Weight Gain in Advanced Non–Small-Cell Lung Cancer Patients During Treatment With Split-Course Concurrent Chemoradiotherapy Is Associated With Superior Survival

Efficacy and Tolerability of Palliative Split-Course Thoracic Chemoradiotherapy for Symptomatic Non–Small Cell Lung Cancer

“…It is worth noting that our results are consistent with our preoperative splitcourse concurrent thoracic chemoradiotherapy experience for radically treated patients, which demonstrated a pathologic complete response rate of 31.5% and minimal esophagitis (4% G2 and 3% G3 by CTCAE v3.0). 10,11 Our palliation rates of cough (45%), dyspnea (63%), hemoptysis (83%), and chest pain (67%) are comparable with other single institution series and randomized trials reported in the literature. For example, in a large single institutional trial using brief split-course radiotherapy without chemotherapy, Reinfuss et al 5 reported successful palliation of cough (54.1%), dyspnea (38.3%), hemoptysis (68.3%), and chest pain (51.1%) using split-course radiotherapy (20 Gy in 5 fractions on weeks 1 and 5).…”

“…At Rush University Medical Center (RUMC), patients with stage IIIA/B disease have been routinely managed with preoperative or definitive split-course concurrent chemoradiotherapy. 9,10 The excellent tolerance of this regimen, particularly with respect to esophagitis, has led to the adoption of this approach for palliative treatment in patients with intact PS. This paradigm allows for both thoracic symptom palliation and the immediate introduction of systemically active cytotoxic chemotherapy.…”

Practical and theoretical implications of weight gain in advanced non-small cell lung cancer patients

“…While weight changes have been used to recalculate treatment doses in advanced non-small cell lung cancer (NSCLC) clinical trials, weight variation duration treatment has not been reported in relation to NSCLC patient outcomes. Gielda et al (7) reported preliminary evidence that weight gain during treatment with chest radiation and concurrent platinum based chemotherapy was associated with longer survival. They evaluated body weight change after completion of chest radiation and concurrent chemotherapy in 54 NSCLC patients who subsequently had resection of their pulmonary neoplasms.…”

“…While these combined observations (7,8) suggest that there is a positive relationship between weight gain during treatment and overall survival in locally stage III NSCLC patients, these were small, retrospective, exploratory, single institution studies which did not define weight changes as a percentage of body weight. Topkan and his colleagues at Baskent University (9) reported results of weight gain and outcome in a retrospective study of 425 good risk stage IIIB NSCLC patients treated with definitive chest radiation and concurrent platinum based chemotherapy.…”

“…Although studies exploring the relationship between tumor regression and weight gain during anti-cancer therapy are needed, the observations that weight gain in NSCLC patients who received concurrent chest radiation and chemotherapy (7)(8)(9) or chemotherapy alone (12) suggest that tumor control reverses mechanisms involved in cancer cachexia. Stene et al have also suggested that achieving tumor control might reverse the catabolic processes involved in cancer cachexia (18).…”