Local control in medically inoperable lung cancer: An analysis of its importance in outcome and factors determining the probability of tumor eradication

Dosoretz, Daniel E.; Galmarini, D.; Rubenstein, James H.; Katin, Michael J.; Blitzer, Peter H.; Salenius, S.; Dosani, Razak; Rashid, Mohammad H.; Mestas, George; Hannan, Stephen E.; Chadha, Tejvir T.; Bhat, Saligrama; Siegel, Alan D.; Chandrahasa, Thongadi; Metke, Michael P.

doi:10.1016/0360-3016(93)90373-4

Cited by 149 publications

(52 citation statements)

References 20 publications

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“…As for inoperable NSCLC, it was suggested that the radiation dose required for a 50% probability of tumor control was approximately 85 Gy (20,21). For patients treated with definitive radiation for small T1 and T2 inoperable tumors of NSCLC, the local control rates were only 30% to 60% with radiation dose at approximately 60 Gy (22)(23)(24). Normal tissue tolerance of the esophagus, trachea, bronchi, lung parenchyma, and heart is a primary dose-limiting factor for chest radiotherapy, thus the radiation doses for inoperable NSCLC have been kept below 70 Gy to avoid complications.…”

Section: Discussionmentioning

confidence: 99%

Toxicity Profile and Pharmacokinetic Study of A Phase I Low-Dose Schedule–Dependent Radiosensitizing Paclitaxel Chemoradiation Regimen for Inoperable Non–Small-Cell Lung Cancer

Chen

Pandya

Feins

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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Purpose-We report the toxicity profile and pharmacokinetic data of a schedule-dependent chemoradiation regimen using pulsed low-dose paclitaxel for radiosensitization in a phase I study for inoperable non-small cell lung cancer (NSCLC).Methods and Materials-Paclitaxel at escalating doses of 15 mg/m 2 , 20 mg/m 2 , and 25 mg/m 2 were infused on Monday, Wednesday, and Friday with daily chest radiation in cohorts of 6 patients. Daily radiation (RT) was delayed for maximal G2/M arrest and apoptotic effect, an observation from preclinical investigations. Plasma paclitaxel concentration was determined by High Performance Liquid Chromatography (HPLC).Results-Dose-limiting toxicities included 3/18 patients with grade 3 pneumonitis and 3/18 patients with grade 3 esophagitis. There was no grade 4 or 5 pneumonitis or esophagitis. There was no grade 3 or 4 neutropenia, thrombocytopenia, anemia or neuropathy. For dose levels I (15 mg/m 2 ), II (20 mg/m 2 ), and III (25 mg/m 2 ), the mean peak plasma level was 0.23 ±0.06 μM, 0.32±0.05 μM, and 0.52±0.14 μM, respectively; AUC was 0.44± 0.09 μM, 0.61± 0.1 μM, and 0.96± 0.23 μM, respectively; and duration of drug concentration above 0.05 μM (t >0.05 μM) was 1.6± 0.3 hr, 1.9± 0.2 hr, and 3.0± 0.9 hr, respectively. Conclusion-Pulsed low-dose paclitaxel chemoradiation is associated with low toxicity. Pharmacokinetic data showed that plasma paclitaxel concentration above 0.05 μM for a minimum of 1.6 hours was sufficient for effective radiosensitization.

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Section: Discussionmentioning

confidence: 99%

Toxicity Profile and Pharmacokinetic Study of A Phase I Low-Dose Schedule–Dependent Radiosensitizing Paclitaxel Chemoradiation Regimen for Inoperable Non–Small-Cell Lung Cancer

Chen

Pandya

Feins

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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“…In a small retrospective study including limited and extensive disease SCLC, COX et al [84] had the same observation. DOSORETZ et al [85] showed that local control resulted in improved survival in irradiated medically inoperable NSCLC. In a retrospective study of Radiation Therapy Oncology Group randomised trials, local control was associated with significantly better survival [86].…”

Section: Question 3: Are Objective Morphological and Metabolic Responmentioning

confidence: 99%

Surrogate markers predicting overall survival for lung cancer: ELCWP recommendations

Berghmans¹,

Pasleau²,

Paesmans³

et al. 2011

European Respiratory Journal

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The present systematic review was performed under the auspices of the European Lung Cancer Working Party (ELCWP) in order to determine the role of early intermediate criteria (surrogate markers), instead of survival, in determining treatment efficacy in patients with lung cancer. Initially, the level of evidence for the use of overall survival to evaluate treatment efficacy was reviewed. Nine questions were then formulated by the ELCWP. After reviewing the literature with experts on these questions, it can be concluded that overall survival is still the best criterion for predicting treatment efficacy in lung cancer. Some intermediate criteria can be early predictors, if not surrogates, for survival, despite limitations in their potential application: these include time to progression, progression-free survival, objective response, local control after radiotherapy, downstaging in locally advanced nonsmall cell lung cancer (NSCLC), complete resection and pathological TNM in resected NSCLC, and a few circulating markers. Other criteria assessed in these recommendations are not currently adequate surrogates of survival in lung cancer.

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“…Como a grande maioria dos tumores irradiados é do está-dio III, provavelmente, esta é uma das causas das baixas taxas de controle local, mesmo com a combinação quí-mio/radioterapia (controle local de apenas 16% (21) ). Além disso, existem evidências de uma relação entre o controle local e o desenvolvimento de metástases hematogêni-cas (22,23) . Para incrementar essa dose, escalonamento gradual deve ser feito, até estabelecer o limite máximo de tolerância dos tecidos.…”

Section: Técnicas De Radioterapia Tratamento Tridimensionalunclassified

Radioterapia no câncer de pulmão

Carvalho

2002

J. Pneumologia

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É apresentada uma revisão sobre o papel da radioterapia no câncer de pulmão, com as inovações mais recentes. São destacadas as indicações da radioterapia pós-operatória, combinação da rádio e quimioterapia, para os carcinomas de não-pequenas células. Recomendação para a irradiação profilática do crânio para os carcinomas de pequenas células e perspectivas da irradiação torácica. São descritas também técnicas recentes e apresentado o resultado do "Consenso Brasileiro -Câncer de Pulmão -Radioterapia". (J Pneumol 2002;28(6):345-50) Radiotherapy in lung cancer Esta atualização tem o objetivo de apresentar onde estamos com relação às possibilidades de melhor controle local da doença com a radioterapia e que influência isso pode ter na sobrevida global dos pacientes com câncer de pulmão. Será dividida em duas partes principais: carcinomas de não-pequenas células e de pequenas células, com referências às principais modificações estabelecidas na última década. Finalizando, será apresentada uma breve explicação das técnicas mais recentes de irradiação e suas indicações. CARCINOMA DE NÃO-PEQUENAS CÉLULAS TRATAMENTO ADJUVANTE (PÓS-OPERATÓRIO)Pacientes que tiveram seu tumor de pulmão ressecado apresentam cerca de 60 a 80% de probabilidades de cura, ou seja, quase a metade dos casos; de acordo com a apresentação inicial, evolui com recidiva local e/ou metásta-ses a distância, o que vai limitar a sobrevida. Existem duas indicações principais da radioterapia adjuvante, com intuito de melhora do controle local: a presença de tumor INTRODUÇÃO Apesar do modesto progresso que o tratamento do câncer de pulmão vem obtendo ao longo dos anos, na última década, algumas modificações chamaram a atenção.Técnicas cirúrgicas mais agressivas e seguras já permitem a ressecção de alguns tumores considerados irressecáveis inicialmente; a associação rádio-quimioterapia demonstrou ser capaz de melhorar a perspectiva de vida de pacientes selecionados do estádio III; e ainda, o grande desenvolvimento técnico da radioterapia, com tratamentos tridimensionais e o surgimento de drogas com mesmo efeito terapêutico e efeitos colaterais menores merecem ser citados.

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Local control in medically inoperable lung cancer: An analysis of its importance in outcome and factors determining the probability of tumor eradication

Cited by 149 publications

References 20 publications

Toxicity Profile and Pharmacokinetic Study of A Phase I Low-Dose Schedule–Dependent Radiosensitizing Paclitaxel Chemoradiation Regimen for Inoperable Non–Small-Cell Lung Cancer

Toxicity Profile and Pharmacokinetic Study of A Phase I Low-Dose Schedule–Dependent Radiosensitizing Paclitaxel Chemoradiation Regimen for Inoperable Non–Small-Cell Lung Cancer

Surrogate markers predicting overall survival for lung cancer: ELCWP recommendations

Radioterapia no câncer de pulmão

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