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  • Wiley  (8)
  • Bi, Nan  (8)
  • 1
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    Online Resource
    Treatment outcomes of patients with stage III non–small cell lung cancer and interstitial lung diseases receiving intensity‐modulated radiation therapy: A single‐center experience of 85 cases
    Wiley ; 2022
    In:  Thoracic Cancer Vol. 13, No. 11 ( 2022-06), p. 1583-1591
    Details
    In: Thoracic Cancer, Wiley, Vol. 13, No. 11 ( 2022-06), p. 1583-1591
    Abstract: Whether curative‐intent radiotherapy could be safely applied to lung cancer patients with interstitial lung diseases (ILD) remains unclear. We aim to evaluate radiation induced lung toxicities (RILTs) and the efficacy of intensity‐modulated radiotherapy (IMRT) in these patients. ILD is characterized by inflammation or fibrosis in the interstitial tissue of the lung. Materials and Methods Stage III non–small cell lung cancer (NSCLC) and ILD patients treated with curative‐intent IMRT between 2010 and 2019 were retrospectively reviewed. Pre‐radiation computed tomography (CT) was scored according to a thin‐section CT scoring system for idiopathic pulmonary fibrosis. Results A total of 85 of 1261 stage III NSCLC patients were found with ILD. Seventeen (20%) of them developed G3+ (greater than or equal to grade 3) RILTs. The incidence abruptly dropped to 11.1%, 3.8%, and 0% for patients with honeycombing score ≤1, V20  〈 20%, or both, respectively. Multivariate analysis showed that honeycombing score  〉 1 and V20 ≥20% were independently associated with higher risk of G3+ RILTs. The median overall survival (OS) and progression‐free survival (PFS) were 14.0 months and 7.4 months in the whole group, whereas 26.5 months and 10.6 months in the low‐risk group (patients with honeycombing score  〈 1 and V20  〈 20%). In the univariate analysis for overall survival, G3+ RILTs were evaluated as risk factors ( p  = 0.026) and low‐risk group as the only protective factor ( p  = 0.063). In the multivariate analysis, G3+ RILTs were the only independent risk factor for OS. Conclusion Honeycombing score  〉 1 and V20 ≥20% were associated with high incidence of RILTs. However, patients with low risk might benefit from IMRT with acceptable toxicities and durable OS.
    Type of Medium: Online Resource
    ISSN: 1759-7706 , 1759-7714
    URL: Issue
    URL: Article
    DOI: 10.1111/tca.v13.11
    DOI: 10.1111/1759-7714.14418
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2559245-2
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  • 2
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    Concurrent chemoradiotherapy versus radiotherapy alone for patients with locally advanced esophageal squamous cell carcinoma in the era of intensity modulated radiotherapy: a propensity score‐matched analysis
    Wiley ; 2021
    In:  Thoracic Cancer Vol. 12, No. 12 ( 2021-06), p. 1831-1840
    Details
    In: Thoracic Cancer, Wiley, Vol. 12, No. 12 ( 2021-06), p. 1831-1840
    Abstract: To investigate the survival benefit of concurrent chemoradiotherapy (CCRT) for patients with locally advanced esophageal squamous cell carcinoma (ESCC) during the years of intensity‐modulated radiotherapy (IMRT). Methods Medical records of 1089 patients with ESCC who received IMRT from January 2005 to December 2017 were retrospectively reviewed. A total of 617 patients received CCRT, 472 patients received radiotherapy (RT) alone. Propensity score matching (PSM) method was used to eliminate baseline differences between the two groups. Survival and toxicity profile were evaluated afterward. Results After a median follow‐up time of 47.9 months (3.2–149.8 months), both overall survival (OS) and progression‐free survival (PFS) of the CCRT group were better than those of the RT alone group, either before or after PSM. After PSM, the 1‐, 3‐, and 5‐year OS of RT alone and CCRT groups were 59.0% versus 70.2%, 27.7% versus 40.5% and 20.3% versus 33.1%, respectively ( p   〈  0.001). The 1‐, 3‐, and 5‐year PFS were 39.4% versus 49.0%, 18.3% versus 30.4% and 10.5% versus 25.0%, respectively ( p   〈  0.001). The rates of ≥ grade 3 leukopenia and radiation esophagitis in the CCRT group were higher than that of RT alone group ( p   〈  0.05). There was no significant difference in the probability of radiation pneumonitis between the two groups ( p  = 0.167). Multivariate Cox analysis indicated that female, EQD2 ≥60 Gy and concurrent chemotherapy were favorable prognostic factors for both OS and PFS. Conclusions Concurrent chemotherapy can bring survival benefits to patients with locally advanced ESCC receiving IMRT. For patients who cannot tolerate concurrent chemotherapy, RT alone is an effective alternative with promising results.
    Type of Medium: Online Resource
    ISSN: 1759-7706 , 1759-7714
    URL: Issue
    URL: Article
    DOI: 10.1111/tca.v12.12
    DOI: 10.1111/1759-7714.13971
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 3
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    Thoracic radiation therapy improves the overall survival of patients with extensive-stage small cell lung cancer with distant metastasis
    Wiley ; 2011
    In:  Cancer Vol. 117, No. 23 ( 2011-12-01), p. 5423-5431
    Details
    In: Cancer, Wiley, Vol. 117, No. 23 ( 2011-12-01), p. 5423-5431
    Type of Medium: Online Resource
    ISSN: 0008-543X
    URL: Issue
    URL: Article
    DOI: 10.1002/cncr.v117.23
    DOI: 10.1002/cncr.26206
    Language: English
    Publisher: Wiley
    Publication Date: 2011
    detail.hit.zdb_id: 1479932-7
    detail.hit.zdb_id: 1429-1
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  • 4
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    Impact of thoracic radiation therapy after chemotherapy on survival in extensive‐stage small cell lung cancer: A propensity score‐matched analysis
    Wiley ; 2019
    In:  Thoracic Cancer Vol. 10, No. 4 ( 2019-04), p. 799-806
    Details
    In: Thoracic Cancer, Wiley, Vol. 10, No. 4 ( 2019-04), p. 799-806
    Abstract: The role of thoracic radiation therapy (TRT) after chemotherapy (CHT) in extensive‐stage small cell lung cancer (ES‐SCLC) has not been well defined. We investigated whether intensity‐modulated radiotherapy (IMRT) improves outcomes in ES‐SCLC after CHT compared to CHT alone. Methods A total of 292 patients who reached a complete response (CR), partial response (PR), or stable disease (SD) after CHT were assigned into groups: CHT + TRT and CHT alone. Propensity score matching was used to balance patient groups ( n  = 72 each). Results The five‐year overall survival (OS: 12.3% vs. 3.6%; P   〈  0.001) and progression‐free survival (PFS: 3.2% vs. 1.7%; P  = 0.006) rates were significantly higher in the CHT + TRT group. This data was confirmed in the matched samples (5‐year OS: 10.5% vs. 1.6%, P 〈  0.001; PFS: 4.3% vs. 0.0%, P  = 0.023). The overall ( P  = 0.002) and locoregional ( P   〈  0.001) recurrence rates in the CHT + TRT group were significantly lower than in the CHT group. Univariate analysis showed that response evaluation after CHT and TRT were significant prognostic factors of OS. Multivariate analyses revealed that N Stage 0–1 ( P  = 0.02), 〉 6 cycles of CHT ( P  = 0.042), CR + PR after CHT ( P   〈  0.001), and TRT ( P 〈  0.001) were independently associated with longer OS compared to CHT alone. Conclusion TRT using IMRT is strongly correlated with improved OS and PFS in ES‐SCLC patients reaching CR, PR or SD after CHT. A multicenter, randomized phase III clinical trial is needed to confirm these findings.
    Type of Medium: Online Resource
    ISSN: 1759-7706 , 1759-7714
    URL: Issue
    URL: Article
    DOI: 10.1111/tca.2019.10.issue-4
    DOI: 10.1111/1759-7714.13001
    Language: English
    Publisher: Wiley
    Publication Date: 2019
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  • 5
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    Clinical outcomes and radiation pneumonitis after concurrent EGFR ‐tyrosine kinase inhibitors and radiotherapy for unresectable stage III non‐small cell lung cancer
    Wiley ; 2021
    In:  Thoracic Cancer Vol. 12, No. 6 ( 2021-03), p. 814-823
    Details
    In: Thoracic Cancer, Wiley, Vol. 12, No. 6 ( 2021-03), p. 814-823
    Abstract: Concurrent epidermal growth factor receptor‐tyrosine kinase inhibitors (EGFR‐TKI) with radiotherapy in patients with EGFR ‐mutant unresectable stage III non‐small cell lung cancer (NSCLC) might improve survival. However, both treatments carry a potential risk of pneumonitis. Methods Between May 2012 and December 2017, patients with unresectable stage III NSCLC treated with concurrent radiotherapy and EGFR‐TKI were enrolled in this retrospective study. The baseline characteristics were evaluated to determine correlations with toxicity development. Results Among 45 eligible patients, 20 (44.4%) had an EGFR mutation and 44 (97.8%) received 50–66 Gy of radiotherapy. The median follow‐up was 62.7 months. The median progression free survival (PFS) and overall survival (OS) for patients with EGFR ‐mutations were 27.9 (95% CI: 18.7–37.2) and 49.7 (95% CI: 27.7–71.8) months, and 13.8 (95% CI: 8.8–18.9) and 31.1 (95% CI: 9.8–52.4) months for EGFR wild‐type/unknown patients. A total of 17 patients (37.7%) developed radiation pneumonitis/pneumonitis (14 grade 2, 3 grade 3). In 16 patients, pneumonitis occurred within the radiation field and one patient had bilateral pneumonitis. The median time from the initial radiotherapy to pneumonitis was 74 days. Logistic regression analysis revealed a trend between the time of EGFR‐TKI and the development of G2+ pneumonitis. For late toxicity, only two patients had G2+ fibrosis. The daily dyspnea symptoms of patients with G2+ pneumonitis recovered significantly after the phase of pneumonitis ( P = 0.007). Conclusions Combined EGFR‐TKI and radiotherapy showed favorable survival in EGFR ‐mutant patients with inoperable stage III NSCLC, with a 6.7% incidence of grade 3 radiation pneumonitis/pneumonitis, despite a higher incidence of mild‐to‐moderate radiation pneumonitis. Key points Significant findings of the study We evaluated the outcomes and radiation pneumonitis after EGFR‐TKI during interval radiotherapy. EGFR‐TKI plus radiotherapy increased survival in patients with EGFR ‐mutant inoperable stage III NSCLC. The mild‐to‐moderate radiation pneumonitis incidence increased but no grade 4–‐5 adverse events occurred. What this study adds The combination of EGFR‐TKI and radiotherapy might carry a risk of pneumonitis; however, there are limited data concerning dose constraints. Our results showed a slightly higher incidence of mild or moderate radiation pneumonitis by strict dose limitation.
    Type of Medium: Online Resource
    ISSN: 1759-7706 , 1759-7714
    URL: Issue
    URL: Article
    DOI: 10.1111/tca.v12.6
    DOI: 10.1111/1759-7714.13816
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 6
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    Development and validation of a prediction model using molecular marker for long‐term survival in unresectable stage III non‐small cell lung cancer treated with chemoradiotherapy
    Wiley ; 2022
    In:  Thoracic Cancer Vol. 13, No. 3 ( 2022-02), p. 296-307
    Details
    In: Thoracic Cancer, Wiley, Vol. 13, No. 3 ( 2022-02), p. 296-307
    Abstract: This study aimed to establish a predictive nomogram integrating epidermal growth factor receptor ( EGFR ) mutation status for 3‐ and 5‐year overall survival (OS) in unresectable/inoperable stage III non‐small cell lung cancer (NSCLC) treated with definitive chemoradiotherapy. Methods A total of 533 stage III NSCLC patients receiving chemoradiotherapy from 2013 to 2017 in our institution were included and divided into training and testing sets (2:1). Significant factors impacting OS were identified in the training set and integrated into the nomogram based on Cox proportional hazards regression. The model was subject to bootstrap internal validation and external validation within the testing set and an independent cohort from a phase III trial. The accuracy and discriminative capacity of the model were examined by calibration plots, C‐indexes and risk stratifications. Results The final multivariate model incorporated sex, smoking history, histology (including EGFR mutation status), TNM stage, planning target volume, chemotherapy sequence and radiation pneumonitis grade. The bootstrapped C‐indexes in the training set were 0.688, 0.710 for the 3‐ and 5‐year OS. For external validation, C‐indexes for 3‐ and 5‐year OS were 0.717, 0.720 in the testing set and 0.744, 0.699 in the external testing cohort, respectively. The calibration plots presented satisfying accuracy. The derivative risk stratification strategy classified patients into distinct survival subgroups successfully and performed better than the traditional TNM staging. Conclusions The nomogram incorporating EGFR mutation status could facilitate survival prediction and risk stratification for individual stage III NSCLC, providing information for enhanced immunotherapy decision and future trial design.
    Type of Medium: Online Resource
    ISSN: 1759-7706 , 1759-7714
    URL: Issue
    URL: Article
    DOI: 10.1111/tca.v13.3
    DOI: 10.1111/1759-7714.14218
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 7
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    Postoperative radiotherapy for pathological stage IIIA‐N2 non‐small cell lung cancer with positive surgical margins
    Wiley ; 2021
    In:  Thoracic Cancer Vol. 12, No. 2 ( 2021-01), p. 227-234
    Details
    In: Thoracic Cancer, Wiley, Vol. 12, No. 2 ( 2021-01), p. 227-234
    Abstract: The aim of this study was to evaluate the efficacy of postoperative radiotherapy (PORT) in stage pIIIA‐N2 non‐small cell lung cancer (NSCLC) patients with positive surgical margins. Methods Between January 2003 and December 2015, patients who had undergone lobectomy or pneumonectomy plus mediastinal lymph node dissection or systematic sampling in our single institution were retrospectively reviewed. Those with pIIIA‐N2 NSCLC and positive surgical margins were enrolled into the study. The Kaplan‐Meier method was used for survival analysis, and the log‐rank test was used to analyze differences between the groups. Univariate and multivariate analyses using Cox proportional hazards regression models were performed to evaluate potential prognostic factors for OS. Statistically significant difference was set as P   〈  0.05. Results Of all the 1547 patients with pIIIA‐N2 NSCLC reviewed, 113 patients had positive surgical margins, including 76 patients with R1 resection and 37 with R2 resection. The median overall survival (OS) was 28.3 months in the PORT group and 22.6 months in the non‐PORT group ( P = 0.568). Subset analysis showed that for patients with R1 resection, the median OS was 52.4 months in the PORT group which was nonsignificantly longer than that of 22.6 months in the non‐PORT group ( P = 0.127), whereas PORT combined with chemotherapy could significantly improve OS, with a median OS of 52.4 months versus 17.2 months ( P = 0.027). For patients with R2 resection, PORT made no significant difference in OS (17.6 vs. 63.8 months, P = 0.529). Conclusions For pIIIA‐N2 NSCLC patients with positive surgical margins, PORT did not improve OS, but OS was improved in those patients who underwent R1 resection combined with chemotherapy. Key points Significant findings of the study Significant findings of the study: Postoperative radiotherapy (PORT) has been recommended to treat patients with positive surgical margins. However, the existing evidence is controversial and high‐level evidence is lacking. What this study adds What this study adds: The PORT group had markedly, but not statistically significant, longer median OS compared with the non‐PORT group in patients with R1 resection. OS was significantly longer in the patients with R1 resection receiving adjuvant CRT than the surgery alone group.
    Type of Medium: Online Resource
    ISSN: 1759-7706 , 1759-7714
    URL: Issue
    URL: Article
    DOI: 10.1111/tca.v12.2
    DOI: 10.1111/1759-7714.13749
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 8
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    Role of radiotherapy in treating patients with primary malignant mediastinal non‐seminomatous germ cell tumor: A 21‐year experience at a single institution
    Wiley ; 2015
    In:  Thoracic Cancer Vol. 6, No. 4 ( 2015-07), p. 399-406
    Details
    In: Thoracic Cancer, Wiley, Vol. 6, No. 4 ( 2015-07), p. 399-406
    Abstract: The aim of this study was to investigate the clinical characteristics and outcomes of patients with primary malignant mediastinal non‐seminomatous germ cell tumor ( MMNSGCT ) by comparing the efficacies of different treatment modalities. Methods The charts of 62 consecutive patients with MMNSGCT between 1990 and 2010 were reviewed. Analyses included K aplan‐ M eier survival and Cox multivariate regression. Results There was sufficient data of 61 patients for inclusion in the study. The median age was 25 years. At diagnosis, 35 patients had tumors located in the mediastinum, 26 had lung and/or distant metastases. At a median follow‐up of 47.2 months, 32 patients had died and 43 had developed progressive disease. The one, three, and five‐year overall survival ( OS ) and progression‐free survival ( PFS ) rates were 72.1%, 50.8%, 49.2% and 47.5%, 32.8%, 32.8%, respectively. Patients who received radiotherapy in the primary treatment regimen showed improved five‐year OS (68.2% vs. 38.5%, P  =  0.043 ), PFS (45.5% vs. 20.5%, P  =  0.023 ), and local recurrence‐free survival ( LRFS ) (77.3% vs. 38.5%, P  =  0.003 ) compared with those who did not receive radiotherapy. Multivariate analysis revealed that radiotherapy was an independent prognostic factor of five‐year OS (hazard ratio [ HR] 0.39, P  =  0.037 ), PFS ( HR 0.42, P  =  0.017 ), and LRFS ( HR 0.31, P  =  0.019 ). Conclusion Radiotherapy in a chemotherapy‐based treatment regimen could significantly reduce local recurrence and improve survival of MMNGCT patients.
    Type of Medium: Online Resource
    ISSN: 1759-7706 , 1759-7714
    URL: Issue
    URL: Article
    DOI: 10.1111/tca.2015.6.issue-4
    DOI: 10.1111/1759-7714.12190
    Language: English
    Publisher: Wiley
    Publication Date: 2015
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