Benefits of postoperative thoracic radiotherapy for small cell lung cancer subdivided by lymph node stage: a systematic review and meta-analysis

Zhang, Shuling; Sun, Xin; Sun, Li; Xiong, Zhicheng; Ma, Jie-Tao; Han, Cheng-Bo

doi:10.21037/jtd.2017.03.174

Cited by 7 publications

(6 citation statements)

References 26 publications

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“…Radiation therapy has been widely used since 1992. However, accumulating evidence has revealed that radiotherapy resistance is usually acquired soon after the treatment, and the corresponding additional irradiation dose often leads to unacceptable toxicity [ 24 , 25 ]. It is urgent for researchers to identify the regulatory mechanism for the metastasis of SCLC cells and reveal the molecular mechanisms underlying acquired radiotherapy resistance.…”

Section: Discussionmentioning

confidence: 99%

hTERT promoter methylation promotes small cell lung cancer progression and radiotherapy resistance

Zhai

Zheng

et al. 2020

Journal of Radiation Research

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Small cell lung cancer (SCLC) has been a devastating actuality in clinic and the molecular mechanisms underlying this disease remain unclear. The epigenetic alterations located in the promoter region of human telomerase reverse transcriptase (hTERT) have been demonstrated as one of the most prevalent non-coding genomic modifications in multiple cancers. However, alteration of hTERT promoter methylation in SCLC and the subsequently induced change in tumor cell behavior remains unclear. In this research, we hypothesized that abnormal methylation of hTERT promotor enhanced the progression of SCLC and the outcome of radiotherapy resistance. Quantitative real-time PCR and western blot assays were performed to evaluate the RNA and protein levels of hTERT and enhancer of zeste homolog 2 (EZH2), respectively. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to estimate the viability and X-ray sensitivity of H20 and H446 cell lines. Functionally, upregulation of hTERT promoted the proliferation and migration of H20 and H446 cells, and the high-level of methylation in the promoter region of hTERT induced by radiation caused radio-resistance in SCLC. Mechanically, methylation of hTERT promoter enhanced the progression and radio-resistance of SCLC through upregulating the expression of its downstream effector EZH2.

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Section: Discussionmentioning

confidence: 99%

hTERT promoter methylation promotes small cell lung cancer progression and radiotherapy resistance

Zhai

Zheng

et al. 2020

Journal of Radiation Research

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“…Here, the exact definition of R0 resection could be substantially complemented with negative results of assays for postoperative detection of circulating tumor cells or DNA in the near future 198 . Importantly, in case of nodal upstaging (N1 or N2) or incomplete surgical resection (i.e., R1), adjuvant chemotherapy should be complemented with thoracic radiotherapy 199,200 . In this setting, postoperative thoracic radiotherapy significantly decreases the 1‐year, 2‐year, and 3‐year local recurrence rates in patients with nodal involvement (i.e., N1 and N2) 199 .…”

Section: Therapeutic Approachesmentioning

confidence: 99%

“…Importantly, in case of nodal upstaging (N1 or N2) or incomplete surgical resection (i.e., R1), adjuvant chemotherapy should be complemented with thoracic radiotherapy 199,200 . In this setting, postoperative thoracic radiotherapy significantly decreases the 1‐year, 2‐year, and 3‐year local recurrence rates in patients with nodal involvement (i.e., N1 and N2) 199 . Postoperative prophylactic cranial irradiation (PCI) has been shown to significantly reduce the risk of brain metastasis and prolong OS in patients who undergo surgery for SCLC 201,202 .…”

Section: Therapeutic Approachesmentioning

confidence: 99%

Clinical insights into small cell lung cancer: Tumor heterogeneity, diagnosis, therapy, and future directions

Gay

Popper

Pirker

et al. 2023

CA A Cancer J Clinicians

112

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Small cell lung cancer (SCLC) is characterized by rapid growth and high metastatic capacity. It has strong epidemiologic and biologic links to tobacco carcinogens. Although the majority of SCLCs exhibit neuroendocrine features, an important subset of tumors lacks these properties. Genomic profiling of SCLC reveals genetic instability, almost universal inactivation of the tumor suppressor genes TP53 and RB1, and a high mutation burden. Because of early metastasis, only a small fraction of patients are amenable to curative‐intent lung resection, and these individuals require adjuvant platinum‐etoposide chemotherapy. Therefore, the vast majority of patients are currently being treated with chemoradiation with or without immunotherapy. In patients with disease confined to the chest, standard therapy includes thoracic radiotherapy and concurrent platinum‐etoposide chemotherapy. Patients with metastatic (extensive‐stage) disease are treated with a combination of platinum‐etoposide chemotherapy plus immunotherapy with an anti‐programmed death‐ligand 1 monoclonal antibody. Although SCLC is initially very responsive to platinum‐based chemotherapy, these responses are transient because of the development of drug resistance. In recent years, the authors have witnessed an accelerating pace of biologic insights into the disease, leading to the redefinition of the SCLC classification scheme. This emerging knowledge of SCLC molecular subtypes has the potential to define unique therapeutic vulnerabilities. Synthesizing these new discoveries with the current knowledge of SCLC biology and clinical management may lead to unprecedented advances in SCLC patient care. Here, the authors present an overview of multimodal clinical approaches in SCLC, with a special focus on illuminating how recent advancements in SCLC research could accelerate clinical development.

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“…PORT can improve 5-year OS in pN2 disease[ 94 - 96 ], but does not significantly improve OS in stage pN1[ 75 ]. A MTA[ 97 ] concluded that PORT improves 1-3 year LC rates in pN1 and pN2 and 1-5 year OS in pN2 disease. However, PORT provides no benefit in pN0[ 98 , 99 ].…”

Section: Definition Of Volumes and Organs At Riskmentioning

confidence: 99%

GOECP/SEOR radiotherapy guidelines for small-cell lung cancer

Couñago

Pinta

Gonzalo

et al. 2021

WJCO

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Small cell lung cancer (SCLC) accounts for approximately 20% of all lung cancers. The main treatment is chemotherapy (Ch). However, the addition of radiotherapy significantly improves overall survival (OS) in patients with non-metastatic SCLC and in those with metastatic SCLC who respond to Ch. Prophylactic cranial irradiation reduces the risk of brain metastases and improves OS in both metastatic and non-metastatic patients. The 5-year OS rate in patients with limited-stage disease (non-metastatic) is slightly higher than 30%, but less than 5% in patients with extensive-stage disease (metastatic). The present clinical guidelines were developed by Spanish radiation oncologists on behalf of the Oncologic Group for the Study of Lung Cancer/Spanish Society of Radiation Oncology to provide a current review of the diagnosis, planning, and treatment of SCLC. These guidelines emphasise treatment fields, radiation techniques, fractionation, concomitant treatment, and the optimal timing of Ch and radiotherapy. Finally, we discuss the main indications for reirradiation in local recurrence.

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Benefits of postoperative thoracic radiotherapy for small cell lung cancer subdivided by lymph node stage: a systematic review and meta-analysis

Cited by 7 publications

References 26 publications

hTERT promoter methylation promotes small cell lung cancer progression and radiotherapy resistance

hTERT promoter methylation promotes small cell lung cancer progression and radiotherapy resistance

Clinical insights into small cell lung cancer: Tumor heterogeneity, diagnosis, therapy, and future directions

GOECP/SEOR radiotherapy guidelines for small-cell lung cancer

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