Lung cancer : journal of the International Association for the Study of Lung Cancer
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We designed a phase I/II trial in order to evaluate the efficacy and tolerability of induction carboplatin and gemcitabine and the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of subsequent chemoradiotherapy with weekly vinorelbine and paclitaxel in patients with stage III non-small cell lung cancer (NSCLC). ⋯ We identified a well-tolerated and active chemoradiotherapy regimen. Survival results are promising and the addition of a biologic agent to this regimen is of interest.
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As local tumour control is poor in stage III non-small cell lung cancer (NSCLC), a radiotherapy planning study was performed to evaluate the potential for treatment acceleration by using a simultaneous integrated boost (SIB) technique in patients who had completed induction chemotherapy. ⋯ A SIB technique that delivers at least 50 Gy to the pre-chemotherapy tumour volume permits accelerated radiotherapy in patients with stage III NSCLC without increasing the expected risks of normal tissue toxicity. By reducing the overall treatment time, the SIB technique may improve local tumour control and survival.
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We have developed a novel irradiation technique for lung cancer that combines a linear accelerator and CT scanner with patient-controlled breath-hold and radiation beam switching. We applied this technique to stereotactic three-dimensional (3D) conformal radiotherapy for stage I non-small cell lung cancer (NSCLC) and evaluated the primary therapeutic outcomes. A total of 35 patients with stage I (15 IA, 20 IB) primary NSCLC (20 adeno, 13 squamous cell, and 2 others) were treated with this technique. ⋯ Two-year overall survival rates for total patients and medically operable patients were 58 and 83%, respectively. In conclusion, this new irradiation technique, utilizing patient-controlled radiation beam switching under self-breath-hold after precise alignment of the isocenter, allows safe high-dose stereotactic radiotherapy with sufficient margins around the CTV and reduced treatment times. Based on the initial results, excellent local control with minimal complications is expected for stage I NSCLC.
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Substaging using molecular markers has been proposed to try to identify prognostic factors allowing to define groups of patients with lung cancer for whom specific therapy might be of benefit. The pre-operative assessment of these markers seems to be important specially in case of neoadjuvant chemotherapy. The aim of our study was to compare the expression of two potential prognostic factors (p53 and Ki-67) and two potential therapeutic targets (EGF-R and c-erbB-2) assessed on biopsy samples (B) of non-small cell lung cancer (NSCLC) with that of the corresponding resected tumor (RT). ⋯ We found 82% CR between B and RT, 14% FN and 4% FP on B. The PPV of the B was 96%. In conclusion, biopsies may provide reliable information about p53, EGF-R, c-erbB-2 and Ki-67 in lung carcinoma and could help to elaborate a therapeutic strategy.
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Clinical Trial
Towards a minimally invasive staging strategy in NSCLC: analysis of PET positive mediastinal lesions by EUS-FNA.
To asses the value of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in the nodal staging of patients with (suspected) non-small cell lung cancer (NSCLC) and a (18)FDG positron emission tomography (PET) scan suspect for N2/N3 mediastinal lymph node (MLN) metastases. ⋯ EUS-FNA yields minimally invasive confirmation of MLN metastases in 69% of the patients with potential mediastinal involvement at FDG PET. The combination of PET and EUS-FNA might qualify as a minimally invasive staging strategy for NSCLC.