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Wulandari L, Soegiarto G, Febriani A, Fatmawati F, Amran WS. Comparison between Vinorelbine–Carboplatin and Vinorelbine–Cisplatin in Stage III–IV EGFR Mutations-Negative NSCLC. ASIAN JOURNAL OF ONCOLOGY 2021. [DOI: 10.1055/s-0041-1730255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Introduction There are a substantial number of lung cancer patients with negative mutations in Indonesia. This type of cancer is deemed to be the major contributor of lung cancer patient’s death. However, reseaerch related to therapy using vinorelbine combined with platinum-based compounds is still scarce in Indonesia. The aim of this study was to compare the efficacy and tolerability between vinorelbine and carboplatin with vinorelbin and cisplatin in stage III-IV epidermal growth factor receptor (EGFR) mutations-negative non-small cell lung cancer (NSCLC).
Methods The participants were divided into two groups—group I(vinorelbine–carboplatin) and group II (vinorelbine–cisplatin). The participants were assessed based on several measurement criteria. Not only Eq-5D was performed, but the body weight and response evaluation criteria for solid tumors (RECIST) were also examined. The participants received chemotherapy for four cycles (1 cycle = 21 days).
Results The quality of life was considered stable in 60% of group I and 60% of group II (p = 0.255). In both groups, 46.67% of participants had an increased body weight, while the other 20.00% was stable (p = 1.000). In terms of RECIST evaluation after the second cycle, 80.00% of group I and 86.67% of group II were considered to have a stable disease, with 20% of group I and none of group II had partial response (p = 0.027). However, after the fourth cycle, there were no significant difference between the groups (p = 0.734).
Conclusion In EGFR mutation-negative NSCLC patients, the combination of vinorelbine and carboplatin showed comparable outcomes to vinorelbine and cisplatin chemotherapy with no significant differences.
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Affiliation(s)
- Laksmi Wulandari
- Division of Thoracic Oncology, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga—Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Gatot Soegiarto
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga—Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Anna Febriani
- Division of Thoracic Oncology, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga—Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Farah Fatmawati
- Division of Thoracic Oncology, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga—Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Wirya Sastra Amran
- Department of Pulmonology and Respiratory Medicine, Universitas Airlangga, Faculty of Medicine—Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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Duan C, Chaovalitwongse WA, Bai F, Hippe DS, Wang S, Thammasorn P, Pierce LA, Liu X, You J, Miyaoka RS, Vesselle HJ, Kinahan PE, Rengan R, Zeng J, Bowen SR. Sensitivity analysis of FDG PET tumor voxel cluster radiomics and dosimetry for predicting mid-chemoradiation regional response of locally advanced lung cancer. Phys Med Biol 2020; 65:205007. [PMID: 33027064 PMCID: PMC7593986 DOI: 10.1088/1361-6560/abb0c7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We investigated the sensitivity of regional tumor response prediction to variability in voxel clustering techniques, imaging features, and machine learning algorithms in 25 patients with locally advanced non-small cell lung cancer (LA-NSCLC) enrolled on the FLARE-RT clinical trial. Metabolic tumor volumes (MTV) from pre-chemoradiation (PETpre) and mid-chemoradiation fluorodeoxyglucose-positron emission tomography (FDG PET) images (PETmid) were subdivided into K-means or hierarchical voxel clusters by standardized uptake values (SUV) and 3D-positions. MTV cluster separability was evaluated by CH index, and morphologic changes were captured by Dice similarity and centroid Euclidean distance. PETpre conventional features included SUVmean, MTV/MTV cluster size, and mean radiation dose. PETpre radiomics consisted of 41 intensity histogram and 3D texture features (PET Oncology Radiomics Test Suite) extracted from MTV or MTV clusters. Machine learning models (multiple linear regression, support vector regression, logistic regression, support vector machines) of conventional features or radiomic features were constructed to predict PETmid response. Leave-one-out-cross-validated root-mean-squared-error (RMSE) for continuous response regression (ΔSUVmean) and area-under-receiver-operating-characteristic-curve (AUC) for binary response classification were calculated. K-means MTV 2-clusters (MTVhi, MTVlo) achieved maximum CH index separability (Friedman p < 0.001). Between PETpre and PETmid, MTV cluster pairs overlapped (Dice 0.70-0.87) and migrated 0.6-1.1 cm. PETmid ΔSUVmean response prediction was superior in MTV and MTVlo (RMSE = 0.17-0.21) compared to MTVhi (RMSE = 0.42-0.52, Friedman p < 0.001). PETmid ΔSUVmean response class prediction performance trended higher in MTVlo (AUC = 0.83-0.88) compared to MTVhi (AUC = 0.44-0.58, Friedman p = 0.052). Models were more sensitive to MTV/MTV cluster regions (Friedman p = 0.026) than feature sets/algorithms (Wilcoxon signed-rank p = 0.36). Top-ranked radiomic features included GLZSM-LZHGE (large-zone-high-SUV), GTSDM-CP (cluster-prominence), GTSDM-CS (cluster-shade) and NGTDM-CNT (contrast). Top-ranked features were consistent between MTVhi and MTVlo cluster pairs but varied between MTVhi-MTVlo clusters, reflecting distinct regional radiomic phenotypes. Variability in tumor voxel cluster response prediction can inform robust radiomic target definition for risk-adaptive chemoradiation in patients with LA-NSCLC. FLARE-RT trial: NCT02773238.
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Affiliation(s)
- Chunyan Duan
- Department of Mechanical Engineering, Tongji University School of Mechanical Engineering, Shanghai China
- Department of Industrial Engineering, University of Arkansas College of Engineering, Fayetteville AR
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle WA
| | - W. Art Chaovalitwongse
- Department of Industrial Engineering, University of Arkansas College of Engineering, Fayetteville AR
| | - Fangyun Bai
- Department of Management Science and Engineering, Tongji University School of Economics and Management, Shanghai China
- Department of Industrial, Manufacturing, & Systems Engineering, University of Texas at Arlington College of Engineering, Arlington, TX
| | - Daniel S. Hippe
- Department of Radiology, University of Washington School of Medicine, Seattle WA
| | - Shouyi Wang
- Department of Industrial, Manufacturing, & Systems Engineering, University of Texas at Arlington College of Engineering, Arlington, TX
| | - Phawis Thammasorn
- Department of Industrial Engineering, University of Arkansas College of Engineering, Fayetteville AR
| | - Larry A. Pierce
- Department of Radiology, University of Washington School of Medicine, Seattle WA
| | - Xiao Liu
- Department of Industrial Engineering, University of Arkansas College of Engineering, Fayetteville AR
| | - Jianxin You
- Department of Management Science and Engineering, Tongji University School of Economics and Management, Shanghai China
| | - Robert S. Miyaoka
- Department of Radiology, University of Washington School of Medicine, Seattle WA
| | - Hubert J. Vesselle
- Department of Radiology, University of Washington School of Medicine, Seattle WA
| | - Paul E. Kinahan
- Department of Radiology, University of Washington School of Medicine, Seattle WA
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle WA
| | - Jing Zeng
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle WA
| | - Stephen R. Bowen
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle WA
- Department of Radiology, University of Washington School of Medicine, Seattle WA
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Zhu J, Liu Y, Zhang J, Wang Y, Chen L. Preliminary Clinical Study of the Differences Between Interobserver Evaluation and Deep Convolutional Neural Network-Based Segmentation of Multiple Organs at Risk in CT Images of Lung Cancer. Front Oncol 2019; 9:627. [PMID: 31334129 PMCID: PMC6624788 DOI: 10.3389/fonc.2019.00627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 06/25/2019] [Indexed: 12/25/2022] Open
Abstract
Background: In this study, publicly datasets with organs at risk (OAR) structures were used as reference data to compare the differences of several observers. Convolutional neural network (CNN)-based auto-contouring was also used in the analysis. We evaluated the variations among observers and the effect of CNN-based auto-contouring in clinical applications. Materials and methods: A total of 60 publicly available lung cancer CT with structures were used; 48 cases were used for training, and the other 12 cases were used for testing. The structures of the datasets were used as reference data. Three observers and a CNN-based program performed contouring for 12 testing cases, and the 3D dice similarity coefficient (DSC) and mean surface distance (MSD) were used to evaluate differences from the reference data. The three observers edited the CNN-based contours, and the results were compared to those of manual contouring. A value of P<0.05 was considered statistically significant. Results: Compared to the reference data, no statistically significant differences were observed for the DSCs and MSDs among the manual contouring performed by the three observers at the same institution for the heart, esophagus, spinal cord, and left and right lungs. The 95% confidence interval (CI) and P-values of the CNN-based auto-contouring results comparing to the manual results for the heart, esophagus, spinal cord, and left and right lungs were as follows: the DSCs were CNN vs. A: 0.914~0.939(P = 0.004), 0.746~0.808(P = 0.002), 0.866~0.887(P = 0.136), 0.952~0.966(P = 0.158) and 0.960~0.972 (P = 0.136); CNN vs. B: 0.913~0.936 (P = 0.002), 0.745~0.807 (P = 0.005), 0.864~0.894 (P = 0.239), 0.952~0.964 (P = 0.308), and 0.959~0.971 (P = 0.272); and CNN vs. C: 0.912~0.933 (P = 0.004), 0.748~0.804(P = 0.002), 0.867~0.890 (P = 0.530), 0.952~0.964 (P = 0.308), and 0.958~0.970 (P = 0.480), respectively. The P-values of MSDs are similar to DSCs. The P-values of heart and esophagus is smaller than 0.05. No significant differences were found between the edited CNN-based auto-contouring results and the manual results. Conclusion: For the spinal cord, both lungs, no statistically significant differences were found between CNN-based auto-contouring and manual contouring. Further modifications to contouring of the heart and esophagus are necessary. Overall, editing based on CNN-based auto-contouring can effectively shorten the contouring time without affecting the results. CNNs have considerable potential for automatic contouring applications.
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Affiliation(s)
| | | | | | | | - Lixin Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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4
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Zhu J, Zhang J, Qiu B, Liu Y, Liu X, Chen L. Comparison of the automatic segmentation of multiple organs at risk in CT images of lung cancer between deep convolutional neural network-based and atlas-based techniques. Acta Oncol 2019; 58:257-264. [PMID: 30398090 DOI: 10.1080/0284186x.2018.1529421] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In this study, a deep convolutional neural network (CNN)-based automatic segmentation technique was applied to multiple organs at risk (OARs) depicted in computed tomography (CT) images of lung cancer patients, and the results were compared with those generated through atlas-based automatic segmentation. MATERIALS AND METHODS An encoder-decoder U-Net neural network was produced. The trained deep CNN performed the automatic segmentation of CT images for 36 cases of lung cancer. The Dice similarity coefficient (DSC), the mean surface distance (MSD) and the 95% Hausdorff distance (95% HD) were calculated, with manual segmentation results used as the standard, and were compared with the results obtained through atlas-based segmentation. RESULTS For the heart, lungs and liver, both the deep CNN-based and atlas-based techniques performed satisfactorily (average values: 0.87 < DSC < 0.95, 1.8 mm < MSD < 3.8 mm, 7.9 mm < 95% HD <11 mm). For the spinal cord and the oesophagus, the two methods had statistically significant differences. For the atlas-based technique, the average values were 0.54 < DSC < 0.71, 2.6 mm < MSD < 3.1 mm and 9.4 mm < 95% HD <12 mm. For the deep CNN-based technique, the average values were 0.71 < DSC < 0.79, 1.2 mm < MSD <2.2 mm and 4.0 mm < 95% HD < 7.9 mm. CONCLUSION Our results showed that automatic segmentation based on a deep convolutional neural network enabled us to complete automatic segmentation tasks rapidly. Deep convolutional neural networks can be satisfactorily adapted to segment OARs during radiation treatment planning for lung cancer patients.
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Affiliation(s)
- Jinhan Zhu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jun Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Bo Qiu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yimei Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaowei Liu
- School of Physics, Sun Yat-sen University, Guangzhou, China
| | - Lixin Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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Chen L, Ta S, Wu W, Wang C, Zhang Q. Prognostic and Added Value of Echocardiographic Strain for Prediction of Adverse Outcomes in Patients with Locally Advanced Non-Small Cell Lung Cancer after Radiotherapy. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:98-107. [PMID: 30366608 DOI: 10.1016/j.ultrasmedbio.2018.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/07/2018] [Accepted: 09/14/2018] [Indexed: 06/08/2023]
Abstract
Radiotherapy (RT) is potentially related to cardiotoxicity, which may partially offset the benefits of cancer treatment. We sought to evaluate subclinical myocardial dysfunction using speckle tracking echocardiography after RT and to explore the associations between early cardiac effects and adverse outcomes in patients with non-small cell lung cancer (NSCLC). In total, 112 patients with stage III NSCLC who were scheduled to receive RT were prospectively recruited. A reduction in global longitudinal strain (GLS) was observed immediately after RT and at 6 mo after RT (6 m-RT). In multivariable analysis, the percentage change in GLS from baseline to 6 mo (ΔGLS%6 m-RT) (hazard ratio = 1.202, 95% confidence interval: 1.095-1.320, p < 0.001) was an independent predictor of all-cause mortality. Based on receiver operating characteristic curve analysis, ΔGLS%6 m-RT ≥13.65% had 65.9% sensitivity and 85.2% specificity for predicting mortality in NSCLC patients (area under the curve = 0.784, 95% confidence interval: 0.692-0.876, p < 0.001). These findings should encourage physicians to perform echocardiography early after RT.
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Affiliation(s)
- Lu Chen
- Department of Ultrasound, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shengjun Ta
- Department of Ultrasound, Yan'an People's Hospital, Yan'an, China
| | - Weihua Wu
- Department of Ultrasound, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Changlu Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qin Zhang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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6
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Kasymjanova G, Jagoe RT, Pepe C, Sakr L, Cohen V, Small D, Muanza TM, Agulnik JS. Does the presence of emphysema increase the risk of radiation pneumonitis in lung cancer patients? ACTA ACUST UNITED AC 2018; 25:e610-e614. [PMID: 30607130 DOI: 10.3747/co.25.4093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction Radiotherapy (rt) plays an important role in the treatment of lung cancer. One of the most common comorbidities in patients with lung cancer is pulmonary emphysema. The literature offers conflicting data about whether emphysema increases the occurrence and severity of radiation pneumonitis (rp). As a result, whether high doses of rt (with curative intent) should be avoided in patients with emphysema is still unclear. Objective We measured the documented incidence of rp in patients with and without emphysema who received curative radiation treatment. Methods This retrospective cohort study considered patients in the lung cancer clinical database of the Peter Brojde Lung Cancer Centre. Data from the database has been used previously for research studies, including a recent publication about emphysema grading, based on the percentage of lung occupied by emphysema on computed tomography (ct) imaging. Results Using previously published methods, chest ct imaging for 498 patients with lung cancer was scored for the presence of emphysema. The analysis considered 114 patients who received at least 30 Gy radiation. Of those 114 patients, 64 (56%) had emphysema, with approximately 23% having severe or very severe disease. The incidence of rp was 34.4% in patients with emphysema (n = 22) and 32.0% in patients with no emphysema (n = 16, p = 0.48). No difference in the incidence of rp was evident between patients with various grades of emphysema (p = 0.96). Similarly, no difference in the incidence of rp was evident between the two treatment protocols-that is, definitive rt 17 (37%) and combined chemotherapy-rt 21 (31%, p = 0.5). Conclusions In our cohort, the presence of emphysema on chest ct imaging was not associated with an increased risk of rp. That finding suggests that patients with lung cancer and emphysema should be offered rt when clinically indicated. However, further prospective studies will be needed for confirmation.
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Affiliation(s)
- G Kasymjanova
- Peter Brojde Lung Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - R T Jagoe
- Peter Brojde Lung Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - C Pepe
- Peter Brojde Lung Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - L Sakr
- Peter Brojde Lung Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - V Cohen
- Peter Brojde Lung Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - D Small
- Peter Brojde Lung Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - T M Muanza
- Radiation Oncology, Segal Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - J S Agulnik
- Peter Brojde Lung Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
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7
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Jiang XE, Xu T, Wei Q, Li P, Gomez DR, Court LE, Liao Z. DNA repair capacity correlates with standardized uptake values from 18F-fluorodeoxyglucose positron emission tomography/CT in patients with advanced non-small-cell lung cancer. Chronic Dis Transl Med 2018; 4:109-116. [PMID: 29988954 PMCID: PMC6034006 DOI: 10.1016/j.cdtm.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Indexed: 12/04/2022] Open
Abstract
Objective The DNA repair capacity (DRC) of tumor cells is an important contributor to resistance to radiation and platinum-based drugs. Because DRC may be affected by tumor cell metabolism, we measured DRC in lymphocytes from patients with non–small-cell lung cancer (NSCLC) and compared the findings with the maximum standardized uptake value (SUVmax) on18F-fluorodeoxyglucose positron emission tomography (FDG PET) after (chemo)radiation therapy. Methods This study included 151 patients with stage IA-IV NSCLC who had FDG PET at a single institution and donated blood samples before chemotherapy. We assessed the correlation of DRC, measured in peripheral T lymphocytes by a host-cell reactivation assay with SUVmax and their associations with overall survival (OS) time by hazards ratios calculated with a Cox proportional hazards regression model. Results SUVmax of the primary tumor at diagnosis was inversely associated with lymphocyte DRC (r = −0.175, P = 0.032), particularly among patients with advanced disease (r = −0.218, P = 0.015). However, ΔSUVmax of primary tumor was not significantly associated with DRC (r = 0.005, P = 0.968). SUVmax of regional lymph nodes at diagnosis (r = −0.307, P = 0.0008) and after (chemo)radiation treatment (r = −0.329, P = 0.034) and SUVmax of the primary tumor after (chemo)radiation treatment (r = −0.253, P = 0.045) were also inversely associated with OS time. Conclusion DRC was inversely associated with primary tumor SUVmax before treatment but not with ΔSUVmax after (chemo)radiation.
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Affiliation(s)
- Xin Eric Jiang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Duke University, Durham, NC 27708, USA
| | - Ting Xu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Qingyi Wei
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
| | - Peng Li
- Department of Medical Oncology, Henan Cancer Hospital, Zhengzhou, Henan 450008, China
| | - Daniel R Gomez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Laurence E Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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8
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Kuijvenhoven JC, Crombag L, Breen DP, van den Berk I, Versteegh MI, Braun J, Winkelman TA, van Boven W, Bonta PI, Rabe KF, Annema JT. Esophageal ultrasound (EUS) assessment of T4 status in NSCLC patients. Lung Cancer 2017; 114:50-55. [DOI: 10.1016/j.lungcan.2017.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/28/2017] [Accepted: 10/30/2017] [Indexed: 12/25/2022]
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9
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Hong CS, Ju SG, Ahn YC, Yoo GS, Noh JM, Oh D, Chung K, Pyo H, Jo K. Normal lung sparing Tomotherapy technique in stage III lung cancer. Radiat Oncol 2017; 12:167. [PMID: 29110732 PMCID: PMC5674800 DOI: 10.1186/s13014-017-0905-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/14/2017] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Radiation pneumonitis (RP) has been a challenging obstacle in treating stage III lung cancer patients. Beam angle optimization (BAO) technique for Tomotherapy was developed to reduce the normal lung dose for stage III non-small cell lung cancer (NSCLC). Comparative analyses on plan quality by 3 different Intensity-modulated radiation therapy (IMRT) methods with BAO were done. MATERIALS AND METHODS Ten consecutive stage IIIB NSCLC patients receiving linac-based static IMRT (L-IMRT) with total 66 Gy in 33 fractions to the PTV were selected. Two additional Tomotherapy-based IMRT plans (helical beam (TH-IMRT) and static beam (TD-IMRT)) were generated on each patient. To reduce the normal lung dose, Beam angles were optimized by using complete and directional block functions in Tomotherapy based on knowledge based statistical analysis. Plan quality was compared with target coverage, normal organ sparing capability, and normal tissue complication probability (NTCP). Actual beam delivery times and risk of RP related with planning target volume (PTV) were also evaluated. RESULTS The best PTV coverage measured by conformity index and homogeneity index was achievable by TH-IMRT (0.82 and 1.06), followed by TD-IMRT (0.81 and 1.07) and L-IMRT (0.75 and 1.08). Mean lung dose was the lowest in TH-IMRT plan followed by TD-IMRT and L-IMRT, all of which were ≤20 Gy. TH-IMRT plan could significantly lower the lung volumes receiving low to medium dose levels: V5~30 when compared to L-IMRT plan; and V5~20 when compared to TD-IMRT plan, respectively. TD-IMRT plan was significantly better than L-IMRT with respects to V20 and V30 and there was no significant difference with respect to V40 among three plans. The NTCP of the lung was the lowest in TH-IMRT plan, followed by TD-IMRT and L-IMRT (6.42% vs. 6.53% vs. 8.11%). Beam delivery time was the shortest in TD-IMRT plan followed by L-IMRT. As PTV length increased, NTCP and Mean lung dose proportionally increased significantly in all three plans. CONCLUSION Advantageous profiles by TH-IMRT could be achieved by BAO by complete and directional block functions. Current observation could help radiation oncologists to make wise selection of IMRT method for stage IIIB NSCLC.
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Affiliation(s)
- Chae-Seon Hong
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Sang Gyu Ju
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea.
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea.
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea.
| | - Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Kwangzoo Chung
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Hongryull Pyo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Kwanghyun Jo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
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Li S, Zhang S, Huang M, Ma Y, Yang Y. Management of occult malignant pleural disease firstly detected at thoracotomy for non-small cell lung cancer patients. J Thorac Dis 2017; 9:3851-3858. [PMID: 29268394 DOI: 10.21037/jtd.2017.09.112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The current study was to investigate the risk factors of occult malignant pleural disease (MPD) detected at thoracotomy and the outcomes of surgical intervention for these non-small cell lung cancer (NSCLC) patients with or without MPD. Methods We reviewed 2,093 consecutive NSCLC patients who underwent thoracotomy from January 2006 to January 2015. We used univariate and multivariate statistics to analyze the associations between clinicopathological variables and occurrence of occult MPD. Survival probability was estimated by the Kaplan-Meier method. Results 5.26% (110/2,093) MPD was observed for these NSCLC patients with 28% of 5-year estimated survival rate. Age ≤50 (P=0.055), high CEA level (P=0.006), advanced N stage (P=0.005), adenocarcinoma (P=0.001) and pleural invasion (P=0.041) were detected to be independent risk factors for the occult MPD. Combination of these five factors, 0.756 of area under curve (AUC) was shown by the integrated prediction model test. Based on the optimal cut-off value (risk score =2.795), low-risk patients have better prognosis than the high-risk patients (median survival time 61.4 months vs. not reached, P<0.001; 5-year survival 71.8% vs. 51.1%, P<0.001). Significantly, 49.0 months/31.7% and 29.4 months/19.5% of the median survival time/5-year survival rate were found for the occult MPD 110 patients receiving primary lesion resection and open-close surgery, respectively (P=0.037). Conclusions We summarized that a new prediction model including 5-risk factors of age, carcinoembryonic antigen (CEA), N stage, adenocarcinoma and pleural invasion was provided to diagnose MPD for the NSCLC patients and primary lesion resection greatly contributed for these MPD patients.
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Affiliation(s)
- Shaolei Li
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Shanyuan Zhang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Miao Huang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Yuanyuan Ma
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Yue Yang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
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11
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Finkle JH, Jo SY, Ferguson MK, Liu HY, Zhang C, Zhu X, Yuan C, Pu Y. Risk-stratifying capacity of PET/CT metabolic tumor volume in stage IIIA non-small cell lung cancer. Eur J Nucl Med Mol Imaging 2017; 44:1275-1284. [PMID: 28265739 PMCID: PMC6048959 DOI: 10.1007/s00259-017-3659-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/14/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Stage IIIA non-small cell lung cancer (NSCLC) is heterogeneous in tumor burden, and its treatment is variable. Whole-body metabolic tumor volume (MTVWB) has been shown to be an independent prognostic index for overall survival (OS). However, the potential of MTVWB to risk-stratify stage IIIA NSCLC has previously been unknown. If we can identify subgroups within the stage exhibiting significant OS differences using MTVWB, MTVWB may lead to adjustments in patients' risk profile evaluations and may, therefore, influence clinical decision making regarding treatment. We estimated the risk-stratifying capacity of MTVWB in stage IIIA by comparing OS of stratified stage IIIA with stage IIB and IIIB NSCLC. METHODS We performed a retrospective review of 330 patients with clinical stage IIB, IIIA, and IIIB NSCLC diagnosed between 2004 and 2014. The patients' clinical TNM stage, initial MTVWB, and long-term survival data were collected. Patients with TNM stage IIIA disease were stratified by MTVWB. The optimal MTVWB cutoff value for stage IIIA patients was calculated using sequential log-rank tests. Univariate and multivariate cox regression analyses and Kaplan-Meier OS analysis with log-rank tests were performed. RESULTS The optimal MTVWB cut-point was 29.2 mL for the risk-stratification of stage IIIA. We identified statistically significant differences in OS between stage IIB and IIIA patients (p < 0.01), between IIIA and IIIB patients (p < 0.01), and between the stage IIIA patients with low MTVWB (below 29.2 mL) and the stage IIIA patients with high MTVWB (above 29.2 mL) (p < 0.01). There was no OS difference between the low MTVWB stage IIIA and the cohort of stage IIB patients (p = 0.485), or between the high MTVWB stage IIIA patients and the cohort of stage IIIB patients (p = 0.459). Similar risk-stratification capacity of MTVWB was observed in a large range of cutoff values from 15 to 55 mL in stage IIIA patients. CONCLUSIONS Using MTVWB cutoff points ranging from 15 to 55 mL with an optimal value of 29.2 mL, stage IIIA NSCLC may be effectively stratified into subgroups with no significant survival difference from stages IIB or IIIB NSCLC. This may result in more accurate survival estimation and more appropriate risk adapted treatment selection in stage IIIA NSCLC.
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Affiliation(s)
- Joshua H Finkle
- Department of Radiology, University of Chicago, 5841 S. Maryland Ave., Chicago, IL, 60637, USA
| | - Stephanie Y Jo
- Department of Radiology, University of Chicago, 5841 S. Maryland Ave., Chicago, IL, 60637, USA
| | - Mark K Ferguson
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Hai-Yan Liu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Chenpeng Zhang
- Department of Nuclear Medicine, RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xuee Zhu
- Department of Radiology, BenQ Medical Center, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Cindy Yuan
- Department of Radiology, University of Chicago, 5841 S. Maryland Ave., Chicago, IL, 60637, USA
| | - Yonglin Pu
- Department of Radiology, University of Chicago, 5841 S. Maryland Ave., Chicago, IL, 60637, USA.
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12
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Chen F, Hu P, Liang N, Xie J, Yu S, Tian T, Zhang J, Deng G, Zhang J. Concurrent chemoradiotherapy with weekly nedaplatin versus radiotherapy alone in elderly patients with non-small-cell lung cancer. Clin Transl Oncol 2017; 20:294-301. [PMID: 28741074 DOI: 10.1007/s12094-017-1716-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/08/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE We conduct this study to compare the efficacy and toxicity of intensity-modulated radiotherapy (IMRT) concurrent weekly nedaplatin (NDP) versus IMRT alone in the stage III/IV non-surgical elderly patients with non-small-cell lung cancer (NSCLC). METHODS 117 patients were enrolled into our study. The patients were assigned into two different groups: radiotherapy (RT) group and chemoradiotherapy (CRT) group. Patients in RT group were treated with IMRT at a single daily dose of 2 Gy for 5 days per week, totally 52-66 Gy. The CRT group, IMRT concurrent weekly NDP at a dose of 25 mg/m2. RESULTS In CRT group, the median survival was 11.0 months (95% confidence interval [CI], 8.894-13.106 months) and in RT group, it was 7.0 months (95% CI 5.771-8.229 months). The 1-year, 2-year, 3-year, survival rates in the combined treatment arm were higher than the radiation therapy arm (46.8 vs 25.9%, 25.1 vs 11.8%, 14.7 vs 8.0%; p < 0.001). The Cox's multiple regression analysis showed that CRT had significantly better overall survival than RT (HR 0.523; 95.0% CI 0.338-0.807; p = 0.003). The objective response rate provided that 73.3% treated with CRT compared with 51.1% (p = 0.018) received RT alone. Of the hematologic toxicities, leukocytes (35.0 vs 0%; p < 0.001), neutrophils (33.3 vs 0%; p < 0.001) were significantly more common in the CRT group than the RT group. CONCLUSIONS We first discovered that NDP concurrent IMRT for treating stage III/IV non-surgical elderly patients with NSCLC was good curative effect of better objective response rate and well-tolerated. However, within the low number of patients, only stage IV gained a survival benefit.
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Affiliation(s)
- F Chen
- Department of Oncology, Weifang Medical College, Weifang, Shandong, China
| | - P Hu
- Department of Radiation Oncology, Qianfoshan Hospital Affiliated Shandong University, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - N Liang
- Department of Radiation Oncology, Qianfoshan Hospital Affiliated Shandong University, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - J Xie
- Department of Radiation Oncology, Qianfoshan Hospital Affiliated Shandong University, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - S Yu
- Department of Radiation Oncology, Qianfoshan Hospital Affiliated Shandong University, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - T Tian
- Department of Radiation Oncology, Qianfoshan Hospital Affiliated Shandong University, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Jingxin Zhang
- Department of Oncology, Weifang Medical College, Weifang, Shandong, China
| | - G Deng
- Department of Oncology, Shandong University School of Medicine, Jinan, Shandong, China
| | - Jiandong Zhang
- Department of Radiation Oncology, Qianfoshan Hospital Affiliated Shandong University, 16766 Jingshi Road, Jinan, 250014, Shandong, China.
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Ryu KH, Lee JH, Jang SW, Kim HJ, Lee JY, Chung SR, Chung MS, Kim HW, Choi YJ, Baek JH. US-guided core-needle biopsy versus US-guided fine-needle aspiration of suspicious cervical lymph nodes for staging workup of non-head and neck malignancies: A propensity score matching study. J Surg Oncol 2017. [PMID: 28650524 DOI: 10.1002/jso.24747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES To compare US-guided core-needle biopsy (USCNB) and US-guided fine-needle aspiration (USFNA) of suspicious cervical lymph nodes for staging workup of malignancies in locations other than the head and neck using propensity score matching (PSM). METHODS This retrospective cohort study included 108 patients who underwent USFNA and 1058 who underwent USCNB for suspicious cervical lymph nodes detected by imaging modalities during the staging workup for malignancies located in regions other than the head and neck. The primary outcome was defined as the inconclusive results. To evaluate the procedures according to the outcome, we performed univariate and multivariate logistic regression analyses and a 1:1 PSM of USCNB and USFNA. RESULTS There was no complication for both USFNA and USCNB. The inconclusive results were 6.5% (7/108) for USFNA and 1.6% (17/1058) for USCNB. A significantly lower rate of the inconclusive results in USCNB than in USFNA before matching was maintained after a 1:1 PSM of 103 patients from each group (before PSM, odds ratio (OR) = 4.489, 95% confidence interval (CI) [1.803-11.177], P = 0.001; after PSM, OR = 1.060, 95%CI [1.013-1.109], P = 0.012). CONCLUSIONS Because USCNB can reduce inconclusive results compared to USFNA, it could be more helpful for staging workup of malignancies in locations other than the head and neck in patients with suspicious cervical lymph nodes.
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Affiliation(s)
- Kyeong Hwa Ryu
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jeong Hyun Lee
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Won Jang
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hwa Jung Kim
- Preventive Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Ye Lee
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,Department of Radiology, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sae Rom Chung
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Mi Sun Chung
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Medical Center, Seoul, Korea
| | - Hyo Weon Kim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Sears CR, Cooney SA, Chin-Sinex H, Mendonca MS, Turchi JJ. DNA damage response (DDR) pathway engagement in cisplatin radiosensitization of non-small cell lung cancer. DNA Repair (Amst) 2016; 40:35-46. [PMID: 26991853 DOI: 10.1016/j.dnarep.2016.02.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/05/2016] [Accepted: 02/15/2016] [Indexed: 12/28/2022]
Abstract
Non-small cell lung cancers (NSCLC) are commonly treated with a platinum-based chemotherapy such as cisplatin (CDDP) in combination with ionizing radiation (IR). Although clinical trials have demonstrated that the combination of CDDP and IR appear to be synergistic in terms of therapeutic efficacy, the mechanism of synergism remains largely uncharacterized. We investigated the role of the DNA damage response (DDR) in CDDP radiosensitization using two NSCLC cell lines. Using clonogenic survival assays, we determined that the cooperative cytotoxicity of CDDP and IR treatment is sequence dependent, requiring administration of CDDP prior to IR (CDDP-IR). We identified and interrogated the unique time and agent-dependent activation of the DDR in NSCLC cells treated with cisplatin-IR combination therapy. Compared to treatment with CDDP or IR alone, CDDP-IR combination treatment led to persistence of γH2Ax foci, a marker of DNA double-strand breaks (DSB), for up to 24h after treatment. Interestingly, pharmacologic inhibition of DDR sensor kinases revealed the persistence of γ-H2Ax foci in CDDP-IR treated cells is independent of kinase activation. Taken together, our data suggest that delayed repair of DSBs in NSCLC cells treated with CDDP-IR contributes to CDDP radiosensitization and that alterations of the DDR pathways by inhibition of specific DDR kinases can augment CDDP-IR cytotoxicity by a complementary mechanism.
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Affiliation(s)
- Catherine R Sears
- Departments of Medicine, Indiana University School of Medicine, United States.
| | - Sean A Cooney
- School of Health and Rehabilitation Sciences, Indiana University-Purdue University, Indianapolis, Indiana, United States
| | - Helen Chin-Sinex
- Radiation Oncology, Indiana University School of Medicine, United States
| | - Marc S Mendonca
- Radiation Oncology, Indiana University School of Medicine, United States; Medical and Molecular Genetics, Indiana University School of Medicine, United States
| | - John J Turchi
- Departments of Medicine, Indiana University School of Medicine, United States; Biochemistry and Molecular Biology, Indiana University School of Medicine, United States
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15
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Feng J, Zhang S, Wu K, Wang B, Wong JYC, Jiang H, Xu R, Ying L, Huang H, Zheng X, Chen X, Ma S. Combined Effects of Suberoylanilide Hydroxamic Acid and Cisplatin on Radiation Sensitivity and Cancer Cell Invasion in Non-Small Cell Lung Cancer. Mol Cancer Ther 2016; 15:842-53. [PMID: 26839308 DOI: 10.1158/1535-7163.mct-15-0445] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 01/19/2016] [Indexed: 11/16/2022]
Abstract
Lung cancer is a leading cause of cancer-related mortality worldwide, and concurrent chemoradiotherapy has been explored as a therapeutic option. However, the chemotherapeutic agents cannot be administered for most patients at full doses safely with radical doses of thoracic radiation, and further optimizations of the chemotherapy regimen to be given with radiation are needed. In this study, we examined the effects of suberoylanilide hydroxamic acid (SAHA) and cisplatin on DNA damage repairs, and determined the combination effects of SAHA and cisplatin on human non-small cell lung cancer (NSCLC) cells in response to treatment of ionizing radiation (IR), and on tumor growth of lung cancer H460 xenografts receiving radiotherapy. We also investigated the potential differentiation effect of SAHA and its consequences on cancer cell invasion. Our results showed that SAHA and cisplatin compromise distinct DNA damage repair pathways, and treatment with SAHA enhanced synergistic radiosensitization effects of cisplatin in established NSCLC cell lines in a p53-independent manner, and decreased the DNA damage repair capability in cisplatin-treated primary NSCLC tumor tissues in response to IR. SAHA combined with cisplatin also significantly increased inhibitory effect of radiotherapy on tumor growth in the mouse xenograft model. In addition, SAHA can induce differentiation in stem cell-like cancer cell population, reduce tumorigenicity, and decrease invasiveness of human lung cancer cells. In conclusion, our data suggest a potential clinical impact for SAHA as a radiosensitizer and as a part of a chemoradiotherapy regimen for NSCLC. Mol Cancer Ther; 15(5); 842-53. ©2016 AACR.
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Affiliation(s)
- Jianguo Feng
- Cancer Research Institute and Key Laboratory Diagnoses and Treatment Technology on Thoracic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Shirong Zhang
- Department of Oncology, Affiliated Hangzhou Hospital of Nanjing Medical University, Hangzhou, China. Affiliated Hangzhou First People's Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Kan Wu
- Affiliated Hangzhou First People's Hospital of Zhejiang Chinese Medical University, Hangzhou, China. Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou, China
| | - Bing Wang
- Affiliated Hangzhou First People's Hospital of Zhejiang Chinese Medical University, Hangzhou, China. Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou, China
| | - Jeffrey Y C Wong
- Department of Radiation Oncology, City of Hope Cancer Center, Duarte, California
| | - Hong Jiang
- Department of Oncology, Affiliated Hangzhou Hospital of Nanjing Medical University, Hangzhou, China
| | - Rujun Xu
- Department of Oncology, Affiliated Hangzhou Hospital of Nanjing Medical University, Hangzhou, China
| | - Lisha Ying
- Cancer Research Institute and Key Laboratory Diagnoses and Treatment Technology on Thoracic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Haixiu Huang
- Department of Oncology, Affiliated Hangzhou Hospital of Nanjing Medical University, Hangzhou, China
| | - Xiaoliang Zheng
- Centre of Molecular Medicine, Zhejiang Academy of Medical Sciences, Hangzhou, China
| | - Xufeng Chen
- Department of Pathology and Laboratory Medicine, University of California at Los Angeles, Los Angeles, California
| | - Shenglin Ma
- Department of Oncology, Affiliated Hangzhou Hospital of Nanjing Medical University, Hangzhou, China. Affiliated Hangzhou First People's Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
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Chan R, Sethi P, Jyoti A, McGarry R, Upreti M. Investigating the Radioresistant Properties of Lung Cancer Stem Cells in the Context of the Tumor Microenvironment. Radiat Res 2016; 185:169-81. [PMID: 26836231 DOI: 10.1667/rr14285.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Lung cancer is the most common cause of cancer-related deaths worldwide and non-small cell lung cancer (NSCLC) accounts for ~85% of all lung cancer. While recent research has shown that cancer stem cells (CSC) exhibit radioresistant and chemoresistant properties, current cancer therapy targets the bulk of the tumor burden without accounting for the CSC and the contribution of the tumor microenvironment. CSC interaction with the stroma enhances NSCLC survival, thus limiting the efficacy of treatment. The aim of this study was to elucidate the role of CSC and the microenvironment in conferring radio- or chemoresistance in an in vitro tumor model for NSCLC. The novel in vitro three-dimensional (3D) NSCLC model of color-coded tumor tissue analogs (TTA) that we have developed is comprised of human lung adenocarcinoma cells, fibroblasts, endothelial cells and NSCLC cancer stem cells maintained in low oxygen conditions (5% O2) to recapitulate the physiologic conditions in tumors. Using this model, we demonstrate that a single 5 Gy radiation dose does not inhibit growth of TTA containing CSC and results in elevated expression of cytokines (TGF-α, RANTES, ENA-78) and factors (vimentin, MMP and TIMP), indicative of an invasive and aggressive phenotype. However, combined treatment of single dose or fractionated doses with cisplatin was found to either attenuate or decrease the proliferative effect that radiation exposure alone had on TTA containing CSC maintained in hypoxic conditions. In summary, we utilized a 3D NSCLC model, which had characteristics of the tumor microenvironment and tumor cell heterogeneity, to elucidate the multifactorial nature of radioresistance in tumors.
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Affiliation(s)
- Ryan Chan
- a Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, Kentucky, 40536-0596; and b Department of Radiation Medicine, University of Kentucky Albert B. Chandler Hospital, Lexington, Kentucky 40536-0293
| | - Pallavi Sethi
- a Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, Kentucky, 40536-0596; and b Department of Radiation Medicine, University of Kentucky Albert B. Chandler Hospital, Lexington, Kentucky 40536-0293
| | - Amar Jyoti
- a Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, Kentucky, 40536-0596; and b Department of Radiation Medicine, University of Kentucky Albert B. Chandler Hospital, Lexington, Kentucky 40536-0293
| | - Ronald McGarry
- a Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, Kentucky, 40536-0596; and b Department of Radiation Medicine, University of Kentucky Albert B. Chandler Hospital, Lexington, Kentucky 40536-0293
| | - Meenakshi Upreti
- a Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, Kentucky, 40536-0596; and b Department of Radiation Medicine, University of Kentucky Albert B. Chandler Hospital, Lexington, Kentucky 40536-0293
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Medbery RL, Gillespie TW, Liu Y, Nickleach DC, Lipscomb J, Sancheti MS, Pickens A, Force SD, Fernandez FG. Nodal Upstaging Is More Common with Thoracotomy than with VATS During Lobectomy for Early-Stage Lung Cancer: An Analysis from the National Cancer Data Base. J Thorac Oncol 2016; 11:222-33. [PMID: 26792589 DOI: 10.1016/j.jtho.2015.10.007] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/22/2015] [Accepted: 10/13/2015] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Questions remain regarding differences in nodal evaluation and upstaging between thoracotomy (open) and video-assisted thoracic surgery (VATS) approaches to lobectomy for early-stage lung cancer. Potential differences in nodal staging based on operative approach remain the final significant barrier to widespread adoption of VATS lobectomy. The current study examines differences in nodal staging between open and VATS lobectomy. METHODS The National Cancer Data Base was queried for patients with clinical stage T2N0M0 or lower lung cancer who underwent lobectomy in 2010-2011. Propensity score matching was performed to compare the rate of nodal upstaging in VATS with that in open approaches. Additional subgroup analysis was performed to assess whether rates of upstaging differed by specific clinical setting. RESULTS A total of 16,983 lobectomies were analyzed; 4935 (29.1%) were performed using VATS. Nodal upstaging was more frequent in the open group (12.8% versus 10.3%; p < 0.001). In 4437 matched pairs, nodal upstaging remained more common for open approaches. For a subgroup of patients who had seven lymph or more nodes examined, propensity matching revealed that nodal upstaging remained more common after an open approach than after VATS (14.0% versus 12.1%; p = 0.03). For patients who were treated in an academic/research facility, however, the difference in nodal upstaging between an open and VATS approach was no longer significant (12.2% versus 10.5%, p = 0.08). CONCLUSIONS For early-stage lung cancer, nodal upstaging was observed more frequently with thoracotomy than with VATS. However, nodal upstaging appears to be affected by facility type, which may be a surrogate for expertise in minimally invasive surgical procedures.
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Affiliation(s)
- Rachel L Medbery
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Theresa W Gillespie
- Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Dana C Nickleach
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Joseph Lipscomb
- Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA; Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Manu S Sancheti
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Allan Pickens
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Seth D Force
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Felix G Fernandez
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
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Induction or consolidation chemotherapy for unresectable stage III non-small-cell lung cancer patients treated with concurrent chemoradiation: a randomised phase II trial GFPC – IFCT 02-01. Eur J Cancer 2016; 52:181-7. [DOI: 10.1016/j.ejca.2015.10.072] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/24/2015] [Accepted: 10/30/2015] [Indexed: 12/25/2022]
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Phase I study evaluating the safety and efficacy of oral panobinostat in combination with radiotherapy or chemoradiotherapy in patients with inoperable stage III non-small-cell lung cancer. Anticancer Drugs 2015; 26:1069-77. [PMID: 26317683 DOI: 10.1097/cad.0000000000000282] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Panobinostat is a radiosensitizing agent and targets the epigenetics of malignancy. This phase I study evaluated the safety and efficacy of combining oral panobinostat with radiotherapy (RT) or chemoradiotherapy (CRT) in patients with inoperable stage III non-small-cell lung cancer. This study had a parallel dose-escalating design combining oral panobinostat twice a week (dose escalations 20, 30, 45 mg) with either palliative RT (group A) or radical CRT (group B) using a standard chemotherapy protocol of cisplatin and etoposide. In group A (RT), nine recruited patients received treatment with oral panobinostat (doses 20, 30, 45 mg) with RT. Two serious adverse events, rapid atrial fibrillation and tracheo-oesophageal fistula, were not attributable to study treatment. The most common grade 3/4 toxicities were thrombocytopenia and lymphopenia, which resolved promptly after cessation of panobinostat. The disease control rate was 66%, the progression-free survival was 3 months and the median overall survival was 9 months. In group B (CRT), panobinostat dose was not escalated beyond 20 mg because of infection-related complications. Serious adverse events included opportunistic infection associated with treatment-related lymphopenia and febrile neutropenia without a source. One patient had cerebral infarct that was not attributed to study treatment. All patients achieved a partial response to treatment. At 33 months of follow-up, all patients were still alive. Panobinostat can be combined with palliative-dose RT at doses up to 45 mg twice a week with tolerable toxicity. Dose-limiting toxicities prevented the dose escalation of the panobinostat with CRT.
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Serum human epididymis protein 4 is associated with the treatment response of concurrent chemoradiotherapy and prognosis in patients with locally advanced non-small cell lung cancer. Clin Transl Oncol 2015; 18:375-80. [PMID: 26329292 DOI: 10.1007/s12094-015-1375-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
Abstract
AIM To investigate the role of human epididymis protein 4 (HE4) in the diagnosis and prognosis of patients with locally advanced non-small cell lung cancer (LA-NSCLC) receiving concurrent chemoradiotherapy (CRT). METHODS A total of 218 patients with LA-NSCLC were enrolled. All patients underwent CRT. The treatment response to CRT was evaluated. The prognosis analysis was performed using relapse-free survival (RFS) and overall survival [1]. RESULTS Our data show that the serum HE4 can discriminate patients who respond well to CRT from those who respond poorly. Higher serum HE4 had dramatically increased risk of being non-responders to CRT. Serum HE4 level is also associated with prognosis of patients after CRT. Patients with high HE4 level had shorter RFS and OS compared to those with low HE4 level. CONCLUSION Our data suggest that serum HE4 may be a useful prognostic biomarker for LA-NSCLC patients who underwent CRT.
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Kowal A, Wiśniewski A, Kuśnierczyk P, Jankowska R. Human leukocyte antigen (HLA)-G gene polymorphism in patients with non-small cell lung cancer. Thorac Cancer 2015; 6:613-9. [PMID: 26445610 PMCID: PMC4567007 DOI: 10.1111/1759-7714.12232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 12/22/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Lung cancer represents the highest morbidity and mortality caused by neoplasms in the world; therefore researchers continue to search for new tools to diagnose and treat the disease. The aim of the study was to establish the role of single nucleotide polymorphisms (SNP) in the promoter region of the human leukocyte antigen (HLA)-G gene in patients with non-small cell lung cancer. METHODS We enrolled 143 patients with a mean age of 63 years, diagnosed with non-small cell lung cancer, in the study. Adenocarcinomas made up 33% of the cases. Patients in stage III or IV of the tumor node metastasis staging system made up 59%. Two polymorphic sites in the promoter region of the HLA-G gene were genotyped (-725C>G>T and -716T>G). RESULTS All genotyped SNPs were in Hardy-Weinberg equilibrium. No proof of a relationship between genotype -725C>G>T or -716T>G and the risk of lung cancer compared with healthy volunteers from the literature was found. We also found no correlation between the two SNPs and survival time, histological type of cancer, T stage, the presence of remote metastases or performance status according to the Eastern Cooperative Oncology Group (ECOG) scale. The only association we found was genotype -725C>G>T and the degree of lymph node metastases (N stage). CONCLUSIONS SNPs of the promoter of the HLA-G gene may have an impact on the development of lymph node metastases. In the study we did not prove a relationship between the examined SNPs and the course of the disease because of the small patient groups studied.
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Affiliation(s)
- Aneta Kowal
- Department of Pulmonology and Lung Cancer, Wrocław Medical UniversityWrocław, Poland
| | - Andrzej Wiśniewski
- Laboratory of Immunogenetics, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of SciencesWrocław, Poland
| | - Piotr Kuśnierczyk
- Laboratory of Immunogenetics, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of SciencesWrocław, Poland
| | - Renata Jankowska
- Department of Pulmonology and Lung Cancer, Wrocław Medical UniversityWrocław, Poland
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Brooks P. Robotic-Assisted Thoracic Surgery for Early-Stage Lung Cancer: A Review. AORN J 2015; 102:40-9. [DOI: 10.1016/j.aorn.2015.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 01/25/2014] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
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Affiliation(s)
- Yuanzeng Min
- Laboratory of Nano- and Translational Medicine, Carolina Institute of Nanomedicine, Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill , Chapel Hill, North Carolina 27599, United States
| | - Joseph M Caster
- Laboratory of Nano- and Translational Medicine, Carolina Institute of Nanomedicine, Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill , Chapel Hill, North Carolina 27599, United States
| | - Michael J Eblan
- Laboratory of Nano- and Translational Medicine, Carolina Institute of Nanomedicine, Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill , Chapel Hill, North Carolina 27599, United States
| | - Andrew Z Wang
- Laboratory of Nano- and Translational Medicine, Carolina Institute of Nanomedicine, Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill , Chapel Hill, North Carolina 27599, United States
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Five-year survival after palliative radiotherapy of T4/N3 lung cancer: case series and review of the literature. JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s1460396914000314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThere is sparse literature regarding extended survival of patients treated for T4 and/or N3 lung cancers. We present the results of a case series from our radiotherapeutic experience over the last 12 years to provide additional information. Out of 189 individuals diagnosed with lung cancer between 1997 and 2008, seven treated patients who survived five years or longer were identified. The median age was 56 years. More than half of the subjects were symptomatic at the time of hospitalization, possessed voluminous, non-small-cell histologic type malignant neoplasms, and received chemotherapy also. All individuals responded to treatment, and their survival ranged from 60 to 169 months. Our observed long-term survivors seem to justify the continued practice of modern standards of care in patients with lung cancer.
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Smoragiewicz M, Laskin J, Wilson D, Ramsden K, Yee J, Lam S, Shaipanich T, Zhai Y, Ho C. Using pet-ct to reduce futile thoracotomy rates in non-small-cell lung cancer: a population-based review. ACTA ACUST UNITED AC 2014; 21:e768-74. [PMID: 25489265 DOI: 10.3747/co.21.2125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Combined positron-emission tomography and computed tomography (pet-ct) reduces futile thoracotomy (ft) rates in patients with non-small-cell lung cancer (nsclc). We sought to identify preoperative risk factors for ft in patients staged with pet-ct. METHODS We retrospectively reviewed all patients referred to the BC Cancer Agency during 2009-2010 who underwent pet-ct and thoracotomy for nsclc. Patients with clinical N2 disease were excluded. An ft was defined as any of a benign lesion; an exploratory thoracotomy; pathologic N2 or N3, stage iiib or iv, or inoperable T3 or T4 disease; and recurrence or death within 1 year of surgery. RESULTS Of the 108 patients who met the inclusion criteria, ft occurred in 27. The main reason for ft was recurrence within 1 year (14 patients) and pathologic N2 disease (10 patients). On multivariate analysis, an Eastern Cooperative Oncology Group performance status greater than 1, a pet-ct positive N1 status, a primary tumour larger than 3 cm, and a period of more than 16 weeks from pet-ct to surgery were associated with ft. N2 disease that had been negative on pet-ct occurred in 21% of patients with a pet-ct positive N1 status and in 20% of patients with tumours larger than 3 cm and non-biopsy mediastinal staging only. The combination of pet-ct positive N1 status and a primary larger than 3 cm had 85% specificity, and the presence of either risk factor had 100% sensitivity, for ft attributable to N2 disease. CONCLUSIONS To reduce ft attributable to N2 disease, tissue biopsy for mediastinal staging should be considered for patients with pet-ct positive N1 status and with tumours larger than 3 cm even with a pet-ct negative mediastinum.
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Affiliation(s)
| | - J Laskin
- British Columbia Cancer Agency, Vancouver, BC
| | - D Wilson
- British Columbia Cancer Agency, Vancouver, BC
| | - K Ramsden
- British Columbia Cancer Agency, Vancouver, BC
| | - J Yee
- Vancouver General Hospital, Vancouver, BC
| | - S Lam
- British Columbia Cancer Agency, Vancouver, BC
| | | | - Y Zhai
- Department of Statistics, University of British Columbia, Vancouver, BC
| | - C Ho
- British Columbia Cancer Agency, Vancouver, BC
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Song H, Zhu J, Suo C, Lu D. Immunotherapy for stage I-III non-small cell lung cancer treated with surgery or radiotherapy with curative intent. Hippokratia 2014. [DOI: 10.1002/14651858.cd011300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Huan Song
- Karolinska Institutet; Department of Medical Epidemiology and Biostatistics; Box 281 Stockholm Sweden SE-17177
| | - Jianwei Zhu
- Shandong Provincial Hospital Affiliated to Shandong University; Department of Orthopaedics; No.324, Jingwu Road Jinan Shandong China 250021
| | - Chen Suo
- Karolinska Institutet; Department of Medical Epidemiology and Biostatistics; Box 281 Stockholm Sweden SE-17177
| | - DongHao Lu
- Karolinska Institutet; Department of Medical Epidemiology and Biostatistics; Box 281 Stockholm Sweden SE-17177
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Prognostic and predictive value of plasma D-dimer in advanced non-small cell lung cancer patients undergoing first-line chemotherapy. Clin Transl Oncol 2014; 17:57-64. [DOI: 10.1007/s12094-014-1198-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
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Al-Shamsi HO, Al Farsi A, Ellis PM. Stage III Non–Small-Cell Lung Cancer: Establishing a Benchmark for the Proportion of Patients Suitable for Radical Treatment. Clin Lung Cancer 2014; 15:274-80. [DOI: 10.1016/j.cllc.2014.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/11/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
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Schytte T, Nielsen TB, Brink C, Hansen O. Pattern of loco-regional failure after definitive radiotherapy for non-small cell lung cancer. Acta Oncol 2014; 53:336-41. [PMID: 24369735 DOI: 10.3109/0284186x.2013.868035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
UNLABELLED Non-small cell lung cancer (NSCLC) is associated with poor survival even though patients are treated with curatively intended radiotherapy. Survival is affected negatively by lack of loco-regional tumour control, but survival is also influenced by comorbidity caused by age and smoking, and occurrence of distant metastasis. It is challenging to evaluate loco-regional control after definitive radiotherapy for NSCLC since it is difficult to distinguish between radiation-induced damage to the lung tissue and tumour progression/recurrence. In addition it may be useful to distinguish between intrapulmonary failure and mediastinal failure to be able to optimize radiotherapy in order to improve loco-regional control even though it is not easy to discriminate between the two sites of failure. MATERIAL AND METHODS This study is a retrospective analysis of 331 NSCLC patients treated with definitive radiotherapy from 2002 to 2011. The patients were treated consecutively at the Department of Oncology, Odense University Hospital, Denmark with at least 60 Gy. All patients were followed in a planned follow-up schedule and no patients were lost for follow-up. RESULTS At the time of the analysis 93 patients had loco-regional failure only. Of these patients, 68 had intrapulmonary failure only, one patient had failure in mediastinum only, and 24 patients had intrapulmonary failure as well as mediastinal failure. Of the patients which had lung failure only, 78% had mediastinal involvement at treatment start. The only covariate with significant impact on developing intrapulmonary failure only was gross tumour volume. Median survival for the total group of 331 patients was 19 months. The median survival for patients with intrapulmonary failure only was 19 months, and it was 20 months for the patients with mediastinal relapse. CONCLUSION We conclude that focus should be on increasing doses to intrapulmonary tumour volume, when dose escalation is applied to improve local tumour control in NSCLC patients treated with definitive radiotherapy, since most recurrences are located here.
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Affiliation(s)
- Tine Schytte
- Department of Oncology, Odense University Hospital , Odense , Denmark
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Results of T4 surgical cases in the Japanese Lung Cancer Registry Study: should mediastinal fat tissue invasion really be included in the T4 category? J Thorac Oncol 2014; 8:759-65. [PMID: 23608818 DOI: 10.1097/jto.0b013e318290912d] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION T4 lung cancer is a heterogeneous group of locally advanced disease. We hypothesized that patients in whom T4 lung cancer invaded only mediastinal fat tissue would show better prognosis after surgery than patients in whom T4 disease invaded other organs. The present study aimed to investigate how different invasive features of T4 disease impacted prognosis, and what types of patients with T4 disease could benefit most from surgical treatment. METHODS A nationwide registry study on lung cancer surgical cases during 2004 was conducted by the Japanese Joint Committee of Lung Cancer Registry, including registries of 11,663 cases within Japan. The present study analyzed 215 of these cases involving T4 structures or with ipsilateral nonprimary lobe pulmonary metastasis (PM). RESULTS Reasons for T4 classification included invasion of only mediastinal tissue in 32 cases (15%), invasion of other structures in 96 cases (45%), and ipsilateral different lobe PM in 87 cases (40%); among these three groups, there were no significant differences in survival, nodal status, and patterns of first recurrence. Multivariate analysis showed an age of 70 years or above (p = 0.022) and nodal status (p = 0.004) to be significant prognostic factors. T4N0 patients less than 70 years of age showed significantly better prognosis than those who were T4N1-2 and 70 years of age or older (p = 0.0001; 5-year survival rate 50.3 versus 19.9%). CONCLUSIONS There was no significant difference in survival between T4 patients with only mediastinal fat invasion and those with other T4 organ invasion and ipsilateral different lobe PM, demonstrating appropriateness of the T4 category definition in the current tumor, node, metastasis staging system. Age and nodal status were significant independent prognostic factors in T4 patients, and the best surgical candidates were shown to be T4N0 patients who were less than 70 years of age and had a 5-year survival rate of more than 50%.
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Zieliński M. The role of transcervical extended mediastinal lymphadenectomy for lung cancer staging. Expert Rev Med Devices 2014; 8:665-7. [DOI: 10.1586/erd.11.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Russell K, Healy B, Pantarotto J, Laurie SA, MacRae R, Sabri E, Wheatley-Price P. Prognostic factors in the radical nonsurgical treatment of stage IIIB non-small-cell lung cancer. Clin Lung Cancer 2013; 15:237-43. [PMID: 24461300 DOI: 10.1016/j.cllc.2013.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/21/2013] [Accepted: 12/23/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Many patients diagnosed with stage IIIB (AJCC sixth edition; T4, N3, or both; no pleural effusion) non-small-cell lung cancer (NSCLC) are treated with curative intent, despite a low cure rate. Guidelines are required to help select patients for radical therapy so that the patients with little chance of cure may be spared the toxicities of aggressive treatment. A retrospective analysis was performed to investigate factors influencing outcomes in these patients. MATERIALS AND METHODS From 2002 to 2009, all cases of stage IIIB NSCLC from the authors' institution were identified. Patients treated with radical radiotherapy (minimum dose, 50 Gy), with or without chemotherapy, were included. Charts were reviewed for patient demographic data, baseline blood work, tumor factors, treatment factors, and hospitalizations. The primary outcome was overall survival (OS), measured from time of diagnosis. RESULTS Of 238 patients identified, 184 eligible cases were reviewed. The median follow-up for all patients was 17.2 months (range, 1.7-237.1). The median progression-free survival was 10.8 months (95% CI, 9.6-12.4). Median survival was 17.9 months, and OS was 68%, 42%, and 28% at 1, 2, and 3 years, respectively. In multivariate analysis, female gender (hazard ratio [HR], 0.58; 95% CI, 0.37-0.88; P = .0013), ≤ 5% weight loss (HR, 0.64; 95% CI, 0.43-0.93; P = .01), and absence of N3 disease (HR, 0.64; 95% CI, 0.42-0.96; P = .03) were associated with significantly longer survival. CONCLUSION OS was significantly longer in women, in patients with ≤ 5% weight loss, and in those without N3 disease. Good patient selection remains important in the radical treatment of stage IIIB NSCLC.
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Affiliation(s)
- Kent Russell
- Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Healy
- Division of Medical Oncology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jason Pantarotto
- Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Scott A Laurie
- Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert MacRae
- Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Elham Sabri
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Wheatley-Price
- Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
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Zhu ZF, Ma HL, Fan M, Bao Y, Zhuang TT, Chen M, Jiang GL, Fu XL. Sequential chemoradiotherapy with accelerated hypofractionated radiotherapy compared to concurrent chemoradiotherapy with standard radiotherapy for locally advanced non-small cell lung cancer. Technol Cancer Res Treat 2013; 13:269-75. [PMID: 24066952 DOI: 10.7785/tcrt.2012.500375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
To compare the outcomes and treatment-related toxicities of two chemoradiotherapy schedules given to the patients with unresectable locally advanced non-small cell lung cancer (NSCLC): sequential chemotherapy with accelerated hypofractionated radiotherapy (SCRT), and concurrent chemotherapy with standard radiotherapy (CCRT), 68 patients from two prospective clinical trials were included. Thirty-four patients were treated with SCRT using an accelerated hypofractionated radiation schedule, 34 patients received CCRT with standard radiation. Between the two treatment groups there were no significant differences in terms of overall survival, progression-free survival (PFS), locoregional-PFS or distant metastasis-PFS. For the SCRT group, the median survival time and 2- and 4-year overall survival rates were 19 months, 38.2%, and 23.5%, respectively, and for the CCRT group these were 19 months, 44.1%, and 19.6%. Esophageal and constitutional toxicities were more pronounced in the CCRT group, while there was no significant difference in pulmonary toxicities. The results suggest that for unresectable stage III NSCLC, the outcomes of SCRT with accelerated hypofractionated radiotherapy and CCRT with standard radiotherapy are similar, but the toxicities associated with treatment are less in the SCRT group.
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Affiliation(s)
- Zheng-Fei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Road, Shanghai, 200032, China.
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Bayraktar S, Rocha-Lima CM. Molecularly targeted therapies for advanced or metastatic non-small-cell lung carcinoma. World J Clin Oncol 2013; 4:29-42. [PMID: 23696960 PMCID: PMC3659261 DOI: 10.5306/wjco.v4.i2.29] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 04/09/2013] [Accepted: 04/17/2013] [Indexed: 02/06/2023] Open
Abstract
Non-small-cell lung cancer (NSCLC) remains the leading cause of cancer-related death in both men and women in the United States. Platinum-based doublet chemotherapy has been a standard for patients with advanced stage disease. Improvements in overall survival and quality of life have been modest. Improved knowledge of the aberrant molecular signaling pathways found in NSCLC has led to the development of biomarkers with associated targeted therapeutics, thus changing the treatment paradigm for many NSCLC patients. In this review, we present a summary of many of the currently investigated biologic targets in NSCLC, discuss their current clinical trial status, and also discuss the potential for development of other targeted agents.
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Nanoparticle albumin bound Paclitaxel in the treatment of human cancer: nanodelivery reaches prime-time? JOURNAL OF DRUG DELIVERY 2013; 2013:905091. [PMID: 23738077 PMCID: PMC3659516 DOI: 10.1155/2013/905091] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/05/2013] [Indexed: 01/17/2023]
Abstract
Nanoparticle albumin bound paclitaxel (nab-paclitaxel) represents the first nanotechnology-based drug in cancer treatment. We discuss the development of this innovative compound and report the recent changing-practice results in breast and pancreatic cancer. A ground-breaking finding is the demonstration that nab-paclitaxel can not only enhance the activity and reduce the toxicity of chromophore-diluted compound, but also exert activity in diseases considered refractory to taxane-based treatment. This is the first clinical demonstration of major activity of nanotechnologically modified drugs in the treatment of human neoplasms.
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Riquet M, Mordant P, Fabre-Guillevin E, Arame A, Foucault C, Dujon A, Le Pimpec Barthes F. Long-term survival with surgery as part of a multimodality approach for N3 lung cancer. Eur J Cardiothorac Surg 2013; 44:1117-22. [DOI: 10.1093/ejcts/ezt171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kuroda Y, Sekine I, Sumi M, Sekii S, Takahashi K, Inaba K, Horinouchi H, Nokihara H, Yamamoto N, Kubota K, Murakami N, Morota M, Mayahara H, Ito Y, Tamura T, Nemoto K, Itami J. Acute radiation esophagitis caused by high-dose involved field radiotherapy with concurrent cisplatin and vinorelbine for stage III non-small cell lung cancer. Technol Cancer Res Treat 2013; 12:333-9. [PMID: 23369154 DOI: 10.7785/tcrt.2012.500319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose of this study is to obtain dose-volume histogram (DVH) predictors and threshold values for radiation esophagitis caused by high-dose involved field radiotherapy (IFRT) with concurrent chemotherapy in patients with stage III non-small cell lung cancer (NSCLC). Thirty-two patients treated by 66 Gy/33 Fr, 72 Gy/36 Fr, and 78 Gy/39 Fr thoracic radiotherapy without elective nodal irradiation plus concurrent cisplatin and vinorelvine were reviewed. Acute radiation esophagitis was evaluated according to common terminology criteria for adverse events version 4.0, and correlations between grade 2 or worse radiation esophagitis and DVH parameters were investigated. Grade 0-1, 2, 3, and 4-5 of radiation esophagitis were seen in 11 (34.4%), 20 (62.5%), 1 (3.1%), and 0 (0%) of the patients, respectively. Multivariate analysis revealed that whole esophagus V35 is a predictor of radiation esophagitis (OR = 0.74 [95%CI; 0.60-0.91], p = 0.006). There is a significant difference (38.4% vs. 89.4%, p = 0.027) in the cumulative rates of acute esophagitis according to V35 values of more than 20% versus less. As compared with other factors concerning patient and tumor and treatment factors, V35 ≤ 20% of the esophagus was an independent predictor (HR 5 0.29 [95%CI; 0.09-0.85], p 5 0.025). In conclusion, whole esophagus V35 < 20% is proposed in high-dose IFRT with concurrent chemotherapy for stage III NSCLC patients.
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Affiliation(s)
- Yuuki Kuroda
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.
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Rios Velazquez E, Aerts HJWL, Gu Y, Goldgof DB, De Ruysscher D, Dekker A, Korn R, Gillies RJ, Lambin P. A semiautomatic CT-based ensemble segmentation of lung tumors: comparison with oncologists' delineations and with the surgical specimen. Radiother Oncol 2012; 105:167-73. [PMID: 23157978 PMCID: PMC3749821 DOI: 10.1016/j.radonc.2012.09.023] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 09/04/2012] [Accepted: 09/12/2012] [Indexed: 12/28/2022]
Abstract
PURPOSE To assess the clinical relevance of a semiautomatic CT-based ensemble segmentation method, by comparing it to pathology and to CT/PET manual delineations by five independent radiation oncologists in non-small cell lung cancer (NSCLC). MATERIALS AND METHODS For 20 NSCLC patients (stages Ib-IIIb) the primary tumor was delineated manually on CT/PET scans by five independent radiation oncologists and segmented using a CT based semi-automatic tool. Tumor volume and overlap fractions between manual and semiautomatic-segmented volumes were compared. All measurements were correlated with the maximal diameter on macroscopic examination of the surgical specimen. Imaging data are available on www.cancerdata.org. RESULTS High overlap fractions were observed between the semi-automatically segmented volumes and the intersection (92.5±9.0, mean±SD) and union (94.2±6.8) of the manual delineations. No statistically significant differences in tumor volume were observed between the semiautomatic segmentation (71.4±83.2 cm(3), mean±SD) and manual delineations (81.9±94.1 cm(3); p=0.57). The maximal tumor diameter of the semiautomatic-segmented tumor correlated strongly with the macroscopic diameter of the primary tumor (r=0.96). CONCLUSIONS Semiautomatic segmentation of the primary tumor on CT demonstrated high agreement with CT/PET manual delineations and strongly correlated with the macroscopic diameter considered as the "gold standard". This method may be used routinely in clinical practice and could be employed as a starting point for treatment planning, target definition in multi-center clinical trials or for high throughput data mining research. This method is particularly suitable for peripherally located tumors.
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Sigel K, Mhango G, Cohen J, Halm EA, Mandeli J, Strauss G, Wisnivesky J. Outcomes after adjuvant platinum-based chemotherapy in elderly NSCLC patients with T4 disease. Ann Surg Oncol 2012; 20:1013-9. [PMID: 23115004 DOI: 10.1245/s10434-012-2717-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The postoperative management of elderly patients with T4, N0-1, M0 non-small cell lung cancer (NSCLC) remains controversial. The objective of this study was to evaluate the association of adjuvant chemotherapy with survival and toxicity among these patients. METHODS Using surveillance, epidemiology and end results registry data linked to Medicare claims, we identified 389 elderly patients with resected T4, N0-1, M0 NSCLC diagnosed between 1992 and 2007. We compared survival of patients treated with and without platinum-based chemotherapy using a Cox regression adjusting for propensity scores for chemotherapy use and use of radiotherapy. We used logistic regression to assess the risk of adverse events in patients receiving chemotherapy. RESULTS No benefit was noted in overall survival with adjuvant chemotherapy after PS adjustment for both N0 (hazard ratio 0.78, 95% confidence interval 0.50-1.23) and N1 (hazard ratio 1.01, 95% confidence interval 0.67-1.53) cancers. Patients receiving adjuvant chemotherapy experienced severe adverse events more frequently than patients who did not receive chemotherapy. CONCLUSIONS Use of adjuvant chemotherapy in elderly patients with T4, N0-1, M0 NSCLC was not associated with a survival advantage and was associated with higher rates of severe toxicity.
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Affiliation(s)
- Keith Sigel
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, USA.
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Govaert SLA, Troost EGC, Schuurbiers OCJ, de Geus-Oei LF, Termeer A, Span PN, Bussink J. Treatment outcome and toxicity of intensity-modulated (chemo) radiotherapy in stage III non-small cell lung cancer patients. Radiat Oncol 2012; 7:150. [PMID: 22958781 PMCID: PMC3493323 DOI: 10.1186/1748-717x-7-150] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 08/25/2012] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The aim of this retrospective cohort study was to assess treatment outcome, and acute pulmonary and esophageal toxicity using intensity modulated (sequential/concurrent chemo)radiotherapy (IMRT) in locally advanced stage III non-small cell lung cancer (NSCLC). METHODS AND MATERIALS Eighty-six patients with advanced stage NSCLC, treated with either IMRT only (66 Gy) or combined with (sequential or concurrent) chemotherapy were retrospectively included in this study. Overall survival and metastasis-free survival were assessed as well as acute pulmonary and esophageal toxicity using the RTOG Acute Radiation Morbidity Scoring Criteria. RESULTS Irrespective of the treatment modality, the overall survival rate for patients receiving 66 Gy was 71% (± 11%; 95% CI) after one year and 56% (± 14%) after two years resulting in a median overall survival of 29.7 months. Metastasis-free survival was 73% (± 11%) after both one and two years. There were no statistically significant differences between the treatment groups. Treatment related esophageal toxicity was significantly more pronounced in the concurrent chemoradiotherapy group (p = 0.013) with no differences in pulmonary toxicity. CONCLUSIONS This retrospective cohort study in advanced non-small cell lung cancer patients shows that IMRT is an effective technique with acceptable acute toxicity, also when (sequentially or concomitantly) combined with chemotherapy.
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Affiliation(s)
- Stephanie LA Govaert
- Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen 6500 HB, The Netherlands
| | - Esther GC Troost
- Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen 6500 HB, The Netherlands
| | - Olga CJ Schuurbiers
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen 6500 HB, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen 6500 HB, The Netherlands
| | - Ariën Termeer
- Department of Pulmonary Diseases, Canisius-Wilhelmina Hospital, Nijmegen The Netherlands
| | - Paul N Span
- Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen 6500 HB, The Netherlands
| | - Johan Bussink
- Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen 6500 HB, The Netherlands
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Abstract
Over the past decade, concomitant chemotherapy and radiotherapy has become the established treatment for patients with stage III non-small-cell lung cancer (NSCLC). Unfortunately, many patients with NSCLC are too old or have multiple comorbidities to withstand such aggressive treatments. Attempts to improve outcomes have included studies of radiotherapy dose escalation and new chemotherapy combinations, as well as adding biological agents and cancer vaccines to existing regimens. Technical radiotherapy modifications, including intensity-modulated radiotherapy and particle beam therapy, have also been investigated. Given the number of potential advances to current models of treatment development, phase III trials of any single new treatment can take years to complete, which is inadequate. To advance research within shorter timescales to improve patient outcomes, we need methods of improving clinical trial accrual, which might require changes in models of research governance, cooperative group activity, trial design and patient consent.
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Provencio M, Isla D, Sánchez A, Cantos B. Inoperable stage III non-small cell lung cancer: Current treatment and role of vinorelbine. J Thorac Dis 2012; 3:197-204. [PMID: 22263088 DOI: 10.3978/j.issn.2072-1439.2011.01.02] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 01/07/2011] [Indexed: 12/25/2022]
Abstract
Most lung cancer patients are diagnosed with a non-resectable disease; and around 40% in advanced stages. Stage III non-small cell lung cancer (NSCLC) is a heterogeneous disease with great variations in its clinical extent which presents a major therapeutic challenge. Although chemo-radiotherapy treatment has become the most widely used, there is currently no consensus on the best standard treatment and the experience of the therapy team plays an important role in the decision taking. We review the treatment of inoperable stage III NSCLC and the role of concomitant vinorelbine in this clinical scenario.
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Affiliation(s)
- Mariano Provencio
- Department of Medical Oncology, University Hospital Puerta de Hierro, Madrid, Spain
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Zhang QN, Wang DY, Wang XH, Hui TJ, Yang KH, Li Z, Li HY, Guo LY. Non-conventional radiotherapy versus conventional radiotherapy for inoperable non-small-cell lung cancer: A meta-analysis of randomized clinical trials. Thorac Cancer 2012; 3:269-279. [PMID: 28920302 DOI: 10.1111/j.1759-7714.2011.00094.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy and safety of non-conventional radiotherapy versus conventional radiotherapy for inoperable non-small-cell lung cancer and to conduct a meta-analysis to compare these two methods of radiotherapy for inoperable NSCLC. METHODS We included randomized controlled trials, which were compared with non-conventional radiotherapy with or without concurrent chemotherapy versus conventional radiotherapy with or without concurrent chemotherapy. RESULTS Meta-analysis of 13 randomized controlled trials with a total of 2206 patients showed that the non-conventional radiotherapy group could significantly improve the objective response rate (OR 1.68, 95% confidence intervals (CI) 1.19-2.37) and overall survival of up to 1-year (OR 1.30, 95% CI 1.09-1.54), 2-year (OR 1.41, 95% CI 1.17-1.70), 3-year (OR 1.55, 95% CI 1.24-1.94), 4-year (OR 1.60, 95% CI 1.20-2.15), 5-year (OR 1.63, 95% CI 1.11-2.38); and local control rate in 1-year (OR 1.35, 95% CI 1.09-1.68), 2-year (OR 1.57, 95% CI 1.23-1.99), 3-year (OR 1.45, 95% CI 1.10-1.91) compared with the conventional radiotherapy group. With regard to the side effects, non-conventional radiotherapy was more likely to result in level III and IV radioactive esophagitis (OR 1.64, 95% CI 1.09-2.46), but there was no significant difference in the incidence of radioactive pneumonitis (OR 0.96, 95% CI 0.67-1.39). In the subgroup analysis we found late course accelerated hyperfractionated radiotherapy (LCHRT) could obviously improve 1-year OS (OR 2.29, 95% CI 1.29-4.06), 2-year OS (OR 4.22, 95% CI 2.03-8.77), 3-year OS (OR 2.49, 95% CI 1.24-5.02) and Objective response rate (OR 2.38, 95% CI 1.17-4.83). However, hyperfractionated radiotherapy (HRT) and accelerated hyperfractionated radiotherapy (AHRT) could not improve 1-, 2-, 3-year OS or OR compared with conventional fractionation radiotherapy. CONCLUSIONS Our findings indicate that NCRT could improve OR, reduce the risk of death by 1-5 years, and significantly increase level III and IV radioactive esophagitis incidence. The late course accelerated hyperfractionated radiotherapy (LCAHRT) group seemed to improve compared with the AHRT and conventional radiotherapy (CRT) groups.
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Affiliation(s)
- Qiu-Ning Zhang
- Radiation Oncology Centre of Gansu Tumor Hospital, Lanzhou City, ChinaEvidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, ChinaFirst Clinical Medical College of Lanzhou University, Lanzhou City, ChinaThe People's Hospital of Gansu Province, Lanzhou City, China
| | - Dao-Ying Wang
- Radiation Oncology Centre of Gansu Tumor Hospital, Lanzhou City, ChinaEvidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, ChinaFirst Clinical Medical College of Lanzhou University, Lanzhou City, ChinaThe People's Hospital of Gansu Province, Lanzhou City, China
| | - Xiao-Hu Wang
- Radiation Oncology Centre of Gansu Tumor Hospital, Lanzhou City, ChinaEvidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, ChinaFirst Clinical Medical College of Lanzhou University, Lanzhou City, ChinaThe People's Hospital of Gansu Province, Lanzhou City, China
| | - Tian-Jin Hui
- Radiation Oncology Centre of Gansu Tumor Hospital, Lanzhou City, ChinaEvidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, ChinaFirst Clinical Medical College of Lanzhou University, Lanzhou City, ChinaThe People's Hospital of Gansu Province, Lanzhou City, China
| | - Ke-Hu Yang
- Radiation Oncology Centre of Gansu Tumor Hospital, Lanzhou City, ChinaEvidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, ChinaFirst Clinical Medical College of Lanzhou University, Lanzhou City, ChinaThe People's Hospital of Gansu Province, Lanzhou City, China
| | - Zheng Li
- Radiation Oncology Centre of Gansu Tumor Hospital, Lanzhou City, ChinaEvidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, ChinaFirst Clinical Medical College of Lanzhou University, Lanzhou City, ChinaThe People's Hospital of Gansu Province, Lanzhou City, China
| | - Hai-Yang Li
- Radiation Oncology Centre of Gansu Tumor Hospital, Lanzhou City, ChinaEvidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, ChinaFirst Clinical Medical College of Lanzhou University, Lanzhou City, ChinaThe People's Hospital of Gansu Province, Lanzhou City, China
| | - Li-Yun Guo
- Radiation Oncology Centre of Gansu Tumor Hospital, Lanzhou City, ChinaEvidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, ChinaFirst Clinical Medical College of Lanzhou University, Lanzhou City, ChinaThe People's Hospital of Gansu Province, Lanzhou City, China
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Sears CR, Turchi JJ. Complex cisplatin-double strand break (DSB) lesions directly impair cellular non-homologous end-joining (NHEJ) independent of downstream damage response (DDR) pathways. J Biol Chem 2012; 287:24263-72. [PMID: 22621925 PMCID: PMC3397852 DOI: 10.1074/jbc.m112.344911] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 05/18/2012] [Indexed: 11/06/2022] Open
Abstract
The treatment for advanced stage non-small cell lung cancer (NSCLC) often includes platinum-based chemotherapy and IR. Cisplatin and IR combination therapy display schedule and dose-dependent synergy, the mechanism of which is not completely understood. In a series of in vitro and cell culture assays in a NSCLC model, we investigated both the downstream and direct treatment and damage effects of cisplatin on NHEJ catalyzed repair of a DNA DSB. The results demonstrate that extracts prepared from cisplatin-treated cells are fully capable of NHEJ catalyzed repair of a DSB using a non-cisplatin-damaged DNA substrate in vitro. Similarly, using two different host cell reactivation assays, treatment of cells prior to transfection of a linear, undamaged reporter plasmid revealed no reduction in NHEJ compared with untreated cells. In contrast, transfection of a linear GFP-reporter plasmid containing site-specific, cisplatin lesions 6-bp from the termini revealed a significant impairment in DSB repair of the cisplatin-damaged DNA substrates in the absence of cellular treatment with cisplatin. Together, these data demonstrate that impaired NHEJ in combined cisplatin-IR treated cells is likely the result of a direct effect of cisplatin-DNA lesions near a DSB and that the indirect cellular effects of cisplatin treatment are not significant contributors to the synergistic cytotoxicity observed with combination cisplatin-IR treatment.
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Affiliation(s)
| | - John J. Turchi
- From the Departments of Medicine and
- Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana 46202
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Expression patterns of USP22 and potential targets BMI-1, PTEN, p-AKT in non-small-cell lung cancer. Lung Cancer 2012; 77:593-9. [PMID: 22717106 DOI: 10.1016/j.lungcan.2012.05.112] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 05/28/2012] [Accepted: 05/29/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recent researches document that an oncogenic role of USP22 activation may contribute to progression and predict the prognosis. We have reported that USP22 mediates cell survival and proliferation by promoting the expression of BMI-1 and upregulation of activated AKT pathway in colon cancer cells. However, little is known about its mechanisms in non-small-cell lung cancer (NSCLC). Here the authors investigated the significance of activation of USP22 and potential targets BMI-1, PTEN and phospho-AKT (p-AKT) in NSCLC. METHODS Expression levels of USP22, BMI-1, PTEN and p-AKT in samples from 114 patients with NSCLC were evaluated immunohistochemically using the tissue microarray method. Clinical significance was analyzed by multivariate Cox regression analysis, Kaplan-Meier curves and the log-rank test. RESULTS Immunohistochemically, USP22, BMI-1, p-AKT and PTEN were positive in 66.66%, 78.07%, 71.92% and 43.85% of NSCLC samples, respectively. Statistical correlation analysis showed USP22 to be significantly correlated with BMI-1 (r=0.315, P=0.001), p-AKT (r=0.271, P=0.003), and PTEN (r=-0.384, P<0.0001). NSCLCs with positive expression of USP22, BMI-1, p-AKT, and negative expression of PTEN were significantly correlated to tumor size (P=0.0240), differentiation (P=0.0457), pT classification (P=0.0077), pN classification (P=0.0064), and AJCC stage (P=0.0363) and poor overall survival (P<0.001). Multivariate Cox proportional hazards model analysis showed that the combined 4 markers was the independent prognostic indicator of overall survival (P<0.001; HR, 5.974; 95% CI, 3.307-10.791). CONCLUSIONS The simultaneous targeting of USP22, and its downstream signal transduction molecules seem highly informative in stratification of the cancer into subgroups with distinct likelihood of therapy failure, which contribute to make decision process regarding the individualized therapy selection and optimization.
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Ríos I, Morales J, Viñolas N, Casas F. Radiochemotherapy in special populations with limited-disease small-cell lung cancer and locally advanced non-small-cell lung cancer. Lung Cancer Manag 2012. [DOI: 10.2217/lmt.12.10] [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 The evidence to date confirms that concurrent radiochemotherapy (RT–ChT) is the treatment of choice in small-cell lung cancer and locally advanced non-small-cell lung cancer. But these patients require a good performance status and an interdisciplinary group of clinicians, which is hard to find at some facilities around the world. Socioeconomic differences worldwide, inadequate tolerance to RT–ChT, tobacco comorbidities, the high percentage of elderly patients and their low level of recruitment in clinical trials could explain, in part, the reason why lung cancer still remains the leading cause of cancer-related death around the world. This review focuses on RT–ChT in a special population of eldery, comorbid patients and populations with limited resources from developing countries with locally advanced non-small-cell lung cancer and limited-disease small-cell lung cancer.
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Affiliation(s)
- Iván Ríos
- Radiation Oncology Department, Hospital Clinic Barcelona, Villarroel 170, Barcelona, Spain
| | - Javier Morales
- Radiation Oncology Department, Hospital Clinic Barcelona, Villarroel 170, Barcelona, Spain
| | - Nuria Viñolas
- Clinical Oncology Department, Hospital Clinic Barcelona, Villarroel 170, Barcelona, Spain
| | - Francesc Casas
- Radiation Oncology Department, Hospital Clinic Barcelona, Villarroel 170, Barcelona, Spain
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Maniatis NA, Chernaya O, Shinin V, Minshall RD. Caveolins and lung function. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012. [PMID: 22411320 DOI: 10.1007/978-1-4614-1222-911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The primary function of the mammalian lung is to facilitate diffusion of oxygen to venous blood and to ventilate carbon dioxide produced by catabolic reactions within cells. However, it is also responsible for a variety of other important functions, including host defense and production of vasoactive agents to regulate not only systemic blood pressure, but also water, electrolyte and acid-base balance. Caveolin-1 is highly expressed in the majority of cell types in the lung, including epithelial, endothelial, smooth muscle, connective tissue cells, and alveolar macrophages. Deletion of caveolin-1 in these cells results in major functional aberrations, suggesting that caveolin-1 may be crucial to lung homeostasis and development. Furthermore, generation of mutant mice that under-express caveolin-1 results in severe functional distortion with phenotypes covering practically the entire spectrum of known lung diseases, including pulmonary hypertension, fibrosis, increased endothelial permeability, and immune defects. In this Chapter, we outline the current state of knowledge regarding caveolin-1-dependent regulation of pulmonary cell functions and discuss recent research findings on the role of caveolin-1 in various pulmonary disease states, including obstructive and fibrotic pulmonary vascular and inflammatory diseases.
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Affiliation(s)
- Nikolaos A Maniatis
- 2nd Department of Critical Care, National and Kapodistrian University of Athens Medical School, Athens, Greece
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Socinski MA, Bondarenko I, Karaseva NA, Makhson AM, Vynnychenko I, Okamoto I, Hon JK, Hirsh V, Bhar P, Zhang H, Iglesias JL, Renschler MF. Weekly nab-paclitaxel in combination with carboplatin versus solvent-based paclitaxel plus carboplatin as first-line therapy in patients with advanced non-small-cell lung cancer: final results of a phase III trial. J Clin Oncol 2012; 30:2055-62. [PMID: 22547591 DOI: 10.1200/jco.2011.39.5848] [Citation(s) in RCA: 563] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This phase III trial compared the efficacy and safety of albumin-bound paclitaxel (nab-paclitaxel) plus carboplatin with solvent-based paclitaxel (sb-paclitaxel) plus carboplatin in advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS In all, 1,052 untreated patients with stage IIIB to IV NSCLC were randomly assigned 1:1 to receive 100 mg/m(2) nab-paclitaxel weekly and carboplatin at area under the concentration-time curve (AUC) 6 once every 3 weeks (nab-PC) or 200 mg/m(2) sb-paclitaxel plus carboplatin AUC 6 once every 3 weeks (sb-PC). The primary end point was objective overall response rate (ORR). RESULTS On the basis of independent assessment, nab-PC demonstrated a significantly higher ORR than sb-PC (33% v 25%; response rate ratio, 1.313; 95% CI, 1.082 to 1.593; P = .005) and in patients with squamous histology (41% v 24%; response rate ratio, 1.680; 95% CI, 1.271 to 2.221; P < .001). nab-PC was as effective as sb-PC in patients with nonsquamous histology (ORR, 26% v 25%; P = .808). There was an approximately 10% improvement in progression-free survival (median, 6.3 v 5.8 months; hazard ratio [HR], 0.902; 95% CI, 0.767 to 1.060; P = .214) and overall survival (OS; median, 12.1 v 11.2 months; HR, 0.922; 95% CI, 0.797 to 1.066; P = .271) in the nab-PC arm versus the sb-PC arm, respectively. Patients ≥ 70 years old and those enrolled in North America showed a significantly increased OS with nab-PC versus sb-PC. Significantly less grade ≥ 3 neuropathy, neutropenia, arthralgia, and myalgia occurred in the nab-PC arm, and less thrombocytopenia and anemia occurred in the sb-PC arm. CONCLUSION The administration of nab-PC as first-line therapy in patients with advanced NSCLC was efficacious and resulted in a significantly improved ORR versus sb-PC, achieving the primary end point. nab-PC produced less neuropathy than sb-PC.
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Affiliation(s)
- Mark A Socinski
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Prospective study of transarterial infusion of docetaxel and cisplatin to treat non-small-cell lung cancer in patients contraindicated for standard chemotherapy. Lung Cancer 2012; 77:353-8. [PMID: 22537620 DOI: 10.1016/j.lungcan.2012.04.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/10/2012] [Accepted: 04/01/2012] [Indexed: 12/11/2022]
Abstract
Our previous retrospective study indicated a good response rate of non-small-cell lung carcinoma (NSCLC) to transarterial infusion chemotherapy, but the precise effect remains unresolved. This prospective study enrolled 25 patients with stage III or IV or recurrent NSCLC without distant metastasis (M1b) who were not candidates for either standard chemotherapy or chemoradiotherapy. The feeding arteries of each tumor detected by angiography were recorded and tumor staining was visually graded on a scale of I-IV. Docetaxel and cisplatin (25 and 25 mg/m(2), respectively) were administered by arterial infusion. The total dose of each was divided among feeding arteries according to the degree of tumor staining. The end points included response rate, progression-free survival (PFS), overall survival (OS) and toxicity. Correlations between effects and some clinical aspects were investigated. Of 25 patients enrolled between May 2007 and April 2011, 24 of them were evaluable. One complete response and 12 partial responses were achieved for an overall response rate of 52% (95% confidence interval [CI]: 35-69%). The median progression-free survival and overall survival periods were 6.5 (95% CI: 5.4-7.6) and 17.4 (95% CI: 14.2-20.6) months, respectively. The 1- and 2-year survival rates were 81% and 32%, respectively. Grade 3-4 hematological toxicity was not evident. Grade 3 general fatigue or appetite loss developed in patients with performance status (PS) ≥3. Neither grade 4 non-hematological toxicity nor treatment-related death occurred. Among various clinical aspects, ECOG PS significantly correlated with PFS and OS, whereas tumor staining significantly correlated with response. Survival was significantly better for patients with good PS (0 or 1) than poor PS (≥2) and those with, than without grade IV tumor staining. If a sufficient number of feeding arteries are detected and the tumor is appropriately stained, then arterial infusion chemotherapy has favorable response rates with less toxicity for patients with stage III or IV or recurrent NSCLC without distant metastasis (M1b) who cannot tolerate standard chemotherapy.
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