Prevention and management of acute esophageal toxicity during concomitant chemoradiotherapy for locally advanced lung cancer

2021 ◽  
pp. 030089162110256
Author(s):  
Paolo Borghetti ◽  
Jessica Imbrescia ◽  
Giulia Volpi ◽  
Gianluca Costantino ◽  
Gianluca Cossali ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Onset Time ◽  
Preventive Measure ◽  
Pharmaceutical Products ◽  
Advanced Lung Cancer ◽  
Common Side Effect ◽  
Concomitant Chemoradiotherapy ◽  
Concomitant Radiochemotherapy

Background: Standard treatment for locally advanced non-small cell lung cancer (LA-NSCLC) is concomitant chemoradiotherapy. The survival benefit of combined treatment is partially counterbalanced by an increased rate of acute esophageal toxicity. Several pharmaceutical products are available for prevention and management of esophagitis, including Faringel Plus. Aim: To assess the incidence and the grade, identify the correlations with clinical, dosimetric, and therapeutic variables, and analyse the role of Faringel Plus as a pharmaceutical preventive measure against acute esophageal toxicity. Methods: Patients with LA-NSCLC treated with concomitant radiochemotherapy were retrospectively reviewed. Acute esophagitis and dysphagia were graded according to Common Terminology Criteria for Adverse Events version 5.0. Clinical, dosimetric, and therapeutic correlations were investigated using χ2 test. Results: Among the 23 analysed patients, 18 (78.3%) and 1 (4.3%) developed G2 and G3 esophagitis, respectively; G1–2 dysphagia were reported in 11 cases (47.8%). No statistically significant correlation between the variables considered and acute esophageal toxicity was identified. In the group of patients who received Faringel Plus as preventive treatment (10 subjects, 43.5%), dysphagia presentation time was significantly longer ( p = 0.038); esophagitis onset time was longer and symptoms duration was shorter. Faringel Plus allowed a reduction in the use of analgesic drugs. Conclusions: Acute mild esophageal toxicity was confirmed to be a common side effect in this setting. No clinical-dosimetric parameter has been demonstrated to be effective in predicting acute esophageal toxicity. The use of Faringel Plus appears effective as a therapeutic and prophylactic tool to manage acute esophageal toxicity.

INDUCTION THERAPY AND METHODS OF PREVENTING THE DEVELOPMENT OF BRONCHOPLEURAL FISTULA IN LOCALLY ADVANCED FORMS OF NON-SMALL CELL LUNG CANCER

2018 ◽  
Vol 64 (3) ◽  
pp. 325-330
Author(s):  
Stepan Yergnyan ◽  
Yevgeniy Levchenko ◽  
I. Kubekov
Keyword(s):  
Lung Cancer ◽  
Main Bronchus ◽  
Bronchopleural Fistula ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Advanced Lung Cancer ◽  
Urgent Problem ◽  
Small Cell Lung ◽  
Locally Advanced Lung Cancer

This review is devoted to the urgent problem of modern oncology - combined treatment of locally advanced lung cancer with neoadjuvant chemotherapy, chemoradiation, targeted therapy. Literature data on the influence of various variants of neoadjuvant therapy on the development of postoperative bronchopleural complications, risk factors, methods of their prevention are analyzed in detail. The role of primary and secondary plastics of the stump of the main bronchus, tracheobronchial anastomoses with various autoflaps is highlighted. The article analyzes the data of large meta-analyzes and works originating from specialized clinics dealing with this problem.

scholarly journals High dose rate endobronchial brachytherapy in the management of advanced lung cancer - comparison according to the presence of lung atelectasis

2021 ◽  
pp. 90-90
Author(s):  
Marko Bojovic ◽  
Nensi Lalic ◽  
Tatjana Boskovic ◽  
Miroslav Ilic ◽  
Olivera Ivanov ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Dose Rate ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
High Dose Rate ◽  
Treatment Modalities ◽  
Advanced Lung Cancer ◽  
High Dose ◽  
Before And After

Introduction/Objective. Locally advanced lung cancer (LC) is often accompanied with atelectasis of either a part or the entire lung. The aim of this study was to establish the benefits of brachytherapy on the patients? quality of life (QoL), the length of the progression free survival (PFS), and the overall survival (OS) as related to the presence or absence of atelectasis after the applied treatment. Methods. The total of 100 patients with locally advanced LC or endobronchial metastasis of other malignancy were treated with the high dose rate endobronchial brachytherapy (HDR-EBB) in 2017. For observing the patients? clinical characteristics, the PFS and OS, the patients were classified into four groups according to the presence of atelectasis before and after HDR-EBB. Results. After HDR-EBB alone or combined with other treatment modalities, a statistically significant symptom alleviation was registered for all the symptoms except cough (p<0.05). The significantly highest PFS value was registered among the patients with atelectasis prior but not after HDR-EBB. The longest survival was registered in the patients who had atelectasis prior to, but not after HDR-EBB, as well as among the patients without of atelectasis either before or after EBB. Conclusion. HDR-EBB is an efficient method that improved the QoL of most patients. There were improved rates of re-aeration after HDR-EBB treatment alone and as a part of combined treatment. Re-aeration after EBB is a positive prognostic factor with respect to PFS and OS of these patients.

scholarly journals Expanded human NK cells from lung cancer patients sensitize patients’ PDL1−negative tumors to PD1-blockade therapy

2021 ◽  
Vol 9 (1) ◽  
pp. e001933
Author(s):  
Sophie M Poznanski ◽  
Tyrah M Ritchie ◽  
Isabella Y Fan ◽  
Abdullah El-Sayes ◽  
Ana L Portillo ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Tumor Microenvironment ◽  
Nk Cells ◽  
Tumor Regression ◽  
Checkpoint Inhibitors ◽  
Combined Treatment ◽  
Death Receptor ◽  
High Rate ◽  
Advanced Lung Cancer ◽  
Pd1 Blockade

Lung cancer remains the leading cause of cancer death worldwide despite the significant progress made by immune checkpoint inhibitors, including programmed death receptor-1 (PD1)/PD ligand 1 (PDL1)-blockade therapy. PD1/PDL1−blockade has achieved unprecedented tumor regression in some patients with advanced lung cancer. However, the majority of patients fail to respond to PD1/PDL1 inhibitors. The high rate of therapy non-response results from insufficient PDL1 expression on most patients’ tumors and the presence of further immunosuppressive mechanisms in the tumor microenvironment. Here, we sensitize non-responding tumors from patients with lung cancer to PD1-blockade therapy using highly cytotoxic expanded natural killer (NK) cells. We uncover that NK cells expanded from patients with lung cancer dismantle the immunosuppressive tumor microenvironment by maintaining strong antitumor activity against both PDL1+ and PDL1− patient tumors. In the process, through a contact-independent mechanism involving interferon γ, expanded NK cells rescued tumor killing by exhausted endogenous TILs and upregulated the tumor proportion score of PDL1 across patient tumors. In contrast, unexpanded NK cells, which are susceptible to tumor-induced immunosuppression, had no effect on tumor PDL1. As a result, combined treatment of expanded NK cells and PD1-blockade resulted in robust synergistic tumor destruction of initially non-responding patient tumors. Thus, expanded NK cells may overcome the critical roadblocks to extending the prodigious benefits of PD1-blockade therapy to more patients with lung cancer and other tumor types.

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 Pulmonary sleeve resection in locally advanced lung cancer using cryopreserved allograft for pulmonary artery replacement

2013 ◽  
Vol 146 (5) ◽  
pp. 1191-1197 ◽  
Author(s):  
Jean-Philippe Berthet ◽  
Marc Boada ◽  
Marina Paradela ◽  
Laureano Molins ◽  
Stefan Matecki ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Pulmonary Artery ◽  
Locally Advanced ◽  
Advanced Lung Cancer ◽  
Sleeve Resection ◽  
Locally Advanced Lung Cancer
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