Chemotherapy in non-small-cell lung cancer: an update of an individual patient data meta-analysis.

Journal of Clinical Oncology (Impact Factor: 18.04). 03/2005; 23(4):924-5; author reply 925-6. DOI: 10.1200/JCO.2005.05.303
Source: PubMed
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    ABSTRACT: Surgery remains the main curative treatment for patients with early-stage non-small-cell lung cancer (NSCLC); however, because many patients probably have undetectable micrometastasis even at diagnosis, adjuvant treatment is usually needed. The results for radiotherapy have mostly been disappointing, and a strong emphasis has, therefore, been placed on chemotherapy as the preferred modality. Adjuvant chemotherapy, and in particular, platinum-based regimens, have been assessed in several studies, but the results have been conflicting. Most trials have included patients with a wide range of disease stages and have shown, at most, only moderate improvements in survival. Thus, although clearly indicated in some patients, whether adjuvant chemotherapy should be used in all patients with resected disease is highly controversial. In this debate, Thierry Le Chevalier and colleagues and Giorgio Scagliotti present opposing arguments for whether this approach should be considered standard.
    The Lancet Oncology 04/2005; 6(3):182-4. · 25.12 Impact Factor
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    ABSTRACT: After publication in 1995 of a meta-analysis of adjuvant chemotherapy in the treatment of NSCLC, a number of randomized trials investigated adjuvant chemotherapy using more active chemotherapeutic regimens and larger numbers of accrued patients per trial. This review will focus on recent clinical trials for adjuvant chemotherapy, and will help to interpret the applicability of these results to daily clinical practice. Four large-scale randomized trials that used platinum-based chemotherapy have reported positive results during the last 3 years. These trials included cisplatin-based chemotherapy [the International Adjuvant Lung Cancer (IALT) trial], cisplatin plus vinorelbine [the National Cancer Institute of Canada (NCIC) BR10 trial], and carboplatin plus paclitaxel [the Cancer and Leukemia Group B (CALGB) 9633 trial]. More recently, another adjuvant trial [Adjuvant Navelbine International Trialist Association (ANITA)] was reported, which has added greatly to our understanding of the potential role of adjuvant treatment. Regarding adjuvant UFT (tegafur and uracil) chemotherapy, an individual patient data-based meta-analysis demonstrated its significant effect on survival in selected patients with completely resected non-small-cell lung cancer. Recent trials indicate a survival benefit of postoperative adjuvant chemotherapy. These findings are anticipated to change the clinical management of patients with completely resectable non-small-cell lung cancer.
    Current Opinion in Oncology 04/2006; 18(2):144-50. · 4.03 Impact Factor
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    ABSTRACT: Die Strahlentherapie ist sowohl beim nicht-kleinzelligen, als auch beim kleinzelligen Bronchialkarzinom neben Chirurgie und Chemotherapie eine zentrale Behandlungsmodalität. Sie wird beim nicht-kleinzelligen Bronchialkarzinom in den Frühstadien unter adjuvanter Intention eingesetzt. Bei fortgeschrittenen, jedoch lokal begrenzten Tumorstadien, ist sie wesentlicher Bestandteil innerhalb multimodaler Therapiekonzepte. Der Effekt der Radiotherapie wird hierbei durch die Kombination mit Zytostatika oder auch zielgerichteten biologischen Substanzen, z.B. Tyrosinkinaseinhibitoren, verstärkt. Indikationen für eine Strahlentherapie beim nicht-kleinzelligen Karzinom sind somit die definitive Therapie und eine prä- sowie postoperative Radiatio. Beim kleinzelligen Bronchialkarzinom erfolgt im Stadium „limited disease“ die Radiotherapie frühzeitig parallel zur definitiven Systemtherapie. Zusätzlich kommt ihr eine wesentliche Bedeutung in der Prophylaxe von Hirnfiliae als Ganzhirnbestrahlung zu. In der palliativen Erkrankungssituation lindert eine Bestrahlung lokale Beschwerden oder hilft bei poststenotischen Komplikationen wie Atelektasen und Entzündungen. Radiation therapy (RT) plays a major role in the treatment of patients with small cell cancer (SCLC) and non-small cell lung cancer (NSCLC). Postoperative RT is used primarily for early-stage NSCLC patients in case of mediastinal lymph node involvement. For patients with locally advanced disease (stages IIIA and IIIB), concurrent chemotherapy and irradiation remains the standard of care. Cytotoxic agents and biologic therapies such as tyrosine kinase inhibitors have been incorporated into multimodal treatment strategies for further improvement of radiosensitivity. Thoracic radiation therapy is an established treatment in the management of limited-stage small cell lung cancer. There is increasing evidence in the literature in favor of early concurrent chemoradiation therapy. Increasing data support the use of prophylactic cranial irradiation (PCI) to prevent intracranial relapse and to improve survival. Palliative RT is useful for patients with metastatic disease, causing symptoms such as dyspnea, cough, hemoptysis, postobstructive pneumonia, and pain. SchlüsselwörterStrahlentherapie-Nicht-kleinzelliges Bronchialkarzinom-Kleinzelliges Bronchialkarzinom-Multimodale Therapie-Palliative Radiatio KeywordsRadiotherapy-Non-small cell lung cancer-Small cell lung cancers-Multimodality treatment-Palliative radiotherapy
    Zeitschrift für Herz- Thorax- und Gefäßchirurgie 01/2009; 23(5):305-310.

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