New approaches to radiotherapy as definitive treatment for inoperable lung cancer.
ABSTRACT The standard curative approach for the treatment of inoperable non-small cell lung cancer (NSCLC) is definitive radiotherapy. Advanced treatment techniques have been developed that maximize radiation dose delivery to the tumor while minimizing the dose to critical surrounding structures. These radiation therapy techniques include three-dimensional conformal radiotherapy, intensity modulated radiation therapy, stereotactic body radiotherapy, and particle beam radiotherapy. Biological imaging with (18)F-FDG-PET and other novel tracers in development have shown the potential to improve target delineation and patient selection for curative treatment. Tumor motion control with respiratory gating techniques and image-guided radiation therapy are recent developments that provide the radiation oncologist with accurate tumor localization on the treatment machine. This review article summarizes the literature on these topics and other state-of-the-art radiation therapy techniques in the management of inoperable NSCLC.
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ABSTRACT: Fluoro-2-deoxy-d-glucose (FDG)-positron emission tomography (PET) and PET/computed tomography (FDG-PET/CT) is regarded as a standard of care in the management of non-small-cell lung carcinoma (NSCLC) and is a useful adjunct in the characterization of indeterminate solitary lung nodules (SLN), and pre-treatment staging of NSCLC, notably mediastinal nodal staging and detection of remote metastases. FDG-PET/CT has the ability to assess locoregional lymph node spread more precisely than CT, to detect metastatic lesions that would have been missed on conventional imaging or are located in difficult areas, and to help in the differentiation of lesions that are equivocal after conventional imaging. Increasingly FDG-PET/CT is employed in radiotherapy planning, prediction of prognosis in terms of tumor response to neo-adjuvant, radiation and chemotherapy treatment. Evidence is accumulating of usefulness of PET/CT in small cell lung cancer.Journal of Infection and Public Health 01/2012; 5:S35–S40.
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ABSTRACT: PURPOSE: In response to the increased risk of radiological terrorist attack, a network of Centers for Medical Countermeasures against Radiation (CMCR) has been established in the United States, focusing on evaluating animal model responses to uniform, relatively homogenous whole- or partial-body radiation exposures at relatively high dose rates. The success of such studies is dependent not only on robust animal models but on accurate and reproducible dosimetry within and across CMCR. To address this issue, the Education and Training Core of the Duke University School of Medicine CMCR organised a one-day workshop on small animal dosimetry. Topics included accuracy in animal dosimetry accuracy, characteristics and differences of cesium-137 and X-ray irradiators, methods for dose measurement, and design of experimental irradiation geometries for uniform dose distributions. This paper summarises the information presented and discussed. CONCLUSIONS: Without ensuring accurate and reproducible dosimetry the development and assessment of the efficacy of putative countermeasures will not prove successful. Radiation physics support is needed, but is often the weakest link in the small animal dosimetry chain. We recommend: (i) A user training program for new irradiator users, (ii) subsequent training updates, and (iii) the establishment of a national small animal dosimetry center for all CMCR members.International Journal of Radiation Biology 10/2011; 87(10):1001-10. · 1.84 Impact Factor
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ABSTRACT: Non-small cell lung cancer (NSCLC) not amenable to surgical resection is associated with high mortality due to ineffectiveness and toxicity of chemotherapy. Thus, there is urgent need for the development of new, safer, and better-tolerated drugs to combat this disease. In this study, we show that targeting the formation of pro-angiogenic epoxyeicosatrienoic acids (EETs) by the cytochrome P450 arachidonic acid epoxygenases (Cyp2c) represents a new and safe mechanism to treat NSCLC growth and progression. Downregulation of Cyp2c44 expression via activation of the peroxisomal proliferator activated receptor (PPAR)α with the PPARα ligands Bezafibrate and Wyeth-14,643 reduced both primary and metastatic NSCLC growth, tumor angiogenesis, endothelial Cyp2c44 expression, and circulating EET levels in the KRasLA2 mouse and human orthotopic models of NSCLC. The beneficial effects of the PPARα ligands were independent of whether their administration started before or after the onset of primary NSCLC, and persisted after withdrawal, suggesting long lasting beneficial effects. These results suggest that maneuvers designed to downregulate Cyp2c expression and/or enzymatic activity represent a new, effective, and safe strategy for the treatment of NSCLC. Moreover, as Bezafibrate is a clinically approved and well-tolerated hypolipidemic drug, these studies may serve as a prelude to future clinical studies to validate the usefulness of PPAR ligands as safe agents for the treatment of lung cancer in humans.Cancer Research 12/2013; · 9.28 Impact Factor