Hyperfractionated Irradiation with 3 Cycles of Induction Chemotherapy in Stage IIIA‐N2 Lung Cancer

Chen, Fengshi; Okubo, Kan; Sonobe, Makoto; Shibuya, Kazuhiko; Matsuo, Yukinori; Kim, Young Hak; Yanagihara, Kazuhiro; Bando, Toru; Date, Hiroshi

doi:10.1007/s00268-012-1747-1

Cited by 10 publications

(4 citation statements)

References 26 publications

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“…In terms of tumor histology, a significantly higher percentage of patients with squamous cell carcinoma had Ef2 or Ef3 than those with non-squamous cell carcinoma (85.1% vs. 59.3%, P=0.018). Similar results have been reported previously (12). The mechanism underlying this result is unclear, however, and further investigation is required.…”

Section: Figuresupporting

confidence: 90%

“…Another approach is to administer induction chemotherapy or chemoradiotherapy (ICRT) before the surgical procedure in order to control microscopic metastases and render the tumor completely resectable. Some analyses have demonstrated that ICRT improved the pathological complete response (CR) and local control rates in comparison to chemotherapy alone (10)(11)(12)(13)(14). ICRT has the potential to reduce the tumor size, achieve complete resection, eradicate micrometastases, and extract occult metastasis by performing a re-staging examination after ICRT (15).…”

Section: Introductionmentioning

confidence: 99%

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Feasibility and prognostic benefit of induction chemoradiotherapy followed by surgery in patients with locally advanced non-small cell lung cancer

Tanahashi¹,

Niwa²,

Yukiue³

et al. 2020

J Thorac Dis

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Background: The optimal treatment for patients with resectable non-small cell lung cancer (NSCLC) involving adjacent organs (T3 or T4) and/or cN2 remains unclear. We investigated whether or not induction chemoradiotherapy (ICRT) followed by surgery improves the survival. Methods: We retrospectively analyzed 84 patients with NSCLC involving the adjacent organs and/or cN2 who underwent ICRT followed by surgery at our hospital from 2006 to 2018. Presurgical treatment consisted of 2 courses of platinum-doublet and concurrent radiotherapy (40-50 Gy) to the tumor and involved field.Results: All 84 patients completed ICRT. One patient died after completion of ICRT due to bacterial pneumonia. Radiological responses to ICRT were a complete response (CR), n=1; partial response (PR), n=48; stable disease (SD), n=32; and progressive disease (PD), n=2 (overall response rate: 58.3%). Eightyone patients underwent radical surgery. The procedures included lobectomy, n=66; bilobectomy, n=7; pneumonectomy, n=6; and segmentectomy, n=2 (including 49 extended resections). Seventy-three patients (90%) underwent complete resection. The postoperative morbidity rate was 30%. The 30-and 90-day mortality rates were 1.2% and 2.4%, respectively. A pathological CR (Ef3) and major response (Ef2) were achieved in 17 (21.0%) and 38 (46.9%) patients, respectively; a minor response (Ef1) was observed in 26 (32%). The 5-year overall survival (OS) and recurrence-free survival (RFS) rates were 58.0% and 45.6%, respectively. The median survival time was 73.2 months. Based on the response to ICRT, patients with radiological CR or PR showed better 5-year OS than those with SD (63.7% vs. 40.0%, P=0.020). Patients with Ef3 or Ef2 demonstrated a much better 5-year OS than those with Ef1 (65.0% vs. 24.4%, P=0.005). Conclusions: ICRT followed by surgery for patients with NSCLC involving the adjacent organs and/or cN2 was feasible and improved the survival. A CR/PR or Ef2/Ef3 after ICRT led to a better prognosis.

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Section: Figuresupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Feasibility and prognostic benefit of induction chemoradiotherapy followed by surgery in patients with locally advanced non-small cell lung cancer

Tanahashi¹,

Niwa²,

Yukiue³

et al. 2020

J Thorac Dis

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“…Our previous studies have shown that prognosis of patients with advanced nonsmall cell lung cancer (NSCLC), especially stage IIIA NSCLC patients with mediastinal lymph node metastasis, can be improved using multimodal therapy . However, cancer progression during chemotherapy or relapse after postoperative therapy often occurs probably because of the induction of chemoresistance through some mechanisms.…”

Section: Introductionmentioning

confidence: 99%

Hypoxia‐inducible factor 1 promotes chemoresistance of lung cancer by inducing carbonic anhydrase IX expression

et al. 2016

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Lung cancer treatment is difficult owing to chemoresistance. Hypoxia‐inducible factor 1 (HIF‐1) and HIF‐1‐induced glycolysis are correlated with chemoresistance; however, this is not evident in lung cancer. We investigated the effect of HIF‐1α and carbonic anhydrase IX (CAIX), a transmembrane protein neutralizing intracellular acidosis, on chemoresistance and prognosis of lung cancer patients after induction chemoradiotherapy. Associations of HIF‐1α, glucose transporter 1 (GLUT1), and CAIX with chemoresistance of lung cancer were investigated using A549 lung cancer cells under normoxia or hypoxia in vitro. HIF‐1α‐induced reprogramming of glucose metabolic pathway in A549 cells and the effects of HIF‐1 and CAIX on the cytotoxicity of vinorelbine were investigated. Immunohistochemical analyses were performed to determine HIF‐1α, GLUT1, and CAIX expression levels in cancer specimens from lung cancer patients after induction chemoradiotherapy. Hypoxia induced HIF‐1α expression in A549 cells. Moreover, hypoxia induced GLUT1 and CAIX expression in A549 cells in a HIF‐1‐dependent manner. Glucose metabolic pathway was shifted from oxidative phosphorylation to glycolysis by inducing HIF‐1α in A549 cells. HIF‐1 and CAIX induced chemoresistance under hypoxia, and their inhibition restored the chemosensitivity of A549 cells. The expression levels of HIF‐1α, GLUT1, and CAIX were associated with poor overall survival of lung cancer patients after induction chemoradiotherapy. HIF‐1 and CAIX affected the chemosensitivity of A549 cells and prognosis of lung cancer patients. Therefore, inhibition of HIF‐1 and CAIX might improve prognosis of lung cancer patients after induction chemoradiotherapy. Further analysis might be helpful in developing therapies for lung cancer.

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“…43 The management of these patients was based on the data from phase III trials for unresectable locally advanced NSCLC, which suggest that a combination of a platinum and third-generation anti-cancer agent with concurrent radiation may become established as the standard treatment for this population. [43][44][45][46][47][48][49] Of note, while a retrospective study 49 has suggested the superiority of chemoradiotherapy over chemotherapy in the induction setting, this result has not been demonstrated prospectively, because randomized studies to compare these two approaches had to be terminated due to the lack of interested participants (Radiation Therapy Oncology Group-0412) or slow accrual (The West Japan Thoracic Oncology Group-9903). 50,51 The Lung Intergroup Trial 0139 was performed as a large randomized phase III trial for mainly resectable N2 disease, but failed to demonstrate the benefit of addition of surgery after chemoradiotherapy in the entire population with 5-year OS of 27.2% and 20.3% in patients treated by induction chemoradiotherapy followed by surgery or by definitive chemoradiotherapy, respectively.…”

Section: Management Of Nsclc With Mediastinal Lymph Node Metastasismentioning

confidence: 99%

MDT lung cancer care: Input from the Surgical Oncologist

2015

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Although there have been many advancements in the multidisciplinary management of non-small cell lung cancer (NSCLC), surgery remains the primary modality of choice for resectable lung cancer when the patient is able to tolerate lung resection physiologically. There have been recent advances in surgical diagnosis and treatment of lung cancer. Increasing use of low-dose computed tomography (CT) screening for lung cancer has resulted in increased detection of small peripheral nodules or semi-solid ground glass opacities. Here, we review different modalities of localization techniques that have been used to aid surgical excisional biopsy when needle biopsy has failed to provide tissue diagnosis. We also report on the current debates regarding the use of sublobar resections for Stage I NSCLC as well as the surgical management of locally advanced NSCLC. Finally, we discuss the complex surgical management of T4 NSCLC lung cancers.

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Hyperfractionated Irradiation with 3 Cycles of Induction Chemotherapy in Stage IIIA‐N2 Lung Cancer

Abstract: This trimodal therapy was effective and well tolerated, and it is an acceptable therapeutic option for patients with locally advanced stage IIIA-N2 NSCLC. Patients without persistent multiple-station N2 showed promising survival.

Cited by 10 publications

References 26 publications

Feasibility and prognostic benefit of induction chemoradiotherapy followed by surgery in patients with locally advanced non-small cell lung cancer

Feasibility and prognostic benefit of induction chemoradiotherapy followed by surgery in patients with locally advanced non-small cell lung cancer

Hypoxia‐inducible factor 1 promotes chemoresistance of lung cancer by inducing carbonic anhydrase IX expression

MDT lung cancer care: Input from the Surgical Oncologist

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