Accelerated hypofractionated radiotherapy plus chemotherapy for inoperable locally advanced non-small-cell lung cancer: final results of a prospective phase-II trial with a long-term follow-up

Parisi, Elisabetta; Genestreti, Giovenzio; Sarnelli, Anna; Ghigi, G.; Arpa, D.; Burgio, Marco Angelo; Gavelli, Giampaolo; Rossi, Alice; Scarpi, Emanuela; Monti, Manuela; Tesei, Anna; Polico, R.; Romeo, Antonino

doi:10.1186/s13014-019-1317-x

Cited by 16 publications

(18 citation statements)

References 36 publications

(36 reference statements)

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“…Some reports contain only toxicity by group (e.g., only > grade 2), some do not distinguish between early and late toxicity, while most consider a short follow-up for toxicity occurrence and do not take into account specific toxicity of late-responding tissues (stricture, fistula, hemorrhage) (62). To illustrate this, the reported outcomes are summarized in Table 1, with a focus on toxicity in the published prospective studies on moderate hypofractionation without the use of concurrent CHT (63)(64)(65)(66)(67)(68)(69)(70)(71)(72).…”

Section: Hypofractionation: Moderate Hypofractionation With or Without Chtmentioning

confidence: 99%

Dose and fractionation schedules in radiotherapy for non-small cell lung cancer

Kępka¹,

Socha²

2021

Transl Lung Cancer Res

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In the field of radiotherapy (RT), the issues of total dose, fractionation, and overall treatment time for non-small cell lung cancer (NSCLC) have been extensively investigated. There is some evidence to suggest that higher treatment intensity of RT, when given alone or sequentially with chemotherapy (CHT), is associated with improved survival. However, there is no evidence that the outcome is improved by RT at a higher dose and/or higher intensity when it is used concurrently with CHT. Moreover, some reports on the combination of full dose CHT with a higher biological dose of RT warn of the significant risk posed by such intensification. Stereotactic body radiotherapy (SBRT) provides a high rate of local control in the management of early-stage NSCLC through the use of high ablative doses. However, in centrally located tumors the use of SBRT may carry a risk of serious damage to the great vessels, bronchi, and esophagus, owing to the high ablative doses needed for optimal tumor control. There is a similar problem with moderate hypofractionation in radical RT for locally advanced NSCLC, and more evidence needs to be gathered regarding the safety of such schedules, especially when used in combination with CHT. In this article, we review the current evidence and questions related to RT dose/fractionation in NSCLC.

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Section: Hypofractionation: Moderate Hypofractionation With or Without Chtmentioning

confidence: 99%

Dose and fractionation schedules in radiotherapy for non-small cell lung cancer

Kępka¹,

Socha²

2021

Transl Lung Cancer Res

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“…He was enrolled in a prospective phase II clinical trial of CRT using AHRT in helical TomoTherapy (TomoTherapy Inc., Madison, WI, United States) for patients with LA-NSCLC (EudractCT registration 2008-006525-14)[ 10 ].…”

Section: Treatmentmentioning

confidence: 99%

“…To plan RT, the patient underwent a multiphasic chest contrast-enhanced free-breathing CT scan to obtain the best definition of tumor and infiltration of organs at risk (OaR). Information on contouring and RT planning are reported in the protocol[ 10 ] (Figure 2 ). Radiological evaluation, PET-CT and total body contrast-enhanced CT scan performed at the end of the protocol showed a reduction in the primary tumor mass, left parahilar mass (standardized uptake value, 4 vs 8.93 pre-RT), no evidence of radiological mediastinal nodes, and the appearance of pulmonary thickening in the lower left lobe.…”

Section: Treatmentmentioning

confidence: 99%

Complete pathological response in locally advanced non-small-cell lung cancer patient: A case report

Parisi

Arpa

Ghigi³

et al. 2021

WJCC

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BACKGROUND Chemotherapy and radiotherapy followed by durvalumab is currently the standard treatment for locally advanced node-positive non-small-cell lung cancer (NSCLC). We describe the case of a patient with locally advanced node-positive NSCLC (LA-NSCLC) treated in a phase II prospective protocol with chemotherapy, accelerated hypofractionated radiotherapy (AHRT) and surgery in the pre-immunotherapy era. CASE SUMMARY A 69-year-old male, ex-smoker (20 PY), with a Karnofsky performance status of 90, was diagnosed with locally advanced squamous cell lung carcinoma. He was staged by total body computed tomography (CT) scanning, and integrated 18 F-fluorodeoxyglucose positron emission tomography/CT scan [cT4 cN3 cM0, stage IIIC according to TNM (tumor-node-metastasis) 8 th edition] and received AHRT between chemotherapy cycles, in accordance with the study protocol (EudractCT registration 2008-006525-14). At the end of the study the patient underwent surgery, which was not part of the protocol, and showed a complete pathological response. CONCLUSION This case report confirms that AHRT can be used successfully to treat primary LA-NSCLC with bilateral mediastinal lymph node involvement. Our case is of particular interest because of the pathological response after AHRT and the lack of surgical complications. We hypothesize that this radiotherapeutic approach, with its proven efficacy, could be delivered as a short course reducing treatment costs, increasing patient compliance and reducing toxicity. We are currently investigating the possibility of combining hypofractionation, chemotherapy and immunotherapy for patients with LA-NSCLC.

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“…CCRT with a double-drug regimen in lung cancer and cervical cancer is approved and widely used in clinical practice 16 , 17 . Radiotherapy combined with docetaxel is feasible and is widely used in non-small-cell lung cancer (NSCLC) and cervical cancer 18 , 19 . Recently, a study demonstrated that CCRT combined with a small weekly dose of docetaxel is an effective and tolerable treatment for locoregionally advanced NPC 20 .…”

Section: Introductionmentioning

confidence: 99%

Clinical value of docetaxel plus cisplatin (TP) induction chemotherapy followed by TP concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma

Tao¹,

Zhan²,

Qiu³

et al. 2021

J. Cancer

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Objective : To investigate the clinical value of induction chemotherapy (IC) with docetaxel plus cisplatin (TP) followed by concurrent chemoradiotherapy (CCRT) with TP in locoregionally advanced nasopharyngeal carcinoma (NPC). Methods : A total of 544 patients with locoregionally advanced NPC that was newly diagnosed from January 2009 to December 2015 were included in this study. Among these patients, 251 were treated with TP induction chemotherapy followed by CCRT with cisplatin (DDP) alone (TP + DDP group), 167 were treated with TP followed by CCRT with TP (TP + TP group), and 126 were treated with docetaxel, DDP and fluorouracil (TPF) followed by CCRT with DDP alone (TPF + DDP group). Overall survival (OS), distant metastasis-free survival (DMFS), progression-free survival (PFS) and locoregional relapse-free survival (LRRFS) were analyzed using the Kaplan-Meier method and a Cox proportional hazards model. Results : Survival analysis showed that the 5-year OS, PFS and DMFS rates in the TP + DDP group were significantly lower than those in the TP + TP group after propensity score matching (PSM). Multivariate analysis revealed that CCRT with TP was an independent prognostic factor for OS, PFS and DMFS. During CCRT, the incidence rates of grade 3/4 nausea/vomiting, oral mucositis, leukocytopenia and neutropenia were significantly increased in the TP + TP group compared with the TP + DDP group (all P < 0.05). To further explore the value of TP + TP, we performed PSM again with the TPF + DDP group. After PSM, there were 100 patients in each group. Survival analysis showed no significant differences in the 5-year OS, PFS, DMFS and LRRFS rates between the two groups. During IC and CCRT, the rate of grade 3/4 nausea/vomiting in the TPF + DDP group was higher than that in the TP+TP group (9.0% vs. 2.0%, P = 0.030; 18.0% vs. 8.0%, P = 0.036, respectively). No significant difference in the incidence of grade 3/4 hematologic toxicity was found between the two groups (all P > 0.05). Conclusion : TP + TP can reduce the distant metastasis of locoregionally advanced NPC and improve OS compared with TP + DDP; TP + TP has the same effect as TPF + DDP and is clinically feasible.

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Accelerated hypofractionated radiotherapy plus chemotherapy for inoperable locally advanced non-small-cell lung cancer: final results of a prospective phase-II trial with a long-term follow-up

Cited by 16 publications

References 36 publications

Dose and fractionation schedules in radiotherapy for non-small cell lung cancer

Dose and fractionation schedules in radiotherapy for non-small cell lung cancer

Complete pathological response in locally advanced non-small-cell lung cancer patient: A case report

Clinical value of docetaxel plus cisplatin (TP) induction chemotherapy followed by TP concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma

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