Can consolidative thoracic radiotherapy improve outcomes in extensive-disease small cell lung cancer after chemotherapy with complete/near-complete responders?

Background: In extensive-disease-small cell lung cancer (ED-SCLC), the median survival is 8–10 months and 2-year survival is <5%. Primary tumor progression occurs in 90% of patients approximately within 1 year. The role of consolidative thoracic radiotherapy (C-TRT) for the postchemotherapy residue with the aim of improving local control (LC) and survival is currently of great interest. The objective of this study is to determine the effectiveness of C-TRT on LC, progression-free survival (PFS), and overall survival (OS) in ED-SCLC. Materials and Methods: Medical records of patients diagnosed as SCLC between January 2010 and December 2015 were evaluated retrospectively. Patients who received C-TRT were identified. Pre- and post-chemotherapy radiological evaluations, radiotherapy schedules, relapse patterns, toxicity incidence, LC, PFS, and OS were analyzed. Results: Among 552 SCLC patients, 26 ED-SCLC patients who underwent C-TRT were analyzed. Median follow-up was 7.5 months (range, 6.5–8.5 months). Nearly 50% of the patients had >4 metastatic lesions. Restaging was performed mostly by positron emission tomography/computed tomography and cranial magnetic resonance imaging. All patients had complete or near-complete response distantly. C-TRT was 10 × 300 cGy (n = 1), 23 × 200 cGy (n = 2), 25 × 200 cGy (n = 7), 30 × 200 cGy (n = 12), and 33 × 200 cGy (n = 4). There was no toxicity ≥ Grade 3. LC rate was 77%; there was no isolated local relapse. PFS was 3 months. Median survival was 13 months. The 1- and 2-year OS rates were 62% and 8%, respectively. Conclusion: In ED-SCLC patients, C-TRT may prevent isolated local recurrence and may improve 1-year survival. This survival improvement might be the reflection of high intrathoracic control achieved in 77% of patients

Drug resistance in pulmonary tuberculosis in new and previously treated cases: experience from Turkey

The emergence of drug resistance is a major problem for tuberculosis [TB] control. The aim of this study was to determine the rates of resistance against TB drugs in patients with pulmonary tuberculosis [PTB]. Data from 387 patients with active PTB between the years of 1999 and 2004 from the Research and Education Hospital for Chest Diseases and Chest Surgery were evaluated retrospectively. The patients were categorized as new, re-treatment, extrapulmonary and chronic cases. The study group consisted of 268 [69%] new, 57 [14.7%] re-treatment, 49 [12.6%] extrapulmonary and 13 [3.3%] chronic TB cases. The rates of resistance to isoniazid [INH], rifampicin [R], ethambutol [E] and streptomycin [S] were calculated separately for each group. The resistance to any of the drugs was 7.8% in the new cases, 58.5% in the re-treatment cases and 100% in the chronic cases. The multidrug-resistance [MDR]-TB rates were found to be 2.16%, 11.3% and 92.3% among the new, re-treatment and chronic cases, respectively. These data are important as they reflect the drug resistance rates during the pre-notification time period in western Turkey

diagnostic efficiency of QuantiFERONTB[registered]-Gold test in the diagnosis of tuberculous pleurisy

Diagnosis of tuberculous pleurisy is difficult and better diagnostic tools are needed. Interferon gamma release assays [IGRAs] are in vitro immunologic diagnostic tests used to identify Mycobacterium TB infections. They cannot differentiate between latent and active infections. As IGRA tests have recently been approved for the differential diagnosis of active TB, the diagnostic accuracy of the latest generation of IGRA were assessed to detect tuberculous pleurisy in this study. The QuantiFERONTB[regestered]-Gold [QFT-G] test was used in pleural fluid from 100 immunocompetent patients [23 patients for the tuberculous group and 77 patients for the non-tuberculous group]. Clinical data were recorded. Adenosine deaminase activity [ADA] analysis and TB culture were performed on pleural fluid. The QFT-G in pleural fluid was positive in 10 [43.5%] patients and indeterminate in 13[56.5%] patients in the tuberculous pleurisy group. There was not a single patient with a negative test result in the tuberculous pleurisy group. The ADA levels were detected as 46.2 +/- 12.6 in patients with tuberculous pleurisy and18.6 +/- 39.8 in patients with nontuberculous pleurisy. The sensitivity, specificity, positive predictive value and negative predictive value of QFT-G in pleural fluid for tuberculous pleurisy were 43.5%, 54.5%, 30.3% and 100%; and of ADA in pleural fluid [>40 IU/ml] for tuberculous pleurisy the results were 82.6%, 96.1%, 90.5% and 92.5% respectively. While the value of the QFT-G test in exclusion of tuberculous pleurisy was found to be higher in this study, its other diagnostic efficiency values were detected to be low. It is recommended that a new cut-off value be established while diagnosing active TB in prospective clinical studies and that it is also essential to do the same for the studies in various regions with high and low prevalence of TB.

Comparison of curative and palliative radiotherapy efficacy in unresectable advanced non-small cell lung cancer patients with or without metastasis

To evaluate the efficacy of curative and palliative radiotherapy in inoperable advanced non-small cell lung cancer [NSCLC] patients with a performance status [PS] equal or greater than 2, and to compare the therapy effect on survival with or without metastatic disease. From January 1998 through December 2004, 797 patients with inoperable stage III and IV NSCLC were treated with radiotherapy alone because of older age, cardiovascular disease, insufficient respiratory reserve or general frailty. Radical radiotherapy, consisting of approximately 60 Gy, given in 30 fractions was performed in 363 [45.5%] of these patients. The other 434 patients [54.5%] were treated with palliative dose radiotherapy. Conventional follow-up of the patients was conducted at Izmir Oncology Center. All results were evaluated statistically. Seven hundred and sixty-three patients [95.7%] were male. The mean age was 61.02 years [ +/- 9.678], ranging from 30-88 years. The prominent histology was squamous cell carcinoma [70.7%]. Sixty-five patients [8.2%] have been staged IIIA, 419 [52.6%] IIIB, and 313 [39.3%] IV. The median follow up of patients was 274.19 days. One-year survival rate was 37%, and 2-year survival rate was 11% in the radical radiotherapy group, while these rates were 20% and 5% in the others. Although radical thoracic radiotherapy for metastatic NSCLC has not been adopted universally, this study shows that curative radiotherapy for the primary tumor provides additional survival benefit in patients with metastatic disease compared with palliative radiotherapy. This result raises the question of whether treatment with radical radiotherapy alone might be the most beneficial and cost-effective treatment of advanced stage NSCLC

Evaluation of curative and palliative radiotherapy efficacy in extensive stage small cell lung cancer

To evaluate the efficacy of curative and palliative radiotherapy in the treatment of extensive stage small cell lung cancer [E-SCLC], and compare therapy effect on survival with or without metastatic disease. From January 1998 through December 2004, 128 patients with E-SCLC were treated with radiotherapy and concomitants combined chemotherapy. Radical radiotherapy, consisting of approximately 60 Gy given in up to 30 fractions was performed in 53 [41.4%] of these patients. Others [58.6%] were treated with palliative dose radiotherapy. In all patients, chemotherapy was planned with cisplatin [80 mg/m2] intravenously [i.v.] on day 1, and etoposide [120 mg/m2] i.v. on days 1, 2 and 3, every 3 weeks for 3-6 cycles. Conventional follow-up of patients was conducted at Izmir Oncology Center, Izmir, Turkey. All results were evaluated statistically. One hundred and twenty-four patients [96.9%] were males. The mean age was 58.49 [ +/- 9.01], ranging from 37-78 years. Metastases were initially determined in 64 patients [50%]. The median follow up of patients was 287.41 days and median survival was 354.87 days. One year survival rate was 35.8%, and 2-year survival rates was 16.9% in the radical radiotherapy group, while these rates were 26.6% and 8% in the others. According to the statistical findings; the gains in duration of median survival with the curative thoracic irradiation are 151.97 days in all 128 patients. This study shows that curative radiotherapy at the primary tumor provides an additional survival benefit in patients with metastatic disease compared with palliative radiotherapy. This finding raises the question of whether treatment with radical thoracic radiotherapy with concomitant chemotherapy, consisting of first-line drugs, might be more beneficial and cost-effective as well as a less toxic treatment of E-SCLC