Accelerated hypofractionated radiotherapy for advanced lung cancer

2017 ◽  
Vol 17 (1) ◽  
pp. 78-84
Author(s):  
Christina Armpilia ◽  
Andriani Harpidou ◽  
Zoi Kalaitzi ◽  
Charilaos Tsapas ◽  
Sofia Tsagouli ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Locally Advanced ◽  
Conformal Radiotherapy ◽  
Hypofractionated Radiotherapy ◽  
Advanced Lung Cancer ◽  
Accelerated Radiotherapy ◽  
Number Of Patients ◽  
Accelerated Repopulation

AbstractIntroduction – purposeThe aim of this study is to review the results of applying a hypofractionated radiotherapy schedule for locally advanced inoperable lung cancer in patients who have received chemotherapy. Lung cancer and especially non-small-cell lung cancer is prone to accelerated repopulation and shorter treatment schedules in the form of accelerated radiotherapy have been shown to improve treatment outcome.Patients – methodIn total, 29 patients with inoperable lung cancer (stage II, IIIa,b, IV) were treated with accelerated hypofractionated 3D conformal radiotherapy. All patients received a dose of 55 Gy in 20 fractions (daily dose of 2·75 Gy). The median age was 65·5 years, 87% of patients had stage III–IV disease, 93% of patients received sequential chemotherapy with their radiotherapy. Median follow-up of patients was 36 months.ResultsThe median overall survival from time of diagnosis was 16·5 months and the 1 year overall survival was 31%. Complications were present in 44·8% of the patients and the most common complication (20·7%) was pneumonitis alone. The complication rate was not significantly different according to histological type, stage, type of chemotherapy, presence of recurrence or death.ConclusionAlthough our study limitation is the small number of patients, these data suggest that the efficacy of this hypofractionated schedule could be considered as alternative option to the conventional regimen of 66 Gy given in 33 fractions.

scholarly journals Clinical Application of a Hybrid RapidArc Radiotherapy Technique for Locally Advanced Lung Cancer

2016 ◽  
Vol 16 (2) ◽  
pp. 224-230
Author(s):  
Scott R. Silva ◽  
Murat Surucu ◽  
Jennifer Steber ◽  
Matthew M. Harkenrider ◽  
Mehee Choi
Keyword(s):  
Lung Cancer ◽  
Clinical Application ◽  
Locally Advanced ◽  
Significant Risk ◽  
Conformal Radiotherapy ◽  
Concurrent Chemotherapy ◽  
Advanced Lung Cancer ◽  
3 Dimensional ◽  
Contralateral Lung ◽  
Locally Advanced Lung Cancer

Objective: Radiation treatment planning for locally advanced lung cancer can be technically challenging, as delivery of ≥60 Gy to large volumes with concurrent chemotherapy is often associated with significant risk of normal tissue toxicity. We clinically implemented a novel hybrid RapidArc technique in patients with lung cancer and compared these plans with 3-dimensional conformal radiotherapy and RapidArc-only plans. Materials/Methods: Hybrid RapidArc was used to treat 11 patients with locally advanced lung cancer having bulky mediastinal adenopathy. All 11 patients received concurrent chemotherapy. All underwent a 4-dimensional computed tomography planning scan. Hybrid RapidArc plans concurrently combined static (60%) and RapidArc (40%) beams. All cases were replanned using 3- to 5-field 3-dimensional conformal radiotherapy and RapidArc technique as controls. Results: Significant reductions in dose were observed in hybrid RapidArc plans compared to 3-dimensional conformal radiotherapy plans for total lung V20 and mean (−2% and −0.6 Gy); contralateral lung mean (−2.92 Gy); and esophagus V60 and mean (−16.0% and −2.2 Gy; all P < .05). Contralateral lung doses were significantly lower for hybrid RapidArc plans compared to RapidArc-only plans (all P < .05). Compared to 3-dimensional conformal radiotherapy, heart V60 and mean dose were significantly improved with hybrid RapidArc (3% vs 5%, P = .04 and 16.32 Gy vs 16.65 Gy, P = .03). However, heart V40 and V45 and maximum spinal cord dose were significantly lower with RapidArc plans compared to hybrid RapidArc plans. Conformity and homogeneity were significantly better with hybrid RapidArc plans compared to 3-dimensional conformal radiotherapy plans ( P < .05). Treatment was well tolerated, with no grade 3+ toxicities. Conclusion: To our knowledge, this is the first report on the clinical application of hybrid RapidArc in patients with locally advanced lung cancer. Hybrid RapidArc permitted safe delivery of 60 to 66 Gy to large lung tumors with concurrent chemotherapy and demonstrated advantages for reduction in low-dose lung volumes, esophageal dose, and mean heart dose.

scholarly journals Nivolumab and Hypofractionated Radiotherapy in Patients With Advanced Lung Cancer: ABSCOPAL-1 Clinical Trial

2021 ◽  
Vol 11 ◽  
Author(s):  
Hua Ye ◽  
Haowen Pang ◽  
Xiangxiang Shi ◽  
Peirong Ren ◽  
Shangke Huang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Trial ◽  
Objective Response ◽  
Progression Free Survival ◽  
Hypofractionated Radiotherapy ◽  
Advanced Lung Cancer ◽  
Clinical Trial Registration ◽  
Before And After ◽  
Grade 3

BackgroundMore clinical practice need to be performed to verify the toxicity of the hypofractionated radiotherapy (HFRT) combined with PD-1 blockade in lung cancer. This phase I study aimed to investigate the safety and efficacy of nivolumab combined with HFRT in patients with progressive advanced lung cancer following multiline treatment.MethodsWe enrolled 31 patients with advanced lung cancer pathologically confirmed to have progressive disease and treated with first-line or a higher therapy. Selected lesions were treated using HFRT, and nivolumab was administered within 7 days subsequently. Nivolumab was administered once a month following partial remission. Peripheral blood was collected before and after 1 month of treatment to evaluate relevant cytokines between nivolumab responders and non-responders.ResultsOverall, 23 patients who completed the treatment were evaluated. Of them, 9 and 14 patients underwent hypofractionated brachytherapy with 30 Gy in a single fraction via percutaneous interstitial implantation of (192)Ir and 40–50 Gy in 5 fractions via stereotactic body radiation therapy, respectively. The median follow-up period was 11 months. At the 1-year follow-up, no patient developed grade ≥ 3 pneumonitis. The overall objective response and complete remission rates were 39.13% and 13.04%, respectively. The 1-year overall survival and median progression-free survival were 60.9% and 6 months, respectively. The plasma levels of interleukin IL-6, IL-10, and IL-17A were significantly reduced after treatment in nivolumab responders.ConclusionsHFRT could increase the responsivity to nivolumab and reduce its administration frequency. This combination treatment is well tolerated with acceptable toxicity and thus merits further trials to validate benefits.Clinical Trial Registrationhttp://www.chictr.org.cn/index.aspx, identifier ChiCTR-1900027768.

A phase II trial of ZD6474 plus docetaxel in patients with previously treated NSCLC: Follow-up results

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7016-7016 ◽  
Author(s):  
J. V. Heymach ◽  
B. E. Johnson ◽  
D. Prager ◽  
E. Csada ◽  
J. Roubec ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Survival Data ◽  
Locally Advanced ◽  
Primary Objective ◽  
Phase Iii ◽  
Double Blind Study ◽  
Once Daily ◽  
Platinum Based Chemotherapy

7016 Background: ZD6474, a once-daily oral agent, targets key signaling pathways in cancer by inhibiting VEGF, EGF and RET receptor tyrosine kinases. ZD6474 in combination with docetaxel (Doc) was assessed in patients (pts) with refractory non-small-cell lung cancer (NSCLC). Methods: Pts eligible for this randomized, double-blind study had locally advanced or metastatic (stage IIIB/IV) NSCLC after failure of 1st-line platinum-based chemotherapy. The primary objective was to determine whether once-daily oral ZD6474 (100 or 300 mg) + Doc (75 mg/m2 i.v. infusion every 21 days) prolonged progression-free survival (PFS) vs Doc alone (80% power to detect 50% prolongation at P<0.2). Overall survival was a secondary objective. Results: A total of 127 pts (73 male/54 female; median age 59 yrs, range 29–82) received ZD6474 100 mg + Doc (n=42), ZD6474 300 mg + Doc (n=44) or Doc (n=41). The study met its primary objective of PFS prolongation with the addition of ZD6474: median PFS was 19 wks for ZD6474 100 mg + Doc (HR=0.64; P=0.074); 17 wks for ZD6474 300 mg + Doc (HR=0.83; P=0.461); and 12 wks for Doc. A total of 64 pts (50%) presented with histology other than adenocarcinoma, including 37 with squamous, and 13 pts (10%) entered with CNS metastases. Exploratory subgroup analyses suggest advantages in PFS for ZD6474 + Doc vs Doc both for adenocarcinoma and for other lung cancer histologies. Common adverse events (AEs) included diarrhea, rash and asymptomatic QTc prolongation, all responded to standard management or dose interruption/reduction. Four pts with squamous experienced hemoptysis (ZD6474 100 mg + Doc, n=2 CTC grade 1/2; Doc, n=2 CTC grade 3/4). No fatal episodes of hemoptysis or any CNS hemorrhage AEs were reported in pts receiving ZD6474. Overall survival data were immature at the time of PFS analysis, and a mature survival analysis will be conducted at ∼75% of deaths (anticipated April 2006, and will be presented at the meeting). As of December 2005, 40/127 (31%) pts were alive, 5 of whom continue to receive ZD6474. The minimum follow-up of pts still alive was 17 months. Conclusions: ZD6474 + Doc prolonged PFS vs Doc alone, and these promising data have led to the initiation of Phase III evaluation of ZD6474 + Doc in 2nd-line NSCLC. [Table: see text]

scholarly journals Clinical features and overall survival among elderly cancer patients in a tertiary cancer center

2015 ◽  
Vol 13 (4) ◽  
pp. 487-491 ◽  
Author(s):  
Yuri Philippe Pimentel Vieira Antunes ◽  
Diogo Diniz Gomes Bugano ◽  
Auro del Giglio ◽  
Rafael Aliosha Kaliks ◽  
Theodora Karnakis ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Solid Tumors ◽  
Early Stage ◽  
Large Population ◽  
Disease Stage ◽  
Cancer Center ◽  
Early Stage Disease ◽  
Number Of Patients

ABSTRACT Objective To evaluate the epidemiological profile and overall survival of a large population of elderly individuals diagnosed with solid tumors in a tertiary hospital. Methods This retrospective study included patients aged >65 years, diagnosed with solid tumors between January 2007 and December 2011, at Hospital Israelita Albert Einstein, São Paulo, Brazil. The medical records were reviewed to obtain information about clinical variables and overall survival. Results A total of 806 patients were identified, and 58.4% were male. Mean age was 74 years (65 to 99 years). The most common types were prostate (22%), colorectal (21%), breast (19%), and lung cancer (13%), followed by bladder (8%), pancreas (6%), and other types (11%). The majority of patients were diagnosed at early stage disease. After a median follow-up of 27 months (15 to 45 months), 29% of the patients (234/806) died, predominantly in the group older than 70 years. For the entire cohort, the median 2-year survival rate was 71%. Median overall survival was not reached within the study period. In a multivariate analysis, age (HR: 1.35; 95%CI: 1.25-1.45; p<0.001) and disease stage (HR: 1.93; 95%CI: 1.75-2.14; p<0.001) were independent negative predictors of poor survival. Conclusion The most prevalent tumors were prostate, colorectal, breast, and lung cancer, with the larger proportion diagnosed at initial stages, reflecting the great number of patients alive at last follow-up.

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