American journal of clinical oncology
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We studied a cohort of cancer patients that underwent curative-intent radiation within the last year of life (LYOL). Given the unexpectedly short survival, we evaluated the proportion with relapsed/refractory disease, determined causes of death, and explored whether treatment intent was associated with aggressiveness of care at the end of life. ⋯ Cancer patients that receive curative-intent radiation in the LYOL appear to be heterogeneous and receive more aggressive care at the end of life compared with palliative-intent patients. Categorizing radiation as curative in patients with metastatic disease may reflect inappropriate decision-making among physicians. Additional studies are needed to understand how radiation oncologists categorize treatment as curative and whether prognostication models may help discriminate patients undergoing curative-intent radiation that have limited life expectancies.
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Am. J. Clin. Oncol. · Mar 2020
ReviewSystemic Immunostimulatory Effects of Radiation Therapy Improves the Outcomes of Patients With Advanced NSCLC Receiving Immunotherapy.
The understanding of localized radiation therapy's immunostimulatory properties combined with its well-known effects on the cell cycle and insights into the immunomodulation mechanisms that occur at the molecular and cellular levels has changed our traditional view of the anticancer effects of ionizing radiation. The potential interactions between the tumor's immune system and radiation therapy have revealed that local radiation has the ability to induce systemic antitumor responses in patients with advanced cancers. The recognition of systemic antitumor effects of radiation therapy has allowed investigators to begin uncovering the integral players in these pathways. ⋯ Available data supports the use of radiation therapy in combination with immunotherapy to achieve improved local and systemic tumor control. Evidence from the early clinical trials has shown that using radiation therapy and immune checkpoint blockade therapies together produces a greater clinical effect than using either modality alone. To maximize the clinical benefit and successful integration of these two modalities as well as optimizing radiation therapy dosing and its schedule, improvement in its field design and the development of reliable predictors of clinical tumor response needs to be established.
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Am. J. Clin. Oncol. · May 2019
Meta AnalysisAdjuvant Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors (TKIs) in Resected Non-Small Cell Lung Cancer (NSCLC): A Systematic Review and Meta-analysis.
The role of adjuvant tyrosine kinase inhibitors (TKIs) in non-small cell lung cancer (NSCLC) is not well defined. Recent randomized controlled trials showed a disease-free survival (DFS) benefit in patients harboring an epidermal growth factor receptor (EGFR) mutation. Yet, older trials on patients with any EGFR status did not demonstrate the same benefit. ⋯ In subgroup analyses, the DFS benefit was more pronounced in trials using TKIs over chemotherapy compared with trials using TKIs postchemotherapy. In conclusion, adjuvant TKIs decrease the risk of recurrence in NSCLC patients harboring an EGFR mutation but do not improve OS. Longer follow-up is needed for a definitive assessment of OS and to define the role of adjuvant TKI for NSCLC in the clinical practice.
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Am. J. Clin. Oncol. · Apr 2019
Mental Health Disorders are More Common in Colorectal Cancer Survivors and Associated With Decreased Overall Survival.
To determine the risk and risk factors for mental illness among colorectal cancer (CRC) survivors across short-term and long-term follow-up periods. ⋯ CRC survivors are at increased risk for mental health disorders in the short-term and long-term. Survivors who develop mental health disorders also experience decreased survival.