Is stereotactic ablative radiotherapy (SABR) clinically suitable in early stage non-small cell lung cancer (NSCLC) patients with WHO performance status (PS) 3?

Lung Cancer ◽  
2018 ◽  
Vol 115 ◽  
pp. S58
Author(s):  
A. Hassani ◽  
R. Pickles ◽  
L. Mackenzie ◽  
H. McCallum ◽  
H. Turnbull ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Early Stage ◽  
Performance Status ◽  
Small Cell ◽  
Stereotactic Ablative Radiotherapy ◽  
Small Cell Lung ◽  
Nsclc Patients

scholarly journals Circulating serum exosomal miR-20b-5p and miR-3187-5p as efficient diagnostic biomarkers for early-stage non-small cell lung cancer

2020 ◽  
Vol 245 (16) ◽  
pp. 1428-1436
Author(s):  
Zhi-Jun Zhang ◽  
Xing-Guo Song ◽  
Li Xie ◽  
Kang-Yu Wang ◽  
You-Yong Tang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Early Stage ◽  
Small Cell ◽  
Small Cell Lung ◽  
Diagnostic Biomarkers ◽  
Non Invasive ◽  
Early Stage Nsclc ◽  
Nsclc Patients

Circulating exosomal microRNAs (ExmiRNAs) provide an ideal non-invasive method for cancer diagnosis. In this study, we evaluated two circulating ExmiRNAs in NSCLC patients as a diagnostic tool for early-stage non-small lung cancer (NSCLC). The exosomes were characterized by qNano, transmission electron microscopy, and Western blot, and the ExmiRNA expression was measured by microarrays. The differentially expressed miRNAs were verified by RT-qPCR using peripheral blood specimens from NSCLC patients ( n = 276, 0 and I stage: n = 104) and healthy donors ( n = 282). The diagnostic values were measured by receiver operating characteristic (ROC) analysis. The results show that the expression of both ExmiR-20b-5p and ExmiR-3187-5p was drastically reduced in NSCLC patients. The area under the ROC curve (AUC) was determined to be 0.818 and 0.690 for ExmiR-20b-5p and ExmiR-3187-5p, respectively. When these two ExmiRNAs were combined, the AUC increased to 0.848. When the ExmiRNAs were administered with either carcinoembryonic antigen (CEA) or cytokeratin-19-fragment (CYFRA21-1), the AUC was further improved to 0.905 and 0.894, respectively. Additionally, both ExmiR-20b-5p and ExmiR-3187-5p could be used to distinguish early stages NSCLC (0 and I stage) from the healthy controls. The ROC curves showed that the AUCs were 0.810 and 0.673, respectively. Combination of ExmiR-20b-5p and ExmiR-3187-5p enhanced the AUC to 0.838. When CEA and CYFRA21-1 were administered with the ExmiRNAs, the AUCs were improved to 0.930 and 0.928, respectively. In summary, circulating serum exosomal miR-20b-5p and miR-3187-5p could be used as effective, non-invasive biomarkers for the diagnosis of early-stage NSCLC, and the effects were further improved when the ExmiRNAs were combined. Impact statement The high mortality of non-small cell lung cancer (NSCLC) is mainly because the cancer has progressed to a more advanced stage before diagnosis. If NSCLC can be diagnosed at early stages, especially stage 0 or I, the overall survival rate will be largely improved by definitive treatment such as lobectomy. We herein validated two novel circulating serum ExmiRs as diagnostic biomarkers for early-stage NSCLC to fulfill the unmet medical need. Considering the number of specimens in this study, circulating serum exosomal miR-20b-5p and miR-3187-5p are putative NSCLC biomarkers, which need to be further investigated in a larger randomized controlled clinical trial.

Efficacy and toxicity hypofractionated radiotherapy for centrally located non-small cell lung cancer

2021 ◽  
pp. 1-4
Author(s):  
Tanzeel Janjua ◽  
Fei Sun ◽  
Katy Clarke ◽  
Pete Dickinson ◽  
Kevin Franks ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Cox Regression ◽  
Early Stage ◽  
Performance Status ◽  
Small Cell ◽  
Small Cell Lung ◽  
Early Stage Lung Cancer ◽  
Cox Regression Analysis

Abstract Aim: Centrally located early-stage non-small cell lung cancer in patients who are unfit for surgery are treated with fractionated radiotherapy. We present the outcomes of a moderately hypofractionated accelerated dose regimen of 50 Gy in 15 fractions from a single centre in the UK. Materials and methods: Electronic case notes and radiotherapy records of lung cancer patients treated between January 2014 and December 2016 were retrospectively reviewed. Adult Comorbidity Evaluation-27 score was used to evaluate comorbidities. Mean lung doses and percentage of lung receiving more than 20 Gy were calculated for all patients. Survival outcomes were estimated using Kaplan–Meier curves. Results: Fifty-three patients were included in the study; the median follow-up was 20.2 months. 87% of patients had stage I disease. There was no 30-day post-treatment mortality. Ninety-day mortality rate after radiotherapy was 3.8%. Grade 2 pneumonitis was seen in five patients while no grade 3 or 4 pneumonitis was observed. The median progression-free survival (PFS) and overall survival (OS) were 18.5 months and 28.2 months, respectively. The estimated 1 and 2 years PFS were 62.3% and 41.3%, respectively, and OS were 77.4% and 56.6%, respectively. Worsening performance status was associated with worse survival on cox regression analysis. Disease relapsed in 36% of patients. 7.5% of patients with relapsed disease had infield recurrence. Findings: 50 Gy in 15 fractions radiotherapy for central early-stage lung cancer is a feasible choice that requires further randomised trials.

Salvage guideline for local-regional failure after stereotactic ablative radiotherapy for early-stage non-small cell lung cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 8501-8501 ◽  
Author(s):  
Eric Brooks ◽  
Bing Sun ◽  
Lina Zhao ◽  
Ritsuko Komaki ◽  
Zhongxing X. Liao ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Early Stage ◽  
Small Cell ◽  
Long Term Results ◽  
Regional Recurrence ◽  
Stereotactic Ablative Radiotherapy ◽  
Small Cell Lung ◽  
Local Regional Recurrence

8501 Background: Up to 1 in 7 patients receiving stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer (NSCLC) will develop local-regional recurrence. While SABR is the pillar of treatment for medically inoperable patients, little is known about outcomes and management for this potentially curable, local-regionally recurrent patient group. Methods: We present the first long-term results for the largest group of salvaged patients with local-regional recurrence after SABR. 772 patients with clinically early-stage I-II NSCLC were treated with SABR (50 Gy in 4 or 70 Gy in 10 fractions) between 2004-2014 at our center. Patients with isolated local recurrence (LR, n = 34) or regional recurrence (RR, n = 41) were analyzed and compared to patients with no recurrence (NR, n = 569). Results: Median time to LR or RR after SABR was 14 months. Salvage was performed in 79.4% of LR and 92.7% of RR patients. Salvage consisted of surgery (20% LR, 2% RR), re-irradiation (24% LR, 17% RR), radiofrequency ablation (15% LR), chemotherapy (15% LR, 26% RR), and chemoradiation (6% LR, 44% RR) based on a standard multi-disciplinary decision approach (Figure 1). 5-year OS was 37.1% for LR and 39.1% for RR patients. Of LR and RR patients, those receiving salvage had significantly better 5-year OS compared to those not receiving salvage (45.2% LR, 42.9% RR, 0% no salvage; p = 0.009). 5-year OS for salvaged patients was not statistically different from patients with NR (53.5% NR, p = 0.466). 5-year lung-cancer specific survival was 51% for LR and 55.1% for RR patients. Subsequent DM occurred in 20.5% of LR and 29.3% of RR patients at a median of 8.4-10.3 months. No salvaged patient experienced grade 5 toxicity. Conclusions: Patients with local or regional recurrence after SABR have excellent outcomes with salvage therapy, with no statistical difference in 5- year OS between LR and RR patients salvaged after SABR, and patients with no recurrence. Because a standard multidisciplinary approach was applied to any LR or RR patient after SABR, a novel treatment algorithm is generated. We offer a much needed management guide for thoracic oncologists treating patients who local-regionally recur after SABR.

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