Pre-treatment serum bicarbonate predicts for primary tumor control after stereotactic body radiation therapy in patients with localized non-small cell lung cancer.
Pre-treatment serum bicarbonate predicts for primary tumor control after stereotactic body radiation therapy in patients with localized non-small cell lung cancer. Radiother Oncol. 2019 Jun 05;140:26-33 Authors: Sebastian N, Wu T, Driscoll E, Willers H, Kelly S, Musunuru HB, Mo X, Tan Y, Bazan J, Haglund K, Xu-Welliver M, Baschnagel AM, Ju A, Keane F, Williams TM Abstract BACKGROUND: Tumor aggressiveness and hypoxia are linked to acidosis in the tumor microenvironment (TME). We hypothesized that low pre-treatment serum bicarbonate, potentially correlating with an acidic and hypoxic TME, predicts for poor outcomes after stereotactic body radiation therapy (SBRT) for non-small cell lung cancer (NSCLC). METHODS: We included patients with localized NSCLC treated to a biologically effective dose (BED) ≥ 100 Gy, with available pre-treatment bicarbonate values within 3 months of treatment. We used receiver operating characteristic analysis to determine the bicarbonate concentration optimally predicting for primary tumor recurrence, and evaluated its association with recurrence and survival. We validated our findings in an independent cohort of patients from three collaborating institutions. RESULTS: A total of 110 patients and 114 tumors were included in the training cohort, with median follow-up of 15.0 months. Bicarbonate
We read with interest the article published by Palma et al reporting a phase 2 clinical trial of preoperative stereotactic ablative radiation therapy (SABR) plus surgery in patients with early stage non-small cell lung cancer (NSCLC).1 Surgery was implemented in 10 weeks after SABR. The authors concluded that the pathologic complete response (pCR) rate after SABR was 60%, which was lower than the hypothesized 90% pCR rate. Preoperative SABR and surgery combination did not increase toxicity more than surgery alone, and there was no perioperative mortality.
Authors: Sabath BF, Casal RF Abstract Lung cancer is the leading cause of cancer-related death worldwide and lobectomy remains the standard of care for patients with early-stage non-small cell lung cancer (NSCLC). The combination of an aging population and the implementation of low-dose CT for lung cancer screening is leading to an increase in diagnosis of early stage NSCLC in medically "inoperable" patients. The recommended treatment for this latter group of patients is stereotactic body radiation therapy (SBRT). However, many patients cannot undergo SBRT because they have received prior radiation or bec...
Publication date: Available online 2 August 2019Source: Practical Radiation OncologyAuthor(s): Robert T. Dess, Yilun Sun, Daniel G. Muenz, Peter A. Paximadis, Michael M. Dominello, Inga S. Grills, Larry L. Kestin, Benjamin Movsas, Kathryn J. Masi, Martha M. Matuszak, Jeffrey D. Radawski, Jean M. Moran, Lori J. Pierce, James A. Hayman, Matthew J. Schipper, Shruti Jolly, Michigan Radiation Oncology Quality ConsortiumAbstractPurposeThe heart has been identified as a potential significant organ at risk in patients with locally-advanced non-small cell lung cancer (NSCLC) treated with radiation. Practice patterns and radiation d...
In conclusion, this is the first study to demonstrate the negative survival impact from the omission of WBRT in patients with EGFR-mutant NSCLC.
To the Editor: We commend Zhang et al1 for their recent systematic review of cardiac dose parameters in radiation therapy for non-small cell lung cancer (NSCLC). The authors rightly point out the limitations with the current literature on this topic: study heterogeneity, retrospective data analysis, and multiplicity of testing. We would also argue that the research into cardiac toxicity in NSCLC radiation therapy lacks well-defined hypotheses and research questions. Nevertheless, we do not agree with the authors that no conclusions regarding cardiac dose parameters can be drawn from these studies.
Metastatic lung cancer has long represented a therapeutic challenge, with treatment primarily consisting of systemic chemotherapy, with limited long-term survival. Patients with limited sites ( ≤ 5) of metastatic disease, known as oligometastatic disease, may derive improved outcomes from aggressive local therapy. Stereotactic ablative radiation therapy (SABR) represent a promising new method of conformal aggressive treatment to oligometastic disease. Herein we report analysis of a prosp ective multi-center phase II trial assess the safety and feasibility of SABR for oligometastatic non-small-cell lung cancer.
PMID: 31315492 [PubMed - as supplied by publisher]
ConclusionIn patients not suitable of concurrent radio-chemotherapy, exclusive or sequential hypofractionated schedule using 60 Gy in 20 fractions was well tolerated and presented promising results. Complete local response was a predictor of better outcomes, and any efforts will be made to perform prospective clinical trials to further evaluate hypofractionated regimens with increased lesional BED.
ConclusionsOur study revealed the clinical characteristics and prognoses of patients who became ineligible for the PACIFIC trial after CRT. Physicians should be careful while prescribing CRT for patients with characteristics such as old age, male gender, and radiation therapy with V20 ≥ 35%.