Fractures of thoracic vertebrae in patients with locally advanced non-small cell lung carcinoma treated with intensity modulated radiotherapy

This study compared the performance of volumetric modulated arc therapy (VMAT) techniques: single arc volumetric modulated arc therapy (SA-VMAT) and double arc volumetric modulated arc therapy (DA-VMAT) with the static beam conventional intensity modulated radiotherapy (C-IMRT) for non-small-cell lung carcinoma (NSCLC). Twelve stage I and II NSCLC patients were recruited and their planning CT with contoured planning target volume (PTV) and organs at risk (OARs) was used for planning. Using the same dose constraints and planning objectives, the C-IMRT, SA-VMAT, and DA-VMAT plans were optimized. C-IMRT consisted of 7 static beams, while SA-VMAT and DA-VMAT plans consisted of one and two full gantry rotations, respectively. No significant difference was found among the three techniques in target homogeneity and conformity. Mean lung dose in C-IMRT plan was significantly lower than that in DA-VMAT plan P=0.04. The ability of OAR sparing was similar among the three techniques, with no significant difference in V20, V10, or V5 of normal lungs, spinal cord, and heart. Less MUs were required in SA-VMAT and DA-VMAT. Besides, SA-VMAT required the shortest beam on time among the three techniques. In treatment of early stage NSCLC, no significant dosimetric superiority was shown by the VMAT techniques over C-IMRT and DA-VMAT over SA-VMAT.

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Major Pulmonary Resection After Neoadjuvant Therapy in Potentially Resectable Stage IIIA/B Non-Small Cell Lung Carcinoma: R0 or No R0

10.21203/rs.3.rs-534014/v1 ◽

2021 ◽

Author(s):

Michael Peer ◽

Sharbel Azzam ◽

Arnold Cyjon ◽

Rivka Katsnelson ◽

Henri Hayat ◽

...

Keyword(s):

Mortality Rate ◽

Neoadjuvant Chemotherapy ◽

Lung Carcinoma ◽

Pulmonary Resection ◽

Small Cell Lung Carcinoma ◽

Locally Advanced ◽

Small Cell ◽

Small Cell Lung ◽

Stage Iiia ◽

Cell Lung Carcinoma

Abstract Objective The aim of this study was to identify predictors of postoperative outcome and survival of locally advanced non-small cell lung carcinoma (NSCLC) resections after neoadjuvant chemotherapy or chemoradiation.Methods Medical records of all patients with clinical stage III potentially resectable NSCLC initially treated by neoadjuvant chemotherapy or chemoradiation followed by major pulmonary resections between 1999 to 2019 were retrieved from the databases of four Israeli Medical Centers. Results: The 124 suitable patients included, 86 males (69.4%) and 38 females (30.6%), mean age of 64.2 years (range 37-82) and mean hospital stay of 12.6 days (range 5-123). Complete resection was achieved in 92.7% of the patients, while complete pathologic response was achieved in 35.5%. Overall readmission rate was 16.1%. The overall 5-year survival rate was 47.9%. One patient (0.8%) had local recurrence. Postoperative complications were reported in 49.2% of the patients, mainly atrial fibrillation (15.9%) and pneumonia (13.7%), empyema (10.3%), and early bronchopleural fistula (7.3%). Early in-hospital mortality rate was 6.5% and the six-month mortality rate was 5.6%. Pre-neoadjuvant bulky mediastinal disease (lymph nodes >20 mm) (p=0.034), persistent postoperative N2 disease (p=0.016), R1 resection (p=0.027) and postoperative stage IIIA (p=0.001), emerged as negative predictive factors for survival. Conclusions: Our findings demonstrate that neoadjuvant chemotherapy or chemoradiation in locally advanced potentially resectable NSCLC followed by major pulmonary resection is a beneficial approach in selected cases.

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