High-Dose Radiotherapy for the Treatment of Inoperable Non–Small Cell Lung Cancer

Sura, S.; Yorke, Ellen; Jackson, Andrew; Rosenzweig, Kenneth E.

doi:10.1097/ppo.0b013e31813ffd7b

Cited by 45 publications

(26 citation statements)

References 21 publications

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“…Unfortunately, outcomes for stage I patients who forgo treatment are dismal, with overall survival ranging from 9 to 14 months [7,22]. Outcomes of conventional EBRT appear to be better than with no treatment but are generally considered to be poor in comparison to either SBRT or surgery, with median overall survival ranging from 21 to 41 months and 5-year survival ranging from 15 to 39% [7,[23][24][25][26]. Our findings therefore suggest that Table 3 Factors associated with the use of SBRT when compared to less aggressive therapy (no treatment or EBRT) on multivariable analysis.…”

Section: Discussionmentioning

confidence: 98%

Racial disparities in the use of SBRT for treating early-stage lung cancer

et al. 2015

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Section: Discussionmentioning

confidence: 98%

Racial disparities in the use of SBRT for treating early-stage lung cancer

et al. 2015

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“…However, the target overall ventilation time in the NIPSV group was met after 3 days. Possible undesired negative effects such as alterations of hemodynamics, appearance of bronchopleural fistula or bronchial stump insufficiency have to be taken into consideration [13,14], as well as the limited or disputable benefit of surgical resection in expected high operative risk [32,33]. Particularly the group with reduced lung capacity bordering on inoperability was the target group of our investigation.…”

Section: Discussionmentioning

confidence: 99%

Non-Invasive Pressure Support Ventilation in Major Lung Resection for High Risk Patients: Does It Matter?

Danner

Koerber²,

Emmert³

et al. 2012

OJTS

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Background and purpose: Patients with severely impaired pulmonary function have an increased operative risk for major lung resection. The clinical benefits of pre-and perioperative, non-invasive pressure support ventilation (NIPSV) have up to now not been extensively evaluated. Patients with severely reduced pulmonary function were investigated in this prospective and randomised single centre clinical trial. Methods: Standard pulmonary evaluation was performed in all patients before major lung resection. To predict postoperative pulmonary function, a lung perfusion-ventilation scan was carried out. All patients enrolled in the study were instructed preoperatively on how to use a NIPSV respirator. After lung resection patients were randomised either for continuation of NIPSV or for standard treatment. Results: Of the 52 patients assessed, 21 patients met the inclusion criteria for the study protocol. Predicted mean postoperative FEV 1 was 1.10 L (range 0.92 -1.27 L). Lobectomy was performed in 14 patients, pneumonectomy in 6 patients and a segmentectomy in 1 patient. No inhospital deaths occurred. Pulmonary complications (reintubation, pneumonia) were more frequent in the NIPSV group than in the control group (3 patients versus 1 patient), without statistical significance (p = 0.31). Conclusions: We observed no mortality and a low morbidity in this high risk group. Postoperative continuation of NIPSV had no beneficial effect on the clinical outcome. Preoperative conditioning with NIPSV, however, seems to be a suitable tool for patients with severely impaired pulmonary function. This study may serve therefore as basis for further investigations for the potential clinical benefits of prophylactic NIPSV in major lung surgery.

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“…Dose intensification can be accomplished by dose escalation (increasing the total radiation dose), acceleration (decreasing the overall treatment time), or a combination of the two. Studies of total dose escalation have demonstrated that when irradiation can be restricted to small volumes of lung tissue using 3DCRT, doses of up to 102.9 Gy could be delivered without excessive pulmonary toxicity [10,11]. Although a strong dose-response relationship was apparent, even at the highest dose levels of over 80 Gy, local failure in the irradiated field remained a significant problem with 5-year local control rates of 49% (including some locally advanced tumors) [10] to 67% [11].…”

Section: Conformal Radiotherapymentioning

confidence: 99%

Alternatives to Surgery for Early Stage Non-Small Cell Lung Cancer-Ready for Prime Time?

Das¹,

Abdelmaksoud

Loo

et al. 2010

Curr. Treat. Options in Oncol.

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Surgery is the standard of care for early stage non-small cell lung cancer (NSCLC), with lobectomy being the most oncologically sound resection. Medically inoperable patients and high-risk surgical candidates require effective alternatives to surgery; even operable patients may opt for less invasive options if they are proven to achieve similar outcomes to surgery. Minimally invasive local treatment modalities including dose-intensified conformal radiation therapy, most notably stereotactic ablative radiotherapy (SABR; also known as stereotactic body radiation therapy), and thermal ablation methods such as radiofrequency ablation (RFA) and microwave ablation (MWA) are emerging as promising treatment options whose roles in the treatment of early stage lung cancer are being defined. Early clinical experience and a rapidly growing body of prospective clinical trials, primarily in medically inoperable patients, are demonstrating encouraging effectiveness and safety outcomes in some cases approaching historical results with surgery. Given the very poor prognosis of the medically inoperable patient population, these alternatives to surgery, particularly SABR, are starting to be considered appropriate first-line therapy in properly selected patients, and prospective cooperative group trials to evaluate and optimize RFA and SABR in specific patient subsets are being conducted. For operable patients, prospective multi-center and cooperative groups trials of SABR are ongoing or completed, and international randomized trials of SABR vs. surgery have been initiated. Thus, promising alternatives to surgery for early stage NSCLC are ready for prime time evaluation in the setting of clinical trials, and participation in ongoing trials for both operable and medically inoperable patients is strongly encouraged.

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High-Dose Radiotherapy for the Treatment of Inoperable Non–Small Cell Lung Cancer

Cited by 45 publications

References 21 publications

Racial disparities in the use of SBRT for treating early-stage lung cancer

Racial disparities in the use of SBRT for treating early-stage lung cancer

Non-Invasive Pressure Support Ventilation in Major Lung Resection for High Risk Patients: Does It Matter?

Alternatives to Surgery for Early Stage Non-Small Cell Lung Cancer-Ready for Prime Time?

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