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Rodrigues G, Choy H, Bradley J, Rosenzweig KE, Bogart J, Curran WJ, Gore E, Langer C, Louie AV, Lutz S, Machtay M, Puri V, Werner-Wasik M, Videtic GMM. Adjuvant radiation therapy in locally advanced non-small cell lung cancer: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based clinical practice guideline. Pract Radiat Oncol 2016; 5:149-155. [PMID: 25957185 DOI: 10.1016/j.prro.2015.02.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/18/2015] [Accepted: 02/25/2015] [Indexed: 01/16/2023]
Abstract
PURPOSE To provide guidance to physicians and patients with regard to the use of adjuvant external beam radiation therapy (RT) in locally advanced non-small cell lung cancer (LA NSCLC) based on available medical evidence complemented by consensus-based expert opinion. METHODS AND MATERIALS A panel authorized by the American Society for Radiation Oncology (ASTRO) Board of Directors and Guidelines Subcommittee conducted 2 systematic reviews on the following topics: (1) indications for postoperative adjuvant RT and (2) indications for preoperative neoadjuvant RT. Practice guideline recommendations were approved using an a priori-defined consensus-building methodology supported by ASTRO and approved tools for the grading of evidence quality and the strength of guideline recommendations. RESULTS For patients who have undergone surgical resection, high-level evidence suggests that use of postoperative RT does not influence survival, but optimizes local control for patients with N2 involvement, and its use in the setting of positive margins or gross primary/nodal residual disease is recommended. No high-level evidence exists for the routine use of preoperative induction chemoradiation therapy; however, modern surgical series and a post-hoc Intergroup 0139 clinical trial analysis suggest that a survival benefit may exist if patients are properly selected and surgical techniques/postoperative care is optimized. CONCLUSIONS A consensus and evidence-based clinical practice guideline for the adjuvant radiotherapeutic management of LA NSCLC has been created addressing 2 important questions.
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Affiliation(s)
- George Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
| | - Hak Choy
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas
| | - Jeffrey Bradley
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Kenneth E Rosenzweig
- Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey Bogart
- Department of Radiation Oncology, State University of New York Upstate Medical University, Syracuse, New York
| | - Walter J Curran
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Elizabeth Gore
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Corey Langer
- Department of Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander V Louie
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Stephen Lutz
- Department of Radiation Oncology, Blanchard Valley Health System, Findlay, Ohio
| | - Mitchell Machtay
- Department of Radiation Oncology, UH Case Medical Center, Cleveland, Ohio
| | - Varun Puri
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Deja S, Porebska I, Kowal A, Zabek A, Barg W, Pawelczyk K, Stanimirova I, Daszykowski M, Korzeniewska A, Jankowska R, Mlynarz P. Metabolomics provide new insights on lung cancer staging and discrimination from chronic obstructive pulmonary disease. J Pharm Biomed Anal 2014; 100:369-380. [PMID: 25213261 DOI: 10.1016/j.jpba.2014.08.020] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 08/13/2014] [Indexed: 12/17/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) and lung cancer are widespread lung diseases. Cigarette smoking is a high risk factor for both the diseases. COPD may increase the risk of developing lung cancer. Thus, it is crucial to be able to distinguish between these two pathological states, especially considering the early stages of lung cancer. Novel diagnostic and monitoring tools are required to properly determine lung cancer progression because this information directly impacts the type of the treatment prescribed. In this study, serum samples collected from 22 COPD and 77 lung cancer (TNM stages I, II, III, and IV) patients were analyzed. Then, a collection of NMR metabolic fingerprints was modeled using discriminant orthogonal partial least squares regression (OPLS-DA) and further interpreted by univariate statistics. The constructed discriminant models helped to successfully distinguish between the metabolic fingerprints of COPD and lung cancer patients (AUC training=0.972, AUC test=0.993), COPD and early lung cancer patients (AUC training=1.000, AUC test=1.000), and COPD and advanced lung cancer patients (AUC training=0.983, AUC test=1.000). Decreased acetate, citrate, and methanol levels together with the increased N-acetylated glycoproteins, leucine, lysine, mannose, choline, and lipid (CH3-(CH2)n-) levels were observed in all lung cancer patients compared with the COPD group. The evaluation of lung cancer progression was also successful using OPLS-DA (AUC training=0.811, AUC test=0.904). Based on the results, the following metabolite biomarkers may prove useful in distinguishing lung cancer states: isoleucine, acetoacetate, and creatine as well as the two NMR signals of N-acetylated glycoproteins and glycerol.
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Affiliation(s)
- Stanislaw Deja
- Faculty of Chemistry, Opole University, Pl. Kopernika 11a, 45-040 Opole, Poland
| | - Irena Porebska
- Department and Clinic of Pulmonology and Lung Cancers, Wroclaw Medical University, Grabiszynska 105, 53-439 Wroclaw, Poland
| | - Aneta Kowal
- Department and Clinic of Pulmonology and Lung Cancers, Wroclaw Medical University, Grabiszynska 105, 53-439 Wroclaw, Poland
| | - Adam Zabek
- Department of Bioorganic Chemistry Wrocław University of Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw, Poland
| | - Wojciech Barg
- Department of Physiology, Wroclaw Medical University, T. Chalubinskiego 10, 50-368 Wroclaw, Poland
| | - Konrad Pawelczyk
- Department and Clinic of Thoracic Surgery, Wroclaw Medical University, Grabiszynska 105, 53-430 Wroclaw, Poland
| | - Ivana Stanimirova
- Institute of Chemistry, The University of Silesia, Szkolna 9, 40-006 Katowice, Poland
| | - Michal Daszykowski
- Institute of Chemistry, The University of Silesia, Szkolna 9, 40-006 Katowice, Poland
| | - Anna Korzeniewska
- Department and Clinic of Pulmonology and Lung Cancers, Wroclaw Medical University, Grabiszynska 105, 53-439 Wroclaw, Poland
| | - Renata Jankowska
- Department and Clinic of Pulmonology and Lung Cancers, Wroclaw Medical University, Grabiszynska 105, 53-439 Wroclaw, Poland
| | - Piotr Mlynarz
- Department of Bioorganic Chemistry Wrocław University of Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw, Poland.
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