Treatment-Related Toxicity in Patients With Early-Stage Non-Small Cell Lung Cancer and Coexisting Interstitial Lung Disease: A Systematic Review

Chen, Hanbo; Senan, Suresh; Nossent, Esther J.; Boldt, Gabriel; Warner, Andrew; Palma, David A.; Louie, Alexander V.

doi:10.1016/j.ijrobp.2017.03.010

Cited by 110 publications

(96 citation statements)

References 68 publications

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“…Metformin has been shown to reduce oxygen consumption in vitro and in vivo in multiple cancer cell lines 6 . Combining these observations and considering radioresistance of hypoxic tumours, the observed tumour reoxygenation may be a plausible radiobiological explanation for the radiosensitising effect of metformin 38 . The hypothesised mechanism of action of metformin on tumour cell proliferation and radiation response is summarised in Figure 2.…”

Section: Discussionmentioning

confidence: 82%

“…Re-irradiation of recurrent lung cancer can be very challenging and harbours a risk of serious treatment-related toxicity due to normal tissue damage, especially when re-irradiating critical mediastinal structures (e.g. large vessels, trachea, bronchi, oesophagus) 38,39 .…”

Section: Treatment Of Recurrent Nsclc and Stage IV Non-small Cell Lunmentioning

confidence: 99%

“…When looking into the risk factors for RR after surgery for early stage NSCLC, there are two types of studies. Most studies have investigated predictive factors for ONM in clinical stage I NSCLC through examination of the resected specimens of the tumour and the lymph nodes 11,[38][39][40][41][42][43] . Identified risk factors for ONM include larger tumour size, solid consistency on high-resolution CT, adenocarcinoma, higher SUV max , increased carcinoembryonic antigen level, visceral pleural invasion (VPI), and poor pathological differentiation.…”

Section: Incidence Of Regional Recurrence and Risk Factors Derived Frmentioning

confidence: 99%

“…Li et al 37 investigated the extent of the interplay effect on IMPT delivery and concluded that for the specific system at MDACC , the this effect may not be a primary concern. Grassberger et al 38 and Dowdell et al 39 have reported that the magnitude of the interplay effect depends on patient parameters such as motion amplitude and beam delivery parameters such as spot size. Several techniques (rescanning, gating, tracking) trying to compensate for the interplay effect are topic of intensive research in several groups worldwide.…”

Section: Proton Therapy Techniques and Considerations For Treatment Pmentioning

confidence: 99%

“…Another patient category potentially able to benefit from the OAR dose reductions achieved by particle therapy is the patient with interstitial lung disease (ILD). ILD is characterised by diffuse, inflammatory or fibrotic changes of the lung parenchyma, often resulting in a mainly restrictive defect on pulmonary function testing 38 . Idiopathic pulmonary fibrosis (IPF) is the most serious form of ILD 39 .…”

Section: Particle Therapy Early Stage Nsclcmentioning

confidence: 99%

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Innovations in the treatment of non-small cell lung cancer

Wink¹

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Section: Discussionmentioning

confidence: 82%

Section: Treatment Of Recurrent Nsclc and Stage IV Non-small Cell Lunmentioning

confidence: 99%

Section: Incidence Of Regional Recurrence and Risk Factors Derived Frmentioning

confidence: 99%

Section: Proton Therapy Techniques and Considerations For Treatment Pmentioning

confidence: 99%

Section: Particle Therapy Early Stage Nsclcmentioning

confidence: 99%

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Innovations in the treatment of non-small cell lung cancer

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Prospective Data on Stereotactic Ablative Radiotherapy Provides Guidance in an Unusual Clinical Scenario

Weiner,

Marks

2024

JAMA Oncol

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Stereotactic Radiation Therapy in Early Non–Small Cell Lung Cancer and Interstitial Lung Disease

Palma,

Bahig,

Hope

et al. 2024

JAMA Oncol

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ImportancePatients with interstitial lung disease (ILD) and early-stage non–small cell lung cancer (NSCLC) have been reported to be at high risk of toxic effects after stereotactic ablative radiotherapy (SABR), but for many patients, there are limited alternative treatment options.ObjectiveTo prospectively assess the benefits and toxic effects of SABR in this patient population.Design, Setting, and ParticipantsThis prospective cohort study was conducted at 6 academic radiation oncology institutions, 5 in Canada and 1 in Scotland, with accrual between March 7, 2019, and January 12, 2022. Patients aged 18 years or older with fibrotic ILD and a diagnosis of T1-2N0 NSCLC who were not candidates for surgical resection were enrolled.InterventionPatients were treated with SABR to a dose of 50 Gy in 5 fractions every other day.Main Outcomes and MeasuresThe study prespecified that SABR would be considered worthwhile if median overall survival—the primary end point—was longer than 1 year, with a grade 3 to 4 risk of toxic effects less than 35% and a grade 5 risk of toxic effects less than 15%. Secondary end points included toxic effects, progression-free survival (PFS), local control (LC), quality-of-life outcomes, and changes in pulmonary function. Intention-to-treat analysis was conducted.ResultsThirty-nine patients enrolled and received SABR. Median age was 78 (IQR, 67-83) years and 59% (n = 23) were male. At baseline, 70% (26 of 37) of patients reported dyspnea, median forced expiratory volume in first second of expiration was 80% (IQR, 66%-90%) predicted, median forced vital capacity was 84% (IQR, 69%-94%) predicted, and median diffusion capacity of the lung for carbon monoxide was 49% (IQR, 38%-61%) predicted. Median follow-up was 19 (IQR, 14-25) months. Overall survival at 1 year was 79% (95%, CI 62%-89%; P &lt; .001 vs the unacceptable rate), and median overall survival was 25 months (95% CI, 14 months to not reached). Median PFS was 19 months (95% CI, 13-28 months), and 2-year LC was 92% (95% CI, 69%-98%). Adverse event rates (highest grade per patient) were grade 1 to 2: n = 12 (31%), grade 3: n = 4 (10%), grade 4: n = 0, and grade 5: n = 3 (7.7%, all due to respiratory deterioration).Conclusions and RelevanceIn this trial, use of SABR in patients with fibrotic ILD met the prespecified acceptability thresholds for both toxicity and efficacy, supporting the use of SABR for curative-intent treatment after a careful discussion of risks and benefits.Trial RegistrationClinicalTrials.gov Identifier: NCT03485378

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Treatment-Related Toxicity in Patients With Early-Stage Non-Small Cell Lung Cancer and Coexisting Interstitial Lung Disease: A Systematic Review

Cited by 110 publications

References 68 publications

Innovations in the treatment of non-small cell lung cancer

Innovations in the treatment of non-small cell lung cancer

Prospective Data on Stereotactic Ablative Radiotherapy Provides Guidance in an Unusual Clinical Scenario

Stereotactic Radiation Therapy in Early Non–Small Cell Lung Cancer and Interstitial Lung Disease

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