The Quality of Curative-intent Radiotherapy for Non-small Cell Lung Cancer in the UK

McAleese, J.; Baluch, S.; Drinkwater, K.

doi:10.1016/j.clon.2015.05.006

Cited by 15 publications

(5 citation statements)

References 26 publications

(28 reference statements)

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“…Given the ongoing uncertainty regarding the optimal dose for curative-intent radiation therapy for NSCLC, and the high levels of toxicity, it is not surprising that radiation therapy practice varies 12, 14, 15. Recent advances are, however, enabling radiation therapy to be delivered with lower toxicity than previously, so knowledge regarding the optimal dose for curative-intent radiation therapy is becoming more important.…”

Section: Introductionmentioning

confidence: 99%

Dose and Fractionation in Radiation Therapy of Curative Intent for Non-Small Cell Lung Cancer: Meta-Analysis of Randomized Trials

Ramroth

Cutter

Darby

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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PurposeThe optimum dose and fractionation in radiation therapy of curative intent for non-small cell lung cancer remains uncertain. We undertook a published data meta-analysis of randomized trials to examine whether radiation therapy regimens with higher time-corrected biologically equivalent doses resulted in longer survival, either when given alone or when given with chemotherapy.Methods and MaterialsEligible studies were randomized comparisons of 2 or more radiation therapy regimens, with other treatments identical. Median survival ratios were calculated for each comparison and pooled.Results3795 patients in 25 randomized comparisons of radiation therapy dose were studied. The median survival ratio, higher versus lower corrected dose, was 1.13 (95% confidence interval [CI] 1.04-1.22) when radiation therapy was given alone and 0.83 (95% CI 0.71-0.97) when it was given with concurrent chemotherapy (P for difference=.001). In comparisons of radiation therapy given alone, the survival benefit increased with increasing dose difference between randomized treatment arms (P for trend=.004). The benefit increased with increasing dose in the lower-dose arm (P for trend=.01) without reaching a level beyond which no further survival benefit was achieved. The survival benefit did not differ significantly between randomized comparisons where the higher-dose arm was hyperfractionated and those where it was not. There was heterogeneity in the median survival ratio by geographic region (P<.001), average age at randomization (P<.001), and year trial started (P for trend=.004), but not for proportion of patients with squamous cell carcinoma (P=.2).ConclusionsIn trials with concurrent chemotherapy, higher radiation therapy doses resulted in poorer survival, possibly caused, at least in part, by high levels of toxicity. Where radiation therapy was given without chemotherapy, progressively higher radiation therapy doses resulted in progressively longer survival, and no upper dose level was found above which there was no further benefit. These findings support the consideration of further radiation therapy dose escalation trials, making use of modern treatment methods to reduce toxicity.

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Section: Introductionmentioning

confidence: 99%

Dose and Fractionation in Radiation Therapy of Curative Intent for Non-Small Cell Lung Cancer: Meta-Analysis of Randomized Trials

Ramroth

Cutter

Darby

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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“…Despite this, SABR has been adopted widely across the world. In the UK, the delivery of both conventional EBRT and SABR for ES lung cancer has recently been audited by McAleese et al 25 They found high levels of conformance with quality standards, including respiratory compensation, and onset verification with cone beam image-guided RT in the UK.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of outcomes following stereotactic ablative radiotherapy in the treatment of early-stage primary lung cancer

Murray

Franks

Hanna

2017

The British Journal of Radiology

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Stereotactic ablative body radiotherapy (SABR) describes a radiotherapy (RT) technique where high doses of radiation are precisely delivered to an extracranial target within the body, using either a single fraction of RT or using multiple small numbers of fractions. SABR has now become the standard of care treatment for patients with early-stage non-small-cell lung cancer (NSCLC) for whom surgery is not appropriate. This systematic review considers the evidence supporting the use of SABR in early-stage NSCLC, reported toxicity rates, the use of SABR in centrally located NSCLC, the use of SABR as salvage therapy following surgery or RT, and future potential drug combinations with SABR.

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“…Differentiation of infection from colonization is possible by quantification of copy number (qPCR) [14]. In our study we used qPCR to determine PJ infection.…”

Section: Discussionmentioning

confidence: 99%

“…Actuarial survival was calculated using MEDCALC version 9.3.9.0 and using the Kaplan Meier method. PJP was considered proven if microbiological or quantitative polymerase chain reaction (qPCR) tests were positive in the presence of clinical and radiological signs of progressive pneumonia [14] (table 1). PJP was considered possible when there were clinical signs of progressive pneumonia and either compatible radiological signs or complete resolution after PJP treatment but with absence of microbiological or qPCR confirmation.…”

Section: Methodsmentioning

confidence: 99%

Risk of Death from Pneumocystis jirovecii after Curative-intent Radiotherapy for Lung Cancer

et al. 2018

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Background Radical radiotherapy is given in the curative setting for patients with non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Pneumocystis jirovecii pneumonia (PJP) in HIV-negative patients carries a high mortality. We determined the risk of death from PJP in a cohort of patients treated with radical radiotherapy. Methods Case records for all patients treated with radical radiotherapy for NSCLC and SCLC in Northern Ireland, between Jan 2011 and Dec 2016 inclusive, were examined to determine the cause of death. Survival was estimated using the Kaplan Meier method. Results 683 patients were studied. At a median follow up of 15 months, 379 patients (55%) had died. The cause of death was determined in all but 5 patients. 6 patients died with progressive pneumonia and quantitative PCR confirmation of PJP infection. A further 8 patients died of progressive pneumonia with bilateral radiological changes. Whilst no serological or microbiological confirmation was available they met the criteria for possible PJP infection. All patients had received corticosteroids within the preceding 3 months; 13 had lymphopenia for at least a month prior to diagnosis. The actuarial risk of death from definite or possible PJP was 2.6% at 2 years (95% CI 1.2% to 4.0%). Conclusions We conclude that there is a clinically significant risk of death from PJP in patients treated with radiotherapy. An association with prior steroid use and prolonged lymphopenia is noted. We advocate the use of chemoprophylaxis in patients receiving steroids who have had radical radiotherapy.

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The Quality of Curative-intent Radiotherapy for Non-small Cell Lung Cancer in the UK

Cited by 15 publications

References 26 publications

Dose and Fractionation in Radiation Therapy of Curative Intent for Non-Small Cell Lung Cancer: Meta-Analysis of Randomized Trials

Dose and Fractionation in Radiation Therapy of Curative Intent for Non-Small Cell Lung Cancer: Meta-Analysis of Randomized Trials

A systematic review of outcomes following stereotactic ablative radiotherapy in the treatment of early-stage primary lung cancer

Risk of Death from Pneumocystis jirovecii after Curative-intent Radiotherapy for Lung Cancer

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