scholarly journals Challenges in optimizing chemoradiation in locally advanced non small-cell lung cancers in India

2013 ◽  
Vol 02 (04) ◽  
pp. 265-271 ◽  
Author(s):  
Sushma Agrawal
Keyword(s):  
Lung Cancer ◽  
Developing Countries ◽  
Locally Advanced ◽  
Developed Countries ◽  
Normal Weight ◽  
Small Cell ◽  
Concurrent Chemoradiation ◽  
Small Cell Lung ◽  
Stage Iiia ◽  
Lung Cancers

AbstractData supporting use of concurrent chemoradiation in locally advanced lung cancers comes from clinical trials from developed countries. Applicability and outcomes of such schedules in developing countries is not widely reported. There are various challenges in delivering chemoradiation in locally advanced non small cell lung cancer in developing countries which is highlighted by an audit of patients treated with chemoradiation in our center. This article deals with the challenges in the context of a developing country. We conclude that sequential chemoradiotherapy is better tolerated than concurrent chemoradiation in Indian patients with locally advanced non-small cell lung cancers. Patients with stage IIIa, normal weight or overweight, and adequate baseline pulmonary function should be offered concurrent chemoradiation.

scholarly journals Elderly Patients with Locally Advanced and Unresectable Non-Small-Cell Lung Cancer May Benefit from Sequential Chemoradiotherapy

Cancers ◽  
2021 ◽  
Vol 13 (18) ◽  
pp. 4534
Author(s):  
Magdalena Zaborowska-Szmit ◽  
Marta Olszyna-Serementa ◽  
Dariusz M. Kowalski ◽  
Sebastian Szmit ◽  
Maciej Krzakowski
Keyword(s):  
Lung Cancer ◽  
Weight Loss ◽  
Elderly Patients ◽  
Charlson Comorbidity Index ◽  
Older Patients ◽  
Locally Advanced ◽  
Small Cell ◽  
Small Cell Lung ◽  
Stage Iiia ◽  
Comorbidity Index

Concurrent chemoradiotherapy is recommended for locally advanced and unresectable non-small-cell lung cancer (NSCLC), but radiotherapy alone may be used in patients that are ineligible for combined-modality therapy due to poor performance status or comorbidities, which may concern elderly patients in particular. The best candidates for sequential chemoradiotherapy remain undefined. The purpose of the study was to determine the importance of a patients’ age during qualification for sequential chemoradiotherapy. The study enrolled 196 patients. Older patients (age > 65years) more often had above the median Charlson Comorbidity Index CCI > 4 (p < 0.01) and Simplified Charlson Comorbidity Index SCCI > 8 (p = 0.03), and less frequently the optimal Karnofsky Performance Score KPS = 100 (p < 0.01). There were no significant differences in histological diagnoses, frequency of stage IIIA/IIIB, weight loss, or severity of smoking between older and younger patients. Older patients experienced complete response more often (p = 0.01) and distant metastases less frequently (p = 0.03). Univariable analysis revealed as significant for overall survival: age > 65years (HR = 0.66; p = 0.02), stage IIIA (HR = 0.68; p = 0.01), weight loss > 10% (HR = 1.61; p = 0.04). Multivariable analysis confirmed age > 65years as a uniquely favorable prognostic factor (HR = 0.54; p < 0.01) independent of lung cancer disease characteristics, KPS = 100, CCI > 4, SCCI > 8. Sequential chemoradiotherapy may be considered as favorable in elderly populations.

Systemic and Radiation Therapy Approaches for Locally Advanced Non–Small-Cell Lung Cancer

2022 ◽  
Author(s):  
Kristin A. Higgins ◽  
Sonam Puri ◽  
Jhanelle E. Gray
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Circulating Tumor Dna ◽  
Small Cell ◽  
Concurrent Chemoradiation ◽  
Driver Mutations ◽  
Small Cell Lung

The treatment for locally advanced non–small-cell lung cancer has changed dramatically over the past several years, with consolidative immunotherapy after concurrent chemoradiation becoming the new standard of care. Five-year survival outcomes have substantially improved with this approach. Despite these advances, further improvements are needed as the majority of patients ultimately develop progression of disease. The next-generation immunotherapy trials are currently being conducted that include approaches such as concurrent immunotherapy and addition of other therapeutic agents in the concurrent and consolidative settings. Specific unmet needs continue to exist for patients who develop disease progression after concurrent chemoradiation and immunotherapy, as well as defining the best treatment for patients with driver mutations. Future directions also include refinement of radiation techniques to reduce toxicities as much as possible, as well as the use of circulating tumor DNA in the surveillance setting. The current scientific landscape shows promising approaches that may further improve outcomes for patients with locally advanced non–small-cell lung cancer.

Daily low-dose cisplatin plus concurrent high-dose thoracic irradiation in locally advanced unresectable non-small-cell lung cancer: results of a phase II Southwest Oncology Group study.

1994 ◽  
Vol 12 (9) ◽  
pp. 1814-1820 ◽  
Author(s):  
M B Hazuka ◽  
J J Crowley ◽  
P A Bunn ◽  
M O'Rourke ◽  
T J Braun ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Low Dose ◽  
Locally Advanced ◽  
Small Cell ◽  
Survival Duration ◽  
High Dose ◽  
Small Cell Lung ◽  
Stage Iiia ◽  
Thoracic Irradiation

PURPOSE This single-arm phase II trial was designed to evaluate the efficacy and toxicity of continuous-course, high-dose thoracic irradiation (RT) combined with concurrent daily low-dose cisplatin followed by high-dose cisplatin consolidation in patients with locally advanced unresectable non-small-cell lung cancer (NSCLC). The daily chemotherapy regimen was designed to optimize the radiosensitizing properties of cisplatin. PATIENTS AND METHODS Sixty-five patients from 21 participating institutions were entered onto the study between April 1989 and May 1991. Protocol therapy consisted of daily intravenous (i.v.) cisplatin (5 mg/m2) plus concurrent continuous-course RT (61 Gy over 6 1/2 weeks) both delivered Monday through Friday each week. After a 3- to 4-week rest period, this was followed by three 28-day cycles of cisplatin at 100 mg/m2 or subsequently 50 mg/m2 administered i.v. on days 1 and 8 of each cycle. RESULTS Sixty-four patients were eligible; the majority had unresectable stage IIIa (36%) or IIIb (55%) NSCLC. The remaining 9% had recurrent disease confined to the chest (five patients) or stage II disease (one patient). The feasibility of this regimen is demonstrated by the fact that only five patients (8%) were unable to complete daily cisplatin and RT because of toxicity. Esophagitis (16%), leukopenia (14%), nausea (8%), and vomiting (6%) were the most common severe (grade 3) toxicities. There was only one life-threatening toxicity (grade 4 nausea) and no treatment-related deaths. The objective response rate was 39%, and six patients (9%) achieved a radiographic complete response (CR). The median survival duration for all patients was 14 months, and the 1- and 2-year actuarial survival rates were 56% and 24%, respectively. For stage IIIa patients, the median survival duration and 2-year survival rate were 17 months and 38%, as compared with 10 months and 14% for stage IIIb patients, respectively. CONCLUSION Daily low-dose cisplatin plus concurrent high-dose continuous-course RT is a well-tolerated out-patient regimen. The survival results are encouraging and appear to be equivalent to more toxic combined approaches. These results warrant further testing of combined daily platinum analogs with RT.

Concurrent Chemoradiation in Inoperable, Locally Advanced Non-small Cell Lung Cancer — Comparison of Efficacy and Toxicity in the Elderly

2012 ◽  
Vol 08 (01) ◽  
pp. 24 ◽  
Author(s):  
Christine Collen ◽  
Denis Schallier ◽  
Mark De Ridder ◽  
◽  
◽  
...  
Keyword(s):  
Lung Cancer ◽  
Elderly Patients ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Locally Advanced ◽  
The Elderly ◽  
Small Cell ◽  
Concurrent Chemoradiation ◽  
Small Cell Lung ◽  
Sequential Administration

Clinicians are faced with the challenge of treating increasing numbers of elderly patients with locally advanced non-small cell lung cancer (LA-NSCLC) and co-morbid conditions. The benefit of combined chemoradiation in the younger patient using the concurrent modality compared with the sequential administration of both modalities has been established in several randomised trials and recent meta-analyses. Because of the underrepresentation of elderly patients in clinical trials on concurrent chemoradiation (CCRT) in LA-NSCLC, treatment guidelines for this age group are not well established. The objective of this report is to summarise the data on efficacy and toxicity of CCRT in the elderly.

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