Thoracic radiotherapy with or without daily low-dose carboplatin in elderly patients with non-small-cell lung cancer: a randomised, controlled, phase 3 trial by the Japan Clinical Oncology Group (JCOG0301)

Atagi, Shinji; Kawahara, Mutsuto; Yokoyama, Akira; Okamoto, Hiroaki; Yamamoto, Nobuyuki; Ohe, Yuichiro; Sawa, Toshiyuki; Ishikura, Satoshi; Shibata, Taro; Fukuda, Haruhiko; Saijo, Nagahiro; Tamura, Tomohide

doi:10.1016/s1470-2045(12)70139-0

Cited by 212 publications

(139 citation statements)

References 31 publications

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“…In a pivotal multicenter, randomized, phase 3 trial for elderly patients with unresectable stage III NSCLC, the Japan Clinical Oncology Group study group recruited 200 patients aged 71 to 89 years (106). Patients received either concurrent chemoradiation with low-dose carboplatin or radiotherapy alone.…”

Section: Chemotherapy Locally Advanced Lung Cancermentioning

confidence: 99%

Update in Lung Cancer and Mesothelioma 2012

Powell

Halmos

Nana‐Sinkam

2013

Am J Respir Crit Care Med

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Lung cancer remains the number one cause of cancer-related death in the United States among both men and women. It is estimated that in 2013, there will be more than 200,000 new diagnoses of lung cancer and nearly 160,000 deaths (1). Despite the discovery and application of targeted therapies, the overall survival (OS) remains poor, with an overall 5-year survival approximating 16%. In addition, there are a growing number of cases among former smokers and never smokers. However, based on research advances in 2012, there is enthusiasm that improvements in early detection, coupled with tobacco cessation and the application of novel genetic and genomics technologies, will lead to improved outcomes. EPIDEMIOLOGYAlthough more than 85% of patients diagnosed with lung cancer will have smoked at some point in their lives, only 15 to 20% of smokers will develop lung cancer, thus suggesting the involvement of additional risk factors. Studies examining the roles of various exposures, including asbestos, welding, arsenic, and concomitant lung diseases, such as chronic obstructive pulmonary disease (COPD), tuberculosis, and pneumonia, as risk factors independent of tobacco consumption are ongoing (2, 3). A recent large epidemiological study in more than 2,000 incident cases of lung cancer cases and control subjects identified a 36% increase in lung cancer risk among welders and flame cutters. Interestingly, welding fumes were an independent risk factor for lung cancer (4). DisparitiesA recent examination of multiple registries confirmed that African Americans have the highest incidence of lung cancer (73/100,000) (5) and have a decreased OS and lower rates of surgical resection. Factors contributing to the disparities in lung cancer include inequities in access to health care, differing perceptions regarding early detection, smoking cessation and treatment, and variation in susceptibilities to the effects of cigarette smoke (6, 7). Conversely, the incidence rates for lung cancer among Hispanic men are much lower, and OS is better than in non-Hispanic whites. The explanations for these differences include a combination of decreased smoking rates among Hispanics, potential genetic variants (8), and histological distribution. Saeed and colleagues conducted a systematic analysis of the SEER database and determined that Hispanics had a higher rate of less aggressive histological subtypes of lung cancer (adenocarcinoma in situ and lepidic predominant adenocarcinoma) (9). Investigation of these areas should help to narrow the lung cancer outcomes gap that exists between ethnic groups.

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Section: Chemotherapy Locally Advanced Lung Cancermentioning

confidence: 99%

Update in Lung Cancer and Mesothelioma 2012

Powell

Halmos

Nana‐Sinkam

2013

Am J Respir Crit Care Med

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“…[17][18][19][20][21] Pignon et al previously studied the effect of age on toxicity in patients undergoing thoracic radiation in a meta-analysis of six randomized trials. 17 Their study overall showed no significant age-dependent distribution of acute or late toxicities.…”

Section: Discussionmentioning

confidence: 99%

Lower Incidence of Esophagitis in the Elderly Undergoing Definitive Radiation Therapy for Lung Cancer

Soni

Boonstra

Schipper

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Introduction-The majority of lung cancer patients are elderly and poorly represented in randomized clinical trials. They are often undertreated due to concerns about their ability to tolerate aggressive treatment. We tested the hypothesis that elderly patients undergoing definitive lung radiation might tolerate treatment differently from younger patients.Methods-125 patients who underwent definitive lung radiotherapy were identified from a prospective institutional database (UM cohort). Logistic regression modelling was performed to assess the impact of age on esophagitis grade ≥3 or ≥2 and pneumonitis grade ≥3 or ≥2, adjusting for esophageal and lung dose respectively, chemotherapy utilization, smoking status, and performance status. The analysis was validated in a large cohort of 691 patients from the Michigan Radiation Oncology Quality Consortium (MROQC) registry, an independent statewide prospective database.Results-In the UM Cohort, multivariable regression models revealed a significant inverse correlation between age and rate of esophagitis for both toxicity levels, (adjusted odds ratio=0.93 for both models, 95% confidence intervals of (0.88,0.98) and (0.87,0.99)), with AUC of 0.747 and 0.721, respectively, demonstrating good fit. This same association was noted in the MROQC cohort. There was no significant association between age and pneumonitis.Conclusions-There is a lower incidence of esophagitis with increasing age even after adjusting for use of chemotherapy. This is a novel finding in thoracic oncology. No age dependence was

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“…The OS of the patients in stage T2 in the uracil-tegafur group improved significantly. Atagi et al 14) performed a randomized controlled phase 3 study that compared radiation therapy alone and chemoradiation (radiation + low-dose carboplatin) in elderly patients with locally advanced NSCLC. The OS of the chemoradiation group improved significantly.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors for Overall and Disease-specific Survival of Stage I Non-Small-Cell Lung Cancer after Stereotactic Body Radiotherapy: A Retrospective Analysis

Abe

Okada

Shinozaki

et al. 2017

J St. Marianna Univ

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Background: The purpose of this study was to investigate the prognostic factors of stereotactic body radiotherapy (SBRT) for stage I non-small-cell lung cancer (NSCLC) to improve outcomes. Materials and methods: Between 2008 and 2016, 71 patients with medically inoperable stage I NSCLC were treated at our hospital with SBRT (48-55 Gy in 4-5 fractions for peripheral lesions or 60-64 Gy in 8-10 fractions for central lesions). Survival outcomes were analyzed using Kaplan-Meier and cumulative incidence methods. Factors including sex, age, tumor location, tumor size, BED (biologically effective dose) 10, and maximum standardized uptake value (SUVmax) were evaluated with regard to overall survival (OS) and disease-specific survival (DSS) using Cox proportional hazard regression. Results: The median follow-up duration of surviving patients was 33 months (range, 6-81 months). Two-year OS and DSS were 78.5% and 91.5%, respectively. Two-year cumulative local recurrence rate, regional recurrence rate, and distant metastasis rate were 6.8%, 10.9%, and 7.3%, respectively. Multivariate analysis revealed that BED10 and SUVmax were prognostic factors for DSS. Conclusion: Lower BED10 and higher SUVmax were predictors of significantly worse DSS. A higher SUVmax may be considered for intensive treatment to improve outcomes.

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Thoracic radiotherapy with or without daily low-dose carboplatin in elderly patients with non-small-cell lung cancer: a randomised, controlled, phase 3 trial by the Japan Clinical Oncology Group (JCOG0301)

Cited by 212 publications

References 31 publications

Update in Lung Cancer and Mesothelioma 2012

Update in Lung Cancer and Mesothelioma 2012

Lower Incidence of Esophagitis in the Elderly Undergoing Definitive Radiation Therapy for Lung Cancer

Prognostic Factors for Overall and Disease-specific Survival of Stage I Non-Small-Cell Lung Cancer after Stereotactic Body Radiotherapy: A Retrospective Analysis

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