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The Response, Outcome and Toxicity of Aggressive Palliative Thoracic Radiotherapy for Metastatic Non-Small Cell Lung Cancer Patients with Controlled Extrathoracic Diseases.

Chiang Y, Yang JC, Hsu FM, Chen YH, Shih JY, Lin ZZ, Lan KH, Cheng AL, Kuo SH - PLoS ONE (2015)

Bottom Line: Patients with squamous cell carcinoma or poorly-differentiated carcinoma had a higher ORR than those with adenocarcinoma (63% vs. 34%, P = 0.034).EGFR mutations was closely associated with a better ORR (45% vs. 29%, P = 0.284).At a median follow-up time of 44 months, the median OS, LRPFS after RT, and OS-RT were 50 months, 15 months, and 18 months.

View Article: PubMed Central - PubMed

Affiliation: Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.

ABSTRACT

Background and purpose: For metastatic non-small cell lung cancer (NSCLC) patients with controlled extrathoracic disease after systemic treatment, stable or progressive primary lung lesions may cause respiratory symptoms and increase comorbidities. In the present study, we sought to investigate whether aggressive palliative thoracic radiotherapy (RT) can enhance local control and improve the survival for this subgroup of patients.

Materials and methods: Between March 2006 and December 2014, 56 patients with metastatic NSCLC who had responsive or stable extrathoracic diseases after chemotherapy and/or molecular targets, and received thoracic RT for stable and progressive primary lung lesions were included. RT with a median dose of 55 Gy (range, 40-62 Gy) was administered in 1.8-2.5 Gy fractions to primary lung tumor and regional mediastinal lymph nodes using modern RT technique. Overall survival (OS) from diagnosis, and locoregional progression-free survival (LRPFS), and survival calculated from radiotherapy (OS-RT) were estimated using the Kaplan-Meier method.

Results: There were 37 men and 19 women with a median age of 60 years at diagnosis. The median interval from the diagnosis of metastatic disease to thoracic RT was 8 months. Following thoracic RT, 26 patients (46%) achieved complete or partial response (overall response rate, ORR). Patients with squamous cell carcinoma or poorly-differentiated carcinoma had a higher ORR than those with adenocarcinoma (63% vs. 34%, P = 0.034). EGFR mutations was closely associated with a better ORR (45% vs. 29%, P = 0.284). At a median follow-up time of 44 months, the median OS, LRPFS after RT, and OS-RT were 50 months, 15 months, and 18 months.

Conclusion: Radical palliative throractic RT is safe and might be beneficial for primary lung lesions of metastatic NSCLC patients with controlled extrathoracic diseases.

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Related in: MedlinePlus

Schema of 56 NSCLC patients received aggressive palliative thoracic RT with and without systemic treatment.Numbers and proportions of patients with or without altered systemic therapy regimens after thoracic RT depending on the treatment response and clinical adjustment. RT, radiotherapy; N, number.
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pone.0145936.g001: Schema of 56 NSCLC patients received aggressive palliative thoracic RT with and without systemic treatment.Numbers and proportions of patients with or without altered systemic therapy regimens after thoracic RT depending on the treatment response and clinical adjustment. RT, radiotherapy; N, number.

Mentions: Among the 27 patients receiving thoracic RT without concurrent systemic treatment, 9 patients (33.3%) received the same systemic therapy regimen as that of the prethoracic RT, whereas 15 (55.6%) patients received alternative regimens that were different from those of the prethoracic RT because of progressive disease (PD) after RT and intolerance to the previous regimen (Fig 1). Moreover, 3 patients (11%) who discontinued systemic therapy after RT achieved a stable disease condition at 4, 5, and 10 months, respectively, until the latest follow-up. Among the 29 patients who had undergone concurrent chemoradiotherapy (CCRT) or received molecular target agents, 6 (20.7%) were maintained on the same pre-RT medication after RT, whereas the remaining 23 (79.3%) patients were treated with different systemic regimens because of PD and intolerance to the pre-RT regimens.


The Response, Outcome and Toxicity of Aggressive Palliative Thoracic Radiotherapy for Metastatic Non-Small Cell Lung Cancer Patients with Controlled Extrathoracic Diseases.

Chiang Y, Yang JC, Hsu FM, Chen YH, Shih JY, Lin ZZ, Lan KH, Cheng AL, Kuo SH - PLoS ONE (2015)

Schema of 56 NSCLC patients received aggressive palliative thoracic RT with and without systemic treatment.Numbers and proportions of patients with or without altered systemic therapy regimens after thoracic RT depending on the treatment response and clinical adjustment. RT, radiotherapy; N, number.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697816&req=5

pone.0145936.g001: Schema of 56 NSCLC patients received aggressive palliative thoracic RT with and without systemic treatment.Numbers and proportions of patients with or without altered systemic therapy regimens after thoracic RT depending on the treatment response and clinical adjustment. RT, radiotherapy; N, number.
Mentions: Among the 27 patients receiving thoracic RT without concurrent systemic treatment, 9 patients (33.3%) received the same systemic therapy regimen as that of the prethoracic RT, whereas 15 (55.6%) patients received alternative regimens that were different from those of the prethoracic RT because of progressive disease (PD) after RT and intolerance to the previous regimen (Fig 1). Moreover, 3 patients (11%) who discontinued systemic therapy after RT achieved a stable disease condition at 4, 5, and 10 months, respectively, until the latest follow-up. Among the 29 patients who had undergone concurrent chemoradiotherapy (CCRT) or received molecular target agents, 6 (20.7%) were maintained on the same pre-RT medication after RT, whereas the remaining 23 (79.3%) patients were treated with different systemic regimens because of PD and intolerance to the pre-RT regimens.

Bottom Line: Patients with squamous cell carcinoma or poorly-differentiated carcinoma had a higher ORR than those with adenocarcinoma (63% vs. 34%, P = 0.034).EGFR mutations was closely associated with a better ORR (45% vs. 29%, P = 0.284).At a median follow-up time of 44 months, the median OS, LRPFS after RT, and OS-RT were 50 months, 15 months, and 18 months.

View Article: PubMed Central - PubMed

Affiliation: Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.

ABSTRACT

Background and purpose: For metastatic non-small cell lung cancer (NSCLC) patients with controlled extrathoracic disease after systemic treatment, stable or progressive primary lung lesions may cause respiratory symptoms and increase comorbidities. In the present study, we sought to investigate whether aggressive palliative thoracic radiotherapy (RT) can enhance local control and improve the survival for this subgroup of patients.

Materials and methods: Between March 2006 and December 2014, 56 patients with metastatic NSCLC who had responsive or stable extrathoracic diseases after chemotherapy and/or molecular targets, and received thoracic RT for stable and progressive primary lung lesions were included. RT with a median dose of 55 Gy (range, 40-62 Gy) was administered in 1.8-2.5 Gy fractions to primary lung tumor and regional mediastinal lymph nodes using modern RT technique. Overall survival (OS) from diagnosis, and locoregional progression-free survival (LRPFS), and survival calculated from radiotherapy (OS-RT) were estimated using the Kaplan-Meier method.

Results: There were 37 men and 19 women with a median age of 60 years at diagnosis. The median interval from the diagnosis of metastatic disease to thoracic RT was 8 months. Following thoracic RT, 26 patients (46%) achieved complete or partial response (overall response rate, ORR). Patients with squamous cell carcinoma or poorly-differentiated carcinoma had a higher ORR than those with adenocarcinoma (63% vs. 34%, P = 0.034). EGFR mutations was closely associated with a better ORR (45% vs. 29%, P = 0.284). At a median follow-up time of 44 months, the median OS, LRPFS after RT, and OS-RT were 50 months, 15 months, and 18 months.

Conclusion: Radical palliative throractic RT is safe and might be beneficial for primary lung lesions of metastatic NSCLC patients with controlled extrathoracic diseases.

Show MeSH
Related in: MedlinePlus