Background and Objective: Based on retrospective trials, most progression sites after first line systemic therapy for metastatic non small cell lung cancer (NSCLC) were the primary disease sites rather than new sites....Background and Objective: Based on retrospective trials, most progression sites after first line systemic therapy for metastatic non small cell lung cancer (NSCLC) were the primary disease sites rather than new sites. Therefore we conducted phase II randomized study to determine whether oligometastatic NSCLC without disease progression after first line chemotherapy, have prolonged progression free survival when treated with local consolidation therapy of residual disease followed by surveillance compared with no local consolidation therapy (observation). Patients and Methods: Forty eight eligible patients were randomized to either immediate or no local consolidation radiotherapy. 26 patients of immediate local consolidation radiotherapy received 3 D-conformal radiation therapy to primary tumor site and metastatic sites of disease. 22 patients were followed up by observation. Results: Patients in local consolidation arm had significantly better progression free survival (PFS) compared with patients in observation group. Median PFS was 9.5 months (95% CI 7.8 - 11.08) in local consolidation arm and 4.5 months (95%CI 3.9 - 5.7) in observation arm. Patients in local consolidation arm had longer median time to appearance of new metastatic sites (10 months CI 9.3 - 12.6) than those patients in observation arm (4.5 months CI 4.2 - 6.9). Median overall survival (OS) of patients in local consolidation arm was 12 months (95% CI 12.1 - 18.01) and in observation arm 10 months (95% CI 8.7 - 13.8). One year OS rate was 42.3% in local consolidation arm and 31.8% in observation arm;2 year OS rate was 23.1% in local consolidation arm and only 4.5% in observation arm. Conclusion: Local consolidation radiotherapy is simple, safe, efficient, and not expensive treatment for oligometastatic non small cell lung cancer after upfront chemotherapy. Local consolidation radiotherapy achieved significantly prolonged progression free survival and delayed appearance of new metastatic sites. Phase III studies are recommended to test benefit of local consolidation radiotherapy to gain prolonged progression free survival and overall survival. Also, define optimal patients’ subgroups that are more likely to benefit of local consolidation radiotherapy.展开更多
Introduction and objectives: Salvage treatment of recurrent Glioblastoma (GBM) is one of the most challenging tasks in neuro-oncology. There is no standard treatment for recurrent GBM as options include resection, che...Introduction and objectives: Salvage treatment of recurrent Glioblastoma (GBM) is one of the most challenging tasks in neuro-oncology. There is no standard treatment for recurrent GBM as options include resection, chemotherapy, and re-irradiation either separate or in combination. Role of concomitant temozolamide with re-irradiation in recurrent disease is still debatable. Therefore, this study evaluates efficacy of concurrent and adjuvant temozolamide with re-irradiation in management of recurrent GBM. Patients and methods: Twenty two patients with recurrent glioblastoma were eligible. Patients were treated with 3 D conformal radiotherapy. The dose ranged from 30 to 40 Gy in 1.6 to 1.8 Gy per fraction for 5 days per week. Temozolamide was administrated at 50 mg/m2 daily dose during radiation therapy. Adjuvant Temozolomide (200 mg/m2) was given orally for five days every four weeks for 4 - 6 cycles for patients who did not receive temozolamide before, and 150 mg/m2 for pretreated patients. Results: 22 patients received re-irradiation with median dose 38 Gy (range 33 - 40 Gy), concurrent with temozolamide. The time interval between primary and re-irradiation ranged from 6 to 23 months with median 12 months. The re-irradiated volume, median was 101.95 cm3 (range 30 - 375 cm3). The median cumulative maximum dose to optic system and brain stem were 53.5 Gy (range 42 - 63 Gy), and 60 Gy (range 54 - 73 Gy), respectively. Response rate was 72.7%, one patient showed complete response (4.5%), partial response and stable disease registered in 22.7% and 45.5%, respectively. The median overall survival (OS) was 10 months (range 4 - 13 months), and median progression-free (PFS) survival was 7.5 months (range 2 - 11 months). The 6 and 12 months OS rate was 100% and 56.6% respectively, and the 6 months PFS rate was 93.3%. No major acute toxicity was observed. About 70% of patients experienced grade 2 toxicity in the form of headache, nausea & vomiting, skin erythema and alopecia. The late toxicity was minimal as GI & II. Symptoms of radiation necrosis were not recorded in any patient. Conclusion: 3D conformal re-irradiation concomitant with temozolamide and adjuvant temozolamide appears effective treatment in recurrent glioblastoma. The treatment protocol is safe, feasible treatment with limited rate of toxicity and improve survival outcome.展开更多
文摘Background and Objective: Based on retrospective trials, most progression sites after first line systemic therapy for metastatic non small cell lung cancer (NSCLC) were the primary disease sites rather than new sites. Therefore we conducted phase II randomized study to determine whether oligometastatic NSCLC without disease progression after first line chemotherapy, have prolonged progression free survival when treated with local consolidation therapy of residual disease followed by surveillance compared with no local consolidation therapy (observation). Patients and Methods: Forty eight eligible patients were randomized to either immediate or no local consolidation radiotherapy. 26 patients of immediate local consolidation radiotherapy received 3 D-conformal radiation therapy to primary tumor site and metastatic sites of disease. 22 patients were followed up by observation. Results: Patients in local consolidation arm had significantly better progression free survival (PFS) compared with patients in observation group. Median PFS was 9.5 months (95% CI 7.8 - 11.08) in local consolidation arm and 4.5 months (95%CI 3.9 - 5.7) in observation arm. Patients in local consolidation arm had longer median time to appearance of new metastatic sites (10 months CI 9.3 - 12.6) than those patients in observation arm (4.5 months CI 4.2 - 6.9). Median overall survival (OS) of patients in local consolidation arm was 12 months (95% CI 12.1 - 18.01) and in observation arm 10 months (95% CI 8.7 - 13.8). One year OS rate was 42.3% in local consolidation arm and 31.8% in observation arm;2 year OS rate was 23.1% in local consolidation arm and only 4.5% in observation arm. Conclusion: Local consolidation radiotherapy is simple, safe, efficient, and not expensive treatment for oligometastatic non small cell lung cancer after upfront chemotherapy. Local consolidation radiotherapy achieved significantly prolonged progression free survival and delayed appearance of new metastatic sites. Phase III studies are recommended to test benefit of local consolidation radiotherapy to gain prolonged progression free survival and overall survival. Also, define optimal patients’ subgroups that are more likely to benefit of local consolidation radiotherapy.
文摘Introduction and objectives: Salvage treatment of recurrent Glioblastoma (GBM) is one of the most challenging tasks in neuro-oncology. There is no standard treatment for recurrent GBM as options include resection, chemotherapy, and re-irradiation either separate or in combination. Role of concomitant temozolamide with re-irradiation in recurrent disease is still debatable. Therefore, this study evaluates efficacy of concurrent and adjuvant temozolamide with re-irradiation in management of recurrent GBM. Patients and methods: Twenty two patients with recurrent glioblastoma were eligible. Patients were treated with 3 D conformal radiotherapy. The dose ranged from 30 to 40 Gy in 1.6 to 1.8 Gy per fraction for 5 days per week. Temozolamide was administrated at 50 mg/m2 daily dose during radiation therapy. Adjuvant Temozolomide (200 mg/m2) was given orally for five days every four weeks for 4 - 6 cycles for patients who did not receive temozolamide before, and 150 mg/m2 for pretreated patients. Results: 22 patients received re-irradiation with median dose 38 Gy (range 33 - 40 Gy), concurrent with temozolamide. The time interval between primary and re-irradiation ranged from 6 to 23 months with median 12 months. The re-irradiated volume, median was 101.95 cm3 (range 30 - 375 cm3). The median cumulative maximum dose to optic system and brain stem were 53.5 Gy (range 42 - 63 Gy), and 60 Gy (range 54 - 73 Gy), respectively. Response rate was 72.7%, one patient showed complete response (4.5%), partial response and stable disease registered in 22.7% and 45.5%, respectively. The median overall survival (OS) was 10 months (range 4 - 13 months), and median progression-free (PFS) survival was 7.5 months (range 2 - 11 months). The 6 and 12 months OS rate was 100% and 56.6% respectively, and the 6 months PFS rate was 93.3%. No major acute toxicity was observed. About 70% of patients experienced grade 2 toxicity in the form of headache, nausea & vomiting, skin erythema and alopecia. The late toxicity was minimal as GI & II. Symptoms of radiation necrosis were not recorded in any patient. Conclusion: 3D conformal re-irradiation concomitant with temozolamide and adjuvant temozolamide appears effective treatment in recurrent glioblastoma. The treatment protocol is safe, feasible treatment with limited rate of toxicity and improve survival outcome.
