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Objective To evaluate the effect of different doses of thoracic radiotherapy (TRT) upon the clinical prognosis of patients with extensive-stage (stage Ⅳ) small cell lung cancer (ES-SCLC) and establish a Nomogram prediction model.Methods Clinical data of 144 patients pathologically diagnosed with ES-SCLC undergoing TRT in Tianjin Medical University Cancer Hospital from month,2010 to month,2016 were retrospectively analyzed.Clinical characteristics,treatment data and responses were evaluated.A Nomogram was established by using Cox's proportional hazard regression model to predict the overall survival (OS).The prediction capability and accuracy were assessed by the concordance index (C-index) and a calibration curve between the model and verification groups.Results The median follow-up time was 31.9 months.The 2-year OS rate was 20.3％.The Nomogram model demonstrated that TRT dose,liver metastases,oligometastases/polymetastases,number of chemotherapy cycle and response to chemotherapy were significantly correlated with clinical prognosis.The calibration curve revealed that the predicted and actual OS were highly consistent.The C-index was calculated as 0.701.In the subgroup analyses,patients with high-dose TRT obtained significantly better OS than their counterparts with low-dose TRT.Conclusion The Nomogram prediction model based on different TRT doses can accurately predict the OS rate of ES-SCLC patients,which is an individualized model for predicting the survival probability.
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Objective To investigate the effect of the timing of radiotherapy on the prognosis of limited-stage small cell lung cancer (LS-SCLC) in the elderly. Methods A retrospective analysis was performed on the clinical data of 80 elderly patients with LS-SCLC who were treated with radical sequential thoracic chemoradiotherapy from 2008 to 2014.The correlations of SER(time from the start of any treatment to the end of radiotherapy) and the number of induction chemotherapy cycles with overall survival(OS) and progression-free survival (PFS) rates was analyzed. The treatment outcomes were compared between early radiotherapy group (no later than 3 cycles of induction chemotherapy,n=37) and late radiotherapy group (after 3 cycles of induction chemotherapy,n=43).The Kaplan-Meier method was used for survival analysis. Results In all patients,the median OS and PFS were 23.5 and 13.3 months respectively. SER was significantly correlated with OS and PFS (P=0.001;P=0.001).The median OS in patients undergoing radiotherapy after 2,3,4,5,and 6 cycles of induction chemotherapy was 33.2,26.7,20.6,16.9,and 17.9 months (P=0.000),respectively. The median OS time and 1-,2-,and 5-year OS rates were 27.8 months, 87%,62%,and 34%,respectively,in the early radiotherapy group,and 17.9 months,74%,37%,and 15%, respectively,in the late radiotherapy group (P=0.017).The median PFS time and 1-,2-,and 5-year PFS rates were 17.1 months,65%,43%,and 28%,respectively,in the early radiotherapy group,and 11.9 months,49%,21%,and 14%,respectively,in the late radiotherapy group( P= 0.022). Conclusions Shorter SER achieves better treatment outcomes in elderly patients with LS-SCLC undergoing sequential chemoradiotherapy. Early radiotherapy provides a survival benefit for patients.
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Objective To investigate the effects of hyperfractionated radiotherapy versus hypofractionated radiotherapy combined with concurrent chemotherapy on the prognosis of limited-stage small-cell lung cancer (SCLC).Methods A total of 188 patients with limited-stage SCLC were enrolled in this study and divided into hyperfractionated group (n=92) and hypofractionated group (n=96).The hyperfractionated group received thoracic radiotherapy at 45 Gy in 30 fractions twice a day, while the hypofractionated group received 55 Gy in 22 fractions once a day.The Kaplan-Meier method was used to calculate survival rates, and the Cox model was used for multivariate prognostic analysis.Results There were not significant differences in 1-, 2-, and 5-year progression-free survival (PFS) rates and 1-, 2-, and 5-year overall survival (OS) rates between the hyperfractionated group and the hypofractionated group (82% vs.85%, 61% vs.69%, 59% vs.69%, P=0.27;85% vs.77%, 41% vs.34%, 27% vs.27%, P=0.37).The multivariate analysis showed that the time from the initiation of chemotherapy to the initiation of thoracic radiotherapy ≤43 days was favorable prognostic factor for PFS (P=0.005).The time from the initiation of chemotherapy to the end of thoracic radiotherapy ≤63 days and prophylactic cranial irradiation were favorable prognostic factors for OS (P=0.044;P=0.000).There were significant differences in incidence rates of grade 2 and 3 acute radiation esophagitis between the two groups (28% vs.16%, 9% vs.2%, P=0.009).Conclusions Both hyperfractionated radiotherapy and hypofractionated radiotherapy combined with chemotherapy can improve the PFS and OS of patients with limited-stage SCLC.The time from the initiation of chemotherapy to the initiation of thoracic radiotherapy ≤43 days and the time from the initiation of chemotherapy to the end of thoracic radiotherapy ≤63 days are favorable prognostic factors for PFS and OS, respectively.However, the hyperfractionated group has significantly higher incidence rates of grade 2 and 3 acute radiation esophagitis than the hypofractionated group.
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Objective To investigate the influence of radiotherapy with concurrent oral epidermal growth factor receptor ( EGFR) and tyrosine kinase inhibitor ( TKI) for advanced non-small cell lung cancer ( NSCLC) on the incidence of interstitial lung disease ( ILD ) , and to analyze the risk factors for the pathogenesis of ILD. Methods The incidence of ILD in 72 patients with NSCLC who were admitted to Department of Radiotherapy Oncology of Lu′an Hospital of Traditional Chinese Medicine and treated with radiotherapy with concurrent oral EGFR-TKI from January 2010 to January 2014 was analyzed retrospectively,and some patients were selected as controls to compare the difference in the incidence of ILD between the TKI concurrent radiotherapy group and the other groups. The univariate analysis using chi-square test and multivariate logistic regression analysis were applied to analyze the risk factors for the incidence of ILD in the patients receiving TKI concurrent radiotherapy. Results The TKI concurrent radiotherapy group had a significantly higher incidence rate of ILD than the palliative chemotherapy group,single TKI group,and concurrent chemoradiotherapy group ( 19. 4% vs. 2. 5%, 12%, and 7. 5%, P= 0. 045 ) . The multivariate regression analysis showed that male sex,long-term smoking,underlying lung disease,tumor volume>5 cm, and application of conventional radiotherapy were the risk factors for the pathogenesis of ILD in the TKI concurrent radiotherapy group. Conclusions Radiotherapy with concurrent TKI for advanced NSCLC may increase the incidence of ILD.
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Objective To analyze the incidence and related factors of acute radiation pneumonitis (RP) in patients with non-small cell lung cancer (NSCLC) who underwent three-dimensional conformal ra-diotherapy with concurrent chemotherapy. Methods From January 2006 to October 2008, 90 NSCLC pa-tients treated with concurrent chemoradiotherapy were retrospectively reviewed. The clinical characteristics and treatment plan parameters from dose-volume histogram (DVH) were analyzed. Results Grade 1, 2,3, 4 and 5 RP was found in 32.2%, 30.0%, 5.6%, 0% and 1.1% of the patients. Primary tumor loca-tion was the only significant clinical factor in univariate analysis. And significant differences were found when the groups was divided by the mean lung dose (MLD) of 17 Gy, V_(5) of 47% ,V_(10) of 36% ,V_(20) of 24%,V_(30) of 23% and V_(40) of 22%, respectively. Multivariate analysis showed the MLD was the only independent predictive factor of RP. Conclusions Some factors may contribute to the RP. MLD should be set below 17 Gy in three-dimensional conformal radiation, especially when the tumor locates in the lower lobe.
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Objective To evaluate the effects of induction chemotherapy plus radiotherapy (ICRT) and concurrent chemotherapy plus radiotherapy (CCRT) for Stage Ⅱ -Ⅲ non-small cell lung carcinoma (NSCLC) . Methods From July 19% to July 1999, 64 patients with Stage Ⅱ -Ⅲ NSCLC were randomized into two groups: ICRT group (32 patients) induction chemotherapy with DDP( 100mg/m2,dl) and VP-16 (100mg/m2,dl-d3) per week, one cycle per 4 weeks was given. Radiation was given after 2-3 cycles. CCRT group (32 patients) received radiotherapy plus concurrent chemotherapy with DDP(20 mg/m2,dl-d5) and VP-16 (50 mg/m2,dl-d5) per week for 8 weeks. In either group, radiation was given with a total dose of 60-70 Gy/6-7 weeks. Results One patient was excluded from ICRT group for development of distant metastasis, and 3 from CCRT group for their acute complications or other diseases. The overall response rates ( CR + PR) of ICRT and CCRT groups were 81.3% and 84.4%, respectively . NR + PD rates of both groups were 18.7% and 15.6% . The median survival periods were 13.4 months in ICRT group and 21.6 months in CCRT group (t = 2.58, P