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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

One patient presented with complete remission of thoracic tumor after radiotherapy.This 66-year-old man had initial lung to lung metastasis, and the disease was controlled by chemotherapy with docetaxel and cisplatin. However, tumors at left upper lobe and mediastinum progressed 5 months after diagnosis. Mediastinal lesions improved after chemotherapy with gemcitabine and vinorelbine, but left upper lung tumor remained stationary. Thoracic radiotherapy (RT) with 55 Gy in 25 fractions was applied to left lung tumor and 45 Gy in 25 fractions to mediastinal lymphatics using IMRT. Complete remission of thoracic lesions was achieved five months after completing RT. Only grade 1 radiation pneumonitis was noted. He remained disease-free 17 months after RT without systemic chemotherapy. (A) Chest CT scan before thoracic RT. (B) Chest CT scan two months after thoracic RT. (C) Chest CT scan five months after thoracic RT.
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pone.0145936.g002: One patient presented with complete remission of thoracic tumor after radiotherapy.This 66-year-old man had initial lung to lung metastasis, and the disease was controlled by chemotherapy with docetaxel and cisplatin. However, tumors at left upper lobe and mediastinum progressed 5 months after diagnosis. Mediastinal lesions improved after chemotherapy with gemcitabine and vinorelbine, but left upper lung tumor remained stationary. Thoracic radiotherapy (RT) with 55 Gy in 25 fractions was applied to left lung tumor and 45 Gy in 25 fractions to mediastinal lymphatics using IMRT. Complete remission of thoracic lesions was achieved five months after completing RT. Only grade 1 radiation pneumonitis was noted. He remained disease-free 17 months after RT without systemic chemotherapy. (A) Chest CT scan before thoracic RT. (B) Chest CT scan two months after thoracic RT. (C) Chest CT scan five months after thoracic RT.

Mentions: Twenty-six patients (46%) achieved complete response (CR) or partial response (PR), while 26 patients (46%) had stable disease (SD) and 4 patients (8%) had PD. As shown in Fig 2, one patient had CR of thoracic tumor 4 months after completing 55 Gy. He was alive without progression at the latest follow-up.


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)

One patient presented with complete remission of thoracic tumor after radiotherapy.This 66-year-old man had initial lung to lung metastasis, and the disease was controlled by chemotherapy with docetaxel and cisplatin. However, tumors at left upper lobe and mediastinum progressed 5 months after diagnosis. Mediastinal lesions improved after chemotherapy with gemcitabine and vinorelbine, but left upper lung tumor remained stationary. Thoracic radiotherapy (RT) with 55 Gy in 25 fractions was applied to left lung tumor and 45 Gy in 25 fractions to mediastinal lymphatics using IMRT. Complete remission of thoracic lesions was achieved five months after completing RT. Only grade 1 radiation pneumonitis was noted. He remained disease-free 17 months after RT without systemic chemotherapy. (A) Chest CT scan before thoracic RT. (B) Chest CT scan two months after thoracic RT. (C) Chest CT scan five months after thoracic RT.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0145936.g002: One patient presented with complete remission of thoracic tumor after radiotherapy.This 66-year-old man had initial lung to lung metastasis, and the disease was controlled by chemotherapy with docetaxel and cisplatin. However, tumors at left upper lobe and mediastinum progressed 5 months after diagnosis. Mediastinal lesions improved after chemotherapy with gemcitabine and vinorelbine, but left upper lung tumor remained stationary. Thoracic radiotherapy (RT) with 55 Gy in 25 fractions was applied to left lung tumor and 45 Gy in 25 fractions to mediastinal lymphatics using IMRT. Complete remission of thoracic lesions was achieved five months after completing RT. Only grade 1 radiation pneumonitis was noted. He remained disease-free 17 months after RT without systemic chemotherapy. (A) Chest CT scan before thoracic RT. (B) Chest CT scan two months after thoracic RT. (C) Chest CT scan five months after thoracic RT.
Mentions: Twenty-six patients (46%) achieved complete response (CR) or partial response (PR), while 26 patients (46%) had stable disease (SD) and 4 patients (8%) had PD. As shown in Fig 2, one patient had CR of thoracic tumor 4 months after completing 55 Gy. He was alive without progression at the latest follow-up.

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