The Role of High-dose-rate Brachytherapy in the Palliation of Symptoms in Patients with Non-small-cell Lung Cancer: A Systematic Review

Purpose: This review addresses the role of high-dose-rate endobronchial brachytherapy (HDREB) for symptom palliation in patients with non-small-cell lung cancer. Methods and materials: Relevant trials were identified through a systematic search of the literature. Results: Twenty-nine trials were eligible. Six randomized trials involved HDREB alone or with external beam radiation therapy (EBR) or laser therapy. Median and 1-year survival ranged from 4 to 10 months and from 11% to 38%, respectively. Symptoms controlled by HDREB were dyspnea, cough, chest pain, and hemoptysis. Fatal hemoptysis ranged from 7% to 22%. Better overall symptom palliation and fewer retreatments were required in previously untreated patients using EBR alone or EBR with HDREB. Conclusions: EBR alone is more effective than HDREB for symptom palliation in previously untreated patients with endobronchial non-small-cell lung cancer. HDREB with EBR seems to provide better symptom relief than EBR alone. HDREB is recommended for symptomatic patients with recurrent endobronchial obstruction previously treated by EBR, providing it is technically feasible

Lung SBRT guideline 2017.pdf

ABSTRACTObjectives For this guideline, we investigated the effectiveness of radiotherapy with curative intent in medicallyinoperable patients with early-stage non-small-cell lung cancer (nsclc).Methods The guideline was developed by Cancer Care Ontario’s Program in Evidence-Based Care and by theLung Cancer Disease Site Group through a systematic review of mainly retrospective studies, expert consensus, andformal internal and external reviews.Recommendations■■ Stereotactic body radiation therapy (sbrt) with curative intent is an option that should be considered for patientswith early-stage, node-negative, medically inoperable nsclc.Qualifying Statements■■ Because of the high dose per fraction, the planning process and treatment delivery for sbrt require theuse of advanced technology to maintain an appropriate level of safety. Consistent patient positioning and4-dimensional analysis of tumour and critical structure motion during simulation and treatment deliveryare essential.■■ Preliminary results for proton-beam therapy have been promising, but the technique requires furtherclinical study.■■ Recommended fractionation schemes for sbrt should result in a biologically effective dose of 100 or greater bythe linear quadric model, choosing an α/β value of 10 [bed10(LQ) ≥ 100].Qualifying Statements■■ Because of the increased risk of treatment-related adverse events associated with centrally located tumours,consideration of tumour size and proximity to critical central structures is required when determining thedose and fractionation.■■ Examples of dose–fractionation schemes used in the included studies have been provided.■■ Based on the current evidence and the opinion of the authors, radiation doses at bed10(LQ) greater than 146might significantly increase toxicity and should be avoided.■■ Determination of the radiation bed by the linear quadratic model has limitations for the extreme hypofractionatedschemes used in sbrt

The Role of Radiation Therapy in Malignant Pleural Mesothelioma: A Systematic Review

Introduction: Radiation therapy may offer patients presenting with malignant pleural mesothelioma (MPM) symptom palliation and improvements in quality of life. This systematic review will address the role of radiation therapy in the management of MPM. Methods: A thorough systematic search of the literature was conducted for published articles and conference proceedings for applicable abstracts. Relevant trials were selected and assessed. Results: Three small randomized controlled trials compared prophylactic external beam radiation therapy to no radiation therapy for patients with thoracic tracts caused by drainage tubes or diagnostic procedures. None of those trials reported any serious adverse effects. A pooled analysis found no significant reduction in the frequency of procedure tract metastases. Four non-comparative studies have shown that hemithoracic irradiation alone resulted in significant toxicity, including radiation-induced pulmonary fibrosis, radiation pneumonitis, and bronchopleural fistula, without any survival benefit. Few of the identified studies reported on symptom control, and no studies included formal measures of quality of life. Conclusion: There is limited evidence for the role of radiotherapy in the management of patients with MPM. Future studies including radiotherapy for the treatment of such patients should include formal measures of quality of life and symptom control

The Management of Thymoma: A Systematic Review and Practice Guideline

INTRODUCTION: Thymoma is a rare tumor for which there is little randomized evidence to guide treatment. Because of the lack of high-quality evidence, a formal consensus-based approach was used to develop recommendations on treatment. METHODS: A systematic refview of the literature was performed. Recommendations were formed from available evidence and developed through a two-round modified Delphi consensus approach. RESULTS: The treatment recommendations are summarized as follows: Stage I--complete resection of the entire thymus without neoadjuvant or adjuvant therapy. Stage II--complete resection of the entire thymus with consideration of adjuvant radiation for high-risk tumors. Stage IIIA--surgery either initially or after neoadjuvant therapy, or surgery followed by adjuvant therapy. Stage IIIB--treatment may include a combination of chemotherapy, radiation, and/or surgery, or if technically possible, surgery in combination with chemoradiotherapy (concurrent cisplatin based). For bulky tumors, consideration should be given to sequential chemotherapy followed by radiation. Stage IVA--as per stage III, with surgery only if metastases can be resected. Stage IVB--treatment on an individual case basis (no generic recommendations). Recurrent disease--consider surgery, radiation, and/or chemoradiation. Chemoradiation should be considered in all medically inoperable and technically inoperable patients. CONCLUSION: Consensus was achieved on these recommendations, which serve to provide practical guidance to the physician treating this rare disease

The Role of High-dose-rate Brachytherapy in the Palliation of Symptoms in Patients with Non-small-cell Lung Cancer: A Systematic Review

Purpose: This review addresses the role of high-dose-rate endobronchial brachytherapy (HDREB) for symptom palliation in patients with non-small-cell lung cancer. Methods and materials: Relevant trials were identified through a systematic search of the literature. Results: Twenty-nine trials were eligible. Six randomized trials involved HDREB alone or with external beam radiation therapy (EBR) or laser therapy. Median and 1-year survival ranged from 4 to 10 months and from 11% to 38%, respectively. Symptoms controlled by HDREB were dyspnea, cough, chest pain, and hemoptysis. Fatal hemoptysis ranged from 7% to 22%. Better overall symptom palliation and fewer retreatments were required in previously untreated patients using EBR alone or EBR with HDREB. Conclusions: EBR alone is more effective than HDREB for symptom palliation in previously untreated patients with endobronchial non-small-cell lung cancer. HDREB with EBR seems to provide better symptom relief than EBR alone. HDREB is recommended for symptomatic patients with recurrent endobronchial obstruction previously treated by EBR, providing it is technically feasible