[Show abstract][Hide abstract] ABSTRACT: Platinum-based chemoradiotherapy (CRT) is a standard front-line treatment for locally advanced non-small cell lung cancer (NSCLC). However, no clinical trials have compared the efficacy and toxicity of platinum combination and docetaxel as subsequent re-challenge chemotherapies after cancer recurrence following CRT. This study aimed to evaluate the efficacy and toxicity of platinum combination chemotherapy versus docetaxel monotherapy in NSCLC patients previously treated with platinum-based CRT.
From September 2002 to December 2009, at three participating institutions, 24 patients with locally advanced NSCLC, who had previously received platinum-based CRT, were treated with platinum combination re-challenge therapy, whereas 61 received docetaxel monotherapy. We reviewed their medical charts to evaluate patient characteristics and data regarding treatment response, survival, and toxicity.
The response rates were 16.7% and 6.6% in the platinum combination chemotherapy and docetaxel monotherapy groups, respectively (p = 0.09), whereas disease control rates were 58.3% and 57.4%, respectively (p = 0.82). Progression-free survival was similar between the two groups (median, 4.2 vs. 2.3 months; hazard ratio [HR] = 0.81; 95% confidence interval [CI] = 0.51–1.29; p = 0.38), as was overall survival (median, 16.5 vs. 13.0 months; HR = 0.82; 95% CI = 0.47–1.41; p = 0.47). The incidence and severity of toxicity was also similar between the two groups. Hematological toxicity, particularly leukopenia and neutropenia, was more frequent in the docetaxel group.
Our results indicated that platinum combination re-challenge was equivalent to docetaxel for relapsed patients previously treated with platinum-based CRT.
[Show abstract][Hide abstract] ABSTRACT: Primary cancer of the trachea is rare and accounts for only 0.1-0.4% of all newly diagnosed respiratory tract cancers, worldwide. In the present study, a case of primary tracheal malignant melanoma, a particularly rare type of cancer, is reported. A 68-year-old male presented with a cough and bloody sputum. A chest computed tomography scan revealed a 25×20×15-mm tracheal tumor, located immediately above the carina, which reduced the cross-sectional area of the trachea by ~90%. Histopathological analysis of biopsy specimens determined a diagnosis of malignant melanoma. The patient was treated with argon plasma coagulation and chemoradiotherapy, which restored airway patency, however, metastasis was detected in the lungs. The patient refused further treatment and received palliative care. Subsequently, the patient succumbed to the disease within four months. Thus, although primary malignant melanoma of the trachea is extremeley rare, the possibility should be considered during diagnosis.
[Show abstract][Hide abstract] ABSTRACT: Few studies have examined the clinical characteristics of patients with brain metastases from small-cell esophageal cancer. In this study, we review the clinical characteristics and outcomes in patients with brain metastases from small-cell esophageal cancer.
From August 2002 to August 2012, consecutive patients diagnosed with brain metastases from small-cell esophageal cancer and treated with radiotherapy were enrolled. Clinical features, diagnostic findings, and survival were analyzed.
Six patients treated with brain radiotherapy were identified. The median age was 64 (range 61-74) years. All patients had neurological impairments. Three patients had supra- and infra-tentorial metastases, and three patients had cerebrum metastases. Brain metastases were detected when esophageal cancer was initially diagnosed in two patients. In three patients, magnetic resonance imaging findings after radiotherapy confirmed a significant response to treatment. The median overall survival was 6.0 months. During the same period, 43 patients with squamous cell carcinoma and seven patients with adenocarcinoma who had brain metastases were identified. Survival periods for squamous cell carcinoma and adenocarcinoma patients who had brain metastases were 5.5 months and 4.2 months, respectively. There was no significant difference in overall survival according to the histological type.
Brain metastases from small-cell esophageal cancer tend to spread to the cerebellum and impair patients' quality-of-life. Brain radiotherapy had a positive effect in this case series; however, overall survival remains short.
Journal of Cancer Research and Therapeutics 12/2014; 10 Suppl(8):256-8. DOI:10.4103/0973-1482.151469 · 0.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to update a previous scoring system for patients with skeletal metastases, that was proposed by Katagiri et al. in 2005, by introducing a new factor (laboratory data) and analyzing a new patient cohort. Between January 2005 and January 2008, we treated 808 patients with symptomatic skeletal metastases. They were prospectively registered regardless of their treatments, and the last follow-up evaluation was performed in 2012. There were 441 male and 367 female patients with a median age of 64 years. Of these patients, 749 were treated nonsurgically while the remaining 59 underwent surgery for skeletal metastasis. A multivariate analysis was conducted using the Cox proportional hazards model. We identified six significant prognostic factors for survival, namely, the primary lesion, visceral or cerebral metastases, abnormal laboratory data, poor performance status, previous chemotherapy, and multiple skeletal metastases. The first three factors had a larger impact than the remaining three. The prognostic score was calculated by adding together all the scores for individual factors. With a prognostic score of ≥7, the survival rate was 27% at 6 months, and only 6% at 1 year. In contrast, patients with a prognostic score of ≤3 had a survival rate of 91% at 1 year, and 78% at 2 years. Comparing the revised system with the previous one, there was a significantly lower number of wrongly predicted patients using the revised system. This revised scoring system was able to predict the survival rates of patients with skeletal metastases more accurately than the previous system and may be useful for selecting an optimal treatment.
Cancer Medicine 10/2014; 3(5). DOI:10.1002/cam4.292
[Show abstract][Hide abstract] ABSTRACT: In locally advanced Non-Small-Cell Lung Cancer (LA-NSCLC) patients treated with chemoradiotherapy (CRT), optimal surrogate endpoint for cure has not been fully investigated.
The clinical records of LA-NSCLC patients treated with concurrent CRT at Shizuoka Cancer Center between Sep. 2002 and Dec. 2009 were reviewed. The primary outcome of this study was to evaluate the surrogacy of overall response rate (ORR) and progression-free survival (PFS) rate at 3-month intervals (from 9 to 30 months after the initiation of treatment) for the 5-year survival rate. Landmark analyses were performed to assess the association of these outcomes with the 5-year survival rate.
One hundred and fifty-nine patients were eligible for this study. The median follow-up time for censored patients was 57 months. The ORR was 72%, median PFS was 12 months, and median survival time was 39 months.Kaplan-Meier curve of progression-free survival and hazard ratio of landmark analysis at each time point suggest that most progression occurred within 2 years. With regard to 5-year survival rate, patients with complete response, or partial response had a rate of 45%. Five-year survival rates of patients who were progression free at each time point (3-months intervals from 9 to 30 months) were 53%, 69%, 75%, 82%, 84%, 89%, 90%, and 90%, respectively. The rate gradually increased in accordance with progression-free interval extended, and finally reached a plateau at 24 months.
Progression-free survival at 2 years could be a reliable surrogate marker for the 5-year survival rate in LA-NSCLC patients treated with concurrent CRT.
BMC Cancer 01/2014; 14(1):18. DOI:10.1186/1471-2407-14-18 · 3.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The lateral electron-photon technique (LEPT) and intensity-modulated radiation therapy (IMRT) are commonly used for total scalp irradiation. However, the treatment planning and irradiation are laborious and time-consuming. We herein present the multijaw-size concave arc technique (MCAT) as a total scalp irradiation method that overcomes these problems. CT datasets for eight patients previously treated for angiosarcoma of the scalp were replanned using MCAT, LEPT, and IMRT. The MCAT was designed with a dynamic conformal arc for the total scalp, with a multileaf collimator to shield the brain. Two additional conformal arcs with a decreased upper-jaw position of the first dynamic conformal arc were used to reduce the cranial hotspots. The prescribed dose was 40 Gy (2 Gy/fraction) to 95% of the planning target volume (PTV, defined as the total scalp plus a 4 mm margin). MCAT was compared with LEPT and IMRT with respect to the PTV dose homogeneity (D5%-95%), underdosage (V < 90%), overdosage (V > 110%), doses to the brain, and the delivery time and monitor units (MUs) for single irradiation. We were able to formulate treatment plans for all three techniques that could deliver the prescription dose in all patients. MCAT was significantly superior to LEPT with respect to PTV dose homogeneity, overdosage, and underdosage, although MCAT was inferior to IMRT with respect to dose homogeneity and overdosage. The mean brain dose and high-dosage volume of all three techniques were low, but IMRT provided larger volume to the brain than did the other two techniques in the low dosage region. In MCAT, the mean delivery time could be reduced by approximately half or more, and the mean MUs could be reduced by at least 100 compared to the other two techniques. MCAT can achieve total scalp irradiation with substantially fewer MUs and a shorter delivery time than LEPT and IMRT.
[Show abstract][Hide abstract] ABSTRACT: To compare proton beam therapy (PBT) and intensity-modulated radiation therapy (IMRT) with conformal radiation therapy (CRT) in terms of their organ doses and ability to cause secondary cancer in normal organs.
Five patients (median age, 4 years; range, 2--11 years) who underwent PBT for retroperitoneal neuroblastoma were selected for treatment planning simulation. Four patients had stage 4 tumors and one had stage 2A tumor, according to the International Neuroblastoma Staging System. Two patients received 36 Gy, two received 21.6 Gy, and one received 41.4 Gy of radiation. The volume structures of these patients were used for simulations of CRT and IMRT treatment. Dose--volume analyses of liver, stomach, colon, small intestine, pancreas, and bone were performed for the simulations. Secondary cancer risks in these organs were calculated using the organ equivalent dose (OED) model, which took into account the rates of cell killing, repopulation, and the neutron dose from the treatment machine.
In all evaluated organs, the mean dose in PBT was 20--80% of that in CRT. IMRT also showed lower mean doses than CRT for two organs (20% and 65%), but higher mean doses for the other four organs (110--120%). The risk of secondary cancer in PBT was 24--83% of that in CRT for five organs, but 121% of that in CRT for pancreas. The risk of secondary cancer in IMRT was equal to or higher than CRT for four organs (range 100--124%).
Low radiation doses in normal organs are more frequently observed in PBT than in IMRT. Assessments of secondary cancer risk showed that PBT reduces the risk of secondary cancer in most organs, whereas IMRT is associated with a higher risk than CRT.
[Show abstract][Hide abstract] ABSTRACT: Patients harboring sensitive epidermal growth factor receptor (EGFR) mutations show a dramatic response to treatment with EGFR tyrosine kinase inhibitors (TKIs). However, there have been no clinical reports in lung cancer patients that compare the time-to-response between radiotherapy and EGFR-TKIs.
We reviewed 17 and 32 consecutive patients with inoperable stage III/IV NSCLC who harbored sensitive EGFR mutations and who were treated with thoracic radiotherapy with or without chemotherapy and EGFR-TKIs, respectively.
There were statistically significant differences in time-to-partial response (PR) with regard to the treatment modalities (radiotherapy vs. EGFR-TKIs, median 57 days vs. 22 days, log-rank test, p=0.008).
EGFR-TKIs elicit tumor shrinkage earlier than does radiotherapy in patients with a sensitive EGFR mutation, suggesting that EGFR-TKIs may be useful for early symptom improvement in these patients.
Anticancer research 08/2013; 33(8):3279-84. · 1.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Metastatic brain tumors have become a critical issue in clinical management for patients with cancer. We retrospectively analysed features of 105 patients with metastatic brain tumors from gastrointestinal cancer, who underwent treatment in our institute between September, 2002 and December, 2010. Treatment strategy was individualized according to the patient's systemic and neurologic conditions, size and location of the brain metastases, and expectant systemic treatment through our cancer board. Treatment outcome was significantly better in patients with RTOG RPA class 2 than in those with class 3(8.6 months vs 3.5 months: p<0.05). Metastatic brain tumors were diagnosed at 6.3/13.1/15.7 months after diagnosis of metastatic lung tumors from esophagus/stomach/colon cancers respectively. A third of the patients with metastatic brain tumor from rectal cancer presented without evident lung metastasis. In conclusion, patients with brain metastasis from gastrointestinal cancers can achieve improvement in survival with early diagnosis and multidisciplinary individualized treatments.
No shinkei geka. Neurological surgery 08/2013; 41(8):669-677. · 0.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: The aim of this retrospective study was to investigate the feasibility of primary treatment with extended-field irradiation and weekly cisplatin (extended-field concurrent chemoradiotherapy, EFCCRT) as initial therapy in patients with International Federation of Gynecology and Obstetrics IB1 to IIIB cervical cancer with paraaortic or high common iliac lymph node metastases. METHODS: Participants comprised patients with confirmed cervical cancer, showing paraaortic or high common iliac lymph node metastases on diagnostic imaging, treated with EFCCRT. Total external radiation doses were 50.4 Gy to the whole pelvis and 45.0 Gy to the lumbar paraaortic region. High-dose-rate intracavitary brachytherapy was performed to deliver a total dose of 18-24 Gy in 6-Gy fractions prescribed at point A. Weekly cisplatin (30-40 mg/m(2)) was given concurrently with radiotherapy. RESULTS: Twenty-four patients were treated. Median follow-up interval was 34 months. The dose of cisplatin was 30 mg/m(2) in 2 cases, 35 mg/m(2) in 8 cases, and 40 mg/m(2) in 14 cases. Twenty-two cases (92 %) received more than 160 mg/m(2) cisplatin. Ten cases (42 %) experienced acute grade 3/4 hematological toxicity, and 9 cases (38 %) experienced acute grade 3 nonhematological toxicity. No case presented late grade 3/4 toxicity. Three-year progression-free and overall survival rates were 54 % and 72 %, respectively. Eleven cases recurred during follow-up. Sites of recurrence were within the irradiation field in 4 cases, outside the field in 6 cases, and in both fields in 1 case. CONCLUSION: EFCCRT and high-dose-rate intracavitary brachytherapy for patients with paraaortic or high common iliac lymph node metastases from cervical cancer is feasible.
International Journal of Clinical Oncology 04/2013; DOI:10.1007/s10147-013-0551-8 · 2.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PURPOSE: To determine the recommended dose (RD) in concurrent conformal radiotherapy with S-1 and cisplatin chemotherapy for inoperable stage III non-small-cell lung cancer. PATIENTS AND METHODS: Eligible patients with inoperable stage III non-small-cell lung cancer, age ≥ 20 years, performance status 0-1 received 4 cycles of intravenous cisplatin (60 mg/m(2), day 1) and oral S-1 (80, 100, or 120 mg based on body surface area, days 1-14) repeated every 4 weeks. Radiation doses were 66, 70, and 74 Gy for arms 1, 2, and 3, respectively. RESULTS: A total of 24 patients were enrolled in our study, including 6 in arm 1, 6 in arm 2, and 12 in arm 3. The patients consisted of 14 men and 10 women, with a median age of 63 years (range, 44-73 years). The median follow-up was 27.3 months (range, 8.5-42.6 months) for all patients and 33.9 months (range, 15.2-42.6 months) for those still alive. Grade 3 febrile neutropenia, lung toxicities, and heart toxicities occurred in 2, 2, and 2 patients, respectively. Dose-limiting toxicity occurred in 2, none, and 1 patient in arms 1, 2, and 3, respectively. The median survival was not reached, and the 2-year survival rate was 70% (95% CI, 51%-89%). Two-year local relapse-free survival and distant metastasis-free survival were 74% (95% CI, 56%-92%) and 45% (95% CI, 25%-65%), respectively. CONCLUSIONS: High-dose radiotherapy with S-1 and cisplatin is feasible, and 74 Gy was determined as the recommended dose.
Clinical Lung Cancer 03/2013; 14(4). DOI:10.1016/j.cllc.2013.01.003 · 3.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: As clinical trials for limited-disease small-cell lung cancer often exclude elderly patients due to comorbidities and a decline in organ function, the most suitable treatment for limited-disease small-cell lung cancer patients aged 75 years or older still remains unclear. METHODS: From July 2002 to June 2011, 20 consecutive patients aged 75 years or older, with Stage II to IIIB limited-disease small-cell lung cancer, were scheduled to be treated with concurrent or sequential chemoradiotherapy at the Shizuoka Cancer Center. We reviewed the medical charts of the patients and evaluated their characteristics, treatment compliance, toxicity and antitumor efficacy. RESULTS: Five patients were treated with concurrent chemoradiotherapy and the other 15 patients were scheduled to be treated with sequential chemoradiotherapy. Of these 15 patients, 12 were treated with four cycles of etoposide (80 mg/m(2), days 1-3, q3-4w) plus carboplatin (area under the curve 5, day 1, q3-4w), followed by thoracic radiotherapy. Of the five patients treated with concurrent chemoradiotherapy, discontinuation of chemotherapy/thoracic radiotherapy occurred in two patients due to toxicity and they suffered a prolonged decrease in performance status. Of the 12 patients treated with etoposide plus carboplatin followed by sequential thoracic radiotherapy, the response rate, median progression-free survival and median overall survival time were 91%, 244 and 601 days. CONCLUSIONS: These results suggest that concurrent chemoradiotherapy is not feasible for all limited-disease small-cell lung cancer patients aged 75 years or older. The alternative of four cycles of etoposide plus carboplatin followed by thoracic radiotherapy is a candidate for the standard treatment of limited-disease small-cell lung cancer patients in this age group. A further trial is warranted to develop and evaluate the optimal treatment for elderly patients with limited-disease small-cell lung cancer.
Japanese Journal of Clinical Oncology 12/2012; 43(2). DOI:10.1093/jjco/hys197 · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES:: Among patients with locally advanced lung adenocarcinoma, the frequency of epidermal growth factor receptor (EGFR) and KRAS mutations was unknown. In addition, it has not been fully evaluated about the role of these mutations treated with concurrent chemoradiotherapy (CCR). METHODS:: The clinical records of locally advanced lung adenocarcinoma patients treated with CCR at Shizuoka Cancer Center between September 2002 and December 2009 were reviewed. RESULTS:: Forty-four patients were eligible for this study. EGFR mutation was detected in 13 (29.5%) of 44 patients, and KRAS mutation was detected in 2 (6.5%) of 31 patients. Among EGFR mutation status known patients, overall response rate, median progression-free survival (PFS), and median survival time were 52.3%, 11.5 months, and 35.8 months, respectively. Overall response rate was significantly higher in EGFR mutant group than in EGFR wild-type group (76.9% vs. 41.9%, P=0.02), but this difference did not translate into a significant PFS benefit (9.6 vs. 13.2 mo, P=0.78). Locoregional relapse occured less frequently in patients with EGFR mutation than those with EGFR wild-type, but not significant (15.4% vs. 32.3%, P=0.46). Brain was the most frequent metastatic site of relapse in EGFR mutant group. CONCLUSIONS:: Among locally advanced lung adenocarcinoma, EGFR mutation was detected in 29.5% and KRAS mutation was detected in 6.5%. We were not able to detect a difference in PFS or overall survival between EGFR mutant and wild-type patients treated with conventional CCR. Locoregional relapse was approximately half in the EGFR mutant group compared with the EGFR wild-type group; however, this finding did not reach statistical significance.
American journal of clinical oncology 12/2012; 37(2). DOI:10.1097/COC.0b013e31826e04f9 · 2.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Leptomeningeal metastasis (LM) is a devastating complication of systemic cancers. New therapies that have beneficial effects on primary cancers outside the central nervous system (CNS) have underscored the significance of LM. Intrathecal chemotherapy plus radiation therapy are less effective for LM from lung adenocarcinoma. We retrospectively studied outcomes of patients with LM from lung adenocarcinoma who underwent multidisciplinary treatments in our institute.
Four patients with LM from lung adenocarcinoma treated with EGFR-TKI, VP shunt and irradiation. Of those four, two presented with increased intracranial pressure, one with epilepsy, and the other with truncal ataxia. Treatment was indicated when LM was confirmed by MR images or cytology, and Karnofsky Performance Status scale was more than 40%, and life expectancy was more than three months if LM was controlled. EGFR mutation was not examined, because of the unsettled approval of Japanese public health insurance at the time of this study. The patients selected for treatment by EGFR-TKI were all Asian women who had never smoked. Treatment sequence was based on clinical symptoms depending on the individual situation.
The mean time from diagnosis of lung adenocarcinoma to LM onset was 28 (24 to 36) months. Mean survival time from LM diagnosis was 9 months. All patients died of LM. No patients suffered from peritoneal carcinomatosis or infection after VP shunt.
The triple modality combination of EGFR-TKI, VP shunt and radiation therapy may improve outcomes and symptoms of patients with LM from lung adenocarcinoma.
No shinkei geka. Neurological surgery 06/2012; 40(6):503-9. · 0.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Based on the results of phase I/II studies, S-1 plus cisplatin (CDDP) and vinorelbine (VNR) plus CDDP are commonly used chemoradiotherapeutic regimens for the treatment of non-small cell lung cancer(NSCCLC) in Japan. However, there have been no studies that have compared S-1 and CDDP combined with thoracic radiotherapy (TRT) with VNR and CDDP combined with TRT.
A total of 39 and 50 patients with stage III non-small cell lung cancer (NSCLC) were treated with S-1 and CDDP plus concurrent TRT, or with VNR and CDDP plus concurrent TRT, respectively, between 2002 and 2010.
In the S-1 plus CDDP plus TRT group, the median progression-free survival (PFS) and the median overall survival (OS) were 327 days and 1012 days, respectively. In the VNR plus CDDP plus TRT group, the median PFS and the median OS were 328 days and 905 days, respectively. The differences in the PFS and OS were not statistically significant. Grade 3 or more leukopenia and neutropenia were significantly more common in the VNR plus CDDP plus TRT group. Grade 3 or more thrombocytopenia, esophagitis and eruption tended to be more common in the S-1 plus CDDP plus TRT group.
Due to the difference in the toxicity profiles of the two combinations, S-1 plus CDDP plus TRT or VNR plus CDDP plus TRT should be selected depending on each patient's baseline characteristics.
Anticancer research 02/2012; 32(2):675-80. · 1.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There have been reports suggesting that continuous administration of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) is advantageous for patients in which disease progression was observed after the establishment of clinical benefit from EGFR-TKIs. We retrospectively evaluated the clinical course of patients who received continuous administration of EGFR-TKIs after disease progression was detected solely in bone lesions.
The medical records of patients administered gefitinib or erlotinib between 2002 and 2010 were reviewed. We evaluated the progression-free survival (PFS) and overall survival (OS) in patients who had bone metastases after the establishment of clinical benefit from EGFR-TKI and who received radiation therapy for the bone lesion and continuous treatment with EGFR-TKI.
Ten patients were enrolled in this study. The median PFS and OS were 88 days and 330 days, respectively. Furthermore, a longer duration from the start of first EGFR-TKI to detection of bone metastases (p=0.0049) was identified as being significantly associated with a longer PFS.
Our data suggest that continuous administration of EGFR-TKI is a treatment option for patients with bone metastases who previously benefited from therapy with EGFR-TKI.
Anticancer research 12/2011; 31(12):4519-23. · 1.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The study was performed to evaluate radiotherapy for patients with intramedullary spinal cord metastasis (ISCM) and to identify the clinical features of ISCM. The subjects were 18 patients (8 men, 10 women) with ISCM who underwent radiotherapy between September 2002 and February 2008. The primary lesions were lung cancer in 8 patients (2 small cell, 6 non-small cell), breast cancer in 6, malignant melanoma in 2, renal cell carcinoma in 1, and rectal cancer in 1 patient. Diagnosis, symptoms and survival of these patients were compared with those for 544 patients with vertebral metastases who underwent radiotherapy at the same institute between September 2002 and November 2006. In the 18 patients with ISCM, the 6-month survival rate after radiotherapy was 36% and the median survival period was 4.0 months. Ten patients had neurological improvement or pain relief after radiotherapy. Brain metastases were six fold more frequent in the patients with ISCM than in those with vertebral metastasis [89% vs. 15%, p = 0.001]. At the time of radiotherapy, back pain in patients with vertebral metastasis was more frequent [97% vs. 33%, p = 0.001] but neurological deficits were less common [24% vs. 100% , p = 0.001]. Most ISCM cases were diagnosed by contrast-enhanced MRI, with detection by contrast-enhanced CT in only 3/18 cases (17%). ISCM has a poor prognosis and most patients have neurological deficits that impair quality of life. Early diagnosis by MRI is important for suspected ISCM to allow initiation of radiotherapy before development of neurological deficits.
Journal of Radiation Research 07/2011; 52(5):641-5. DOI:10.1269/jrr.10187 · 1.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the safety and efficacy of concurrent vinorelbine and thoracic radiotherapy in elderly patients with locally advanced non-small-cell lung cancer (NSCLC).
Eligible patients were 71 years of age or older with unresectable Stage III NSCLC. Patients were treated with thoracic radiotherapy (60 Gy) and concurrent vinorelbine (20 mg/m(2) in Level 1 and 25 mg/m(2) in Level 2) on Days 1 and 8 every 3 weeks for two cycles, followed by adjuvant vinorelbine (25 mg/m(2)) on Days 1 and 8 every 3 weeks for two cycles.
Four patients were enrolled at Level 1. One patient experienced Grade 3 febrile neutropenia at Level 1 and the dose was escalated to Level 2. At Level 2, 2 of 6 patients experienced dose-limiting toxicities (Grade 4 neutropenia in 1 patient and Grade 3 infection in another). Three of 6 patients developed late Grade 2 or 3 pneumonitis. Therefore, the dose was de-escalated to Level 1. An additional 6 patients were enrolled at Level 1, 4 of whom experienced dose-limiting toxicities (incomplete radiotherapy because of Grade 2 pneumonitis in 1 patient and Grade 3 infection in 1, Grade 3 febrile neutropenia in 1, and Grade 3 esophagitis in 1). Moreover, late Grade 3 pneumothorax and Grade 5 pneumonitis occurred in 1 and 1 patient, respectively. Overall, Grade 2, 3 and 5 pneumonitis occurred in 3, 3, and 1 among 16 patients, respectively.
Concurrent vinorelbine and thoracic radiotherapy resulted in a high incidence of severe pneumonitis when the standard dose of this agent was used for elderly patients. We therefore recommend caution in the use of this regimen and schedule for elderly patients.
International journal of radiation oncology, biology, physics 05/2011; 82(5):1777-82. DOI:10.1016/j.ijrobp.2011.03.037 · 4.18 Impact Factor