Yale University School of Medicine, New Haven, CT ... histology as adenocarcinoma, squamous cell carcinoma, or other; and stage as IIIA or IIIB. Kaplan-Meier ...
Proceedings of the 53rd Annual ASTRO Meeting in RT-treated lung than either M867 or combination. Shift of AIF levels from cytoplasm to nucleus has been noticed in western blots. Conclusions: Our data suggested that anti-cancer effect of M867 in combination with RT is through caspase-independent apoptosis, data also suggested that M867 is of protective for normal lung from radiation-induced lung injury. M867 is showing great potential in lung cancer therapy not only in its anti-cancer effects, but also its effect of protection upon normal lung tissue. As for why M867 acts differently in lung cancer and normal lung tissue is unclear so far, further study to reveal the mechanism will surely benefit radiotherapy for lung cancer, and likely other cancers as well. Author Disclosure: B. Li: None. A. Torossian: None. B. Lu: None.
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Prophylactic Cranial Irradiation for High-Risk Patients with Locally Advanced Non-small Cell Lung Cancer
H. S. Park, R. H. Decker, L. D. Wilson, J. B. Yu Yale University School of Medicine, New Haven, CT Purpose/Objective(s): Although prophylactic cranial irradiation (PCI) was found to confer no significant benefit in overall survival or progression-free survival for patients with locally advanced non-small lung cancer (LA-NSCLC) in the RTOG 0241 phase III trial, there is some speculation that PCI may be helpful for certain subpopulations at higher risk for brain metastases, particularly for patients who are younger, have adenocarcinoma, or have bulkier disease. The purpose of this study is to evaluate the effect of PCI on survival among these high-risk patients with LA-NSCLC on a national scale. Materials/Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database from 1988 - 1997, we included all adult patients with primary Stage III NSCLC (excluding sarcoma and lymphoma) and no other lifetime malignancies. Receipt of PCI was determined by a specific variable recorded for only lung and leukemia cases that coded for radiation given to the central nervous system as part of the first course of therapy. Patient age was classified in quintiles (#49, 50 - 59, 60 - 69, 70 - 79, $80); histology as adenocarcinoma, squamous cell carcinoma, or other; and stage as IIIA or IIIB. Kaplan-Meier and Cox proportional hazard model analyses were used to measure the impact of PCI on overall survival (OS) and cancer-specific survival (CSS) in this study population, and hazard ratios for death (HR) and 95% confidence intervals (CI) were recorded. Results: A total of 18,174 patients were included in the analysis, among whom 326 (1.8%) received PCI. Median OS for all patients was 8.5 months. Patients in the youngest two quintiles and those with adenocarcinoma were significantly more likely to receive PCI. After adjustment for age, sex, race, marital status, geography, stage, and histology in multivariate analysis, there was no statistically significant difference between PCI and non-PCI patients in 1-year OS (38% vs. 38%, HR 1.04, 95% CI 0.93 - 1.16) or 1-year CSS (41% vs. 43%, HR 1.11, 95% CI 0.99 - 1.25). In all subgroups by age, histology, and stage, there continued to be no statistically significant difference between PCI and non-PCI patients in 1-year OS or 1-year CSS. Conclusions: Despite the potential theoretical benefit of PCI in patients with LA-NSCLC who may be at higher risk for brain metastases, this population-based analysis suggests no overall or cancer-specific survival benefit for PCI among patients with younger age, adenocarcinoma histology, or bulkier disease. Author Disclosure: H.S. Park: None. R.H. Decker: None. L.D. Wilson: None. J.B. Yu: None.
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Safety and Effectiveness of Stereotactic Body Radiotherapy for Clinically Diagnosed Primary Lung Cancers
K. Sakanaka1, Y. Matsuo1, Y. Nagata2, S. Maki3, K. Shibuya1, K. Takayama4, Y. Norihisa1, M. Narabayashi1, T. Mizowaki1, M. Hiraoka1 1 Department of Radiation Oncology and Image Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan, 2Department of Radiation Oncology, Hiroshima University, Graduate School of Medical Science, Hiroshima, Japan, 3 Department of Radiology Nagoya University Graduate School of Medicine, Nagoya, Japan, 4Department of Radiology, Kobe City Medical Center General Hospital, Kobe, Japan
Purpose/Objective(s): To investigate safety and effectiveness of stereotactic body radiotherapy (SBRT) for clinically diagnosed primary lung cancers. Materials/Methods: This study included 33 patients (34 lesions) treated with SBRT who were clinically diagnosed as a primary Stage I lung cancer (seventh edition of the TNM classification for lung cancer) without histological confirmation from August 1998 to April 2009. The diagnosis was based on radiological findings with a patient’s history as follows; 1) continuous enlargement of tumor size in serial images of computed tomography (CT) with abnormal accumulation of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in 12 patients; 2) continuous enlargement of tumor size in serial images of CT without FDG-PET image in 12 patients (13 lesions); 3) a solitary nodule with abnormal accumulation of FDG-PET in 8 patients; and 4) a large-sized nodule (30 mm) with a suspected clinical history in one patient. For histological confirmation, bronchoscope- and/or CT-guided biopsy were carried out in 22 of 33 patients (67% of patients), although they failed. A biopsy couldn’t be performed due to a poor medical condition in 8 patients or a patient’s refusal in 3 patients. A median age of patients was 77 years (range, 53 89). A median diameter of tumor was 20 mm (range, 10 - 42). All patients received linear accelerator-based SBRT using noncoplanar static 6 - 8 fields. Dose was prescribed to the isocenter with 48 Gy in 4 fractions, except 1 lesion (40 Gy in 4 fractions). Local progression was diagnosed based on continuous enlargement of the tumor on serial CT images for at least 6 months. FDGPET was used as a supportive modality. Overall survival rates (OS), local progression free rate (LPFR) and disease free rate (DFR) were calculated with Kaplan-Meier method. Toxicities were evaluated using the Common Terminology Criteria for Adverse Events version 4.0. Results: The median follow-up period was 32 months (range, 9 - 145). The 1-year OS, LPFR and DFR were 90.5%, 96.6% and 81.6%, respectively. The 3-year OS, LPFR and DFR were 75.7%, 92.8% and 59.9%. The relapse occurred in 13 patients. The initial relapsed sites were a local region in 3 patients, a regional lymph node in 3 patients and a distant organ in 7
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