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Abstract: The optimal combination of chemotherapy with radiation therapy for treatment locally advanced non-small cell lung cancer (NSCLC) remains an open issue. This randomized phase II study compared gemcitabine in two different schedules and cisplatin - as induction chemotherapy, followed by radiation therapy concurrent with cisplatin and etoposid. Patients and methods. Eligible patients had microscopically confirmed inoperable non-metastatic non-small cell lung cancer; fulfilled the standard criteria for platin-based chemotherapy; and signed informed consent. Patients were treated with 3 cycles of induction chemotherapy with gemcitabine and cisplatin. Two different aplications of gemcitabine were compared: patients in arm A received gemcitabine at 1250 mg/m2 in a standard half hour i.v. infusion on days 1 and 8; patients in arm B received gemcitabine at 250 mg/m2 in prolonged 6-hours i.v. infusion on days 1 and 8. In both arms, cisplatin 75 mg/m2 on day 2 was administered. All patients continued treatment with radiation therapy with 60-66 Gy concurrent with cisplatin 50 mg/m2 on days 1, 8, 29 and 36 and etoposid 50 mg/m2 on days 1-5 and 29-33. The primary endpoint was response rate (RR) after induction chemotherapy; secondary endpoints were toxicity, progression-free survival (PFS) and overall survival (OS). Results. From September 2005 to November 2010, 106 patients were recruited to this study. No statistically signifficant differences were found in RR after induction chemotherapy between the two arms (48.1% and 57.4%, p = 0.34). Toxicity profile was comparable and mild with grade 3/4 neutropenia as primary toxicity in both arms. One patient in arm B suffered from acute peripheral ischemia grade 4 and an amputation of lower limb was needed. With a median follow-up of 69.3 months, progression-free survival and median survival in arm A were 15.7 and 24.8 months compared to 18.9 and 28.6 months in arm B. The figures for 1- and 3-year overall survival were 73.1% and 30.8% in arm A, and 81.5 % and 44.4% in arm B, respectively. Conclusions. Among the two cisplatin-based doublets of induction chemotherapy for inoperable NSCLC, both schedules of gemcitabine have a comparable toxicity profile. Figures for RR, PFS and OS are among the best reported in current literature. While there is a trend towards better efficacy of the treament with prolonged infusion of gemcitabine, the difference between the two arms did not reach statistical significance
Keywords: induction chemotherapy, non-small cell lung cancer, radiation therapy, randomized clinical trial
Published in DiRROS: 11.04.2024; Views: 348; Downloads: 287
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Abstract: V prispevku bomo predstavili rezultate fizikalnih modelov imunoterapije, ki smo jih razvili v programski skupini Medicinska fizika na Fakulteti za matematiko in fiziko Univerze v Ljubljani. Glavni cilj raziskav je bila prepoznava bioloških značilnosti tumorjev, od katerih je odvisen odziv na zdravljenje s protitelesi receptorja programirane celične smrti l (angl. anti-programmed-death-1 (anti-PD-1)). Posebno pozornost smo namenili meritvam modelskih parametrov ter preverbi rezultatov modeliranja, kar je eden izmed predpogojev za uspešno translacijo modeliranja v rutinsko predklinično in klinično prakso. Predstavili bomo tudi načrte za prihodnost, tj. modeliranje kombinacije anti-PD-1 in radioterapije.
Keywords: imunoterapija, radioterapija, medicinska fizika, tumorji
Published in DiRROS: 16.06.2023; Views: 437; Downloads: 109
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Abstract: Breme pljučnega raka v Sloveniji v zadnjem desetletju ostaja nacionalni problem. Incidenčna stopnja se je pri moških sicer ustalila v zadnjih nekaj desetletjih, podatki pri ženskah pa kažejo na strm porast incidence v zadnjem desetletju, saj vsako leto zboli za skoraj 6 % več žensk. Kar dobra polovica bolnikov s pljučnim rakom ima ob diagnozi razsejan pljučni rak, ki ga kljub sodobnim načinom zdravljenja ne moremo pozdraviti. Po umrljivosti je pljučni rak pri moških in pri ženskah na prvem mestu. Vsako peto smrt zaradi raka pripišemo pljučnemu raku. Petletno preživetje bolnikov, zbolelih v obdobju 2015–2019, je bilo 19,5 %, bolnic pa 26,4 %. Izzivi v prihodnosti so v zgodnejšem odrivanju pljučnega raka. Raziskave so pokazale, da lahko presejanje pljučnega raka zniža umrljivost za 20 %, saj omogoča odkrivanje zgodnjih oblik raka. V presejalni program pljučnega raka morajo biti vključeni učinkoviti programi za opuščanje kajenja, prav tako pa je potrebno intenzivirati aktivnosti primarne preventive.
Keywords: pljučni rak, onkološko zdravljenje, bolniki
Published in DiRROS: 12.05.2023; Views: 312; Downloads: 167
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Keywords: rak pljuč, radiomika, imunoterapija
Published in DiRROS: 04.04.2022; Views: 614; Downloads: 204
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Abstract: The standard treatment for inoperable locally advanced non-small cell lung cancer (LA NSCLC) includes concurrent or sequential chemotherapy (ChT) and radiation therapy (RT). Long term survival rates with these approaches remains only in the order of 15%, therefore new treatment strategies, including immunotherapy, are under investigation, with programmed death ligand-1 (PD-L1) as one of the major players. We evaluated the clinical significance of PD-L1 expression in tumor samples from patients with inoperable LA NSCLC who underwent concurrent chemoradiotherapy (CRT) in our institution between 2005 and 2010 and correlated their expression with clinicopathological parameters and outcome of treatment. Among 107 patients treated with concurrent CRT, a total of 43 (36 males and 7 females) had sufficient tissue for immunohistochemical (IHC) staining. The expression of PD-L1 was demonstrated in 7 tumors, in 6 males and 1 female. No statistical significant differences in patient characteristics, including age, smoking status and gender, were found according to the PD-L1 expression. After a median follow up of 103.6 months, median progression free survival (PFS) was 19.9 months in patients without and 10.1 months in patients with PD-L1 expression (p=0.008). Median overall survival (OS) was 28.4 and 12.1 months for PD-L1 negative and PD-L1 positive patients, respectively (p=0.012). In conclusions, patients with PD-L1 expression had shorter PFS and OS after concurrent CRT in LA NSCLC. Unfortunately, only small number of patients had tissue available for the IHC testing, therefore no firm conclusions could be made and further investigation is warranted.
Keywords: non-small cell lung cancer, lung cancer, chemoradiotherapy, survival
Published in DiRROS: 17.12.2020; Views: 1391; Downloads: 439
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