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Background: Adaptive radiation therapy (ART) refers to redesigning of radiation therapy (RT) treatment plans with respect to dynamic changes in tumor size and location throughout the treatment course. In this study, we performed a comparative volumetric and dosimetric analysis to investigate the impact of ART for patients with limited-stage small cell lung cancer (LS-SCLC). Methods: Twenty-four patients with LS-SCLC receiving ART and concomitant chemotherapy were included in the study. ART was performed by replanning of patients based on a mid-treatment computed tomography (CT)-simulation which was routinely scheduled for all patients 20� days after the initial CT-simulation. While the first 15 RT fractions were planned using the initial CT-simulation images, the latter 15 RT fractions were planned using the mid-treatment CT-simulation images acquired 20� days after the initial CT-simulation. In order to document the impact of ART, target and critical organ dose-volume parameters acquired from this adaptive radiation treatment planning (RTP) were compared with the RTP based solely on the initial CT-simulation to deliver the whole RT dose of 60 Gy. Results: Statistically significant reduction was detected in gross tumor volume (GTV) and planning target volume (PTV) during the conventionally fractionated RT course along with statistically significant reduction in critical organ doses with incorporation of ART. Conclusion: One-third of the patients in our study who were otherwise ineligible for curative intent RT due to violation of critical organ dose constraints could be treat
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OBJECTIVE@#To investigate the efficacy of integrated Chinese and Western medicine extending the progression-free survival (PFS) and overall survival (OS) of limited-stage small cell lung cancer (LS-SCLC) patients after the first-line chemoradiotherapy.@*METHODS@#The data of 67 LS-SCLC patients who received combined treatment of CM and Western medicine (WM) between January 2013 and May 2020 at the outpatient clinic of Guang'anmen Hospital were retrospectively analyzed. Thirty-six LS-SCLC patients who received only WM treatment was used as the WM control group. The medical data of the two groups were statistically analyzed. Survival analysis was performed using the product-limit method (Kaplan-Meier analysis). The median OS and PFS were calculated, and survival curves were compared by the Log rank test. The cumulative survival rates at 1, 2, and 5 years were estimated by the life table analysis. Stratified survival analysis was performed between patients with different CM administration time.@*RESULTS@#The median PFS in the CM and WM combination treatment group and the WM group were 19 months (95% CI: 12.357-25.643) vs. 9 months (95% CI: 5.957-12.043), HR=0.43 (95% CI: 0.27-0.69, P<0.001), respectively. The median OS in the CM and WM combination group and the WM group were 34 months (95% CI could not be calculated) vs. 18.63 months (95% CI: 16.425-20.835), HR=0.40 (95% CI: 0.24-0.66, P<0.001), respectively. Similar results were obtained in the further stratified analysis of whether the duration of CM administration exceeded 18 and 24 months (P<0.001).@*CONCLUSION@#The combination treatment of CM and WM with continuing oral administration of CM treatment after the first-line chemoradiotherapy for LS-SCLC patients produced better prognosis, lower risks of progression, and longer survival than the WM treatment alone. (Registration No. ChiCTR2200056616).
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Humans , Small Cell Lung Carcinoma/drug therapy , Lung Neoplasms/drug therapy , Retrospective Studies , Prognosis , Combined Modality TherapyABSTRACT
Objective To investigate the efficacy and safety of hypofractionated thoracic radiotherapy combined with EP chemotherapy in the treatment of limited-stage small-cell lung cancer (LS-SCLC). Methods A total of 117 patients with LS-SCLC were enrolled and randomly divided into test group (n=59) and control group (n=58). Patients in the experiment group were given hypofractionated thoracic radiotherapy combined with EP chemotherapy, while patients in the control group were given hyperfractionation radiotherapy combined with EP chemotherapy. Objective response rate (ORR), 2-year overall survival (OS), 2-year progression free survival (PFS), and immune cell level were used to evaluate clinical efficacy. We compared the incidence of side effects between the two groups. Results After the treatment, the ORR of patients in the test group was higher than that in the control group (P > 0.05). The mean OS and PFS of patients in the test group were significantly longer than those in the control group (P < 0.05). The levels of CD3+, CD4+, CD4+/CD8+, and NK cells in the test group were significantly higher, whereas the levels of CD8+ were significantly lower than those in the control group (P < 0.05). The incidence of radiation pneumonitis, radiation esophagitis, and severe dermatitis in the test group was significantly lower than that in the control group (P < 0.05). Conclusion Hypofractionated radiotherapy combined with EP chemotherapy for treatment of LS-SCLC can effectively improve the anticancer efficacy and patient survival, reduce the damage to the body's immune function, and alleviate adverse reaction of radiotherapy.
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Objective: To evaluate the effect of depth of remission of induction chemotherapy on the overall prognosis of limited stage small cell lung cancer (L-SCLC). Methods: The study was a retrospective, L-SCLC patients who contained complete imaging data and underwent consecutive standardized treatments at the Department of Thoracic Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University between January 2013 and June 2021 were included. To delineate the volume of tumor before and after induction chemotherapy and to calculate the depth of remission caused by the induced chemotherapy. The time receiver operating characteristic (timeROC) method was used to determine the optimal predictors for prognosis, multi-factor analysis using Cox risk proportional model. Results: A total of 104 patients were included in this study. The median PFS and OS of this cohort were 13.7 months and 20.9 months, respectively. It was observed by timeROC analysis that residual tumor volume after induction chemotherapy had the optimal predictive value of PFS at 1 year (AUC=0.86, 95% CI: 0.78~0.94) and OS at 2 years (AUC=0.76, 95% CI: 0.65~0.87). Multivariate analysis showed residual tumor volume after induction chemotherapy was the independent prognostic factor to PFS (HR=1.006, 95% CI: 1.003~1.009, P<0.01) and OS (HR=1.009, 95% CI: 1.005~1.012, P<0.001). For those whose residual tumor volume remitted to less than 10 cm(3) after induction chemotherapy, the favorable long-term outcomes could be achieved, regardless of their initial tumor load. Conclusion: The depth of remission of induction chemotherapy could be a promising prognostic predictor to the L-SCLC and provide the individualized treatment guidance.
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Humans , Small Cell Lung Carcinoma/pathology , Lung Neoplasms/pathology , Induction Chemotherapy , Retrospective Studies , Neoplasm, Residual , PrognosisABSTRACT
Objective To observe the impact of the prophylactic cranial irradiation (PCI) and its different interventional times on the prognosis of patients with limited-stage small cell lung cancer (LSCLC) who received comprehensive therapy of complete response (CR). Methods A total of 184 LSCLC patients who received radiotherapy and chemotherapy based on comprehensive treatment were retrospectively analyzed. Patients were divided into two groups based on with or without PCI intervention. There were 50 patients (27.2%) in the PCI group and 134 patients (72.8%) in the non PCI group. The PCI group was subdivided into two groups, PCI1 group (n=20) and PCI2 group (n=30), according to whether patients completed 4 cycles of chemotherapy. Chemotherapy regimen, irradiation method and dose were identical for two groups. Results The brain metastasis rates were 14.0%and 30.6%for PCI group and non PCI group. There was significant difference in brain metastasis rate between the two groups (P<0.05). The median survival times were 25 months (95%CI:21.487-28.513) and 17 months (95%CI:15.175-18.825) for PCI group and non PCI group (P<0.05). The 1, 2 and 3-year survival rates were 54%, 36%, 15% and 37%, 18%, 13% for the two groups. There were no significant differences in brain metastasis rates between PCI1 group and PCI2 group (10.0% and 16.7%). There was no significant difference in median survival time between the two subgroups. Conclusion PCI can reduce the incidence of SCLC brain metastases, and prolong the overall survival time. However, different intervention times of PCI have no significant influence on the prognosis of LSCLC.
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Objective To compare the dosimetric difference in planning target volume(PTV)and organ at risk(OAR)with conventional and the three-dimensional treatment planning for limlted-stage small cell lung cancer.Methods Ten patients with limited-stage small cell lung cancer were chosen in the present study.Two treatment planning were designed twice respectively with the Cadplan R 3.1.2 treatment planning system for each patient in two-course.The total radiation dose was 50 Gy.The dosimetric parameters were assessed with dose volume histograms in PIT and OAR.Results For the first course,the dose homogeneity indices(HI)of PTV1,conformal indices(CI)of PTV2,contralateral lung V3o and eontralateral mean lung dose in the three-dimensional treatment planning were better than that in the conventional treatment planning.For the second course,the HI,CI and mean dose of PTV1,CI and mean dose of PTV2 in the three-dimensional treatment planning were better than that in the conventional treatment planning.Conclusions By comparison with conventional treatment planning,the three-dimensional conformal treatment planning could meet the demands of dosimetrie requirements well for limited-stage small cell lung cancer with three-dimensional conformal radiotherapy,but with no significant dnsimetric differences in the OAR.
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PURPOSE: A phase II study of etoposide, ifosfamide, cisplatin combination chemotherapy and concurrent thoracic irradiation in patients with untreated limited small cell lung cancer (SCLC) was conducted to assess toxicities, response rate, response duration, and median survival. MATERIALS AND METHODS: Patients with histologically confirmed SCLC with a ECOG criteria 2 and adequate renal function and bone marrow reserve were eligible. Each cycle consisted of VP-16 100 mg/m i.v, days 1-3, ifosfamide 1,200 mg/m i.v. days 1-3 with Mesna, and cisplatin 30 mg/m i.v. days 1-3. Cycles were repeated every 21 days. Concutrent thoracic itradiation was given as total 40-45 Gy for 4-5 weeks beginning within 24 hours of the third cycle. Patients with complete remission received prophylactic cranial irradiation after the 6th cycle. RESULT: Forty two patients with limited SCLC were treated at Seoul National University Hospital between December 1993 and August 1996. Three patients were not evaluable because of lost to follow up (2 patients) and one treatment-related early death. Of 39 evaluable patients, responses were seen in 38 (97%) patients including 22 (56%) complete responses and 16 (41%) partial responses. The median remission duration was 65 wks. The median disease free survival was 60 wks. The median overall survival was not reached and 2-year survival was 69% with median duration of follow up of 63.5 wks. Hematologic side effects (WHO Gr>III/IV) of evaluable 228 cycles of chemotherapy were leukopenia in 34%, thrombocytopenia in 16%. One patient expired after prolonged leukopenia and sepsis. Nonhematologic side effects (WHO Gr>II) included nausea and vomiting (17%) and peripheral neuropathy (2%). CONCLUSION: VIP combination chemotherapy with concurrent thoracic irradiation is effective and tolerable in limited SCLC.
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Humans , Bone Marrow , Cisplatin , Cranial Irradiation , Disease-Free Survival , Drug Therapy , Drug Therapy, Combination , Etoposide , Follow-Up Studies , Ifosfamide , Leukopenia , Lost to Follow-Up , Mesna , Nausea , Peripheral Nervous System Diseases , Seoul , Sepsis , Small Cell Lung Carcinoma , Thrombocytopenia , VomitingABSTRACT
PURPOSE: To improve treatment modality and results by analysis of clinical characteristics. local control, survival and resurrence rate in limited stage small cell lung cancer. METHODS AND MATERIALS : 26 patients with limited stage small cell lung cancer were treated with combined radiation and chemotherapy from Feb. 1986 to Dec. 1992 at the National Medical Center. We followed up on 21 patients (81%) , who were mostly irradiated with 4,000-5,000cGy (75% of all patients) in the results by the analysis retrospectively. Survival rate was evaluated by the Kaplan-Meier method. RESULTS: Mean survival of irradiated patients with limited small cell lung cancer was 12 months. 1-year and 2-year survival rate were 65.3% and 15.4%. Tumor response rate and median survival after combined chemotherapy and irradiation were the following ; 50% and 15 months of complete response, and 23% and 11 months of partial response respectively. Response rates by radiation dose were 66% for below 4,000cGy. 69% for between 4,000-5,000cGy and 86% for above 5,000cGy. 21 of all patients showed treatment failure(81%), which as appeared 9 of local failure.9 of distant failure and 3 of local and distant failure. CONCLUSION: Local response rate after induction chemotherapy alone in limited stage of small cell lung cancer was 54%. Furthermore it was increased to 73% after adding of radiation. We have to increase radiation dose above 5,000cGy and need to try new effective chemotherapy agents for the improvement of local control and survival rate and also will try concurrent chemoradiotherapy in near time.
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Humans , Chemoradiotherapy , Drug Therapy , Induction Chemotherapy , Retrospective Studies , Small Cell Lung Carcinoma , Survival RateABSTRACT
A retrospective analysis of various characteristics in 32 limited stage small cell lung cancer patients treated at the Department of Therapeutic Radiology in Kangnam ST. Mary's Hospital, Catholic University Medical College from April 1983 to September 1991, was carried out to identify factors which had prognostic signficance for survival from intiation of radiation therapy. There were 26 men and 6 women. Median age was 63 years )range:24-78 years). The follow up duration was 1.5 to 44 months(median:9 months). External radiation therapy was done with daily 160-180 cGy, 5 fraction/week, total of 1000-6660 cGy (median: 4500 cGy) to the mediatinum by 6 MY linear accelerator. Of 32 patients, 27 (84.4%) patients were treated with combined modality (chemotheraphy plus radiation therapy), and 5 (15.6%) patients were treated with radiation theraphy only. Complete responders were 12 patients (37.5%), partial responders were 11(34.4%), and no responders were 9(28.1%). Karnofsky performance status over 70(p< 0.007), chemotherapy regimen (CAV, PV, and CAV+PV) (p<0.04), 6 or more cycles of chemotherapy (p<0.007), radiation therapy over 4500 cGy (p<0.03), and radiation therapy responder (CR+PR) (p<0.003) showed a significantly favorable influence on 1 year survival rate. Age (p=0.545), sex (p=0.666), presence of superior vena cava syndrome (p=0.719), prophylactic cranial irradiation (p=0.217), and radiation therapy duration (p=0.491) had no effect on survival. Radiation induced side effects were transient esophagitis in 11(34%), general weakness in 9(28%), gastrointestianl sysptoms in terms of nausea, vomiting and indigestion in 5(15%) and leukopenia in 1(3%).