Locally advanced non-small cell lung cancer(NSCLC) continues to be a challenging disease to treat. With high rates of both local and distant failures, there is signiicant interest in inding more biologically active ch...Locally advanced non-small cell lung cancer(NSCLC) continues to be a challenging disease to treat. With high rates of both local and distant failures, there is signiicant interest in inding more biologically active chemotherapy regimens that can contribute to reduce both failures. The phase III PROCLAIM trial, recently published in the Journal of Clinical Oncology entitled "PROCLAIM: randomized phase III trial of pemetrexed–cisplatin or etoposide–cisplatin plus thoracic radiation therapy followed by consolidation chemotherapy in locally advanced nonsquamous non-small-cell lung cancer", compared two diferent chemotherapy regimens given concurrently with radiotherapy in patients with stage III non-squamous lung cancer: pemetrexed plus cisplatin versus cisplatin plus etoposide. Both groups received consolidation chemotherapy. After enrolling 598 of planned 600 patients, the study was stopped early due to futility as no diference was seen in the primary end-point of overall survival. Since PROCLAIM was designed as a superiority trial, these results suggest that pemetrexed regimens do not ofer a clinical advantage over standard cisplatin plus etoposide. There are some subpopulations who might still beneit from pemetrexed, especially if clinicians are concerned about myelosuppression-related adverse events. Future trials are needed to investigate novel biologic agents and irradiation techniques that can result in more durable local and distant disease control in locally advanced NSCLC.展开更多
The management of localized breast cancer has changed dramatically over the past three to four decades.Breastconserving therapy,which involved lumpectomy followed by adjuvant irradiation,is now widely considered the s...The management of localized breast cancer has changed dramatically over the past three to four decades.Breastconserving therapy,which involved lumpectomy followed by adjuvant irradiation,is now widely considered the standard of care in women with early-stage breast cancer.Accelerated partial breast irradiation(APBI),which involves focal irradiation of the lumpectomy cavity over a short period of time,has developed over the past two decades as an alternative to whole breast irradiation(WBI).Multiple APBI modalities have been developed including brachytherapy,external beam irradiation,and intraoperative irradiation.These new technigues have provided early-stage breast cancer patients with shorter treatment duration and more focused irradiation,delivering very high biological doses to the region at a high risk of failures over a much shorter treatment course as compared with conventional radiotherapy.However,the advantages of APBI over conventional radiotherapy are controversial,including a higher risk of complications reported in retrospective literature and shorter follow-up duration in the intraoperative APBI trials.Nevertheless,APBI presents a valuable alternative to WBI for a selected population of women with early-stage breast cancer.展开更多
文摘Locally advanced non-small cell lung cancer(NSCLC) continues to be a challenging disease to treat. With high rates of both local and distant failures, there is signiicant interest in inding more biologically active chemotherapy regimens that can contribute to reduce both failures. The phase III PROCLAIM trial, recently published in the Journal of Clinical Oncology entitled "PROCLAIM: randomized phase III trial of pemetrexed–cisplatin or etoposide–cisplatin plus thoracic radiation therapy followed by consolidation chemotherapy in locally advanced nonsquamous non-small-cell lung cancer", compared two diferent chemotherapy regimens given concurrently with radiotherapy in patients with stage III non-squamous lung cancer: pemetrexed plus cisplatin versus cisplatin plus etoposide. Both groups received consolidation chemotherapy. After enrolling 598 of planned 600 patients, the study was stopped early due to futility as no diference was seen in the primary end-point of overall survival. Since PROCLAIM was designed as a superiority trial, these results suggest that pemetrexed regimens do not ofer a clinical advantage over standard cisplatin plus etoposide. There are some subpopulations who might still beneit from pemetrexed, especially if clinicians are concerned about myelosuppression-related adverse events. Future trials are needed to investigate novel biologic agents and irradiation techniques that can result in more durable local and distant disease control in locally advanced NSCLC.
文摘The management of localized breast cancer has changed dramatically over the past three to four decades.Breastconserving therapy,which involved lumpectomy followed by adjuvant irradiation,is now widely considered the standard of care in women with early-stage breast cancer.Accelerated partial breast irradiation(APBI),which involves focal irradiation of the lumpectomy cavity over a short period of time,has developed over the past two decades as an alternative to whole breast irradiation(WBI).Multiple APBI modalities have been developed including brachytherapy,external beam irradiation,and intraoperative irradiation.These new technigues have provided early-stage breast cancer patients with shorter treatment duration and more focused irradiation,delivering very high biological doses to the region at a high risk of failures over a much shorter treatment course as compared with conventional radiotherapy.However,the advantages of APBI over conventional radiotherapy are controversial,including a higher risk of complications reported in retrospective literature and shorter follow-up duration in the intraoperative APBI trials.Nevertheless,APBI presents a valuable alternative to WBI for a selected population of women with early-stage breast cancer.
