF group, 29 in the SF <54 Gy group, and 61 in the SF > or =54 Gy group. RESULTS Fifty-five patients (43%) were alive at the time of this analysis, and the median follow-up time of the surviving patients was 33 months. The median survival times were 30.0 months (95% confidence interval [CI] 16.3-43.7) for the AHF group, 14.0 months (CI 6.6-21.4) for the SF <54 Gy group, and 41.0 months (CI 33.9-48.1) for the SF > or = 54 Gy group. As for the local control rates, and the overall and progression-free survival rates, all outcomes were significantly lower in the SF <54 Gy group than in the other two groups, although no significant difference was found between the AHF and SF >/=54 Gy groups. CONCLUSIONS These results suggest the importance of a high dose of radiation when using once-daily regimen. This study will support future prospective studies to establish optimal radiation doses and fractionation.
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Affiliation(s)
- Natsuo Tomita
- Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusaku, Nagoya 464-8681, Japan.
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