Purpose
: To clarify whether the percentage of pulmonary volume irradiated to >20 Gy (
V20) is related to the incidence and grade of radiation pneumonitis (RP) in cases of lung cancer treated with ...concurrent chemoradiation.
Methods and Materials
: The subjects comprised 71 patients with lung cancer who were treated with conventionally fractionated definitive concurrent chemoradiation. The chemotherapy agents were carboplatin or cisplatin combined with taxane for most patients. Radiotherapy was delivered at 1.8–2.0 Gy fractions once daily to a total of 48–66 Gy (median 60). We analyzed the relation between RP grade and
V20. Univariate and multivariate analyses were performed to assess patient- and treatment-related factors, including age, gender, smoking history, pulmonary function (forced expiratory volume in 1 s), tumor location (upper lobe vs. middle/lower lobe), chemotherapy regimen (platinum + taxane vs. other), total dose, overall radiation periods in addition to
V20.
Results
: With a median follow-up of 7.5 months, an RP grade of 0, 1, 2, 3, and 5 was observed in 16, 35, 17, 1, and 2 patients, respectively; the corresponding mean
V20 values were 20.1%, 22.0%, 26.3%, 27.0%, and 34.5%. The 6-month cumulative incidence of RP greater than Grade 2 was 8.7%, 18.3%, 51%, and 85% in patients with a
V20 of ≤20%, 21–25%, 26–30%, and ≥31%, respectively (
p <0.0001). According to both univariate and multivariate analyses,
V20 was the only factor associated with RP of Grade 2 or greater.
Conclusion
: The incidence and grade of RP are significantly related to the
V20 value. Thus,
V20 appears to be a factor that can be used to predict RP after concurrent chemoradiation for lung cancer.
The aim of this study was twofold: to determine whether the dose-volume metrics are valuable in predicting radiation pneumonitis (RP) in small-cell lung cancer (SCLC) patients treated with ...accelerated hyperfractionated radiotherapy and chemotherapy (AHFRT + CT); and to clarify how AHFRT influences the risk of RP in comparison to conventional once-daily radiotherapy and chemotherapy (QDRT + CT).
Study subjects were 43 patients with SCLC treated with AHFRT + CT. Radiotherapy was delivered at 1.5 Gy/fraction (fr) twice daily to 45 Gy/30 fr/3 weeks. We analyzed the relation between RP incidence and several dosimetric factors. We also compared this series data with our previously published data from lung cancer patients treated with QDRT + CT.
Radiation pneumonitis Grades 1, 2, and 3 were observed in 28 patients, 7 patients, and 1 patient, respectively. Univariate analysis revealed that the percentage of lung volume receiving more than 15 Gy, 20 Gy, and 30 Gy (V15, V20, V30) and normal tissue complication probability were of predictive value for the development of RP. The 12-month cumulative incidences of RP greater than Grade 2 were 0%, 7.1%, 25%, and 42.9% in patients with a V20 of < or =20%, 21-25%, 26-30%, and > or =31%, respectively. These incidences were lower than that of our patients treated with QDRT + CT.
Dosimetric factors are valuable in predicting RP in SCLC patients treated with AHFRT + CT. Regarding the incidence of RP, AHFRT appears to have some advantage over QDRT.
To establish dosimetric predictors of radiation esophagitis (RE) in patients treated with a combination of carboplatin, paclitaxel, and radiotherapy.
Three-dimensional radiotherapy plans of 26 ...patients with non-small-cell lung cancer who received 50-60 Gy of radiotherapy concurrently with weekly administration of carboplatin (AUC 2) and paclitaxel (40-45 mg/m(2)) were reviewed in conjunction with RE. The factors analyzed included the following: percentages of organ volumes receiving >40 Gy (V40), >45 Gy (V45), >50 Gy (V50), and >55 Gy (V55); the length of esophagus (total circumference) treated with >40 Gy (LETT40), >45 Gy (LETT45), >50 Gy (LETT50), and >55 Gy (LETT55); the maximum dose in the esophagus (Dmax); and the mean dose in the esophagus (Dmean). Data were obtained on the basis of superposition algorithm.
All factors except Dmax showed statistical correlation with RE. Good correlations were shown between RE and LETT45 (rho = 0.714) and V45 (rho = 0.686).
LETT45 and V45 appear to be useful dosimetric predictors of RE. It is also suggested that Dmax does not predict RE.
Purpose. We evaluated chronological changes in desire to be told the truth by lung cancer patient. Method. We compared results of a questionnaire for lung cancer patients in our institution, in 1996 ...and in 2001. We obtained 176 responses in 1996 (response rate 71.3%) and 246 in 2001 (respons rate 89.5%). Result. The percentage of patients who wanted to receive a detailed explanation about their disease increased significantly to 69.5% in 2001 from 46.0% in 1996. The percentage of patients who wanted to be told the truth about their disease increased significantly to 91.1% in 2001 from 65.9% in 1996. Even the patients who were elderly or were in advanced stages of the disease wanted to be told the truth.Conclusions. Lung cancer patients who wanted to know the truth clearly increased in this five-year period.
Background: There are a few reports of pulmonary toxicity concerning combined chemotherapy with gemcitabin (GEM) and docetaxel (TXT). In this report, we describe five cases with non-small cell lung ...cancer which developed interstitialpnemonitis as drug adverse reaction under the treatment of combined chemotherapy with GEM (800-1000mg/m2, day 1 & 8) and TXT (50-60mg/m2, day 8) every 3 weeks. Cases: Out of 25 patients treated with combined chemotherapy from August 1999 to April 2001, five patients showedinterstitial pneumonitis, and all showed the same toxicity pattern on days 15-18 in the 2nd course with the same events, such as fever, hypoxia, LDH elevation and interstitial shadow on X-ray film. These patients responded to steroid therapyand recovered quickly. Three of these 5 patients showed cutaneous toxicity (eruption or itch) before pulmonary toxicity.We observed this pulmonary toxicity only in this combination, and not in other combinations such as TXT and other (none out of 46 cases) or GEM and other (none out of 30 cases) in this period. Conclusion: Careful attention should be paid in these rare cases. It is necessary to investigate incidences and mechanismsof this toxicity in the future.
Objective: The aim of this study was to examine the relationship between bronchial hyperresponsiveness, both in vivo and in vitro, and the type of lung cancer (squamous cell or adenocarcinoma).
...Methodology: We measured airway responsiveness by methacholine inhalation test in 33 patients with squamous cell lung cancer and 44 patients with lung adenocarcinoma. In addition, airway smooth muscle reactivity to acetylcholine was measured in vitro in specimens from some patients.
Results: Seventeen of 33 patients with squamous cell cancer and three of 44 patients with adenocarcinoma showed bronchial hyperresponsiveness (BHR). Multiple regression analysis as used to assess the log of the minimum cumulative dose to decrease respiratory conductance vs six variables: cancer phenotype, FEV1 (%predicted), FEV1/FVC (%), smoking pack years, gender and the location of tumour. The phenotype (squamous cell cancer) was the only factor associated with BHR. However, there was no significant difference in airway smooth muscle reactivity to acetylcholine in vitro in bronchial muscle samples from squamous cell cancer patients (n = 6) and adenocarcinoma patients (n = 6).
Conclusion: The present findings suggest that bronchial hyperresponsiveness in patients with squamous cell lung cancer is not determined solely by bronchial smooth muscle hyperreactivity.
A 53-year-old-female underwent hysterectomy and bilateral oophorectomy in September, 1994. Bronchofiberscopic examination was performed because her chest Xray film revealed a solitary nodule in the ...right lung, but there were no malignant findings. After four months of follow-up by chest X-ray, the nodule showed a marked reduction in the size. However in June, 1995, the size of the nodule increased, so she underwent a right upper lobectomy. Histological examination of the uterine and lung lesions revealed leiomyosarcoma, and progesterone receptors was found in the lung metastatic tumor. This case indicates the hormonal dependence of leiomyosarcoma.
A case of a 66-year-old man with primary leiomyosarcoma arising in the lung from right main bronchus was reported. The patient consulted with complaints of cough and hemoptysis and an abnormal shadow ...was found on chest radiograph and cytological examination showed malignant findings. He was admitted to our medical center. Right middle and lower lobectomy was carried out on the suspicious diagnosis of lung cancer. Histologically, the resected specimen disclosed the tumor composed of spindle cells with blunt-ended nuclei and polygonal cells with pleomorphic nuclei. Immunohistological study disclosed that α-smooth-muscle actin was positive and that Vimentin was weakly positive. Ultrastructural findings revealed myofilaments with dense-patch in the cytoplasm of the tumor cells. The patient is alive 19 months postoperatively without any evidence of recurrence or metastasis. Primary pulmonary leiomyosarcoma wasdiagnosed.
In patients with unresectable stage III non-small cell lung cancer, we performed chemotherapy and concurrent thoracic radiotherapy. Thirty-five registered patients were intravenously treated with ...cisplatin (80mg/m2) on day 1 and vindesine (3mg/m2) on days 1, 3 and were irradiated from days 1 to 10 with single doses of 2.5Gy up to a total dosage of 20Gy. Each course lasted 28 days. Patients received 3 courses, and a total dosage of 60Gy was delivered. Response to this treatment was evaluable in terms of results in 35 patients. Twenty-two patients showed partial response (response rate 62.9%), 10 had no change, and 3 cases had progressive disease. In 7.5 to 37.8 months observation, three PR patients are alive for more than 24 months without recurrence, but eight PR patients died of local relapse, and the median survival time was 15.7 months. Throughout this treatment course, grade 4 leukopenia was noted in 66% and grade 3 thrombocytopenia was obserbed in 3%. However all were reversible condition and no treatment-related death was observed. However, two cases died due to complications of pulmonary abscess, which occured in the area of radiation pulmonary fibrosis about one year later after treatment. Although this concurrent chemo-radiotherapy is a tolerable treatment for non-small cell lung cancer and obtained a good response rate, it did not improve the survival rate.
A cytologic examination of pleural lavage was performed before and after pulmonary resection in 102 of 144 patients undergoing curative pulmonary resection for primary lung cancer in the period of ...3.5 years. The cytologic results of pleural lavage were positive for malignant cells in 2 of 102 patients (2.0%) before pulmonary resection and in 5 of the 102 patients (4.9%) after the resection. One of the 2 patients with positive cytology before pulmonary resection was T2 N0M0 (P0), the other was T2 N 2 M0 (P2). Positive cytologic findings on lavage after resection was only seen in patients with adenocarcinoma. No patients with negative hilar and mediastinal nodes for metastasis had positive findings on this cytologic study. In contrast, 2 patients with N1 disease (9.5 %) and 3 patients with N2 disease (10%) had positive cytologic findings.
PDF
