Primary Tumor Radiotherapy During EGFR-TKI Disease Control Improves Survival of Treatment Naïve Advanced EGFR-Mutant Lung Adenocarcinoma Patients.

BACKGROUND: Whether radiotherapy only for primary lung tumor (RTPLT) after epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) therapy improves survival of treatment naïve advanced EGFR-mutant lung adenocarcinoma (LAD) patients with/without polymetastasis. MATERIALS AND METHODS: This was a retrospective, single-center, observational study. Patients with stage IIIB-IV EGFR-mutant LAD with disease control by EGFR-TKI therapy were divided into curative RTPLT, and control, without radiotherapy (WRTPLT) groups. RESULTS: A total of 138 patients were enrolled; 46 in the RTPLT group and 92 in the WRTPLT group. Amongst them, 37% had oligometastasis, and 26.1% brain metastasis. The RTPLT group had both significantly longer progression-free survival (PFS) (27.5 months [95% CI 18.1-36.9] vs 10.9 months [95% CI 6.3-15.5], P<0.001) and overall survivor (OS) (NR [95% CI NR-NR] vs 38.0 months [95% CI 31.2-44.8], P<0.001), respectively, when compared to the WRTPLT group. In multivariate analysis, the adjusted HR of radiotherapy on PFS was 0.30 (0.19-0.47) and on OS, 0.11 (0.04-0.30). Patients with oligometastasis had significantly longer PFS than those with polymetastasis with an HR of 0.35 (0.14-0.85), P=0.02. Patients with either oligometastasis or polymetastasis had significant longer PFS when undergoing radiotherapy than those without (both P<0.05). An EGFR-TKI to radiotherapy interval <24 weeks seemed more beneficial (P=0.097). Radiation pneumonitis comprised 32 (69.6%), 12 (26.1%), and two (4.3%) cases of common terminology criteria grade I, II, and III, respectively. CONCLUSION: Curative RTPLT can prolong survival in patients with LAD following EGFR-TKI disease control, both involving oligometastasis and polymetastasis. RTPLT within 24 weeks after EGFR-TKI initiation appeared to be more beneficial with tolerable radiation pneumonitis.

Three corrections for overshoot effect improved the dose for step-and-shoot intensity-modulated radiation therapy.

We measured the overshoot effect in a linac and reduced it using block correction, reverse-sequence correction, and index correction. A StarTrack detector was used on a Varian iX. Five segments, 1 × 10 cm2 in area, were designed; the centers were at -4, -2, 0, 2, and 4 cm on the x axis for measuring the overshoot effect on a 10 × 10 cm2 collimator setting. Block correction was applied to two segments. The first was on the new first segment at -6 cm, and the other was on the new last segment at 6 cm. Both two new segments were obtained from the 10 × 10 cm2 collimator setting. The order of segments was reversed in reverse-sequence correction. Reverse-sequence correction averages the dose at every segment after two irradiations. When we used MLC Shaper, index correction reduced the first segment's index (cumulative radiation occupation) by 60% and increased the last segment's radiation occupation by 60% in a new MLC.log file. As for relative dose, the first segment had an overdose of 52.4% and the last segment had an underdose of 48.6%, when irradiated at 1 MU at 600 MU/min. The relative doses at the first segment, irradiated at 1 MU, after block correction, reverse-sequence correction, and index correction were applied decreased from 152.5% to 95.1%, 104.8%, and 100.1%, respectively. The relative doses at the last segment, irradiated at 1 MU, after block correction, reverse-sequence correction, and index correction were applied increased from 48.6% to 97.3%, 91.1%, and 95.9%, respectively. The overshoot effect depended on the speed of irradiation. High irradiation speeds resulted in notable overdosing and underdosing at the first and last segments, respectively. The three corrections mitigated the overshoot effect on dose. To save time and effort, the MLC.log file should be edited with a program in the future.

The use of transdermal fentanyl in cancer pain--a compliance study of outpatients in Taiwan.

The aim of this study is to investigate cancer patients' response and side effects associated with transdermal therapeutic fentanyl (TTS-F), whose pain was hardly controlled by nonweak/weak opioids in Taiwan. From 2005 to 2006, 822 outpatients received TTS-F to collect pain assessment forms and diaries for 4 weeks. Most (78.7%) patients were initially prescribed 25 microg/h TTS-F. Doses were adjusted weekly at clinicians' discretion, according to pain assessment and side effects. Patients receiving 50 microg/h, 75 microg/h, and > 75 microg/h TTS-F had increased from 17.5% to 32.1%, 1.8% to 3.4%, and 1.9% to 2.2%, respectively, by week 2; further small increases were found in weeks 3 and 4. Pain palliation improved from 60.6% during week 1 to 78.6% at week 4. The common adverse effects were nausea/vomiting. Patient's compliance was >90%. This study found that the TTS-F is effective and well tolerated.