This study compared the therapeutic effect of first-line epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)with that of EGFR-TKI plus whole brain radiotherapy(WBRT)on patients with EGFR mutation-posi...This study compared the therapeutic effect of first-line epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)with that of EGFR-TKI plus whole brain radiotherapy(WBRT)on patients with EGFR mutation-positive lung adenocarcinoma and brain metastases.A total of 139 patients with lung adenocarcinoma and brain metastases treated with first-line EGFR-TK1therapy from September 2008 to December 2017 were enrolled in this study.The study endpoints were intracranial time to progression(TTP)and overall survival(OS).The effects of clinical pathological parameters and EGFR gene status on the study endpoints were compared.The results showed that the intracranial TTP was significantly longer in EGFR-TKI plus WBRT group than in EGFR-TKI group (median 30.0 vs.18.2 months,χ2=10.824,P=0.001),but no significant difference in the OS was noted between the two groups (median 48.0 vs.41.1 months,χ2=0.012, P=0.912).Also,there was no statistically significant difference in the OS between patients treated with early and late radiotherapy (P=0.849)and between those with asymptomatic and those with symptomatic intracranial metastases (P=0.189).The OS and intracranial TTP of patients with intracranial oligometastases (≤3metastatic sites)were not significantly different from those of patients with multiple intracranial metastases (P=0.104 and P=0.357,respectively),and exon 19 and exon 21 mutations didn't show significant effects on the OS and intracranial TTP of patients (P=0.418 and P=0.386,respectively).In conclusion,there was no statistically significant difference in the OS between the EGFR-TKI alone group and EGFR-TK1 plus WBRT group.However, simultaneous use of WBRT was found to significantly prolong intracranial TTP and improve cerebral symptoms,and thus EGFR-TKI and WBRT combined may be clinically beneficial for patients with EGFR mutation-positive lung adenocarcinoma and brain metastases.展开更多
To review current recommendations for palliative radiotherapy for bone metastases secondary to lung cancer, and to analyze surveys to examine whether global practice is evidence-based, English language publications re...To review current recommendations for palliative radiotherapy for bone metastases secondary to lung cancer, and to analyze surveys to examine whether global practice is evidence-based, English language publications related to best practice palliative external beam radiotherapy(EBRT) for bone metastases(BM) from lung cancer were sought via literature search(2003-2013). Additional clinical practice guidelines and consensus documents were obtained from the online Standards and Guidelines Evidence Directory. Eligible survey studies contained hypothetical case scenarios which required participants to declare whether or not they would administer palliative EBRT and if so, to specify what dose fractionation schedule they would use. There is no convincing evidence of differential outcomes based on histology or for spine vs non-spine uncomplicated BM. For uncomplicated BM, 8Gy/1 is widely recommended as current best practice; this schedule would be used by up to 39.6% of respondents to treat a painful spinal lesion. Either 8Gy/1 or 20Gy/5 could be considered standard palliative RT for BM-related neuropathic pain; 0%-13.2% would use the former and 5.8%-52.8% of respondents the latter(range 3Gy/1-45Gy/18). A multifraction schedule is the approach of choice for irradiation of impendingpathologic fracture or spinal cord compression and 54% would use either 20Gy/5 or 30Gy/10. Survey results regarding management of complicated and uncomplicated BM secondary to lung cancer continue to show a large discrepancy between published literature and patterns of practice.展开更多
[Objectives] To observe the clinical efficacy,adverse reaction and survival time of temozolomide combined with whole brain radiotherapy in the treatment of lung cancer. [Methods] A total of 43 patients with lung cance...[Objectives] To observe the clinical efficacy,adverse reaction and survival time of temozolomide combined with whole brain radiotherapy in the treatment of lung cancer. [Methods] A total of 43 patients with lung cancer and cerebral metastases were reviewed and analyzed. Three-dimensional conformal radiotherapy(3D-CRT) technique was used to perform whole brain radiotherapy,one time a day and5 times a week. At the same time of radiotherapy,temozolomide chemotherapy was performed,150 mg/( m2·d),continuous oral administration of 5 d,every 28 days were a cycle( those patients who continue receiving temozolomide chemotherapy did not receive other related antitumor therapy,such as systemic chemotherapy and molecular targeted therapy,etc.),and drugs were administered for 4-6 cycles according to tolerance of patients. Kaplan-Meier method was used to calculate the survival rate. [Results]The objective response rate of 43 patients was79. 0%(34/43),in which CR was 6/43,PR was 28/43,and 9 cases had PD. By December 31,2016,7 patients in 43 cases died,one patient died of cerebral hernia due to intracranial lesions and 6 patients died of failure of other important organs due to metastasis. The OS and PFS of the whole group of patients in one year were 49. 1% and 56. 9% respectively. The adverse reactions were mild and the patients could tolerate such treatment. [Conclusions] Temozolomide combined with whole brain radiotherapy in the treatment of lung cancer with cerebral metastases has excellent clinical efficacy,while patients can tolerate such treatment.展开更多
Stereotactic ablative body radiotherapy(SABR)is an effective technique comparable to surgery in terms of local control and efficacy in early stages of non-small cell lung cancer(NSCLC)and pulmonary metastasis.Several ...Stereotactic ablative body radiotherapy(SABR)is an effective technique comparable to surgery in terms of local control and efficacy in early stages of non-small cell lung cancer(NSCLC)and pulmonary metastasis.Several fractionation schemes have proven to be safe and effective,including the single fraction(SF)scheme.SF is an option costeffectiveness,more convenience and comfortable for the patient and flexible in terms of its management combined with systemic treatments.The outbreak of the severe acute respiratory syndrome coronavirus 2 pandemic has driven this not new but underutilized paradigm,recommending this option to minimize patients’visits to hospital.SF SABR already has a long experience,strong evidence and sufficient maturity to reliably evaluate outcomes in peripheral primary NSCLC and there are promising outcomes in pulmonary metastases,making it a valid treatment option;although its use in central locations,synchronous and recurrencies tumors requires more prospective safety and efficacy studies.The SABR radiobiology study,together with the combination with systemic therapies,(targeted therapies and immunotherapy)is a direction of research in both advanced disease and early stages whose future includes SF.展开更多
Brain metastases risk at the time of diagnosis or during the course of disease is high in non-small cell lung cancer (NSCLC). Even the incidence of brain metastases has increased in recent years, due to detection of s...Brain metastases risk at the time of diagnosis or during the course of disease is high in non-small cell lung cancer (NSCLC). Even the incidence of brain metastases has increased in recent years, due to detection of smaller asymptomatic lesions with MRI screening as well as improved survival as a consequence of developments in systemic therapies. In the last decade, there have been many trials in the management of NSCLC patients with brain metastases, questioning the role of adjuvant whole brain radiotherapy (WBRT) after surgery or stereotactic radiosurgery (SRS), WBRT, compared to best supportive care in patients not amenable to surgery, aggressive local therapies in solitary brain metastases, postsurgical cavity SRS, SRS in non-oligometastatic patients, cranial radiotherapy in patients with driver mutations, thyrosine kinase inhibitors, immune check point inhibitors and the impact of therapies on neurocognitive functions and quality of life. The main objective of this review is to provide an update on current trends in radiotherapy in the management of newly diagnosed brain metastases from NSCLC.展开更多
Small-cell lung cancer (SCLC) has a high propensity to metastasize into the brain. Radiotherapy plays a major role in the treatment of brain metastases (BM) from SCLC. Whole-brain radiotherapy (WBRT) is the standard t...Small-cell lung cancer (SCLC) has a high propensity to metastasize into the brain. Radiotherapy plays a major role in the treatment of brain metastases (BM) from SCLC. Whole-brain radiotherapy (WBRT) is the standard treatment of BM from SCLC. However, the neurocognitive toxicity and modest efficacy of this approach have led to the increased use of stereotactic radiosurgery. We have no strong evidence for the use of different forms of radiation (WBRT vs. radiosurgery) in SCLC, because BM from this primary tumor were excluded from clinical trials. In this review, the use of radiation in form of WBRT or radiosurgery is discussed in distinct clinical indications: as a primary treatment and at relapse;without prior use of prophylactic cranial irradiation (PCI);and after PCI. Combinations of radiotherapy with chemotherapy are discussed as BM in SCLC occur rarely as a sole event.展开更多
Bone metastases from lung cancer account for 8.5%,with those located in the hyoid bone being extremely rare.In this editorial,we made a review about Hsu et al case report highlighted the importance of palliative radio...Bone metastases from lung cancer account for 8.5%,with those located in the hyoid bone being extremely rare.In this editorial,we made a review about Hsu et al case report highlighted the importance of palliative radiotherapy,even with an unusual but effective scheme in pain control in a patient with non-small cell lung cancer in stage IV.展开更多
Lung cancer is responsible for the most cancer deaths worldwide with an incidence that is still rising. One third of patients have unresectable stage ⅢA or stage ⅢB disease. The standard of care for locally advanced...Lung cancer is responsible for the most cancer deaths worldwide with an incidence that is still rising. One third of patients have unresectable stage ⅢA or stage ⅢB disease. The standard of care for locally advanceddisease in patients with good performance status consists of combined modality therapy in particular concurrent chemoradiotherapy. But despite a lot of efforts done in the past, local control and survival of patients with unresectable stage Ⅲ non-small-cell lung cancer(NSCLC) remains poor. Improving outcomes for patients with unresectable stage Ⅲ NSCLC has therefore been an area of ongoing research. Research has focused on improving systemic therapy, improving radiation therapy or adding a maintenance therapy to consolidate the initial therapy. Also implementation of newer targeted therapies and immunotherapy has been investigated as well as the option of prophylactic cranial irradiation. This article reviews the latest literature on improving local control and preventing distant metastases. It seems that we have reached a plateau with conventional chemotherapy. Radiotherapy dose escalation did not improve outcome although increasing radiation dose-intensity with new radiotherapy techniques and the use of newer agents, e.g., immunotherapy might be promising. In the future well-designed clinical trials are necessary to prove those promising results.展开更多
目的评价小细胞肺癌全脑放疗后再发病灶立体定向放疗的疗效及安全性。方法收集2015年1月至2019年12月于丽水市中心医院经全脑放疗后的再发脑转移病灶(18个病灶)给予再程立体定向放疗的13例小细胞肺癌患者,对再程放疗的疗效及不良反应进...目的评价小细胞肺癌全脑放疗后再发病灶立体定向放疗的疗效及安全性。方法收集2015年1月至2019年12月于丽水市中心医院经全脑放疗后的再发脑转移病灶(18个病灶)给予再程立体定向放疗的13例小细胞肺癌患者,对再程放疗的疗效及不良反应进行回顾性分析。结果治疗3个月后影像学评估18个病灶,完全缓解3个(16.7%),病灶最大径≤20 mm;部分缓解12个(66.7%),其中病灶最大径≤20 mm 3个,21~30 mm 4个,>30 mm 5个;疾病稳定2个(11.1%),病灶最大径21~30 mm;疾病进展1个(5.6%),病灶最大径>30 mm。再程立体定向放疗后3个月的客观缓解率为83.3%。按照美国肿瘤放射治疗协作组(Radiation Therapy Oncology Group,RTOG)放疗毒性分级标准(中枢神经系统)评估,13例患者中,0级2例,1~2级7例,3级4例。11例有相应症状,主要表现为头晕、头痛和恶心呕吐。再程放疗前后1个月内接受化疗6例,其中中枢神经系统毒性反应3级3例(50.0%);未行化疗的7例中,中枢神经系统毒性反应3级1例(14.3%)。13例中影像学提示脑放射性坏死3例。结论经过全脑放疗的小细胞肺癌患者,再发脑转移病灶挽救性立体定向放疗安全可行。放射性脑坏死作为严重并发症发生率较低,可能与病灶最大径以及放疗剂量高低相关,≥3级的中枢神经系统毒性反应在1个月内接受全身化疗患者中更多见。展开更多
基金Project of Wuhan University Natural Science Foundation the Independent Research(No.2042016kf0127)the of Hubei Province(No.2017CFB245)+1 种基金the Guidance Fund of Renmin Hospital of Wuhan Univcrsity(No.RMYD2018M48)the National Natural Science Foundation of China(No.U1604175).
文摘This study compared the therapeutic effect of first-line epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)with that of EGFR-TKI plus whole brain radiotherapy(WBRT)on patients with EGFR mutation-positive lung adenocarcinoma and brain metastases.A total of 139 patients with lung adenocarcinoma and brain metastases treated with first-line EGFR-TK1therapy from September 2008 to December 2017 were enrolled in this study.The study endpoints were intracranial time to progression(TTP)and overall survival(OS).The effects of clinical pathological parameters and EGFR gene status on the study endpoints were compared.The results showed that the intracranial TTP was significantly longer in EGFR-TKI plus WBRT group than in EGFR-TKI group (median 30.0 vs.18.2 months,χ2=10.824,P=0.001),but no significant difference in the OS was noted between the two groups (median 48.0 vs.41.1 months,χ2=0.012, P=0.912).Also,there was no statistically significant difference in the OS between patients treated with early and late radiotherapy (P=0.849)and between those with asymptomatic and those with symptomatic intracranial metastases (P=0.189).The OS and intracranial TTP of patients with intracranial oligometastases (≤3metastatic sites)were not significantly different from those of patients with multiple intracranial metastases (P=0.104 and P=0.357,respectively),and exon 19 and exon 21 mutations didn't show significant effects on the OS and intracranial TTP of patients (P=0.418 and P=0.386,respectively).In conclusion,there was no statistically significant difference in the OS between the EGFR-TKI alone group and EGFR-TK1 plus WBRT group.However, simultaneous use of WBRT was found to significantly prolong intracranial TTP and improve cerebral symptoms,and thus EGFR-TKI and WBRT combined may be clinically beneficial for patients with EGFR mutation-positive lung adenocarcinoma and brain metastases.
文摘To review current recommendations for palliative radiotherapy for bone metastases secondary to lung cancer, and to analyze surveys to examine whether global practice is evidence-based, English language publications related to best practice palliative external beam radiotherapy(EBRT) for bone metastases(BM) from lung cancer were sought via literature search(2003-2013). Additional clinical practice guidelines and consensus documents were obtained from the online Standards and Guidelines Evidence Directory. Eligible survey studies contained hypothetical case scenarios which required participants to declare whether or not they would administer palliative EBRT and if so, to specify what dose fractionation schedule they would use. There is no convincing evidence of differential outcomes based on histology or for spine vs non-spine uncomplicated BM. For uncomplicated BM, 8Gy/1 is widely recommended as current best practice; this schedule would be used by up to 39.6% of respondents to treat a painful spinal lesion. Either 8Gy/1 or 20Gy/5 could be considered standard palliative RT for BM-related neuropathic pain; 0%-13.2% would use the former and 5.8%-52.8% of respondents the latter(range 3Gy/1-45Gy/18). A multifraction schedule is the approach of choice for irradiation of impendingpathologic fracture or spinal cord compression and 54% would use either 20Gy/5 or 30Gy/10. Survey results regarding management of complicated and uncomplicated BM secondary to lung cancer continue to show a large discrepancy between published literature and patterns of practice.
文摘[Objectives] To observe the clinical efficacy,adverse reaction and survival time of temozolomide combined with whole brain radiotherapy in the treatment of lung cancer. [Methods] A total of 43 patients with lung cancer and cerebral metastases were reviewed and analyzed. Three-dimensional conformal radiotherapy(3D-CRT) technique was used to perform whole brain radiotherapy,one time a day and5 times a week. At the same time of radiotherapy,temozolomide chemotherapy was performed,150 mg/( m2·d),continuous oral administration of 5 d,every 28 days were a cycle( those patients who continue receiving temozolomide chemotherapy did not receive other related antitumor therapy,such as systemic chemotherapy and molecular targeted therapy,etc.),and drugs were administered for 4-6 cycles according to tolerance of patients. Kaplan-Meier method was used to calculate the survival rate. [Results]The objective response rate of 43 patients was79. 0%(34/43),in which CR was 6/43,PR was 28/43,and 9 cases had PD. By December 31,2016,7 patients in 43 cases died,one patient died of cerebral hernia due to intracranial lesions and 6 patients died of failure of other important organs due to metastasis. The OS and PFS of the whole group of patients in one year were 49. 1% and 56. 9% respectively. The adverse reactions were mild and the patients could tolerate such treatment. [Conclusions] Temozolomide combined with whole brain radiotherapy in the treatment of lung cancer with cerebral metastases has excellent clinical efficacy,while patients can tolerate such treatment.
文摘Stereotactic ablative body radiotherapy(SABR)is an effective technique comparable to surgery in terms of local control and efficacy in early stages of non-small cell lung cancer(NSCLC)and pulmonary metastasis.Several fractionation schemes have proven to be safe and effective,including the single fraction(SF)scheme.SF is an option costeffectiveness,more convenience and comfortable for the patient and flexible in terms of its management combined with systemic treatments.The outbreak of the severe acute respiratory syndrome coronavirus 2 pandemic has driven this not new but underutilized paradigm,recommending this option to minimize patients’visits to hospital.SF SABR already has a long experience,strong evidence and sufficient maturity to reliably evaluate outcomes in peripheral primary NSCLC and there are promising outcomes in pulmonary metastases,making it a valid treatment option;although its use in central locations,synchronous and recurrencies tumors requires more prospective safety and efficacy studies.The SABR radiobiology study,together with the combination with systemic therapies,(targeted therapies and immunotherapy)is a direction of research in both advanced disease and early stages whose future includes SF.
文摘Brain metastases risk at the time of diagnosis or during the course of disease is high in non-small cell lung cancer (NSCLC). Even the incidence of brain metastases has increased in recent years, due to detection of smaller asymptomatic lesions with MRI screening as well as improved survival as a consequence of developments in systemic therapies. In the last decade, there have been many trials in the management of NSCLC patients with brain metastases, questioning the role of adjuvant whole brain radiotherapy (WBRT) after surgery or stereotactic radiosurgery (SRS), WBRT, compared to best supportive care in patients not amenable to surgery, aggressive local therapies in solitary brain metastases, postsurgical cavity SRS, SRS in non-oligometastatic patients, cranial radiotherapy in patients with driver mutations, thyrosine kinase inhibitors, immune check point inhibitors and the impact of therapies on neurocognitive functions and quality of life. The main objective of this review is to provide an update on current trends in radiotherapy in the management of newly diagnosed brain metastases from NSCLC.
文摘Small-cell lung cancer (SCLC) has a high propensity to metastasize into the brain. Radiotherapy plays a major role in the treatment of brain metastases (BM) from SCLC. Whole-brain radiotherapy (WBRT) is the standard treatment of BM from SCLC. However, the neurocognitive toxicity and modest efficacy of this approach have led to the increased use of stereotactic radiosurgery. We have no strong evidence for the use of different forms of radiation (WBRT vs. radiosurgery) in SCLC, because BM from this primary tumor were excluded from clinical trials. In this review, the use of radiation in form of WBRT or radiosurgery is discussed in distinct clinical indications: as a primary treatment and at relapse;without prior use of prophylactic cranial irradiation (PCI);and after PCI. Combinations of radiotherapy with chemotherapy are discussed as BM in SCLC occur rarely as a sole event.
文摘Bone metastases from lung cancer account for 8.5%,with those located in the hyoid bone being extremely rare.In this editorial,we made a review about Hsu et al case report highlighted the importance of palliative radiotherapy,even with an unusual but effective scheme in pain control in a patient with non-small cell lung cancer in stage IV.
文摘Lung cancer is responsible for the most cancer deaths worldwide with an incidence that is still rising. One third of patients have unresectable stage ⅢA or stage ⅢB disease. The standard of care for locally advanceddisease in patients with good performance status consists of combined modality therapy in particular concurrent chemoradiotherapy. But despite a lot of efforts done in the past, local control and survival of patients with unresectable stage Ⅲ non-small-cell lung cancer(NSCLC) remains poor. Improving outcomes for patients with unresectable stage Ⅲ NSCLC has therefore been an area of ongoing research. Research has focused on improving systemic therapy, improving radiation therapy or adding a maintenance therapy to consolidate the initial therapy. Also implementation of newer targeted therapies and immunotherapy has been investigated as well as the option of prophylactic cranial irradiation. This article reviews the latest literature on improving local control and preventing distant metastases. It seems that we have reached a plateau with conventional chemotherapy. Radiotherapy dose escalation did not improve outcome although increasing radiation dose-intensity with new radiotherapy techniques and the use of newer agents, e.g., immunotherapy might be promising. In the future well-designed clinical trials are necessary to prove those promising results.
文摘目的评价小细胞肺癌全脑放疗后再发病灶立体定向放疗的疗效及安全性。方法收集2015年1月至2019年12月于丽水市中心医院经全脑放疗后的再发脑转移病灶(18个病灶)给予再程立体定向放疗的13例小细胞肺癌患者,对再程放疗的疗效及不良反应进行回顾性分析。结果治疗3个月后影像学评估18个病灶,完全缓解3个(16.7%),病灶最大径≤20 mm;部分缓解12个(66.7%),其中病灶最大径≤20 mm 3个,21~30 mm 4个,>30 mm 5个;疾病稳定2个(11.1%),病灶最大径21~30 mm;疾病进展1个(5.6%),病灶最大径>30 mm。再程立体定向放疗后3个月的客观缓解率为83.3%。按照美国肿瘤放射治疗协作组(Radiation Therapy Oncology Group,RTOG)放疗毒性分级标准(中枢神经系统)评估,13例患者中,0级2例,1~2级7例,3级4例。11例有相应症状,主要表现为头晕、头痛和恶心呕吐。再程放疗前后1个月内接受化疗6例,其中中枢神经系统毒性反应3级3例(50.0%);未行化疗的7例中,中枢神经系统毒性反应3级1例(14.3%)。13例中影像学提示脑放射性坏死3例。结论经过全脑放疗的小细胞肺癌患者,再发脑转移病灶挽救性立体定向放疗安全可行。放射性脑坏死作为严重并发症发生率较低,可能与病灶最大径以及放疗剂量高低相关,≥3级的中枢神经系统毒性反应在1个月内接受全身化疗患者中更多见。
