Inoperable Non-small Cell Lung Cancer Research Articles

Final Results of a Phase I Trial of Stereotactic Body Radiotherapy for Larger (>3cm) Inoperable Non-Small Cell Lung Cancer

Final Results of a Phase I Trial of Stereotactic Body Radiotherapy for Larger (>3cm) Inoperable Non-Small Cell Lung Cancer

Amiodarone Use and Radiation Pneumonitis in Patients Undergoing Stereotactic Body Radiation Therapy for Non-Small Cell Lung Cancer

Stereotactic body radiation therapy (SBRT) has become a standard of care for inoperable early-stage non-small cell lung cancer (NSCLC) patients. Amiodarone is a well-known cause of pneumonitis and an increasing number of patients treated with SBRT are also on amiodarone. Given this potential risk of pulmonary toxicity, it is of interest to examine whether amiodarone may potentiate the risk of RP. We sought to examine the impact of amiodarone use on RP in patients treated with SBRT. Patients with early-stage NSCLC who were taking amiodarone and underwent SBRT from January 2005 to January 2019 were identified from an IRB-approved institutional database. Amiodarone was required to be taken within 3 months before or after SBRT for inclusion. RP status was confirmed using CTCAE guidelines. Follow-up was defined as the time from the end of SBRT treatment until the most recent follow-up or date of death. Thirty-three patients met the inclusion criteria. Median follow up was 14 months (range, 1 to 55 months). The median dose of radiation was 54 Gy (range, 45 to 60) delivered in 3 to 12 fractions. Three patients (9%) developed radiation pneumonitis; all cases of pneumonitis were grade 2. One patient (3%) had a diagnosis of interstitial lung disease (ILD) and no presence of pneumonitis. In this single-institution series, the use of amiodarone in concert with lung SBRT was not associated with numerically increased rates of RP compared with the established literature. These results will need to be validated in larger cohorts with proper control of established metrics (lung V20, ILD), as well as other patient populations such as those undergoing cardiac radio-ablation, where the risks and mechanisms of injury may be different.

Risk factors for symptomatic radiation pneumonitis after stereotactic body radiation therapy (SBRT) in patients with non-small cell lung cancer

Background and purposeRadiation pneumonitis (RP) can be a potential fatal toxicity of stereotactic body radiation therapy (SBRT) for medically inoperable non-small cell lung cancer (NSCLC). This study aimed to examine the risk factors that predict RP and explore dosimetric tolerance for safe practice in a large institutional series of NSCLC patients. Materials and methodsPatients with early-stage and locally recurrent NSCLC who received lung SBRT between 2002 and 2015 formed the study population. The primary endpoint was grade 2 or above radiation pneumonitis (RP2). Lungs were re-contoured consistently by one radiation oncologist according to the RTOG atlas for organs at risk. Dosimetric factors were computed consistently with exclusion of gross tumor volume of either ipsilateral, contralateral, or total lungs. ResultsA total of 339 patients were eligible. With a median follow-up of 47 months, RP2 was recorded in 10% patients. History of respiratory comorbidity, previous thoracic radiation, right lung location, mean lung doses of total or ipsilateral lung, and total lung volume receiving 20 Gy were all significantly associated with the risk of RP2. The dosimetric parameters of contralateral lung, including mean dose and volume receiving more than 5, 10, and 20 Gy, were not significantly associated with RP2 (ps > 0.05). A model of combining significant clinical and dosimetric factors had a predictive accuracy AUC of 0.76. According to this model, RP2 can be limited to <10% should the patient have no previous lung radiation and the mean dose of total and ipsilateral lungs be kept less than 6 Gy and 20 Gy, respectively. ConclusionDosimetric factors of total or ipsilateral lung together with important clinical factors were significant risk factors for symptomatic radiation pneumonitis after SBRT. Constraining mean lung dose can limit clinically significant lung toxicity.

Radioactive seeds insertion with chemotherapy for advanced non-small-cell lung cancer: A meta-analysis.

Non-small-cell lung cancers (NSCLCs) are only eligible to undergo curative surgical resection in <20% of patients. In patients with inoperable NSCLC, computed tomography (CT)-guided radioactive seed insertion (RSI) is a common treatment practice. To assess the relative efficacy of chemotherapy alone versus chemotherapy in combination with CT-guided RSI in patients with advanced NSCLC. We searched the Pubmed, Embase, and Cochrane Library databases for relevant articles published as of July 2020. Complete and total response rates (CR and TR, respectively) served as the primary endpoints for this meta-analysis, with disease control (DC) rate, myelosuppression rate, progression-free survival (PFS), overall survival (OS), and CT-guided RSI-related pneumothorax serving as secondary endpoints. In total, eight studies incorporating 281 patients that underwent combination treatment and 297 patients that underwent chemotherapy along were included in this meta-analysis. The CR (21.5% vs. 4.0%, P<0.00001), TR (73.8% vs. 42.6%, P<0.00001), and DC (94.1% vs. 78.2%, P<0.00001) rates were significantly higher for patients in the combined treatment group relative to patients in the chemotherapy only group. Furthermore, pooled PFS (P<0.00001) and OS (P=0.0006) were significantly longer for patients in the combined treatment group, whereas no differences in pooled myelosuppression rates were observed between groups (34.3% vs. 30.7%, P=0.47). The pooled rate of CT-guided RSI-related pneumothorax was 15%. Combination chemotherapy and CT-guided RSI can significantly improve clinical response and prolong survival in advanced-stage NSCLC patients without inducing other significant toxic side effects.

Technical challenges of linac-based stereotactic ablative body radiotherapy: short review for non-radiation oncologists.

Stereotactic ablative radiotherapy (SABR) is a radiation technique delivering high doses of radiation in a small number of treatments, to extracranial targets. It is standard of care in patients with inoperable early stage non-small cell lung cancer, and it is increasingly used in patients with oligometastatic disease. The main advantage of SABR is a steep dose gradient, allowing delivery of high biologically effective doses to the target, while minimizing irradiation exposure of the neighboring normal tissues. This results in high rates of local control of the treated target and minimal toxicity risks, and minimal impact on the quality of life of the patients. However, it requires high precision, accuracy and reproducibility during the entire process, from simulation to treatment planning and treatment delivery. This article will focus on general principles of SABR treatment planning and delivery, with emphasis on the strategies to reduce errors related to immobilization, respiratory management and treatment verification.

Study protocol: a multicentre, prospective, phase II trial of isotoxic hypofractionated concurrent chemoradiotherapy for non-small cell lung cancer

IntroductionConcurrent chemoradiotherapy with conventional fractionation has been acknowledged as one of the standard treatments for locally advanced non-small cell lung cancer (NSCLC). The radiotherapy dose of 60 Gy is far...

Long non-coding RNA CASC2 enhances irradiation-induced endoplasmic reticulum stress in NSCLC cells through PERK signaling.

Radiotherapy is instrumental in the treatment of inoperable non-small cell lung cancer (NSCLC). Studies have revealed that radiotherapy induces endoplasmic reticulum (ER) stress, which consequently induces apoptosis and sensitization of cancer cells. A recent study has revealed that long non-coding RNA (lncRNA) CASC2 is negatively correlated with the malignancy of NSCLC cells. The present study investigated the effects and molecular mechanisms of CASC2 on radiosensitivity and ER stress in NSCLC cells. The overexpression of CASC2 markedly decreased cell survival and increased apoptosis, expression of PERK, phosphorylated-eIF2α and CHOP in irradiated human NSCLC cells, whereas knocking down PERK reversed these effects. Moreover, CASC2 considerably promoted the stability of PERK mRNA, but had no effect on the activity of PERK gene promoter in irradiated NSCLC cells. Strikingly, CASC2 exhibited no apparent effect on non-irradiated NSCLC cells. This study demonstrated that lncRNA CASC2 increases the stability of PERK mRNA, which consequently triggers the PERK/eIF2α/CHOP ER stress pathway and promotes radiosensitivity or apoptosis in irradiated NSCLC cells. Results of the present study suggest that CASC2 can act as an effective therapeutic target to enhance the efficacy of radiotherapy in the treatment of NSCLC.

Image‐guided percutaneous microwave ablation of early‐stage non–small cell lung cancer

Although surgical lobectomy with systematic mediastinal lymph node evaluation is considered as the "gold standard" for management ofearly stage non-small cell lung cancer (NSCLC), image-guided percutaneous thermalablationhas been increasingly used for medically inoperable patients. Radiofrequency ablation (RFA) is a research-based technique that has the most studies for medically inoperable early-stage NSCLC. Other thermal ablation techniques used to treat pulmonary tumors include microwave ablation (MWA), cryoablation and laser ablation. MWA has several advantages over RFA including reduced procedural time, reduced heat-sink effect, large ablation zones, decreased susceptibility to tissue impedance, and simultaneous use of multiple antennae. This review article highlights the most relevant updates of MWA for the treatment of early-stage NSCLC, including mechanism of action, clinical outcomes, potential complications, the existing technique problems and future directions.

A meta-analysis comparing stereotactic body radiotherapy vs conventional radiotherapy in inoperable stage I non-small cell lung cancer.

Stereotactic body radiotherapy (SBRT) superseded conventional radiotherapy (CRT) for the treatment of patients with inoperable early stage non-small cell lung cancer (NSCLC) over a decade ago. However, the direct comparisons of the outcomes of SBRT and CRT remain controversial. This meta-analysis was performed to compare the survival and safety of SBRT and CRT in patients with inoperable stage I NSCLC. We systematically searched the Cochrane Library, Embase, PubMed, Web of Science, Ovid MEDLINE, ScienceDirect, Scopus and Google Scholar for relevant articles. Overall survival (OS), progression-free survival (PFS), lung cancer-specific survival (LCSS), local control rate (LCR) and adverse effects (AEs) were the primary outcomes. We identified 11,110 articles, 17 of which were eventually included in this study; these 17 articles had 17,973 patients (SBRT: 7395; CRT: 10,578). Compared to CRT for the treatment of inoperable stage I NSCLC, SBRT had superior survival in terms of OS (hazard ratio [HR]: 0.66, 95% confidence interval [CI]: 0.62-0.70, P < .00001), LCSS (HR: 0.42 [0.35-0.50], P < .00001), and PFS (HR: 0.34 [0.25-0.48], P < .00001). The 4-year OS rate (OSR); 4-year LCSS rate (LCSSR); 3-year local control rate (LCR); 5-year PFS rate (PFSR) with SBRT were all higher than those with CRT. With regard to all-grade AEs, the SBRT group had a significantly lower rate of dyspnea, esophagitis and radiation pneumonitis; no significant difference was found in grade 3-5 AEs (risk ratio [RR]: 0.68 [0.30-1.53], P = .35). With better survival and a lower rate of dyspnea, esophagitis and radiation pneumonitis than CRT, SBRT appears to be more suitable for patients with inoperable stage I NSCLC.

Intratumoral hyperthermic chemotherapy injection in peripheral non-small cell lung cancer

BackgroundIntratumoral chemotherapy (ITC) has been used by many groups; the combination of heat and cytotoxic drugs increases the ability to destroy the malignant cells. The aim of this study was to assess the efficacy and safety of percutaneous injection of hyperthermic chemotherapy in conjunction with systemic chemotherapy as a palliative management of peripheral inoperable non-small cell lung cancer (NSCLC) compared to conventional systemic chemotherapy.ResultsThere was a statistically significant improvement in quality of life score in group A and B, but deterioration in group C after 6 months. As regards radiology, after 6 months in group A, one patient (10%) showed complete response, 6 patients (60%) showed partial response, one patient (10%) stable response, and two patients (20%) showed progression; in group B, 6 patients (60%) showed partial response, two patients (20%) showed stable response, and two patients (20%) showed progression; and in group C, 7 patients (70%) showed progression, two patients (20%) showed partial response, and one patient (10%) showed stable response. There were few controllable complications. Median survival in group A was 16 months, in group B was 15 months, and in group C was 8 months.ConclusionIntratumoral hyperthermic chemotherapy is a promising, effective, harmless palliative therapy for inoperable peripheral NSCLC.

The CT appearance pattern of radiation-induced lung injury and tumor recurrence after stereotactic body radiation therapy in early stage non-small cell lung cancer.

BackgroundRadiographic changes after stereotactic body radiation therapy (SBRT) have not been well studied. The purpose of this study was to investigate the computed tomography (CT) appearance pattern of radiation-induced lung injury (RILI) and recurrence after SBRT in patients with early stage non-small cell lung cancer (NSCLC).MethodsWe retrospectively analyzed clinical data of inoperable early stage NSCLC patients undergoing SBRT treatment from February 2012 to June 2018. All patients had undergone serial CT scanning before SBRT and after completion of SBRT. An experienced radiation oncologist and radiologist reviewed all CT images, and identified the RILI and CT high-risk features (HRFs).ResultsA total of 60 patients were enrolled in this study; 55 patients had RILI (91.67%) and 7 patients had local failure. In the early CT findings of observers 1 and 2, there were diffuse ground glass opacities (GGOs) in 3 and 4 patients, diffuse consolidation in 10 and 12 patients, patchy consolidation in 22 and 15 patients, patchy GGOs in 19 and 24 patients, and no changes in 5 and 4 patients, respectively (kappa =0.706). In the late CT findings of observer 1 and 2, there were modified conventional patterns in 37 and 37 patients, mass-like patterns in 10 and 9 patients, scar-like patterns in 7 and 8 patients, and no changes in 5 and 5 patients, respectively (kappa =0.726). In the results of the CT-based HRFs of disease local failure, there were ≥1 HRFs in 7 patients, ≥2 HRFs in 7 patients, ≥3 HRFs in 6 patients, ≥4 HRFs in 5 patients, and ≥5 HRFs in 3 patients, respectively. Patients with only 1 HRF showed high sensitivity (100%) and low specificity (52.80%), with the specificity increasing and the sensitivity decreasing as the number of HRFs increased.ConclusionsThe agreement of the CT appearance on RILI between 2 observers was good. Regular follow-up and attention to HRFs are vital for better identifying RILI and local disease failure.

Central Airway Toxicity After High Dose Radiation: A Combined Analysis of Prospective Clinical Trials for Non-Small Cell Lung Cancer

To study the dosimetric risk factors for radiation-induced proximal bronchial tree (PBT) toxicity in patients treated with radiation therapy for non-small cell lung cancer (NSCLC). Patients with medically inoperable or unresectable NSCLC treated with conventionally fractionated 3-dimensional conformal radiation therapy (3DCRT) in prospective clinical trials were eligible for this study. Proximal bronchial tree (PBT) and PBT wall were contoured consistently per RTOG 1106 OAR-Atlas. The dose-volume histograms (DVHs) of physical prescription dose (DVHp) and biological effective dose (α/β = 2.5; DVH2.5) were generated, respectively. The primary endpoint was PBT toxicities, defined by CTCAE 4.0 under the terminology of bronchial stricture/atelectasis. Of 100 patients enrolled, with a median follow-up of 64 months (95% confidence interval [CI], 50-78), 73% received 70 Gy or greater and 17% developed PBT toxicity (grade 1, 8%; grade 2, 6%; grade 3, 0%; and grade 4, 3%). The median time interval between RT initiation and onset of PBT toxicity was 8.4 months (95% CI, 4.7-44.1). The combined DVHs showed that no patient with a PBT maximum physical dose <65 Gy developed any PBT toxicity. Cox proportional hazards analysis and receiver operating characteristic analysis demonstrated that V75 of PBT was the most significant dosimetric parameter for both grade 1+ (P = .035) and grade 2+ (P = .037) PBT toxicities. The dosimetric thresholds for V75 of PBT were 6.8% and 11.9% for grade 1+ and grade 2+ PBT toxicity, respectively. V75 of PBT appeared be the most significant dosimetric parameter for PBT toxicity after conventionally fractionated thoracic 3DCRT. Constraining V75 of PBT can limit clinically significant PBT toxicity.

Acute Esophageal Damage in Patients with Inoperable Non-small Cell Lung Cancer Treated with Concurrent and Sequential Chemoradiotherapy

BACKGROUND: Acute esophageal damage may be a dose-limited factor for application the full planning radiotherapy (RT) dose in patients with inoperable non-small cell lung cancer (NSCLC). A combination of chemotherapy and RT may increase esophageal toxicity, but three-dimensional (3D) conformal RT offers better sparing of the organs at risk.&#x0D; AIM: The purpose of this study was to show the incidence and degree of acute esophageal damage in lung cancer patients treated with sequential and concurrent chemoradiotherapy.&#x0D; MATERIALS AND METHODS: The total number was 73 patients, of whom 26 (34.7%) had previously received sequential chemotherapy with a four-cycle followed by RT. In the second concurrent group, 47 (65.3%) patients were received concomitant chemotherapy and RT.&#x0D; RESULTS: Of the 73 patients included in the study, 43 (57.3%) did not present any grade of esophagitis during the treatment. In the sequential group, 73.1% presented no esophagitis and in the concurrent group, 49%, respectively. Although there were differences between the two groups, none were statistically significant.&#x0D; CONCLUSIONS: The reason for the good tolerability of the combination of chemotherapy and RT for inoperable NSCLC patients was using 3D conformal RT. Further improvements may be obtained with more sophisticated RT or radioprotective drugs.

Atezolizumab plus stereotactic ablative therapy for medically inoperable patients with early-stage non-small cell lung cancer.

9011 Background: Stereotactic ablative radiation therapy (SABR) is the standard-of-care for medically inoperable, early stage non-small cell lung cancer (NSCLC), but regional and distant failures remain problematic. Based on our in vivo data showing synergy between radiation and immune checkpoint inhibitors (ICI) and the known efficacy and mild toxicity profile of ICI in NSCLC, we conducted a phase I study to determine the maximum tolerated dose of neoadjuvant, concurrent, and adjuvant atezolizumab with SABR for early stage NSCLC patients (pts). Methods: Eligible pts had histologically confirmed T1-3 NSCLC with at least one feature predictive of increased recurrence risk: diameter ≥1 cm, SUV ≥6.2 on PET, or moderately/poorly differentiated histology, were medically inoperable or refused surgery and had a Zubrod PS ≤2. Patients received 6 cycles of atezolizumab. A 3+3 dose finding design was employed with 3 dose levels: 3 mg/kg, 10 mg/kg, and 1200 mg flat dosing. SABR was delivered starting cycle 3 to 50 Gy over 4-5 fractions. Dose limiting toxicity (DLT) was assessed during the first 9 weeks. Results: 20 pts were enrolled, 15 pts in the dose finding and 5 pts at the recommended phase II dose (RP2D). Patient factors: MedIan age 77; 45% male, 85% smoking history, 85% PS 0-1 and 35% squamous. One pt on dose level 2 had a DLT – a grade 3 rash. Atezolizumab 1200 mg flat dosing was the RP2D. Grade 3 pneumonitis was not observed. Partial responses after 2 cycles were seen in 3/17 evaluable pts (18%) and 1 pt had a minor response. No patient progressed on treatment. PD-L1 expression was 0% 8/13 (62%), &gt;1% - 50% 4/13 (31%), &gt;50% 1/13 (8%) in pts with sufficient tissue. Of 5 pts with PD-L1 expression 3 (60%) were responders and 1 (12.5%) of 8 pts with 0% PD-L1 expression responded. Multi-plex Quantitative Immunofluorescence (QIF) using a T cell activation panel demonstrated to correlate with ICI response was performed on 9 samples (including 2 responders, 1 minor responder). The CD3 QIF score was &gt; two-fold higher in the responders compared to non-responders, and the levels of proliferating and activated T cells were likewise &gt; two-fold higher. Comprehensive stool and serial blood analyses have been completed. Correlative endpoints will be reported along with additional efficacy outcomes. Conclusions: Atezolizumab plus SABR is feasible, safe and shows an efficacy signal in medically inoperable early stage NSCLC. This combination will be tested in a randomized phase III trial SWOG/NRG S1914. Funding: This work was supported by the DOD CDMRP W81XWH-15-2-0063 and Genentech. Clinical trial information: NCT02599454.

Comparision of Radiochemotherapy Applications that Committing with Two Different Chemotherapies Route in Locally Advanced Lung Cancer.

This study investigated pre- and post-treatment tumor and lymph node dimension response rates and differences between side-effect profiles in patients with locally advanced inoperable nonsmall-cell lung cancer (NSCLC) receiving radiotherapy (RT) and concurrent chemotherapy (CT). A total of 30 inoperable patients who had not previously received RT and having a mean age of 58.73±8.65 years with sufficient hematological reserves and normal hepatic and renal functions were included in the study. Those with pleural effusion, supraventricular lymph node metastasis, and N3 lymph node involvement were excluded. Group I (n=15) received a 21-day 75 mg/m2 cisplatin (D1) and 15 mg/m2 vinorelbine (D1, D8), whereas Group II (n=15) received 45 mg/m2 paclitaxel and AUC2 carboplatin weekly. RT was administered using a linear accelerator device with the 3D conformal RT technique at 6-18 MV energy with a 1.8-2 Gy fraction for 6-7 weeks. Patients were randomized into Group I receiving RT and concurrent cisplatin-vinorelbine and Group II receiving weekly paclitaxel-carboplatin CT. Pre- and post-treatment tumor and lymph node dimensions significantly differed in both groups (p<0.001 and p<0.01, respectively). No significant change was observed in post-RT tumor and lymph node dimensions in terms of applied CT regimens (p>0.05). The significant response achieved with concurrent RT and CT in groups I and II in the local advanced stage of NSCLC is important for local tumor control. Responses to treatment in the group of two arms did not differ.

Survival of Primary Stereotactic Body Radiation Therapy Compared With Surgery for Operable Stage I/II Non-small Cell Lung Cancer

Stereotactic body radiation therapy (SBRT) is an accepted primary treatment option for inoperable early-stage non-small cell lung cancer (NSCLC). The role of SBRT in the treatment of operable disease remains unclear. We retrospectively evaluated patients with operable early-stage NSCLC who elected to receive primary SBRT, examined factors associated with SBRT, and compared overall survival after surgical resection and SBRT. The National Cancer Database was queried for patients with stage I/II, N0 NSCLC from 2004 to 2016. The proportion of patients who refused recommended surgery and were treated with SBRT was calculated. A propensity score predicting the probability of refusing surgery and receiving SBRT was generated and used to match SBRT and resected patients. Long-term overall survival was compared in the matched cohort using the Kaplan-Meier method and Cox regression. We identified 1359 patients (0.98%) who refused recommended surgery and elected SBRT. This proportion increased annually, from 0.1% in 2004 to 1.7% in 2016. Factors associated with SBRT were older age, black race, Medicaid coverage, lower T stage, and more recent diagnosis year. Propensity matching resulted in 1315 well-balanced pairs. Surgery was associated with higher median survival (74 vs 47 months, P < .01) in the matched cohort. Survival benefit persisted after adjusting for covariates on Cox regression (hazard ratio, 1.69; P < .01). Median survival was significantly higher after surgery compared with SBRT in a risk-adjusted matched cohort of patients judged to be surgical candidates. Operable patients considering primary SBRT should be educated regarding this difference in survival.

Applicability of the PACIFIC trial results in patients not eligible for the PACIFIC trial: Canadian rapid consensus statement and recommendations.

BackgroundThe PACIFIC study established durvalumab as a standard of care for consolidation therapy in patients treated with radical intent chemoradiation for stage III inoperable non-small cell lung cancer. In clinical practice, many patients are not eligible for trials, yet radical intent chemoradiation may still be used. MethodsA virtual anonymous tumour board Delphi-model was used in order to generate consensus on the use of durvalumab in six clinical situations where chemoradiation is used in clinical practice and recommended in guidelines, yet not PACIFIC eligible. Two anonymous iterations were sent and recommendations were circulated for approval and comment. Results are presented using a modified PICOT format (patients, intervention, control, outcomes, and ongoing trials). ResultsIn three of the scenarios, consensus was reached and recommendations were for the use of consolidation durvalumab, but being respectful of potentially increased toxicity/reduced benefit in comparison to PACIFIC results (treatment of stage IIB inoperable, recurrent mediastinal disease, and residual gross disease post attempted surgical removal). There was a recommendation against using durvalumab in resected stage III disease with R1 or R0 margins, even if chemoradiation were considered. There was not consensus on the use of consolidation durvalumab in the setting of oligometastatic disease or in the setting of large cell neuroendocrine carcinoma or combined small cell carcinoma. ConclusionTreatment of ‘real-world’ lung cancer often involves chemoradiation in settings outside of stage III and eligible for the PACIFIC study. This paper offers recommendations in these scenarios based on a consensus approach.

129 - An audit of toxicity from first-line immunotherapy in inoperable or metastatic non-small cell lung cancer patients divided by ECOG performance status

129 - An audit of toxicity from first-line immunotherapy in inoperable or metastatic non-small cell lung cancer patients divided by ECOG performance status

Clinical outcomes of stereotactic body radiation therapy for T2N0M0 non-small cell lung cancer

Objective To investigate the clinical efficacy and adverse effects of stereotactic body radiotherapy (SBRT) in the treatment of T2N0M0 non-small cell lung cancer (NSCLC) patients. Methods By retrospectively analyzing the clinical data of 30 inoperable patients with stage T2N0M0 NSCLC treated by SBRT, the overall survival, progression-free survival, cancer-specific survival and adverse effects were determined. Results The median follow-up was 18.4 months. The 1-, 2-, and 3-year overall survival rates were 92.2%, 92.2% and 80.6%, respectively. The corresponding cause-specific survivals were 95.7%, 95.7% and 83.7%. The progression-free survivals were 70.2%, 54.1% and 40.6%. The local control rates were 100%, 94.4%, and 94.4%. The regional controls were 84.2%, 72.1%, and 54.1%; and distant controls were 84.6%, 72.4% and 64.3%, respectively. Twenty patients (66.7%) developed symptoms of grade 1 radiation-related toxicities: dyspnea, chest pain, fatigue, cough, esophagitis, or pneumonia. Among these, 5 patients suffered grade ≥2 radiation pneumonitis, and one patient experienced grade 4 radiation pneumonitis. Conclusions SBRT was efficient and safe for patients with inoperable T2N0M0 NSCLC, imposing tolerable toxicities. Key words: Stereotactic body radiation therapy; Non-small cell lung cancer; Overall survival; Progression-free survival; Cause-specific survival

Outcome of patients with locally advanced Non-small cell lung cancer treated with sequential chemotherapy and radiotherapy in Duhok/ Iraq

Background and objectives: About one-third of non-small cell lung cancer patients present with locally advanced unresectable disease. The overall survival and progression-free survival evaluated of patients with stage IIIA and B non-small cell lung cancer treated with sequential chemotherapy and radiotherapy. The aim of the study was to evaluate the efficacy of sequential chemotherapy and radiotherapy in advance non-operable non-small cell lung cancer. Methods: This retrospective study included 45 patients with advanced non-small cell lung cancer diagnosed between May 2014 and May 2017 treated with sequential chemotherapy and radiotherapy. All patients were treated at Azadi Cancer Centre, Azadi Teaching Hospital, Duhok with at least 4 cycles of chemotherapy then sent to radiotherapy in other centre to complete their planned treatment protocol. Results: This study showed that squamous cell cancer was the most common histological subtype. The overall survival of patients treated with sequential chemotherapy and radiotherapy was 19.6 months (95% confidence interval 13.5–27.8, 95% confidence interval). The median progression-free survival time was 11.1 months (95% confidence interval; 8.6–13.7 months). Over all chemotherapy and radiotherapy tolerated well in most of the patients with mild adverse effect. Conclusions: Sequential chemotherapy and radiotherapy is a valid option of treatment in inoperable non-small cell lung cancer. This mainly helpful in area with limited resources for radiotherapy. These results provide hope and support of using sequential chemotherapy and radiotherapy in advanced stage lung cancer ineligible for surgery.