Metachronous NSCLC in previously irradiated patients: is re-irradiation with SBRT a good option as definitive treatment?

AbstractAim:Treatment of metachronous second primary non-small cell lung cancer (NSCLC) in patients already treated with definitive radiotherapy is a matter of debate, since most patients are excluded from surgical treatment, which remains a therapeutic standard for patients with isolated lung masses. Salvage chemotherapy or immunotherapy alone offers a low probability of disease control. The option of re-irradiation often remains the only viable, but the risks of severe acute or late toxicities affecting the surrounding normal tissues make this a real clinical challenge.Materials and methods:From January 2015 to April 2018, five patients (male/female: 4/1; age 54–81 years, median 68) with previously irradiated NSCLC presented with a second primary lung tumour.Results:A partial response was seen in four patients, one complete responses in the fifth. The toxicity was low: two patients experienced a grade 2 asymptomatic radiation pneumonitis after 6 and 12 months from the end of stereotactic body radiation therapy, resolved with cortisone therapy. No acute or late oesophageal or cardiac toxicity was found.Findings:In this work, we present our initial experience about the use of stereotactic radiotherapy technique in already irradiated patients. We reported a local disease control in all cases with an acceptable toxicity.

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Stereotactic radiosurgery for cerebral metastatic melanoma: factors affecting local disease control and survival

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/s0360-3016(98)00272-7 ◽

1998 ◽

Vol 42 (3) ◽

pp. 581-589 ◽

Cited By ~ 175

Author(s):

Yoshimasa Mori ◽

Douglas Kondziolka ◽

John C Flickinger ◽

John M Kirkwood ◽

Sanjiv Agarwala ◽

...

Keyword(s):

Disease Control ◽

Metastatic Melanoma ◽

Stereotactic Radiosurgery ◽

Factors Affecting ◽

Local Disease ◽

Local Disease Control

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Endobronchial brachytherapy and optimization of local disease control in medically inoperable non-small cell lung carcinoma: a matched-pair analysis

Brachytherapy ◽

10.1016/j.brachy.2004.09.005 ◽

2004 ◽

Vol 3 (4) ◽

pp. 183-190 ◽

Cited By ~ 11

Author(s):

Constantine A. Mantz ◽

Daniel E. Dosoretz ◽

James H. Rubenstein ◽

Peter H. Blitzer ◽

Michael J. Katin ◽

...

Keyword(s):

Disease Control ◽

Lung Carcinoma ◽

Small Cell Lung Carcinoma ◽

Small Cell ◽

Matched Pair ◽

Small Cell Lung ◽

Cell Lung Carcinoma ◽

Matched Pair Analysis ◽

Local Disease Control ◽

Pair Analysis

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Adenoviral-Based Immunotherapy Provides Local Disease Control in an Orthotopic Murine Model of Esophageal Cancer

Journal of Immunotherapy ◽

10.1097/cji.0000000000000038 ◽

2014 ◽

Vol 37 (5) ◽

pp. 283-292 ◽

Cited By ~ 6

Author(s):

Jon G. Quatromoni ◽

Jarrod D. Predina ◽

Pratik Bhojnagarwala ◽

Ryan P. Judy ◽

Jack Jiang ◽

...

Keyword(s):

Esophageal Cancer ◽

Disease Control ◽

Murine Model ◽

Local Disease ◽

Local Disease Control

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Radiosurgery and stereotactic radiotherapy with cyberknife system for meningioma treatment

The Neuroradiology Journal ◽

10.1177/1971400917744885 ◽

2017 ◽

Vol 31 (1) ◽

pp. 18-26 ◽

Cited By ~ 10

Author(s):

Rossella Di Franco ◽

Valentina Borzillo ◽

Vincenzo Ravo ◽

Sara Falivene ◽

Francesco Jacopo Romano ◽

...

Keyword(s):

Disease Control ◽

Stereotactic Radiosurgery ◽

Local Control ◽

Stereotactic Radiotherapy ◽

Histological Grade ◽

Fractionated Stereotactic Radiotherapy ◽

Subtotal Resection ◽

Local Disease ◽

Local Disease Control ◽

The Impact

Objective The aim of this work was to evaluate the impact of stereotactic radiosurgery/fractionated stereotactic radiotherapy with the Cyberknife system on local disease control, clinical outcome and toxicity in patients with meningioma, according to the site and histological grade of lesion. From January 2013 to April 2017, 52 patients with intracranial meningiomas were treated with the Cyberknife system. Twenty-four patients had undergone previous surgery: 38% gross total resection, 10% subtotal resection; 27 patients underwent no surgery; 22 patients had a recurrence of meningioma. Methods Radiosurgery was used for lesions smaller than 2 cm, stereotactic radiotherapy for lesions larger than 2 cm, or smaller but close to a critical site such as the optical chiasm, optic pathway or brainstem. Results Local control and clinical outcomes were analysed. Median follow-up was 20 months: six patients died, one after re-surgery died from post-surgical sepsis, three from heart disease. Progression-free survival had a mean value of 38.3 months and overall survival of 41.6 months. We evaluated at 12 months 28 patients (100% local control); at 24 months 19 patients (89% local control); at 36 months nine patients (89% local control). At baseline, 44/52 patients (85%) were symptomatic: 19 visual disorders, 17 motor disorders, six hearing disorders, 10 headache and six epilepsy. Visual symptoms remained unchanged in 52%, improved in 32%, resolved in 16%. Headache was improved in 40%, resolved in 10%, unchanged in 50%. Epilepsy was resolved in 17%, unchanged in 33%, worsened in 33%. Conclusions Stereotactic radiosurgery/fractionated stereotactic radiotherapy with Cyberknife provides a good local disease control, improving visual, hearing and motor symptoms.

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Low-grade soft-tissue sarcomas: What is an adequate margin for local disease control?

Surgical Oncology ◽

10.1016/j.suronc.2020.08.022 ◽

2020 ◽

Vol 35 ◽

pp. 303-308

Author(s):

Tomohiro Fujiwara ◽

Yoichi Kaneuchi ◽

Yusuke Tsuda ◽

Jonathan Stevenson ◽

Michael Parry ◽

...

Keyword(s):

Soft Tissue ◽

Disease Control ◽

Soft Tissue Sarcomas ◽

Low Grade ◽

Local Disease ◽

Local Disease Control ◽

Adequate Margin

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Role of surgical resection in pelvic Ewing's sarcoma.

Journal of Clinical Oncology ◽

10.1200/jco.1995.13.9.2336 ◽

1995 ◽

Vol 13 (9) ◽

pp. 2336-2341 ◽

Cited By ~ 63

Author(s):

S P Scully ◽

H T Temple ◽

R J O'Keefe ◽

M T Scarborough ◽

H J Mankin ◽

...

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

Disease Control ◽

Surgical Resection ◽

Ewing’S Sarcoma ◽

Ewing's Sarcoma ◽

Disease Free Survival ◽

Local Disease ◽

Local Disease Control

PURPOSE The improved survival in patients with Ewing's sarcoma over the past two decades has placed increased importance on achievement of local disease control. Ewing's sarcoma that arises in the pelvis has been recognized to have a worse prognosis than that in the appendicular skeleton, and the role of surgical resection in these cases remains controversial. The current study attempts to identify a benefit to surgical resection in these patients. METHODS We retrospectively examined 39 patients who presented with Ewing's sarcoma in a pelvic location, all of whom were treated systemically with chemotherapy. Twenty patients received radiation only as a means of local control, and 19 underwent resection with or without radiation therapy. The patients were evaluated with end points of disease-free survival and overall survival for a minimum of 24 months and a mean of 58 months. RESULTS There was an even distribution among patients who underwent surgical resection for local control as compared with those who received only radiation therapy with respect to age, site, date of treatment, and stage of disease. Despite uncontrolled biases including tumor size and response to chemotherapy that would be expected to favor patients who undergo resection, surgery in addition to or in substitution for radiation therapy did not result in a statistically significant increase in disease-free survival or overall survival. Local disease control was comparable between those who underwent resection and those who did not: three patients in each group developed a local recurrence. CONCLUSION Currently, morbidity of surgical resection should be weighed against the efficacy and secondary complications of radiation therapy in the decision-making process for local disease control. The issue of whether overall survival and local disease control is improved in patients who undergo surgical resection remains controversial and may require a prospective randomized trial to be answered definitively.

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Postoperative radiotherapy for advanced medullary thyroid cancer—Local disease control in the modern era

Head & Neck ◽

10.1002/hed.20791 ◽

2008 ◽

Vol 30 (7) ◽

pp. 883-888 ◽

Cited By ~ 59

Author(s):

David L. Schwartz ◽

Vishal Rana ◽

Stephanie Shaw ◽

Cynthia Yazbeck ◽

Kie-Kian Ang ◽

...

Keyword(s):

Thyroid Cancer ◽

Disease Control ◽

Medullary Thyroid Cancer ◽

Postoperative Radiotherapy ◽

Medullary Thyroid ◽

Local Disease ◽

Local Disease Control ◽

Modern Era

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Early Lung Cancer Detection and Localization

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947508400503 ◽

1975 ◽

Vol 84 (5) ◽

pp. 583-588 ◽

Cited By ~ 14

Author(s):

David R. Sanderson ◽

Robert S. Fontana

Keyword(s):

Lung Cancer ◽

High Risk ◽

Screening Program ◽

Upper Airway ◽

Tracheobronchial Tree ◽

Definitive Treatment ◽

Second Primary ◽

High Risk Population ◽

Upper Respiratory Tract ◽

Early Lung Cancer

The Mayo Lung Project was established to develop and evaluate a screening program for early lung cancer in high-risk subjects. Men who are more than 45 years of age and who smoke one package of cigarettes or more daily are screened by the use of thoracic roentgenograms, three-day pooled sputum cytology, and lung health questionnaires at four-month intervals. These data are compared with data from similar subjects screened only on entry into the project. During the past three years, 34 patients who had no roentgenographic evidence of lung cancer were identified and examined because of carcinoma cells in sputum. Of these 34 patients, 27 have had bronchoscopic localization of their tumors and definitive treatment, and 3 had upper respiratory tract neoplasms and also have been treated. Of the remaining four, one patient died suddenly after myocardial infarction and three patients have not had localization or treatment because of other severe complicating medical problems. Localization of roentgenographically occult lung cancer is reliable by the use of bronchofiberoscopy and meticulous, thorough sampling from the tracheobronchial tree. A search must be made for upper airway cancers in the same high-risk population, and the possibility of second primary bronchogenic tumors also must be considered. Although follow-up is short, 22 of the 27 treated lung cancer patients were found with stage I disease. The outlook for 19 of these 27 is encouraging an average of 16 months after surgical resection.

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The Effects of Rituximab Added to Front-Line or Salvage Chemotherapy in Diffuse Large B-Cell Lymphoma (DLBCL) Undergoing High-Dose Chemotherapy (HDC) and Autologous Stem Cell Transplant (ASCT).

Blood ◽

10.1182/blood.v112.11.1138.1138 ◽

2008 ◽

Vol 112 (11) ◽

pp. 1138-1138 ◽

Cited By ~ 1

Author(s):

Umeer Ashraf ◽

Ritika Mahajan ◽

Theresa Hahn ◽

Shannon L Smiley ◽

Philip L. McCarthy ◽

...

Keyword(s):

Overall Survival ◽

Multivariate Analysis ◽

Disease Control ◽

B Cell ◽

Salvage Therapy ◽

Salvage Chemotherapy ◽

Front Line ◽

Resistant Disease ◽

Line Therapy ◽

Line Setting

Abstract Despite the improved outcome in patients with DLBCL treated with rituximab (R) in combination with systemic chemotherapy (R + chemotherapy), a significant number of patients either relapse or fail to respond as a consequence of resistant disease. HDC and ASCT is the best therapeutic strategy to rescue relapsed/refractory DLBCL. It has been postulated that R+chemotherapy may lead to the selection of highly resistant lymphoma cells diminishing the clinical benefit of HDC and ASCT. Preliminary data from the CORAL study (Gisselbrecht et al Blood2007; 11:517a) suggest that overall response rates (ORR) and 2-year event free survival (EFS) are lower in R+chemotherapy relapsed/ refractory DLBCL when compared to DLBCL treated with chemotherapy alone. However the second randomization of this study to observation versus R-maintenance may affect the interpretation of the data. We retrospectively studied the difference in the outcomes of relapsed/refractory DLBCL patients following HDC and ASCT according to the front line therapy utilized (R+chemotherapy versus chemotherapy). Using the Roswell Park Cancer Institute (RPCI) Tumor Registry and the RPCI Blood and Marrow Transplant (BMT) Database we identified 130 patients with relapsed/refractory NHL who underwent for HDC + ASCT from 1991 to 2008. After excluding patients with a diagnosis other than B-cell DLBCL (patients with transformed NHL were excluded) and those patients receiving allo-BMT after progression from ASCT, the analysis included 63 refractory/ relapsed DLBCL. Demographic characteristics, clinical data, treatment history in the front line and salvage setting were collected. In addition response to salvage therapy and disease status at day +100 from ASCT was recorded for each subject. Progression free and overall survival were calculated from ASCT. Differences in clinical outcomes between patients receiving R as part of first line or salvage treatment and those treated with chemotherapy alone were evaluated by multivariate analysis, adjusting for significant univariate predictors of survival. The patient cohort included 34 males and 29 females with median age of 46 yrs (14.4 to 69.4). Two-thirds of the patients had advance disease and the majority had a Karnofsky performance status (KPS) of 80–100% at diagnosis. R+chemotherapy was given in the front line setting to 25 pts and while 38 received chemotherapy alone. In the salvage setting, 35 pts (55%) received R+chemotherapy. Most relapses (44 pts) occurred within 6 months of completion of front line therapy (17 pts with vs. 27 pts without R). The use of R in the front line setting was associated with significantly higher response rates (PR + CR) to salvage chemotherapy (P = 0.036) and better disease control on day +100 post-ASCT (P = 0.016) when compared to chemotherapy alone. In our cohort, there have been 32 deaths, 23 in chemotherapy treated DLBCL in contrast to 9 deaths in R+chemotherapy treated patients There was a significantly higher response rate post-ASCT for R+chemotherapy treated (as front-line or salvage) DLBCL versus chemotherapy alone (P = 0.007). A multivariate analysis demonstrated that achieving a CR pre-ASCT was the most important predictor of post-ASCT progression free and overall survival . In summary, our data suggest that the use of R + chemotherapy during frontline therapy and in the salvage setting yields better disease control and less incidence of chemo-resistant disease at the time of BMT. Applying the natural selection theory, the use of R+chemotherapy is expected to result in the development of resistant lymphomas. The length of time and the amount of R therapy that will render lymphoma cells resistant to chemo-immunotherapy remain to be determined. Standard doses of R (6 to 8 doses) do not appear to affect response to salvage therapy or autologous BMT outcomes. In our single institution analysis over the last 18 years, it appears that HDC + ASCT is an effective and viable option for patients with R +/− chemotherapy relapsed/refractory DLBCL.

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