Concurrent chemoradiotherapy for large-volume locally-advanced non-small cell lung cancer

Wiersma, T.; Dahele, Max; Verbakel, Wilko F.A.R.; Ven, Peter M. van de; Haan, Patricia F. de; Smit, Egbert F.; Reij, E. J. F. van; Slotman, Ben J.; Senan, Suresh

doi:10.1016/j.lungcan.2013.01.006

Cited by 17 publications

(12 citation statements)

References 12 publications

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“…The median survival time for patients with tumors larger than 7 cm was comparable with the findings in other studies, 5,7 where better prognosis patients received definitive CRT or radiation alone. In a smaller retrospective material, Wiersma et al 6 found that approximately one of five patients with large tumors survived 3 years when given treatment with definitive CRT containing a cisplatin doublet. In our material, we observed a slightly better 3-year survival (20%) in the larger than 7 cm tumor group receiving palliative CRT.…”

Section: Discussionmentioning

confidence: 99%

“…6 After the development of three-dimensional radiation planning and therapy, researchers have found that large gross tumor volume as determined by computed tomography (CT) and three dimensional-chemoradiotherapy (CRT) to be a negative prognostic factor. 7–9 On behalf of The International Association for the Study of Lung Cancer (IASLC) Staging Committee and Participating Institutions, Ball et al 10 recently reported data from approximately 900 NSCLC patients selected for radical radiotherapy or CRT.…”

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confidence: 99%

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Poor Prognosis Patients with Inoperable Locally Advanced NSCLC and Large Tumors Benefit from Palliative Chemoradiotherapy: A Subset Analysis from a Randomized Clinical Phase III Trial

Strøm¹,

Bremnes

Sundstrøm

et al. 2014

Journal of Thoracic Oncology

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Introduction:Poor prognosis patients with bulky stage III locally advanced non–small-cell lung cancer may not be offered concurrent chemoradiotherapy (CRT). Following a phase III trial concerning the effect of palliative CRT in inoperable poor prognosis patients, this analysis was performed to explore how tumor size influenced survival and health-related quality of life (HRQOL).Methods:A total of 188 poor prognosis patients recruited in a randomized clinical trial received four courses intravenous carboplatin day 1 and oral vinorelbine day 1 and 8, at 3-week intervals. The experimental arm (N = 94) received radiotherapy with fractionation 42 Gy/15, starting at the second chemotherapy course. This subset study compares outcomes in patients with tumors larger than 7 cm (N = 108) versus tumors 7 cm or smaller (N = 76).Results:Among those with tumors larger than 7 cm, the median overall survival in the chemotherapy versus CRT arm was 9.7 and 13.4 months, respectively (p = 0.001). The 1-year survival was 33% and 56%, respectively (p = 0.01). Except for a temporary decline during treatment, HRQOL was maintained in the CRT arm, regardless of tumor size. Among those who did not receive CRT, patients with tumors larger than 7 cm experienced a gradual decline in the HRQOL. The CRT group had significantly more esophagitis and hospitalizations because of side effects regardless of tumor size.Conclusion:In patients with poor prognosis and inoperable locally advanced non–small-cell lung cancer, large tumor size should not be considered a negative predictive factor. Except for performance status 2, patients with tumors larger than 7 cm apparently benefit from CRT.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Poor Prognosis Patients with Inoperable Locally Advanced NSCLC and Large Tumors Benefit from Palliative Chemoradiotherapy: A Subset Analysis from a Randomized Clinical Phase III Trial

Strøm¹,

Bremnes

Sundstrøm

et al. 2014

Journal of Thoracic Oncology

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“…These are the patients that in general are likely to benefit less from aggressive chemoradiation programs. In a single institution retrospective study of 121 patients, patients with planning target volumes of greater than 700 cc were found to be associated with death within 6 months of concurrent chemoradiotherapy (16). This effect was magnified in patients with Charlson comorbidity index greater than or equal to 1 in which 1 in 4 patients died within 6 months of treatment.…”

Section: Controversies On Lung Cancer: Pros and Consmentioning

confidence: 99%

Cons: concurrent chemo-radiotherapy remains the ideal treatment in fit patients with inoperable large volume stage III non-small cell lung cancer

Rodrigues

2016

Transl. Lung Cancer Res.

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“…Both PSPT and PBS are still permitted in this study. While the improved OAR sparing with PBT makes it a seemingly attractive option for treating large tumors, a large volume has consistently been associated with poorer survival [92–94], which suggests that survival gains may be modest, at best. There is, therefore, currently no high-level evidence to support the routine use of proton therapy in locally advanced NSCLC, and evidence supporting IMRT is based on population-based analysis of patient sub-groups.…”

Section: Introductionmentioning

confidence: 99%

A critical review of recent developments in radiotherapy for non-small cell lung cancer

Baker¹,

et al. 2016

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Lung cancer is the leading cause of cancer mortality, and radiotherapy plays a key role in both curative and palliative treatments for this disease. Recent advances include stereotactic ablative radiotherapy (SABR), which is now established as a curative-intent treatment option for patients with peripheral early-stage NSCLC who are medically inoperable, or at high risk for surgical complications. Improved delivery techniques have facilitated studies evaluating the role of SABR in oligometastatic NSCLC, and encouraged the use of high-technology radiotherapy in some palliative settings. Although outcomes in locally advanced NSCLC remain disappointing for many patients, future progress may come about from an improved understanding of disease biology and the development of radiotherapy approaches that further reduce normal tissue irradiation. At the moment, the benefits, if any, of radiotherapy technologies such as proton beam therapy remain unproven. This paper provides a critical review of selected aspects of modern radiotherapy for lung cancer, highlights the current limitations in our understanding and treatment approaches, and discuss future treatment strategies for NSCLC.

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Concurrent chemoradiotherapy for large-volume locally-advanced non-small cell lung cancer

Cited by 17 publications

References 12 publications

Poor Prognosis Patients with Inoperable Locally Advanced NSCLC and Large Tumors Benefit from Palliative Chemoradiotherapy: A Subset Analysis from a Randomized Clinical Phase III Trial

Poor Prognosis Patients with Inoperable Locally Advanced NSCLC and Large Tumors Benefit from Palliative Chemoradiotherapy: A Subset Analysis from a Randomized Clinical Phase III Trial

Cons: concurrent chemo-radiotherapy remains the ideal treatment in fit patients with inoperable large volume stage III non-small cell lung cancer

A critical review of recent developments in radiotherapy for non-small cell lung cancer

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