Weight gain in advanced non-small-cell lung cancer patients during treatment with split-course concurrent chemoradiotherapy is associated with superior survival.

BACKGROUND: Preoperative concurrent chemoradiotherapy (CRT) is an accepted treatment for potentially resectable, locally advanced, non-small-cell lung cancer (NSCLC). We reviewed a decade of single institution experience with preoperative split-course CRT followed by surgical resection to evaluate survival and identify factors that may be helpful in predicting outcome. METHODS AND MATERIALS: All patients treated with preoperative split-course CRT and resection at Rush University Medical Center (RUMC) between January 1999 and December 2008 were retrospectively analyzed. Endpoints included overall survival (OS), progression-free survival (PFS), local-regional progression-free survival (LRPFS), and distant metastasis-free survival (DMFS). Patient and treatment related variables were assessed for correlation with outcomes. RESULTS: A total of 54 patients were analyzed, 76% Stage IIIA, 18% Stage IIIB, and 6% oligometastatic. The pathologic complete response (pCR) rate was 31.5%, and the absence of nodal metastases (pN0) was 64.8%. Median OS and 3-year actuarial survival were 44.6 months and 50%, respectively. Univariate analysis revealed initial stage (p < 0.01) and percent weight change during CRT (p < 0.01) significantly correlated with PFS/OS. On multivariate analysis initial stage (HR, 2.4; 95% CI, 1.18-4.90; p = 0.02) and percent weight change (HR, 0.79; 95% CI, 0.67-0.93; p < 0.01) maintained significance with respect to OS. There were no cases of Grade 3+ esophagitis, and there was a single case of Grade 3 febrile neutropenia. CONCLUSIONS: The strong correlation between weight change during CRT and OS/PFS suggests that this clinical parameter may be useful as a complementary source of predictive information in addition to accepted factors such as pathological response.

Intraoperative high-dose-rate brachytherapy--a novel technique in the surgical management of axillary recurrence.

Treating recurrent disease in the axilla is a challenging and complex clinical problem. Several reports in the literature suggest better outcomes with the combination of both surgery and radiation therapy than either modality alone. However, the available options for re-treatment are limited by the extent of disease at relapse, and the prior therapy that the patient has already received. The choice of re-irradiation using conventional external beam therapy is generally limited because of the risk of exceeding the radiation tolerance of the brachial plexus. In lieu of our concerns regarding excessive morbidity from re-irradiation with external radiation therapy when treating an axillary relapse, we applied intraoperative high-dose-rate brachytherapy (HDR-IORT) at the time of surgical resection +/- a modest dose of postoperative external beam radiation therapy. In this paper, we describe the feasibility of HDR-IORT technique in three patients presenting with recurrent disease in the axilla.

Function and organ preservation in adult cancers of the head and neck.

Treatment for primary head and neck cancer has evolved from the use of radical approaches to therapies preserving important functions. Essential to this concept is the maintenance of therapeutic efficacy. The advances of organ-sparing surgery, improved radiation techniques and fractionation, and the addition of chemotherapy and targeted systemic agents, have added to the number of patients who undergo organ-preservation therapy. Crucial functions that can be spared include speech, swallowing, vision, salivation and cosmesis. This paper examines advances in therapy that allow the preservation of these important functions, scenarios where organ and function preservation is indicated, given current technology and agents, and where there might be future improvements.

Long term disease-free survival resulting from combined modality management of patients presenting with oligometastatic, non-small cell lung carcinoma (NSCLC).

We report outcomes on 23 patients with oligometastastic (1 or 2 sites) NSCLC treated with aggressive local, regional, and systemic treatment. The results suggest that this is a favorable subset of patients who may benefit from such an approach, with a 22% rate of long-term survival. This treatment strategy is a departure from the usual practice of palliative-only therapy for all NSCLC patients presenting with metastatic disease.

A dosimetric comparison of three-dimensional conformal, intensity-modulated radiation therapy, and MammoSite partial-breast irradiation.

PURPOSE: Limited information is available comparing target volume and normal tissue dosimetry with the different techniques of partial breast irradiation (PBI). We present results of a dosimetric comparison of single catheter, balloon-based brachytherapy using the MammoSite catheter (BRT), 3D conformal radiation therapy (3DCRT), and intensity-modulated radiation therapy (IMRT). METHODS AND MATERIALS: Fifteen patients were treated using the BRT device. With the use of CT scans with balloons in inflated and deflated states, plans were developed for each patient using each of the methods of PBI, for a total of 45 plans. The plans were then compared using the below dosimetric parameters. RESULTS: The mean V100 was 95%, 92%, and 94% for the BRT, 3DCRT, and IMRT techniques, respectively. The mean ipsilateral breast V50 was 29%, 56%, and 46% (p < 0.0001) and the mean ipsilateral lung V30 was 5%, 7%, and 2% (p < 0.001 for IMRT vs. others) for the BRT, 3DCRT, and IMRT methods, respectively. For the 10 patients with left-sided breast tumors, the mean heart V5 was 12%, 4%, and 1% for the BRT, 3DCRT, and IMRT methods, respectively (p < 0.01). CONCLUSIONS: With increasing interest in PBI, our data may help clinicians individualize patient treatment decisions.