Reirradiation of recurrent node-positive non-small cell lung cancer after previous stereotactic radiotherapy for stage I disease

Nieder, Carsten; Ruysscher, Dirk De; Gaspar, Laurie E.; Gückenberger, Matthias; Mehta, Minesh P.; Cheung, Patrick; Sahgal, Arjun

doi:10.1007/s00066-017-1130-0

Cited by 13 publications

(6 citation statements)

References 49 publications

(56 reference statements)

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“…Among these combined treatments, the combination of platinum-based chemotherapy with intensity-modulated radiotherapy is an effective method for non-small-cell lung cancer (NSCLC) therapy. 4 However, the five-year survival rate for NSCLC, the most common type of lung cancer, 16.1%. 5 Elevated radiation doses during radiotherapy may improve the local control of resistant tumors located in the lung, but it increases the risk of side effects in the lungs and heart.…”

Section: Introductionmentioning

confidence: 99%

<p>Ultra-small gadolinium oxide nanocrystal sensitization of non-small-cell lung cancer cells toward X-ray irradiation by promoting cytostatic autophagy</p>

Li¹,

Li²,

Jiang³

et al. 2019

IJN

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Background Gadolinium-based nanoparticles (GdNPs) have been used as theranostic sensitizers in clinical radiotherapy studies; however, the biomechanisms underlying the radio-sensitizing effects of GdNPs have yet to be determined. In this study, ultra-small gadolinium oxide nanocrystals (GONs) were employed to investigate their radiosensitizing effects and biological mechanisms in non-small-cell lung cancer (NSCLC) cells under X-ray irradiation. Method and materials GONs were synthesized using polyol method. Hydroxyl radical production, oxidative stress, and clonogenic survival after X-ray irradiation were used to evaluate the radiosensitizing effects of GONs. DNA double-strand breakage, cell cycle phase, and apoptosis and autophagy incidences were investigated in vitro to determine the radiosensitizing biomechanism of GONs under X-ray irradiation. Results GONs induced hydroxyl radical production and oxidative stress in a dose- and concentration-dependent manner in NSCLC cells after X-ray irradiation. The sensitizer enhancement ratios of GONs ranged between 19.3% and 26.3% for the NSCLC cells under investigation with a 10% survival rate compared with that of the cells treated with irradiation alone. Addition of 3-methyladenine to the cell medium decreased the incidence rate of autophagy and increased cell survival, supporting the idea that the GONs promoted cytostatic autophagy in NSCLC cells under X-ray irradiation. Conclusion This study examined the biological mechanisms underlying the radiosensitizing effects of GONs on NSCLC cells and presented the first evidence for the radiosensitizing effects of GONs via activation of cytostatic autophagy pathway following X-ray irradiation.

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Section: Introductionmentioning

confidence: 99%

<p>Ultra-small gadolinium oxide nanocrystal sensitization of non-small-cell lung cancer cells toward X-ray irradiation by promoting cytostatic autophagy</p>

Li¹,

Li²,

Jiang³

et al. 2019

IJN

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“…Re-irradiation for symptom palliation has long been used in a large number of different clinical scenarios [1], including advanced lung cancer [2]. It has also been shown that selected patients with non-small cell lung cancer (NSCLC) are able to tolerate high-dose re-irradiation, which aims beyond relief of symptoms [3][4][5]. In contrast to other indications, no randomized trials of lung cancer re-irradiation have been published [6].…”

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confidence: 99%

Provider decision regret—a useful method for analysis of palliative thoracic re-irradiation for lung cancer?

et al. 2020

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Background: The overall usefulness of palliative thoracic re-irradiation depends on the balance between efficacy, survival and toxicity, and is difficult to judge from previous studies. In the absence of patient-reported data, we developed a method for provider decision regret that addresses the question "would we re-irradiate this patient again in light of the known outcome?" Furthermore, we analyzed different reasons for decision regret and defined a subgroup at increased risk.Patients and Methods: A retrospective analysis of 33 patients with lung cancer reirradiated with 17-45 Gy was performed. Reasons for decision regret included reirradiation within the last 30 days of life, immediate radiological progression after re-irradiation (as opposed to stable disease or objective response), radiation myelopathy, any grade 4-5 toxicity, grade 3 pneumonitis, other grade 3 toxicity in the absence of a symptomatic benefit or a time period of at least 3 months without worsening of the treated tumor.Results: Median survival time was 5.2 months (95% confidence interval 3.4-7.0 months). Symptomatic and radiological responses were observed. Provider decision regret was declared in 12 patients (36%, two patients with grade 3 pneumonitis, three patients with a short survival (radiotherapy during the last 30 days of life), seven patients with progression). Decision regret was declared only in patients with ECOG performance status (PS) 2 or 3 and was associated with time interval to re-irradiation <6 months. Conclusion:Our data support the usefulness and acceptable side effect profile of palliative re-irradiation for lung cancer. Patients with reduced PS are at increased risk of futile treatment. Future research should aim at prediction of immediate disease progression (the prevailing cause of decision regret). Evaluation of provider decision regret has the potential to improve the way we learn from retrospective databases and should also be considered for other scenarios where high-quality prospective outcome data are lacking.

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“…Regarding regional failure, an international consortium of expert radiation oncologists discussed treatment recommendations for a case with recurrent node-positive NSCLC after previous SBRT for stage I disease. 12 All the experts agreed that salvage chemoradiotherapy is not contraindicated in such a case. However, no consensus was made regarding radiotherapy (RT) dose and fractionation used for the patient.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Literature Review on Salvage Radiotherapy for Local or Regional Recurrence After Previous Stereotactic Body Radiotherapy for Lung Cancer

Matsuo

2018

Technol Cancer Res Treat

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Purpose:The purpose of this review article was to summarize available data on the efficacy and safety of salvage radiotherapy for isolated local or regional recurrence after prior stereotactic body radiotherapy for lung cancer.Methods:Studies were systematically searched on PubMed, following which suitable papers were selected. Reported outcomes and toxicities were qualitatively reviewed.Results:Nineteen papers, which were retrospective studies based on single institution experiences, were selected. Sixteen papers were on salvage radiotherapy for local tumor recurrence, and the remaining 3 papers evaluated radiotherapy for regional failures after stereotactic body radiotherapy for lung cancer. Patient cohorts in the selected papers seemed very frail with 2-year survival of 30% to 40% after the salvage. Local control was reported to be approximately 60% to 70%, which is worse than that after primary stereotactic body radiotherapy. Reported rates of toxicity grade 3 or worse were considered acceptable. Larger target volume and central tumor localization were suggested as risk factors for severe toxicities. Dosimetric data on patients having toxicities were found to help with considering dose constraints for organs at risk.Conclusion:Based on data from a limited number of articles, salvage radiotherapy is a reasonable treatment option for select patients with local or regional tumor recurrence after prior stereotactic body radiotherapy for lung cancer. Optimal patient selection and dose prescription can be clarified with a larger study that include more data on experiences with salvage radiotherapy.

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Reirradiation of recurrent node-positive non-small cell lung cancer after previous stereotactic radiotherapy for stage I disease

Cited by 13 publications

References 49 publications

<p>Ultra-small gadolinium oxide nanocrystal sensitization of non-small-cell lung cancer cells toward X-ray irradiation by promoting cytostatic autophagy</p>

<p>Ultra-small gadolinium oxide nanocrystal sensitization of non-small-cell lung cancer cells toward X-ray irradiation by promoting cytostatic autophagy</p>

Provider decision regret—a useful method for analysis of palliative thoracic re-irradiation for lung cancer?

A Systematic Literature Review on Salvage Radiotherapy for Local or Regional Recurrence After Previous Stereotactic Body Radiotherapy for Lung Cancer

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