Final results of phase III trial in regionally advanced unresectable non-small cell lung cancer

Sause, W.; Kolesar, Patricia; Taylor, Samuel G.; Johnson, David H.; Livingston, Robert B.; Komaki, Ritsuko; Emami, Bahman; Byhardt, Roger W.; Dar, R.; Turrisi, Andrew T.

doi:10.1016/s1278-3218(00)00076-7

Cited by 16 publications

(16 citation statements)

References 5 publications

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“…Particularly for patients with squamous histology and patients older than 70 years, a number of analyses suggest that both the benefit of accelerated and high-dose radiotherapy techniques may be superior to chemoradiation approaches. 4,15 Our patterns of relapse are consistent with the published literature, which suggests that local control is better with concurrent chemotherapy, but it did not confirm lower distant disease failure with sequential neoadjuvant chemotherapy in addition to concurrent chemotherapy. The adjuvant approach is attractive as it does not delay definitive concurrent chemoradiation, which appears superior to neoadjuvant chemotherapy and offers the opportunity for early use of non-crossresistant chemotherapy agents.…”

Section: Resultssupporting

confidence: 75%

“…Indirect observations investigating across seven sequential studies is that positive studies were platinum based, used at least doublets of cisplatin and vinblastin and high continuous doses of conventionally fractionated radiotherapy to at least 60 Gy. [11][12][13][14][15][16][17] Examining randomized concurrent chemotherapy studies, the positive studies provided improvements of 2-10 months in median survival and approximately 10% benefit in 2-year survival to approximately 25-35%. [18][19][20][21][22][23][24][25] All were platinum based, with no clear advantage to cisplatin or carboplatin, but positive studies were more likely to use doublets (containing etoposide), were more likely to use more frequent administration of chemotherapy (daily or weekly rather than less often) and use a biologically equivalent radiation dose Gy10 .70 and/or hyperfractionation.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Concurrent end‐phase boost high‐dose radiation therapy for non‐small‐cell lung cancer with or without cisplatin chemotherapy*

Graham

Clark

Abell

et al. 2006

Australasian Radiology

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The aim of this study was to audit the results of a high-dose, combined-modality prospective protocol for non-small-cell lung cancer in terms of survival, disease-specific survival and toxicity. One hundred and twenty-one patients with non-small-cell lung cancer were treated with a concurrent, end-phase, boost, high-dose radiotherapy protocol with 65 Gy in 35 fractions for more than 5 weeks. Sixty-six patients received radiotherapy alone (group 1), 29 received concurrent chemoradiation (group 2) and 26 received neoadjuvant and concurrent chemotherapy (group 3). Thirty-four patients had stage I disease, six had stage II and 81 had stage III. Overall median survival was 23 months: 75% at 1 year and 23% at 5 years. Median survivals for patients with stage I and stages II and III disease were 43 and 19 months, respectively. For stages II and III patients by groups 1-3, median survivals were 18, 25 and 18 months, respectively, and 2-year survivals were 36, 52 and 38%, respectively. Toxicity was acceptable. Overall, 9% had symptomatic pneumonitis and 7% had grades 3 and 4 oesophagitis. For those who had the mediastinum included in the volume, grade > or = 3 oesophagitis occurred in 0, 11 and 22% (n = 110, P = 0.001), respectively, for treatment groups 1-3. Overall treatment-related mortality was 3%, consisting of two septic deaths, one pneumonitis and possibly one late cardiac event, all occurring in patients who had chemotherapy (7% of 55 patients). Treatment-related mortality declined over the study period. Accelerated radiotherapy was well tolerated, with only moderate increased acute toxicity when combined with concurrent platinum chemotherapy. Toxicity was enhanced by induction chemotherapy. Overall survival outcomes were excellent for this condition. Continued use of this radiotherapy schedule is recommended as the platform for assessment of other chemotherapy schedules.

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Section: Resultssupporting

confidence: 75%

Section: Resultsmentioning

confidence: 99%

Concurrent end‐phase boost high‐dose radiation therapy for non‐small‐cell lung cancer with or without cisplatin chemotherapy*

Graham

Clark

Abell

et al. 2006

Australasian Radiology

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“…Of note, only patients with good performance status (Karnofsky performance status [KPS] Ն70) were included in the study. 41 Pooled data from six prospective Phase II or III Radiation Therapy Oncology Group studies of patients with locally advanced lung cancer were analyzed with respect to age. Data were included for 979 patients with Stages II to IIIB inoperable NSCLC who received one of six treatment regimens of either concurrent chemoradiation or radiation therapy alone.…”

Section: Concurrent Versus Sequential Chemotherapy and Thoracic Irradmentioning

confidence: 99%

Management of Lung Cancer in Older Adults

Hurria

Kris

2003

CA: A Cancer Journal for Clinicians

103

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Lung cancer is the leading cause of cancer death in the United States. At the time of diagnosis, most patients are older than 65 years and have Stage III or IV disease. More than 80% of patients have non-small cell lung cancer and the rest have small cell lung cancer. Age is not a significant prognostic factor for overall survival and response to treatment for patients with either type of lung cancer. Treatment options should be tailored to older patients based on the same selection process and benefits seen in the population as a whole. This article reviews the available data regarding surgery, radiation, and systemic treatment for older patients with lung cancer and considers the role of geriatric assessment in the evaluation of older patients.

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“…For unresectable locally advanced NSCLC (LA-NSCLC) patients, concurrent chemoradiotherapy (CCRT) has become the standard of care based on several randomized trials and metaanalyses. [2][3][4][5][6] Nevertheless, prognosis is still very poor. In addition, a significant proportion of these patients are not candidates for concurrent chemotherapy because of their advanced age and/or coexistent morbidities such as renal insufficiency.…”

Section: Introductionmentioning

confidence: 99%

A prospective nonrandomized phase I/II study of carbon ion radiotherapy in a favorable subset of locally advanced non–small cell lung cancer (NSCLC)

Takahashi

Nakajima²,

Yamamoto³

et al. 2015

Cancer

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BACKGROUND: Although concurrent chemoradiotherapy (CCRT) has become the standard approach for unresectable locally advanced non-small cell lung cancer (LA-NSCLC), most patients are not candidates for this treatment because of comorbidities. We evaluated the safety and efficacy of carbon ion radiotherapy (CIRT) in LA-NSCLC patients. METHODS: Patients with stage IIA to IIIA (UICC 7th edition) LA-NSCLC were enrolled in a sequential phase I/II trial. For a phase I dose escalation study, the total prescribed dose was increased by 4 Gray equivalents (GyE) in 2 steps, from 68 to 72 GyE and then to 76 GyE, using 16 fractions over 4 weeks. After determining the recommended dose, the phase II trial was started in an expanded cohort. RESULTS: Of the 36 patients treated in phase I, 2 grade 3 adverse events (radiation pneumonitis and tracheoesophageal fistula) were observed in the 76 GyE group. Accordingly, for phase II, the next consecutive 26 patients were treated with 72 GyE, with no grade 3 to 5 toxicities resulting. A total of 62 eligible patients were recruited. The majority of patients (49 of 62) were N0 or N1 patients, and the rest (13 of 62) were singlestation N2 patients. The median follow-up period was 25.2 months. The 2-year local control rate (LCR) and overall survival (OS) for the entire cohort were 93.1% and 51.9%, respectively. In particular, patients with cT3-4N0 had an excellent prognosis; the 2-year OS and LCR were 69.3% and 100%, respectively. CONCLUSIONS: Short-course CIRT monotherapy shows promise as an effective nonsurgical treatment for inoperable LA-NSCLC. Cancer 2015;121:1321-7.

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Final results of phase III trial in regionally advanced unresectable non-small cell lung cancer

Cited by 16 publications

References 5 publications

Concurrent end‐phase boost high‐dose radiation therapy for non‐small‐cell lung cancer with or without cisplatin chemotherapy*

Concurrent end‐phase boost high‐dose radiation therapy for non‐small‐cell lung cancer with or without cisplatin chemotherapy*

Management of Lung Cancer in Older Adults

A prospective nonrandomized phase I/II study of carbon ion radiotherapy in a favorable subset of locally advanced non–small cell lung cancer (NSCLC)

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