22 research outputs found
Are patients with stage III non-small cell lung cancer treated with chemoradiotherapy at risk for cardiac events? Results from a retrospective cohort study
Objectives Dyspnoea is one of the symptoms frequently
encountered after treatment with chemoradiotherapy
(CRT) in stage III non-small cell lung cancer (NSCLC).
Long-term data on mild to moderately severe cardiac
events as underlying cause of dyspnoea in patients with
stage III NSCLC are lacking. Therefore, the incidence of
new cardiac events, with a common terminology criteria
for adverse events (CTCAE) score of ≥2 within 5 years after
diagnosis, were analysed.
Design Retrospective multicentre cohort study of patients
with stage III NSCLC treated with CRT from 2006 to 2013.
The medical files of the treated patients were reviewed.
Outcome measures The primary endpoint of the study
was the incidence of new cardiac events with a CTCAE
score of ≥2 within 5 years after diagnosis. Secondary
endpoint was to identify risk factors associated with the
development of a cardiac event.
Results Four hundred and sixty patients were included
in the study. Of all patients, 150 (32.6%) developed a new
cardiac event. In patients with a known cardiac history
(n=138), 44.2% developed an event. The most common
cardiac events were arrhythmia (14.6%), heart failure
(7.6%) and symptomatic coronary artery disease (6.8%).
Pre-existent cardiac comorbidity (HR 1.96; p<0.01) and
WHO-performance score ≥2 (HR 2.71; p<0.01) were
significantly associated with developing a cardiac event.
The majority of patients did not have pre-existent cardiac
comorbidity (n=322). Elevated WHO/International Society
of Hypertension score was not identified as a significant
predictor for cardiac events.
Conclusion One-third of patients with stage III NSCLC
treated in daily clinical practice develop a new cardiac
event within 5 years after CRT. All physicians confronted
with patients with NSCLC should take cardiac comorbidity
as a serious possible explanation for dyspnoea after
treatment with CRT
The effect of prophylactic cranial irradiation (PCI) for young stage III NSCLC patients: Subgroup analyses of the NVALT-11/DLCRG-02 study
Background: The NVALT-11/DLCRG-02 phase III study compared PCI to observation
after chemo-radiotherapy (RT) for stage III NSCLC and showed a significant decrease
in the cumulative incidence of symptomatic brain metastases (BM) in the PCI arm at
two years (7% vs 27% [HR 0.23]). We here performed exploratory subgroup analyses.
Methods: Two year cumulative incidence rates were calculated and competing risk
regression, with death of any cause as competing risk, was used to examine the time to
symptomatic BM in the following subgr
Nitroglycerin as a radiosensitizer in non-small cell lung cancer: Results of a prospective imaging-based phase II trial
Background: Nitroglycerin is proposed as an agent to reduce tumour hypoxia by improving tumour perfusion. We investigated the potent
Factors determining the effect of prophylactic cranial irradiation (PCI) in patients with stage-III nonsmall cell lung cancer: exploratory subgroup analyses of the NVALT-11/DLCRG-02 phase-III study
LINAC based stereotactic radiosurgery for multiple brain metastases: guidance for clinical implementation
Introduction: Stereotactic radiosurgery (SRS) is a promising treatment option for patients with multiple brain metastases (BM). Recent technical advances have made LINAC based SRS a patient friendly
technique, allowing for accurate patient positioning and a short treatment time. Since SRS is increasingly being used for patients with multiple BM, it remains essential that SRS be performed with the
highest achievable quality in order to prevent unnecessary complications such as radionecrosis. The
purpo
How to optimize the incorporation of immunotherapy in trials for oligometastatic non-small cell lung cancer: a narrative review
Patients with oligometastatic disease (OMD) non-small cell lung cancer (NSCLC) are considered as a subgroup of metastatic NSCLC that can obtain long-term survival or even cure. Oligometastatic refers to a state of a limited number of metastases in a limited number of organs. In clinical guidelines it is stated that patients with oligometastatic NSCLC can benefit from the addition of local radical therapy (LRT) to systemic therapy. With the introduction of minimally invasive surgery, advances in interventional radiology and stereotactic radiotherapy (SRT), LRT is becoming feasible for more and more patients. Furthermore, the introduction of immune checkpoint inhibitors (ICI) in the treatment landscape of advanced NSCLC has improved the survival of these patients. Importantly, the use of ICI in combination with LRT is also of interest in the subgroup of NSCLC patients with OMD. For example, it has been suggested that SRT may synergize with ICI as several preclinical studies reported an increased tumor antigen release, improved antigen presentation, and T-cell infiltration in irradiated tumors. In this narrative review, we describe the current evidence of immunotherapy treatment in OMD NSCLC, with a focus on future trial design and problems that need to be addressed
Immunotherapy in small cell lung cancer: one step at a time: a narrative review
Chemotherapy with or without radiotherapy has been the standard of care for many years for patients with small cell lung cancer (SCLC). Despite exceptionally high responses (up to 80%) with chemotherapy, the majority of patients relapse rapidly within weeks to months after treatment completion. Therefore, new and better treatment options are necessary. Recently, synergistic activity has been reported for the addition of immune checkpoint inhibitors (ICI) to standard platinum-based chemotherapy in the therapeutic strategy of advanced SCLC. For the first time after several decades, a significant survival improvement was achieved for this population. However, the overwhelming majority of patients do not respond to ICI, or relapse rapidly. There is need for better knowledge about the biology, histopathologic features, and molecular pathways of SCLC. This can probably help to identify the optimal predictive biomarkers, which are warranted to develop an individual therapeutic strategy including the rational use of a combination of immunotherapeutic agents. Here, we provide an overview of the rationale for and clinical results of the completed and ongoing trials using different strategies of immunotherapy in SCLC. In addition, opportunities for further improvement of therapies will be discussed, including the addition of radiotherapy, co-stimulatory antibodies, and other immune modifying agents
Fatal Bilateral Pneumonitis After Locoregional Thoracic Chemoradiation in a Transplanted Patient Under Immunosuppressive Therapy
Biological, physical and clinical aspects of cancer treatment with ionising radiatio