Survival of Patients Treated with High-dose Radiotherapy and Concurrent Chemotherapy for Unresectable Non-small-cell Lung Cancer

2010 ◽  
Vol 06 ◽  
pp. 32
Author(s):  
Steven E Schild ◽  
Helen J Ross ◽  
◽  
Keyword(s):  
Standard Dose ◽  
Small Cell Lung Carcinoma ◽  
Survival Rates ◽  
Therapeutic Index ◽  
Concurrent Chemotherapy ◽  
Small Cell ◽  
Phase Iii ◽  
High Dose ◽  
Small Cell Lung ◽  
Cell Lung Carcinoma

Radiotherapy (RT) has been used to treat cancers for 110 years. Today, megavoltage RT is delivered with very precise linear accelerators. Computed tomography and/or positron-emission tomography are used to define both tumor and normal tissue volumes. Powerful computers analyze these volumes in 3D space and design complex treatment plans. Over time, the ratio of dose administered to tumor compared with dose administered to the normal structures has increased, resulting in a better therapeutic index and improved survival. In the 1970s and 1980s, the five-year survival rate of unresectable non-small-cell lung carcinoma was 5% with standard RT alone. Adding chemotherapy before or after radiation improved the five-year survival to about 15%. More recently, concurrent chemotherapy and RT has achieved five-year survival rates of up to 29%. Pilot trials employing chemotherapy and higher-dose RT have resulted in still better local control and survival. A phase III trial of chemotherapy plus either standard-dose RT (60Gy/30) or high-dose RT (74Gy/37) is ongoing. New technology is providing ways to improve the therapeutic ratio and administer greater RT doses more safely.

A randomized study comparing a high and a standard dose of cisplatin in combination with etoposide in the treatment of advanced non-small-cell lung carcinoma.

1986 ◽  
Vol 4 (12) ◽  
pp. 1780-1786 ◽  
Author(s):  
J Klastersky ◽  
J P Sculier ◽  
P Ravez ◽  
P Libert ◽  
J Michel ◽  
...  
Keyword(s):  
Lung Carcinoma ◽  
Standard Dose ◽  
Small Cell Lung Carcinoma ◽  
Performance Status ◽  
Randomized Study ◽  
Objective Response ◽  
Small Cell ◽  
High Dose ◽  
Small Cell Lung ◽  
Cell Lung Carcinoma

We conducted a randomized trial comparing a high (120 mg/m2 day 1) v a standard (60 mg/m2 day 1) dose of cisplatin in combination with etoposide (120 mg/m2 days 3, 5, and 7) in advanced non-small-cell lung carcinoma (NSCLC). Two hundred forty-one patients were evaluable for survival and 207 for response. We obtained a 25% objective response rate in the standard-dose arm and 29% in the high-dose arm; this difference was not statistically significant. There was no significant improvement in the overall survival or survival of responders with the high-dose regimen. However, toxicity (mainly myelosuppression) was significantly increased in the patients receiving the higher dose of cisplatin. An analysis of prognostic factors showed that disease progression, loss of body weight, performance status, and prior therapy were predictive parameters of survival.

Difficulty Climbing the Stairs

2021 ◽  
pp. 149-151
Author(s):  
Anastasia Zekeridou ◽  
Vanda A. Lennon
Keyword(s):  
Computed Tomography ◽  
Intravenous Immunoglobulin ◽  
Lung Carcinoma ◽  
Small Cell Lung Carcinoma ◽  
Concurrent Chemotherapy ◽  
Small Cell ◽  
Small Cell Lung ◽  
Cell Lung Carcinoma ◽  
History Of ◽  
Myasthenic Syndrome

A 72-year-old woman with a history of rheumatoid arthritis and chronic obstructive pulmonary sought care for a 3-month history of progressive difficulty walking on uneven terrain and climbing stairs. In the 2 preceding weeks, she also noted difficulty standing up from a seated position. She reported no sensory symptoms but recently noticed dry mouth and new-onset constipation with decreased appetite. Electromyography showed diffusely low-amplitude compound muscle action potential responses to single-nerve stimuli at rest, with normal sensory nerve action potentials. Studies of the ulnar and femoral motor nerves demonstrated a decrement to low-frequency repetitive stimulation (12%) and substantial postexercise facilitation (200%) and decrement repair. The serum was positive for cyclic citrullinated peptide antibody, rheumatoid factor, and P/Q-type voltage-gated calcium channel antibody. Computed tomography of the chest showed subcarinal and right hilar lymphadenopathy without evidence of a primary lesion, with avidity on 18F-fludeoxyglucose–positron emission tomography/computed tomography. Transbronchial fine-needle aspiration biopsy of the lymph node revealed small cell lung carcinoma. The patient was diagnosed with Lambert-Eaton myasthenic syndrome and small cell lung carcinoma. Concurrent chemotherapy and radiation were administered for the small cell lung carcinoma, with some improvement of the patient’s weakness. Symptomatic treatment for Lambert-Eaton myasthenic syndrome was initiated. Therapy with 3,4-diaminopyridine improved the patient’s weakness, but her daily activities were limited by persistent, moderate, lower extremity weakness. The weakness objectively improved with intravenous immunoglobulin therapy. Two years later, the patient was maintained on 3,4-diaminopyridine and monthly intravenous immunoglobulin, with minimal persistent weakness and no evidence of cancer recurrence. Lambert-Eaton myasthenic syndrome was first described at Mayo Clinic in 1956 as a “myasthenic syndrome associated with malignant tumors” that had characteristic electromyographic findings, later shown to be presynaptic by microelectrophysiologic testing.

Radiotherapy for Medically Inoperable Non-Small Cell Lung Cancer at Clinical Stage I and II

2003 ◽  
Vol 89 (1) ◽  
pp. 75-79 ◽  
Author(s):  
Kazunari Yamada ◽  
Toshinori Soejima ◽  
Yosuke Ota ◽  
Ryohei Sasaki ◽  
Eisaku Yoden ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Local Control ◽  
Significant Influence ◽  
Small Cell Lung Carcinoma ◽  
Clinical Stage ◽  
Survival Rates ◽  
Small Cell ◽  
Small Cell Lung ◽  
Cell Lung Carcinoma ◽  
Cause Specific Survival

We reviewed the records of 36 patients with medically inoperable stage l-ll non-small cell lung carcinoma who were treated with radiotherapy. The median dose to the target was 60 Gy with conventional fractionation. Fifteen patients were treated without elective irradiation fields, while the remaining 21 were treated with extended fields including elective mediastinal regional lymph nodes. The overall survival rates at three and five years were 32.3% and 18.8%, the cause-specific survival rates were 40.9% and 27.3%, and the local control rates were 31.7% and 23.8%, respectively. In multivariate analysis the radiation dose had a marginally significant influence on the cause-specific survival, while tumor size had a significant influence on the local control rate. Only one patient had relapse in the regional mediastinal lymph nodes as the only site of metastasis. We conclude that the dose used in the present study is inadequate and recommend that further efforts be made to improve local control by dose escalation within a small target volume.

Pharmacobiologically Based Scheduling of Capecitabine and Docetaxel Results in Antitumor Activity in Resistant Human Malignancies

2002 ◽  
Vol 20 (11) ◽  
pp. 2616-2623 ◽  
Author(s):  
Padma Nadella ◽  
Charles Shapiro ◽  
Gregory A. Otterson ◽  
Marsha Hauger ◽  
Selnur Erdal ◽  
...  
Keyword(s):  
Antitumor Activity ◽  
Small Cell Lung Carcinoma ◽  
Therapeutic Index ◽  
Dose Schedule ◽  
Small Cell ◽  
Bronchioloalveolar Carcinoma ◽  
Small Cell Lung ◽  
Cell Lung Carcinoma ◽  
Weekly Docetaxel ◽  
Hand Foot Syndrome

PURPOSE: Capecitabine and docetaxel have demonstrated preclinical antitumor synergy. This synergy is thought to occur from docetaxel-mediated upregulation of thymidine phosphorylase (dThdPase), an enzyme responsible for the relative tumor selectivity of capecitabine. On the basis of the time-dependency and transiency for this upregulation, we performed a phase I study of capecitabine in combination with weekly docetaxel. We hypothesized that weekly docetaxel would result in sustained dThdPase expression and that capecitabine administration at times of maximum dThdPase upregulation would increase the therapeutic index for this combination. PATIENTS AND METHODS: Patients with advanced solid malignancies received docetaxel on days 1, 8, and 15, and capecitabine bid on days 5 to 18, every 4 weeks. Docetaxel was fixed at 36 mg/m2/wk, whereas capecitabine was escalated in successive patients cohorts. RESULTS: Sixteen patients received 77 courses at capecitabine doses from 950 to 1,500 mg/m2/d. The most common toxicities were hand-foot syndrome, diarrhea, nausea/vomiting, and asthenia. Grades 3 to 4 hematologic toxicities were infrequent and no treatment-related hospitalizations occurred. Three of three patients treated at 1,500/36 mg/m2 capecitabine/docetaxel developed grade 3 hand-foot syndrome or diarrhea during either their first or second course, whereas only two of 13 patients at 1,250/36 mg/m2 doses developed significant toxicity. Antitumor responses (n = 7) occurred in patients with hepatocellular, non–small-cell lung, and chemotherapy-refractory breast, bladder, and colorectal carcinomas. Prolonged stabilizations occurred in patients with metastatic mesothelioma (n = 2), chemorefractory non–small-cell lung carcinoma, and bronchioloalveolar carcinoma. CONCLUSION: Capecitabine in combination with weekly docetaxel is well tolerated. Recommended doses are capecitabine 1,250 mg/m2/d (625 mg/m2 bid) with docetaxel 36 mg/m2/wk. The acceptable toxicity profile in this dose schedule, and the antitumor activity observed, warrant further evaluation of this regimen.

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