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By Alessandro Franciscon doctor
Kathy S Albain, R Suzanne Swann, Valerie W Rusch, Andrew T Turrisi, Frances A Shepherd, Colum Smith, Yuhchyau Chen, Robert B Livingston, Richard H Feins, David R Gandara, Willard A Fry, Gail Darling, David H Johnson, Mark R Green, Robert C Miller, Joanne Ley, Willliam T Sause, James D Cox
BACKGROUND: Results from phase II studies in patients with stage IIIA non-small-cell lung cancer with ipsilateral mediastinal nodal metastases (N2) have shown the feasibility of resection after concurrent chemotherapy and radiotherapy with promising rates of survival. We therefore did this phase III trial to compare concurrent chemotherapy and radiotherapy followed by resection with standard concurrent chemotherapy and definitive radiotherapy without resection. METHODS: Patients with stage T1-3pN2M0 non-small-cell lung cancer were randomly assigned in a 1:1 ratio to concurrent induction chemotherapy (two cycles of cisplatin [50 mg/m(2) on days 1, 8, 29, and 36] and etoposide [50 mg/m(2) on days 1-5 and 29-33]) plus radiotherapy (45 Gy) in multiple academic and community hospitals...
August 1, 2009: Lancet
A T Turrisi, K Kim, R Blum, W T Sause, R B Livingston, R Komaki, H Wagner, S Aisner, D H Johnson
BACKGROUND: For small-cell lung cancer confined to one hemithorax (limited small-cell lung cancer), thoracic radiotherapy improves survival, but the best ways of integrating chemotherapy and thoracic radiotherapy remain unsettled. Twice-daily accelerated thoracic radiotherapy has potential advantages over once-daily radiotherapy. METHODS: We studied 417 patients with limited small-cell lung cancer. All the patients received four 21-day cycles of cisplatin plus etoposide...
January 28, 1999: New England Journal of Medicine
Cécile Le Péchoux, Alexander Sun, Ben J Slotman, Dirk De Ruysscher, José Belderbos, Elizabeth M Gore
The incidence of brain metastases in patients with lung cancer has increased as a result of improved local and systemic control and better diagnosis from advances in brain imaging. Because brain metastases are responsible for life-threatening symptoms and serious impairment of quality of life, resulting in shortened survival, prophylactic cranial irradiation has been proposed in both small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC) to try to improve incidence of brain metastasis, survival, and eventually quality of life...
July 2016: Lancet Oncology
David Benjamin Shultz, Maximilian Diehn, Billy W Loo
Stereotactic ablative radiotherapy (SABR) is a highly effective treatment for early-stage non-small cell lung cancer. Although direct comparisons from randomized trials are not available, rates of both primary tumor control and distant metastasis are similar between SABR and surgery. Overall survival is lower after SABR compared with surgery, largely reflecting that a primary selection criterion for SABR has been medical inoperability because of decreased cardiopulmonary function and other comorbidities that lead to decreased survival independent of non-small cell lung cancer...
April 2015: Seminars in Radiation Oncology
Sue S Yom
Despite convincing evidence that the principles of accelerated repopulation would open up additional therapeutic opportunities in the treatment of advanced-stage non-small cell lung cancer, this strategy has been generally underexplored. The implementation of accelerated radiotherapy schedules has been hampered by logistical barriers, concerns about acute toxicity, and the prioritization of integrating concurrent chemotherapy into the standard treatment platform. At present, it is unclear to what extent accelerated fractionation will influence future treatment paradigms in non-small cell lung cancer, although technical advances in radiotherapy, allowing higher dose delivery with reduced toxicity, could permit the development of more convenient and tolerable forms of accelerated schedules...
April 2015: Seminars in Radiation Oncology
Ben J Slotman, Harm van Tinteren, John O Praag, Joost L Knegjens, Sherif Y El Sharouni, Matthew Hatton, Astrid Keijser, Corinne Faivre-Finn, Suresh Senan
BACKGROUND: Most patients with extensive stage small-cell lung cancer (ES-SCLC) who undergo chemotherapy, and prophylactic cranial irradiation, have persistent intrathoracic disease. We assessed thoracic radiotherapy for treatment of this patient group. METHODS: We did this phase 3 randomised controlled trial at 42 hospitals: 16 in Netherlands, 22 in the UK, three in Norway, and one in Belgium. We enrolled patients with WHO performance score 0-2 and confirmed ES-SCLC who responded to chemotherapy...
January 3, 2015: Lancet
Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Godehard Friedel, Stefanie Veit, Vanessa Heinrich, Stefan Welter, Wilfried Budach, Werner Spengler, Martin Kimmich, Berthold Fischer, Heinz Schmidberger, Dirk De Ruysscher, Claus Belka, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, Georgios Stamatis, Martin Stuschke
PURPOSE: Concurrent chemoradiotherapy with or without surgery are options for stage IIIA(N2) non-small-cell lung cancer. Our previous phase II study had shown the efficacy of induction chemotherapy followed by chemoradiotherapy and surgery in patients with IIIA(N2) disease and with selected IIIB disease. Here, we compared surgery with definitive chemoradiotherapy in resectable stage III disease after induction. PATIENTS AND METHODS: Patients with pathologically proven IIIA(N2) and selected patients with IIIB disease that had medical/functional operability received induction chemotherapy, which consisted of three cycles of cisplatin 50 mg/m(2) on days 1 and 8 and paclitaxel 175 mg/m(2) on day 1 every 21 days, as well as concurrent chemoradiotherapy to 45 Gy given as 1...
December 10, 2015: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Charles M Rudin, Nofisat Ismaila, Christine L Hann, Narinder Malhotra, Benjamin Movsas, Kim Norris, M Catherine Pietanza, Suresh S Ramalingam, Andrew T Turrisi, Giuseppe Giaccone
PURPOSE: The American College of Chest Physicians (ACCP) produced an evidence-based guideline on treatment of patients with small-cell lung cancer (SCLC). Because of the relevance of this guideline to American Society of Clinical Oncology (ASCO) membership, ASCO reviewed the guideline, applying a set of procedures and policies used to critically examine guidelines developed by other organizations. METHODS: The ACCP guideline on the treatment of SCLC was reviewed for developmental rigor by methodologists...
December 1, 2015: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Ben Slotman, Corinne Faivre-Finn, Gijs Kramer, Elaine Rankin, Michael Snee, Matthew Hatton, Pieter Postmus, Laurence Collette, Elena Musat, Suresh Senan
BACKGROUND: We conducted a randomized trial of prophylactic cranial irradiation in patients with extensive small-cell lung cancer who had had a response to chemotherapy. METHODS: Patients between the ages of 18 and 75 years with extensive small-cell lung cancer were randomly assigned to undergo prophylactic cranial irradiation (irradiation group) or receive no further therapy (control group). The primary end point was the time to symptomatic brain metastases. Computed tomography or magnetic resonance imaging of the brain was performed when any predefined key symptom suggestive of brain metastases was present...
August 16, 2007: New England Journal of Medicine
E Senkus-Konefka, R Dziadziuszko, E Bednaruk-Młyński, A Pliszka, J Kubrak, A Lewandowska, K Małachowski, M Wierzchowski, M Matecka-Nowak, J Jassem
A prospective randomised study compared two palliative radiotherapy schedules for inoperable symptomatic non-small-cell lung cancer (NSCLC). After stratification, 100 patients were randomly assigned to 20 Gy/5 fractions (fr)/5 days (arm A) or 16 Gy/2 fr/day 1 and 8 (arm B). There were 90 men and 10 women aged 47-81 years (mean 66), performance status 1-4 (median 2). The major clinical characteristics and incidence and degree of initial disease-related symptoms were similar in both groups. Treatment effects were assessed using patient's chart, doctor's scoring of symptomatic change and chest X-ray...
March 28, 2005: British Journal of Cancer
F R Macbeth, J J Bolger, P Hopwood, N M Bleehen, J Cartmell, D J Girling, D Machin, R J Stephens, A J Bailey
In patients with non-metastatic but inoperable non-small cell lung cancer that is locally too extensive for radical radiotherapy (RT), but who have good performance status, it is important to determine whether thoracic RT should be the minimum that is required to palliate thoracic symptoms or whether treatment should be more intensive, with the aim of prolonging survival. A total of 509 such patients from 11 centres in the UK between November 1989 and October 1992 were admitted to a trial comparing palliative versus more intensive RT with respect to survival and quality of life...
1996: Clinical Oncology: a Journal of the Royal College of Radiologists
Stein Sundstrøm, Roy Bremnes, Ulf Aasebø, Steinar Aamdal, Reidulv Hatlevoll, Paal Brunsvig, Dag Clement Johannessen, Olbjørn Klepp, Peter M Fayers, Stein Kaasa
PURPOSE: To investigate whether the effect of hypofractionated thoracic radiotherapy (TRT) is comparable to more standard fractionated radiotherapy (RT) in advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: A total of 421 patients with locally advanced stage III or stage IV NSCLC tumors were included. Inclusion criteria were inoperable, disease too advanced for curative radiotherapy, and chest symptoms or central tumor threatening the airways. Patients were randomly assigned to three arms: A, 17 Gy per two fractions (n = 146); B, 42 Gy per 15 fractions (n = 145); and C, 50 Gy per 25 fractions (n = 130)...
March 1, 2004: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Michael Poullis
No abstract text is available yet for this article.
November 2013: Journal of Thoracic Oncology
Andrea Bezjak, Sarah Temin, Gregg Franklin, Giuseppe Giaccone, Ramaswamy Govindan, Melissa L Johnson, Andreas Rimner, Bryan J Schneider, John Strawn, Christopher G Azzoli
PURPOSE: The American Society for Radiation Oncology (ASTRO) produced an evidence-based guideline on external-beam radiotherapy for patients with locally advanced non-small-cell lung cancer (NSCLC). Because of its relevance to the American Society of Clinical Oncology (ASCO) membership, ASCO endorsed the guideline after applying a set of procedures and a policy that are used to critically examine and endorse guidelines developed by other guideline development organizations. METHODS: The ASTRO guideline was reviewed by ASCO content experts for clinical accuracy and by ASCO methodologists for developmental rigor...
June 20, 2015: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Olivier Chapet, Feng-Ming Kong, Leslie E Quint, Andrew C Chang, Randall K Ten Haken, Avraham Eisbruch, James A Hayman
PURPOSE: Accurate delineation of the mediastinal and hilar lymph node regions is essential for a reproducible definition of target volumes used in conformal irradiation of non-small-cell lung cancer. The goal of this work was to generate a consensus to delineate these nodal regions based on definitions from the American Joint Committee on Cancer. METHODS AND MATERIALS: A dedicated thoracic radiologist, thoracic surgeon, medical physicist, and three radiation oncologists were gathered to generate a three-dimensional radiologic description for the mediastinal and hilar nodal regions on axial CT scans...
September 1, 2005: International Journal of Radiation Oncology, Biology, Physics
Alysa Fairchild, Kristin Harris, Elizabeth Barnes, Rebecca Wong, Stephen Lutz, Andrea Bezjak, Patrick Cheung, Edward Chow
PURPOSE: The optimal dose of radiotherapy (RT) to palliate symptomatic advanced lung cancer is unclear. We systematically reviewed randomized controlled trials (RCTs) of palliative thoracic RT. METHODS: RCTs comparing two or more dose fractionation schedules were reviewed using the random-effects model of a freely available information management system. The relative risk and 95% CI for each outcome were presented in Forrest plots. Exploratory analysis comparing dose schedules after conversion to the time-adjusted biologically equivalent dose (BED) was performed to investigate for a dose-response relationship...
August 20, 2008: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Jeffrey D Bradley, Rebecca Paulus, Ritsuko Komaki, Gregory Masters, George Blumenschein, Steven Schild, Jeffrey Bogart, Chen Hu, Kenneth Forster, Anthony Magliocco, Vivek Kavadi, Yolanda I Garces, Samir Narayan, Puneeth Iyengar, Cliff Robinson, Raymond B Wynn, Christopher Koprowski, Joanne Meng, Jonathan Beitler, Rakesh Gaur, Walter Curran, Hak Choy
BACKGROUND: We aimed to compare overall survival after standard-dose versus high-dose conformal radiotherapy with concurrent chemotherapy and the addition of cetuximab to concurrent chemoradiation for patients with inoperable stage III non-small-cell lung cancer. METHODS: In this open-label randomised, two-by-two factorial phase 3 study in 185 institutions in the USA and Canada, we enrolled patients (aged ≥ 18 years) with unresectable stage III non-small-cell lung cancer, a Zubrod performance status of 0-1, adequate pulmonary function, and no evidence of supraclavicular or contralateral hilar adenopathy...
February 2015: Lancet Oncology
Ankit Modh, Andreas Rimner, Eric Williams, Amanda Foster, Mihir Shah, Weiji Shi, Zhigang Zhang, Daphna Y Gelblum, Kenneth E Rosenzweig, Ellen D Yorke, Andrew Jackson, Abraham J Wu
PURPOSE: Stereotactic body radiation therapy (SBRT) in central lung tumors has been associated with higher rates of severe toxicity. We sought to evaluate toxicity and local control in a large cohort and to identify predictive dosimetric parameters. METHODS AND MATERIALS: We identified patients who received SBRT for central tumors according to either of 2 definitions. Local failure (LF) was estimated using a competing risks model, and multivariate analysis (MVA) was used to assess factors associated with LF...
December 1, 2014: International Journal of Radiation Oncology, Biology, Physics
Patrick Cheung, Sergio Faria, Shahida Ahmed, Pierre Chabot, Jonathan Greenland, Elizabeth Kurien, Islam Mohamed, James R Wright, Helmut Hollenhorst, Catherine de Metz, Holly Campbell, Thi Toni Vu, Anand Karvat, Elaine S Wai, Yee C Ung, Glenwood Goss, Frances A Shepherd, Patti O'Brien, Keyue Ding, Chris O'Callaghan
BACKGROUND: A multi-institutional phase II trial was performed to assess a hypofractionated accelerated radiotherapy regimen for early stage non-small cell lung cancer (NSCLC) in an era when stereotactic body radiotherapy was not widely available. METHODS: Eighty patients with biopsy-proven, peripherally located, T1-3 N0 M0 NSCLC were enrolled. Eligible patients received 60 Gy in 15 fractions using a three-dimensional conformal technique without inhomogeneity correction...
August 2014: Journal of the National Cancer Institute
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