Symptomatic Radiation Pneumonitis in NSCLC Patients Receiving EGFR-TKIs and Concurrent Once-daily Thoracic Radiotherapy: Predicting the Value of Clinical and Dose-volume Histogram Parameters / 中国肺癌杂志

BACKGROUND@#The incidence of symptomatic radiation pneumonitis (RP) and its relationship with dose-volume histogram (DVH) parameters in non-small cell lung cancer (NSCLC) patients receiving epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) and concurrent once-daily thoracic radiotherapy (TRT) remain unclear. We aim to analyze the values of clinical factors and dose-volume histogram (DVH) parameters to predict the risk for symptomatic RP in these patients.@*METHODS@#Between 2011 and 2019, we retrospectively analyzed and identified 85 patients who had received EGFR-TKIs and once-daily TRT simultaneously (EGFR-TKIs group) and 129 patients who had received concurrent chemoradiotherapy (CCRT group). The symptomatic RP was recorded according to the Common Terminology Criteria for Adverse Event (CTCAE) criteria (grade 2 or above). Statistical analyses were performed using SPSS 26.0.@*RESULTS@#In total, the incidences of symptomatic (grade≥2) and severe RP (grade≥3) were 43.5% (37/85) and 16.5% (14/85) in EGFR-TKIs group vs 27.1% (35/129) and 10.1% (13/129) in CCRT group respectively. After 1:1 ratio between EGFR-TKIs group and CCRT group was matched by propensity score matching, chi-square test suggested that the incidence of symptomatic RP in the MATCHED EGFR-TKIs group was higher than that in the matched CCRT group (χ2=4.469, P=0.035). In EGFR-TKIs group, univariate and multivariate analyses indicated that the percentage of ipsilateral lung volume receiving ≥30 Gy (ilV30) [odds ratio (OR): 1.163, 95%CI: 1.036-1.306, P=0.011] and the percentage of total lung volume receiving ≥20 Gy (tlV20) (OR: 1.171, 95%CI: 1.031-1.330, P=0.015), with chronic obstructive pulmonary disease (COPD) or not (OR: 0.158, 95%CI: 0.041-0.600, P=0.007), were independent predictors of symptomatic RP. Compared to patients with lower ilV30/tlV20 values (ilV30 and tlV20<cut-off point values) and without COPD, patients with higher ilV30/tlV20 values (ilV30 and tlV20>cut-off point values) and COPD had a significantly higher risk for developing symptomatic RP, with a hazard ratio (HR) of 1.350 (95%CI: 1.190-1.531, P<0.001).@*CONCLUSIONS@#Patients receiving both EGFR-TKIs and once-daily TRT were more likely to develop symptomatic RP than patients receiving concurrent chemoradiotherapy. The ilV30, tlV20, and comorbidity of COPD may predict the risk of symptomatic RP among NSCLC patients receiving EGFR-TKIs and conventionally fractionated TRT concurrently.

Effect of tumor and normal lung volumes on the lung volume-dose parameters of IMRT in non-small-cell lung cancer

OBJECTIVES: To explore the effect of tumor and normal lung volumes on lung volume-dose parameters in patients with non-small-cell lung cancer (NSCLC) who had undergone intensity-modulated radiation therapy (IMRT). METHODS: The clinical data of 208 patients with NSCLC who underwent radical IMRT between June 2014 and June 2018 were retrospectively analyzed. A regression model curve was used to evaluate the effect of tumor and normal lung volumes on normal lung relative volumes receiving greater than 5 and 20 Gy (V5, V20), on mean lung dose (MLD), and on absolute volumes spared from greater than 5 and 20 Gy (AVS5, AVS20). RESULTS: The V5, V20, and MLD of the bilateral lung were fitted to a quadratic equation curve with the change in tumor volume, which increased initially and then decreased when the tumor volume increased. The V5, V20, and MLD of the lung reached their apex when the tumor volumes were 288.07, 341.69, and 326.83 cm3, respectively. AVS5 and AVS20 decreased in a logarithmic curve with an increase in tumor volume. The V5, V20, and MLD of the small normal lung volume group were all significantly higher than those of the large normal lung volume group (p<0.001, p=0.004, p=0.002). However, the AVS5 and AVS20 of the small normal lung volume group were all significantly lower than those of the large normal lung volume group (p<0.001). CONCLUSION: The effects of tumor volume and normal lung volume on dose-volume parameters should be considered. AVS5 is an important supplementary dose limitation parameter for patients whose tumor volume exceeds a certain boundary value (approximately 300 cm3).

Research Progress in CircRNA and Radiotherapy Resistance of Non-small Cell Lung Cancer / 中国肺癌杂志

As the main type of lung cancer, non-small cell lung cancer (NSCLC) is a common cancer which is characterized by low 5-year survival rate and worse prognosis. Nowadays, some studies show that the low survival rate and worse prognosis are due to the resistance to radiotherapy caused by circRNA. Therefore, to find out the relationship between circRNA and radiotherapy resistance of NSCLC was imoprtant. According to research the relevant literatures, the relationship between circRNA and radiotherapy resistance of NSCLC was explored. CircRNA plays an important role in the invasion, metastasis, proliferation and treatment resistance of NSCLC. The radiation resistance of tumor cells induced by circRNA has become a crucial problem in radiotherapy. CircRNA plays an important role in the radiotherapy resistance of NSCLC.
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Involvement of endothelial CK2 in the radiation induced perivascular resistant niche (PVRN) and the induction of radioresistance for non-small cell lung cancer (NSCLC) cells

BACKGROUND: Tumor microenvironment (TME) plays a vital role in determining the outcomes of radiotherapy. As an important component of TME, vascular endothelial cells are involved in the perivascular resistance niche (PVRN), which is formed by inflammation or cytokine production induced by ionizing radiation (IR). Protein kinase CK2 is a constitutively active serine/threonine kinase which plays a vital role in cell proliferation and inflammation. In this study, we investigated the potential role of CK2 in PVRN after IR exposure. RESULT: Specific CK2 inhibitors, Quinalizarin and CX-4945, were employed to effectively suppressed the kinase activity of CK2 in human umbilical vein endothelial cells (HUVECs) without affecting their viability. Results showing that conditioned medium from IR-exposed HUVECs increased cell viability of A549 and H460 cells, and the pretreatment of CK2 inhibitors slowed down such increment. The secretion of IL-8 and IL-6 in HUVECs was induced after exposure with IR, but significantly inhibited by the addition of CK2 inhibitors. Furthermore, IR exposure elevated the nuclear phosphorylated factor-κB (NF-κB) p65 expression in HUVECs, which was a master factor regulating cytokine production. But when pretreated with CK2 inhibitors, such elevation was significantly suppressed. CONCLUSION: This study indicated that protein kinase CK2 is involved in the key process of the IR induced perivascular resistant niche, namely cytokine production, by endothelial cells, which finally led to radioresistance of non-small cell lung cancer cells. Thus, the inhibition of CK2 may be a promising way to improve the outcomes of radiation in nonsmall cell lung cancer cells.

Actualización en el tratamiento del cáncer pulmonar de células no pequeñas en etapa IIIA con afectación N2 / Update on treatment of stage IIIA non-small cell lung cancer with N2 disease

Los pacientes afectados de cáncer de células no pequeñas del pulmón en etapa IIIA, con afectación ganglionar N2, son comunes y considerados por muchos médicos como un subgrupo heterogéneo, y su tratamiento es controversial. Con el objetivo de realizar una revisión bibliográfica actualizada del tema en cuestión y definir cuáles son las opciones de tratamiento de estos enfermos en esta etapa, se realizó una búsqueda de resúmenes y artículos completos en diferentes bases de datos (Medline, Cochrane, Pubmed, Ebsco, Hinari), y se utilizó para ello el buscador End Note, con las siguientes palabras en inglés y su traducción en español: lung cáncer, stage IIIA, radiotherapy, chemotherapy, adyuvant treatment, surgery, limphoadenectomy. El manejo óptimo de pacientes en etapa IIIA N2 permanece como una de las áreas más polémicas en el cuidado del paciente con cáncer pulmonar de células no pequeñas, probablemente por las amplias variaciones patológicas en esta etapa, por lo que se acepta el tratamiento quirúrgico de primera intención en aquellos pacientes con una enfermedad N2 mínima y en el otro extremo se realiza tratamiento con quimiorradioterapia definitivo o prequirúrgico de inducción en casos seleccionados(AU)

The patients suffering stage IIIA non-small cell lung cancer with N2 ganglionic diseases are common and considered as an heterogeneous group by many physicians. Their treatment arouses controversies. For the purpose of making an updated literature review on this topic and defining the treatment options for these patients on this stage III, a number of full articles and of abstracts was searched on several database (Medline, Cochrane, Pubmed, Ebsco, Hinari). To this end, the End Note locator was used with the following English words and their respective Spanish translations: lung cancer, stage IIIa, radiotherapy, chemotherapy, adjuvant treatment, surgery, lymphoadenectomy. The optimal management of patients classified as stage IIIA (N2) remains one of the most controversial areas in the care of patients who suffered non-small cell lung cancer, probably due to the wide pathological variations occurring in this stage. Therefore, it is accepted to apply surgical treatment as first option in those patients presenting with minimal N2 disease, and on the other hand, the definite treatment with chemoradiotherapy or presurgical induction treatment in selected cases(AU)

A case report: successful treatment of meningeal metastasis with concurrent whole brain radiotherapy and erlotinib in a patient with non-small cell lung cancer / Reporte de caso: tratamiento exitoso de una metástasis meníngea con radioterapia total concurrente del cerebro y erlotinib en un paciente con cáncer pulmonar de células no pequeñas

We report a case of successful treatment with erlotinib of a patient with non-small cell lung cancer (stage IV) and meningeal metastasis. Combined treatment with whole brain radiotherapy (WBRT) and erlotinib mitigated neurologic symptoms of the patient. Magnetic resonance imaging showed reduction of the brain metastasis. Partial remission was observed by chest computed tomography (CT) scan after six months of erlotinib therapy.

Reportamos un caso de tratamiento exitoso con el erlotinib de un paciente con cáncer pulmonar de células no pequeñas (fase IV) y metástasis meníngea. El tratamiento combinado con la radioterapia total del cerebro (WBRT) y erlotinib mitigaron los síntomas neurológicos del paciente. Las imágenes de resonancia magnética mostraron una reducción de la metástasis del cerebro. La remisión parcial fue observada mediante CT scan de tórax tras seis meses de terapia con erlotinib.

Tratamento adjuvante em câncer de pulmão de células não pequenas / Adjuvant therapy for non-small cell lung cancer

OBJETIVO: A quimioterapia adjuvante é recomendada na maioria dos casos de câncer de pulmão de células não pequenas (CPCNP) ressecados em pacientes nos estádios II ou IIIA. No entanto, diferentes esquemas quimioterápicos contendo cisplatina foram utilizados em estudos de fase III, e a melhor escolha permanece obscura. O objetivo deste estudo foi descrever a experiência do Instituto Nacional de Câncer (INCA), localizado na cidade do Rio de Janeiro (RJ), com o uso da combinação de cisplatina e etoposídeo nessa situação, com especial foco para os dados de sobrevida. MÉTODOS: Foram avaliados retrospectivamente os prontuários dos pacientes com diagnóstico de CPCNP que receberam terapia adjuvante no INCA entre 2004 e 2008. RESULTADOS: Foram incluídos 51 pacientes, e todos foram tratados com a combinação de cisplatina e etoposídeo. A mediana de tempo de seguimento foi de 31 meses de seguimento, e a mediana de sobrevida global foi de 57 meses. Na análise univariada, a sobrevida foi inferior nos pacientes submetidos a radioterapia + quimioterapia do que aqueles somente submetidos a quimioterapia (mediana de 19 vs. 57 meses; p < 0,001), e houve uma tendência a menor sobrevida nos pacientes em estádio III em relação àqueles em estádios I-II (mediana de 34 vs. 57 meses, respectivamente; p = 0,22). Não houve associações significativas entre a sobrevida global e gênero (p = 0,70), padrão histológico (p = 0,33) ou dose de cisplatina (p = 0,13). CONCLUSÕES: Nossos resultados corroboram a utilização da quimioterapia adjuvante, e os resultados de sobrevida se aproximam daqueles descritos nos principais ensaios clínicos randomizados. Contudo, é importante o acompanhamento a longo prazo nessa população.

OBJECTIVE: Adjuvant chemotherapy is recommended for most patients submitted to resection due to non-small cell lung cancer (NSCLC) staged as II or IIIA. However, although various chemotherapy regimens that include cisplatin have been used in phase III trials, the best choice remains unclear. The objective of this study was to describe the experience of the Instituto Nacional do Câncer (INCA, Brazilian National Cancer Institute), located in the city of Rio de Janeiro, Brazil, with the use of the cisplatin-etoposide combination in such patients, with a special focus on survival data. METHODS: We retrospectively evaluated the medical charts of the patients receiving adjuvant therapy for NSCLC at the INCA between 2004 and 2008. RESULTS: We included 51 patients, all of whom were treated with the cisplatin-etoposide combination. The median follow-up period was 31 months, and the median overall survival was 57 months. In the univariate analysis, median survival was lower in the patients submitted to chemotherapy plus radiotherapy than in those submitted to chemotherapy alone (19 vs. 57 months; p < 0.001), and there was a trend toward lower median survival in stage III patients than in stage I-II patients (34 vs. 57 months; p = 0.22). Overall survival was not significantly associated with gender (p = 0.70), histological pattern (p = 0.33), or cisplatin dose (p = 0.13). CONCLUSIONS: Our results support the use of adjuvant chemotherapy, and our survival data are similar to those reported in major randomized clinical trials. However, long-term follow-up is warranted in this population.

Radiation dose escalation by percutaneous interstitial brachytherapy in locally advanced non-small cell lung cancer.

Management of locally advanced non-small cell lung cancer is associated with a poor overall survival using concurrent chemoradiotherapy. Therefore, newer approaches to treatment which enable dose escalation are warranted. Interstitial brachytherapy in lung is a new emerging concept with many distinct advantages. We report here a case of locally advanced non-small cell lung cancer with residual disease after conventional treatment. The patient was successfully treated using percutaneous interstitial brachytherapy and is disease-free at 18-month follow-up.

Experiencia de una década en el tratamiento del cáncer de pulmón no a células pequeñas estadios IIIA y IIIB: comparación de dos series / A decade of experience in the treatment of lung cancer in non-small cell stages IIIA and IIIB: comparison of two sets

Objetivo: Presentar la experiencia en el tratamiento de pulmón no a células pequeñas Estadio IIIa y IIIb. Quimioterapia, Radioterapia y Cirugía. Diseño: Trabajo comparativo de dos series; una retrospectiva de 2/5 casos entre junio de 1997 y junio de 2002 y otra de 179 casos entre julio de 2002 y julio de 2007. Población: En la primera serie fueron tratados 56 pacientes y 74 en la segunda. Método: Se compararán ambas series analizando la metodología diagnóstica y terapéutica como así también los resultados obtenidos que nos permitan optimizar conclusiones. Conclusiones: El aporte del PET y a videotoracoscopia incorporados en la segunda serie permitieron seleccionar con mayor precisión diagnóstica los pacientes candidatos a cumplir este protocolo de tratamiento. El tratamiento neoadyudante seguido de cirugía es una indicación para pacientes con cáncer de pulmón Estadio IIIa; en el Estadio IIIb no se han obtenido resultados alentadores a mediano plazo.

O uso de FDG-PET/TC scan no planejamento da radioterapia em câncer do pulmão não de pequenas células / Use of FDG-PET/CT scan in the planning of radiation therapy for non-small cell lung cancer

Radioterapia é uma importante alternativa de tratamento curativo em pacientes com câncer do pulmão não de pequenas células. Entretanto, pulmões são muito sensíveis à radiação e isto aumenta a importância em se delimitar o volume a ser irradiado com precisão. Ultimamente, a tomografia por emissão de pósitron (PET) e a tomografia computadorizada (TC) são feitas de forma combinada, e a literatura sugere que seu impacto no planejamento da radioterapia é significativo. Ao se utilizar exames de PET/TC no planejamento da radioterapia é importante reconhecer e adaptar-se às diferenças entre os equipamentos de diagnóstico e de tratamento. Este texto discute alguns dos problemas técnicos que devem ser resolvidos quando se incorpora PET no planejamento radioterápico.

Radiation therapy represents an important alternative for curative treatment of patients with nonsmall cell lung cancer. However, an accurate definition of the volume to be irradiated becomes even more important, considering that lungs are highly sensitive to radiation. Most recently, combined FDG-PET/CT scan has been utilized, and the literature reports its significant role in the planning of radiation therapy, since it seems to influence the target-volume delineation in cases of lung cancer. Differences between diagnostic and treatment equipments must be taken into consideration when FDG-PET/CT scan is utilized in the planning of radiation therapy. The present study discusses some of the many technical problems that must be solved when PET is incorporated into the planning of radiation therapy for non-small cell lung cancer.

Resultados del tratamiento inductivo en el cáncer de pulmón de células no pequeñas localmente avanzado / Results of the inductive treatment of locally advanced non-small cell lung cancer

Se evaluaron 44 pacientes con cáncer de pulmón de células no pequeñas localmente avanzado que recibieron radioquimioterapia basada en platino para la inducción de la cirugía. Nueve pacientes (20,5 por ciento) tuvieron respuestas radiológicas completas y en 17 pacientes (38,6 por ciento) se logró una reducción mayor o igual que la mitad del diámetro inicial del tumor en su eje mayor. La respuesta radiológica completa o parcial fue predictiva de resecabilidad (p = 0,048) y se asoció a mejores respuestas patológicas (p = 0,031). Cuatro pacientes (9,9 por ciento) alcanzaron remisiones histológicas y 25 (31,3 por ciento), respuestas patológicas parciales. En 23 (74,1 por ciento) de 31 pacientes con afectación inicial se logró la esterilización patológica de los grupos ganglionares. Se alcanzaron resecciones completas en 39 pacientes (88,6 por ciento), la morbilidad fue aceptable y no se produjeron muertes posoperatorias. El tratamiento neoadyuvante fue útil en este grupo de pacientes, pues indujo la respuesta patológica y aumentó también las posibilidades de resecabilidad(AU)

Forty-four patients with locally advanced non-small cell lung cancer, who had received platinum-based radiochemotherapy for surgery induction, were assessed. Nine patients (20,5 per cent) had complete radiological responses and 17 patients(38,6 per cent) achieved a reduction higher than or equal to half of the tumor´s initial diameter in its greater axis. The complete or partial radiological response was predictive of resectability (p = 0,048) and associated to better pathological responses (p = 0,031). Four patients (9,9 per cent) reached histological remission whereas 25 (31,3 per cent) had partial pathological responses. Pathological sterilization of the ganglionary groups was observed in 23 (74,1 per cent) of 31 affected subjects. Complete resection was applied in 39 patients (88,6 per cent), morbidity was acceptable and no post-operative deaths occured. The neoadjuvant treatment was useful for this group of patients since it induced the pathological response and also increased the resectability possibilities(AU)

Optimization of dose and fractionation of endobronchial brachytherapy with or without external radiation in the palliative management of non-small cell lung cancer: a prospective randomized study.

AIMS: Endobronchial brachytherapy (EBBT) is an established modality for the palliation in advanced non-small cell lung cancer. We compared three different schedules using EBBT with or without external radiation (XRT) in this setting. MATERIALS AND METHODS: Forty-five patients were randomized to three treatment arms. Arm A received XRT to a dose of 30 Gy/10 fr/2 weeks and two sessions of EBBT 8 Gy each. Arm B received the same XRT and a single session of EBBT 10 Gy at 1 cm. Arm C received only a single fraction of brachytherapy to a dose of 15 Gy at 1 cm without XRT. Symptomatic response rates, duration of symptom palliation, obstruction scores, quality of life outcomes and complications were assessed and compared. RESULTS: The overall symptomatic response rates were 91% for dyspnea, 84% for cough, 94% for hemoptysis and 83% for obstructive pneumonia. There was no significant difference between the arms. The median time to symptom relapse was 4-8 months for all symptoms and the median time to symptom progression was 6-11 months. The results were comparable between groups except for hemoptysis, where a shorter palliation was seen in Arm C that achieved statistical significance (P < 0.01). Quality of life showed significant improvement, with maximum benefit in Arm A. Complication rates were low. Only one patient died of fatal hemoptysis. CONCLUSION: EBBT is thus a safe and effective palliative tool in advanced non-small cell lung cancer, either alone or in conjunction with XRT. The difference between the treatment arms were not statistically significant in most categories, but patients treated with XRT and two endobronchial sessions of 8 Gy had the most consistent benefit in terms of all the parameters studied.

Cisplatino y vinorelbina en cáncer avanzado de células no pequeñas de pulmón. Experiencia en el Instituto Nacional de Cancerología / Treatment with cisplatin and vinorelbine in advanced no-small cell lung carcinoma

Para determinar la eficacia y seguridad de un régimen de quimioterapia a base de cisplatino y vinorelbina con o sin radioterapia en cáncer de células no pequeñas de pulmón, revisamos retrospectivamente 16 expedientes clínicos (nueve hombres y siete mujeres; edad media de 53 años; dos en etapa clínica IIIA, 11 en IIIB y tres en IV). Distinguimos tres modalidades de tratamiento: quimioterapia sola (cinco casos), quimioterapia y radioterapia concomitantes (dos pacientes) y quimioterapia de induccción seguida de quimioterapia y radioterapia concomitantes (nueve enfermos). La respuesta global fue 68.7 por ciento (18.7 por ciento completas y 50 por ciento parciales). La mediana de supervivencia global fue 13 meses y la de supervivencia libre de progresión 12 meses. La tasa de supervivencia a un año fue 75 por ciento. Se observó una tendencia a mayor supervivencia global, supervivencia libre de progresión, respuestas globales y supervivencia a un año en quienes recibieron alguna modalidad de radioterapia agregada. La toxicicdad grado 3-4 se distribuyó así hematológica (neutropenia) en seis pacientes, ninguno de los cuales requirió hospitalización ni antibióticos; y no hematológica (náuses y vómitos) en siete enfermos. Hubo neuropatía periférica grado 1-2 en cinco sujetos. No observamos mayor toxicidad asociada a tratamiento combinados. Cisplatino y vinorelbina con o sin radioterapia es un régimen eficaz y bien tolerado

Respuesta al tratamiento con neoadyuvancia y cirugía de pacientes con cáncer de pulmón no oat cell, estadíos IIIA y IIIB / Response to neoadjuvant and surgical treatment of patients with non small cell lung cancer (stages IIIA and IIIB)

El objetivo de este trabajo fue analizar la respuesta al tratamiento quirúrgico de pacientes con cáncer de pulmón no oat cell, estadios IIIa y IIIb, tratados con neoadyuvancia. Entre enero de 1992 y enero de 1996 colocaron en protocolo de quimioterapia y/o radioterapia 39 pacientes, 12 (31 por ciento) de los cuales se rescataron para tratamiento quirúrgico. El 67 por ciento (8) de los pacientes se encuentran vivos, mientras que el 16,5 por ciento (2) no posee seguimiento desde el último control y el 16,5 por ciento restante (2) falleció. El promedio de supervivencia fue de 17,83 ñ 9,04 meses y no hubo diferencias significativas en las supervivencias correspondientes a las respuestas por estadio, por histología y por neoadyuvancia (quimioterapia, quimioterapia y radioterapia); (test de Mann-Whitney). La supervivencia obtenida está dentro del rango de 10 a 20 meses citado en la literatura actual; los pacientes mejoraron su calidad de vida y se reintegraron a sus tareas, constituyendo un paso importante en el tratamiento multidisciplinario de estadios avanzados de cáncer de pulmón

Cáncer de pulmón de células no pequeñas, localmente avanzado. Tratamiento combinado con radio y quimioterapia / Combined radio-chemotherapy in locally advanced small cell lung cancer

En el mundo occidental, el cáncer de pulmón presentan la segunda causa de fallecimiento, sin que aún se haya podido obtener una mejor respuesta. Dentro del grupo denominado como cáncer de pulmón, el correspondiente al de células no pequeñas constituye el 82 por ciento de todos los tumores primarios. Cerca del 30 por ciento de los tumores son atendidos cuando ya se encuentran en etapa avanzadas, con tratamiento basados en cirugía, radioterapia o una combinación de ambas, cuando la supervivencia que se logra es muy baja. En el estadio III, con tumores ya localmente avanzados, existen varios subgrupos de tumores inoperables. La combinación de radio y quimioterapia a base de cisplatino administradas simultánea o secuencialmente, ha notificado en varios estudios aleatorizados resultados positivos en relación a la aplicación de redioterapia sola, con una mejor supervivencia media, y el doble de pacientes vivos a dos años. La toxicidad se relaciona con el esófago, médula ósea y pulmón, y puede ocasionar que los tratamientos se retrasen o que la dosis requiera ser reducida. Los factores pronósticos en la planeación del tratamiento incluyen involucro del tejido linfático, pérdida de peso, así como el género y el estado general del paciente

Radioterapia en cáncer de pulmón no-oat cell / Radiotherapy in no oat-cell lung cancer

Se han revisado 96 historias correspondientes a pacientes portadores de cáncer de pulmón no-oat cell tratados con Radioterapia o Radioterapia postquirúrgica, de 1988 a 1990 en el Instituto Nacional de Enfermedades Neoplásicas. Las edades estuvieron entre 30 y 91 años, estando la mayoría en la sexta década de la vida, 76 fueron varones y 20 mujeres. Se encontró 56 casos de carcinoma epidermoide , 37 adenocarcinomas, 4 otros y 2 no tuvieron datos histológicos. La mayor parte correspondió a neoplasias avanzadas, cuya distribución por estadíos clínicos fue la siguiente: I 0, II 3, IIIA 21, IIIB 37, IV 33, no determinado 2. No han sido considerados para esta evaluación los pacientes que tuvieron tratamiento sistémico. Todos los casos fueron tratados con radioterapia externa usando para ello Cobalto 60, con múltiples fraccionamientos. Se evalúa en este estudio el cumplimiento de éste y el resultado en cuanto a la mejoría clínica a fin de intentar determinar el esquema óptimo, pues la mayoría presentó enfermedad avanzada con una expectativa de vida corta. Se logró alcanzar 53.12 por ciento de mejoría clínica en forma global, siendo las curvas de sobrevida similares para los diferentes esquemas de tratamiento. En la actualidad hay solamente 4 pacientes vivos

Quimioterapia-Radioterapia en cáncer pulmonar a células no pequeñas (CPCNP) / Chemotherapy-Radiotherapy in non small cell lung cancer

Trece pacientes con cáncer inoperable de pulmón de células no pequeñas, recibieron tratamiento secuencial con quimioterapia y radioterapia. El régimen de quimioterapia consistió de cis-Platino (CDDP) 100 mg/m2/día, en una infusión intravenosa continua por 5 días; esta combinación fue administrada cada 21 días por 4 ciclos. Todos los pacientes fueron programados para recibir radioterapia al tumor primario, con una dosis total de 6000 rads., dividos en 3 pulsos de 10 fracciones o días cada uno administrados durante los intervalos de reposo del 1º, 2º y 3º ciclos de quimioterapia. Se observaron 2 (15.4 por ciento) remisiones completas y 4 (31 por ciento) parciales. La duración mediana de las respuestas fue de 8 meses; la sobrevida mediana de aquellos que respondieron fue de 15 meses y la sobrevida del grupo total de 9.5 meses. La toxicidad fue evaluada en 13 pacientes que corresponden a 52 ciclos de quimioterapia. Toxicidad gastrointestinal (náusea y vómito) fue importante: Grado 3 (27 por ciento), Gr 2 (54 por ciento),Gr 1 (18 por ciento); toxicidad hematológica fue moderada: Gr 3 (27 por ciento), Gr 2 (18 por ciento) y toxicidad neurológica fue leve: Gr 3 (9 por ciento), Gr 2 (9 por ciento), Gr 1 (18 por ciento). No se observó toxicidad renal ni hepática. En conclusión, el tratamiento combinado y secuencial con quimioterapia (CDDP, VP-16.5-FU) y radioterapia demostró una eficacia comparable a otros regímenes similares, con una toxicidad gastrointestinal y hematológica manejables. El rol de esta modalidad terapéutica deberá ser evaluado en un número mayor de pacientes y posiblemente en un estudio randomizado

Within-field irradiation for bronchogenic carcinoma

Sixty patients with stage II and III non-small cell lung cancer were randomized between within-field [concomitant boost] and conventional fractionation radiotherapy. The total tumor dose in both groups was 66 Gy. There were 12 complete responders in the first group and only 4 in the second group. Total objective response was 86.7% with within-field versus 73.3% with conventional treatment. The direct overall survival at 18 months was 33.3% in the first group versus 20% in the second group. All patients tolerated their treatment well with minimal variation in the incidence and severity of treatment morbidity between both groups