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Second cancers occurring in patients with early stage non-small-cell lung cancer (NSCLC) treated with radiation therapy (RT) alone
Therapy
Tuesday, 12 September 2000
-
10:30-12:00
ORAL SESSION
Radiation
•
of •patients'A and doctors' perception of 2comparison symptom prevention: Results from a randomised trial of supportive treatment in advanced non-small cell lung cancer (NSCLC)
D.J. Giding, S.J. Falk, R.J. White, W. Qian, D.J. Girling, S.J. Falk, R.J. White, W. Qian. On behalf of all Collaborators; MRC Clinical Trials Unit, London, UK The MRC/BTS LU 17 randomised trial compared immediate thoracic radiotherapy (IM), and thoracic radiotherapy delayed (D) unless or until needed, in patients with unresectable, locally advanced NSCLC and minimal thoracic symptoms. The main outcome measure was defined as being alive and without moderate or severe chest symptoms (cough, chest pain, haemoptysis or dyspnoea) at 6 months. This paper compares patients' and doctors' reports of symptoms in this randomised trial. Both patients' quality of life (QoL) questionnaires and doctors' clinical forms were to be completed at 1, 2, 4, and 6 months from randomisation. Patients were categorised as having moderate or severe chest symptoms either prevented, not prevented or unevaluable at each assessment time from both reports separately. The difference for each pair of this summary measure was calculated. 230 patients were randomised with 115 patients in each group. The prevention rates assessed by patients and doctors at 1, 2, 4 and 6 months were 43% and 59%, 32% and 53%, 27% and 29%, and 21% and 28% for the IM group, and 36% and 53%, 28% and 40%, 29% and 39%, and 14% and 27% for the D group, respectively. There were 638 (81%) pairs of reports completed by both patients and doctors on all four occasions. In 493 (77%) their reports were the same, in 109 (17%) doctors but not patients reported prevention, and in 36 (6%) patients but not doctors reported prevention. The p value of the McNemar test for the matched pairs was <0.001. The percentages of the pairs that differed at 1, 2, 4, and 6 months were 32%, 22%, 24%, and 15% (p = 0.01). In conclusion, the prevention rate from doctors' clinical reports was significantly higher than that from patients' QoL forms, and the differences were largest at the start of treatment and were relatively small at 6 months.
1-53~ Preliminary report of external radiation therapy combined with hyperthermia in primary lung cancer with direct bony invasion H. Sakurai, K. Hayakawa, N. Mitsuhashi, T. Akimoto, S. Nasu, H. Kurosaki, J. Saitoh, R. Imai, Y. Nakayama, H. Niibe. Gunma University School of Medicine, Maebashi, Japan Objectives: Local control in lung cancer with directly invaded to the the bone is rather poor. We have retrospectively evaluated the effects of regional hyperthermia combined with conventional external radiation therapy. Materials and Methods: Nine curative and four palliative non-small cell lung cancer patients with direct bony invasion were included in this protocol. Primary response and patients outcome in hyperthermia
Radiation group were compared with those in historical control group (n = 13). In patient with no metastasis, radiation therapy at total dose of 64 to 70 Gy was administered. Hyperthermia wab performed for 45 to 60 min immediately after irradiation for a total 2 to 4 sessions using radiofrequency capacitive heating devices. Results: Overall intratumoral temperature data were; Tmax 42.5 + 0.30 °C, Tav 41.7 ± 0.26 °C, Tmin 40.8 ± 0.22 °C (Temperature ± SE). For primary response, nine of 13 tumors responded to the treatment (5 achieved CR, 4 PR) in hyperthermia group, whereas seven of 13 tumors responded (1 CR, 6 PR) in control group. The 2-year cumulative local recurrence rate for clinical M0 patients in hyperthermia group and that in control group were 11 and 83%, respectively (p < 0.05). In autopsy cases in hyperthermia group, 2 of 3 tumors disappeared even in the histological examination. The 2-year overall survival rate for clinical M0 patients in hyperthermia group and that in control group were 44 and 7%, respectively. Conclusion: Regional hyperthermia could be a potential tool to improve local control in patient with non-small cell lung cancer deeply invaded to the chest wall.
F•-•
Second cancers occurring in patients with early stage non-small-cell lung cancer (NSCLC) treated with radiation therapy (RT) alone
B. Jeremic, Y. Shibamoto, L. Acimovic, N. Nikolic, A. Dagovic, B. Milicic, S. Milisavljevic, J. Aleksandrovic, G. RadosavIjevic-Asic. University Hospital, Kragujevac, Yugoslavia, Institite for Frontier Medical Sciences, Kyoto, Japan
Purpose: To investigate the incidence of second cancers occurring in patients with early stage (1/11)non-small-cell lung cancer (NSCLC) treated with radiation therapy (RT) alone. Material and Methods: A total of 194 patients treated with RT alone were followed up. Seventy-eight patients had been treated with conventionally fractionated (CF) RT (1982-1987), while 116 patients had been treated with hyperfractionated (Hfx) RT (1988-1993). Tumor doses were 60 Gy for CF and 69.6 Gy (1.2 Gy b.i.d.) for Hfx. Results: A total of 26 patients developed second cancer. The cumulative incidence of second cancer was 21.8% (SE, 4.7%) at 5 years and 34.8% (SE, 6.7%) at 10 years. For second lung cancers it was 6.0% (SE, 2.8%) at 5 years and 14.2% (SE, 5.2%) at 10 years, and for second non-lung cancers it was 16.3% (SE, 4.2%) at 5 years and 22.2% (SE, 5.7%) at 10 years. The rate of developing second cancer per patient per year was 4.3% [95% confidence intervals (CI), 2.7-5.9%], with the rates being 1.4% (CI, 0.5-2.3%) for the second lung cancers and 2.8% (CI, 1.5-4.1%) for second non-lung can-cers. The rate of developing second cancers during the first and second 5-year period was 3.7% (CI, 2.0-5.4%) and 4.2% (CI, 0.6%-7.8%), respectively, for all cancers, but it doubled from 1.0% (CI, 0.1-1.9%) to 2.2% (CI, 0-4.6%) for second lung cancers, while for second nonlung cancers it halved from 3.2% (CI, 1.6%-4.8%) to 1.5% (CI, 03.6%). There was no difference in the incidence between stage I and II patients and between CF and Hfx groups. Conclusions: Long-term survivors after RT alone for early stage NSCLC carry the same risk of developing second cancer, either lung or non-lung, as their counterparts treated surgically.
Tuesday, 12 September 2000
-
10:30-12:00
ORAL SESSION
Radiation
•
of •patients'A and doctors' perception of 2comparison symptom prevention: Results from a randomised trial of supportive treatment in advanced non-small cell lung cancer (NSCLC)
D.J. Giding, S.J. Falk, R.J. White, W. Qian, D.J. Girling, S.J. Falk, R.J. White, W. Qian. On behalf of all Collaborators; MRC Clinical Trials Unit, London, UK The MRC/BTS LU 17 randomised trial compared immediate thoracic radiotherapy (IM), and thoracic radiotherapy delayed (D) unless or until needed, in patients with unresectable, locally advanced NSCLC and minimal thoracic symptoms. The main outcome measure was defined as being alive and without moderate or severe chest symptoms (cough, chest pain, haemoptysis or dyspnoea) at 6 months. This paper compares patients' and doctors' reports of symptoms in this randomised trial. Both patients' quality of life (QoL) questionnaires and doctors' clinical forms were to be completed at 1, 2, 4, and 6 months from randomisation. Patients were categorised as having moderate or severe chest symptoms either prevented, not prevented or unevaluable at each assessment time from both reports separately. The difference for each pair of this summary measure was calculated. 230 patients were randomised with 115 patients in each group. The prevention rates assessed by patients and doctors at 1, 2, 4 and 6 months were 43% and 59%, 32% and 53%, 27% and 29%, and 21% and 28% for the IM group, and 36% and 53%, 28% and 40%, 29% and 39%, and 14% and 27% for the D group, respectively. There were 638 (81%) pairs of reports completed by both patients and doctors on all four occasions. In 493 (77%) their reports were the same, in 109 (17%) doctors but not patients reported prevention, and in 36 (6%) patients but not doctors reported prevention. The p value of the McNemar test for the matched pairs was <0.001. The percentages of the pairs that differed at 1, 2, 4, and 6 months were 32%, 22%, 24%, and 15% (p = 0.01). In conclusion, the prevention rate from doctors' clinical reports was significantly higher than that from patients' QoL forms, and the differences were largest at the start of treatment and were relatively small at 6 months.
1-53~ Preliminary report of external radiation therapy combined with hyperthermia in primary lung cancer with direct bony invasion H. Sakurai, K. Hayakawa, N. Mitsuhashi, T. Akimoto, S. Nasu, H. Kurosaki, J. Saitoh, R. Imai, Y. Nakayama, H. Niibe. Gunma University School of Medicine, Maebashi, Japan Objectives: Local control in lung cancer with directly invaded to the the bone is rather poor. We have retrospectively evaluated the effects of regional hyperthermia combined with conventional external radiation therapy. Materials and Methods: Nine curative and four palliative non-small cell lung cancer patients with direct bony invasion were included in this protocol. Primary response and patients outcome in hyperthermia
Radiation group were compared with those in historical control group (n = 13). In patient with no metastasis, radiation therapy at total dose of 64 to 70 Gy was administered. Hyperthermia wab performed for 45 to 60 min immediately after irradiation for a total 2 to 4 sessions using radiofrequency capacitive heating devices. Results: Overall intratumoral temperature data were; Tmax 42.5 + 0.30 °C, Tav 41.7 ± 0.26 °C, Tmin 40.8 ± 0.22 °C (Temperature ± SE). For primary response, nine of 13 tumors responded to the treatment (5 achieved CR, 4 PR) in hyperthermia group, whereas seven of 13 tumors responded (1 CR, 6 PR) in control group. The 2-year cumulative local recurrence rate for clinical M0 patients in hyperthermia group and that in control group were 11 and 83%, respectively (p < 0.05). In autopsy cases in hyperthermia group, 2 of 3 tumors disappeared even in the histological examination. The 2-year overall survival rate for clinical M0 patients in hyperthermia group and that in control group were 44 and 7%, respectively. Conclusion: Regional hyperthermia could be a potential tool to improve local control in patient with non-small cell lung cancer deeply invaded to the chest wall.
F•-•
Second cancers occurring in patients with early stage non-small-cell lung cancer (NSCLC) treated with radiation therapy (RT) alone
B. Jeremic, Y. Shibamoto, L. Acimovic, N. Nikolic, A. Dagovic, B. Milicic, S. Milisavljevic, J. Aleksandrovic, G. RadosavIjevic-Asic. University Hospital, Kragujevac, Yugoslavia, Institite for Frontier Medical Sciences, Kyoto, Japan
Purpose: To investigate the incidence of second cancers occurring in patients with early stage (1/11)non-small-cell lung cancer (NSCLC) treated with radiation therapy (RT) alone. Material and Methods: A total of 194 patients treated with RT alone were followed up. Seventy-eight patients had been treated with conventionally fractionated (CF) RT (1982-1987), while 116 patients had been treated with hyperfractionated (Hfx) RT (1988-1993). Tumor doses were 60 Gy for CF and 69.6 Gy (1.2 Gy b.i.d.) for Hfx. Results: A total of 26 patients developed second cancer. The cumulative incidence of second cancer was 21.8% (SE, 4.7%) at 5 years and 34.8% (SE, 6.7%) at 10 years. For second lung cancers it was 6.0% (SE, 2.8%) at 5 years and 14.2% (SE, 5.2%) at 10 years, and for second non-lung cancers it was 16.3% (SE, 4.2%) at 5 years and 22.2% (SE, 5.7%) at 10 years. The rate of developing second cancer per patient per year was 4.3% [95% confidence intervals (CI), 2.7-5.9%], with the rates being 1.4% (CI, 0.5-2.3%) for the second lung cancers and 2.8% (CI, 1.5-4.1%) for second non-lung can-cers. The rate of developing second cancers during the first and second 5-year period was 3.7% (CI, 2.0-5.4%) and 4.2% (CI, 0.6%-7.8%), respectively, for all cancers, but it doubled from 1.0% (CI, 0.1-1.9%) to 2.2% (CI, 0-4.6%) for second lung cancers, while for second nonlung cancers it halved from 3.2% (CI, 1.6%-4.8%) to 1.5% (CI, 03.6%). There was no difference in the incidence between stage I and II patients and between CF and Hfx groups. Conclusions: Long-term survivors after RT alone for early stage NSCLC carry the same risk of developing second cancer, either lung or non-lung, as their counterparts treated surgically.