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      Combination of Iodine-125 brachytherapy and chemotherapy for locally recurrent stage III non-small cell lung cancer after concurrent chemoradiotherapy

      research-article
      Author(s): , , ,
      Publication date (Electronic):
      Journal: BMC Cancer
      Publisher: BioMed Central
      Keywords: Brachytherapy, Iodine-125, Non-small cell lung cancer, Recurrence

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          Abstract

          Background

          Locally recurrent non-small cell lung cancer (NSCLC) poses a great challenge to physicians. This study aimed to explore the efficacy and safety of the combination of brachytherapy and docetaxel and cisplatin for the treatment of locally recurrent stage III NSCLC.

          Methods

          Fifty two patients with locally recurrent stage III NSCLC after concurrent chemoradiotherapy were randomly divided into two groups ( n = 26). The patients in experimental group were treated with implantation of radioactive 125I seeds and DP regimen (docetaxel 60 mg/m 2/cisplatin 75 mg/m 2). Patients in control group received DP chemotherapy. The local control rate (LCR), progression-free survival (PFS), and overall response rate (ORR) were defined according to the Response Evaluation Criteria in Solid Tumors (RECIST).

          Results

          With a median follow-up time of 11 months, PFS and LCR was 8 months (95 % CI: 6.99–9.01 months) vs. 5.5 months (95 % CI: 4.43–6.57 months) ( P < 0.05) and 10 months (95 % CI: 8.72–11.28 months) vs. 6.2 months (95 % CI: 5.27–7.13 months) ( P < 0.05) in the experimental and control groups, respectively. The ORR did not differ between treatment groups and was noted to be 69.2 % and 57.7 %, respectively ( P >0.05). There was no occurrence of severe complications in experimental and control groups.

          Conclusion

          The combination of 125I brachytherapy and second-line chemotherapy is superior to chemotherapy alone and is an effective and safe therapy for this disease.

          Trial registration number

          ChiCTR-IOR-15006560

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          Most cited references18

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          Aflibercept and Docetaxel versus Docetaxel alone after platinum failure in patients with advanced or metastatic non-small-cell lung cancer: a randomized, controlled phase III trial.

          Nicholas Thatcher, Tinh S. Le, Vera Gorbunova … (2012)
          To compare the efficacy of aflibercept (ziv-aflibercept), a recombinant human fusion protein targeting the vascular endothelial growth factor (VEGF) pathway, with or without docetaxel in platinum-pretreated patients with advanced or metastatic nonsquamous non-small-cell lung cancer. In this international, double-blind, placebo-controlled phase III trial, 913 patients were randomly assigned to (ziv-)aflibercept 6 mg/kg intravenous (IV; n = 456) or IV placebo (n = 457), both administered every 3 weeks and in combination with docetaxel 75 mg/m(2). The primary end point was overall survival (OS). Other efficacy outcomes, safety, and immunogenicity were also assessed. Patient characteristics were balanced between arms; 12.3% of patients had received prior bevacizumab. (Ziv-)Aflibercept did not improve OS (hazard ratio [HR], 1.01; 95% CI, 0.87 to 1.17; stratified log-rank P = .90). The median OS was 10.1 months (95% CI, 9.2 to 11.6 months) for (ziv-)aflibercept and 10.4 months (95% CI, 9.2 to 11.9 months) for placebo. In exploratory analyses, median progression-free survival was 5.2 months (95% CI, 4.4 to 5.6 months) for (ziv-)aflibercept versus 4.1 months (95% CI, 3.5 to 4.3 months) for placebo (HR, 0.82; 95% CI, 0.72 to 0.94; P = .0035); overall response rate was 23.3% of evaluable patients (95% CI, 19.1% to 27.4%) in the (ziv-)aflibercept arm versus 8.9% (95% CI, 6.1% to 11.6%; P < .001) in the placebo arm. Grade ≥ 3 adverse events occurring more frequently in the (ziv-)aflibercept arm versus the placebo arm were neutropenia (28.0% v 21.1%, respectively), fatigue (11.1% v 4.2%, respectively), stomatitis (8.8% v 0.7%, respectively), and hypertension (7.3% v 0.9%, respectively). The addition of (ziv-)aflibercept to standard docetaxel therapy did not improve OS. In exploratory analyses, secondary efficacy end points did seem to be improved in the (ziv-)aflibercept arm. The study regimen was associated with increased toxicities, consistent with known anti-VEGF and chemotherapy-induced events.
          Article 0 comments Cited 49 times – based on 0 reviews     Review now
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            Defining local-regional control and its importance in locally advanced non-small cell lung carcinoma.

            Mitchell Machtay, Rebecca Paulus, Jennifer Moughan … (2012)
            Local-regional control (LRC) rates for non-small cell lung cancer after chemoradiotherapy were studied (using two different definitions of LRC) for the association between LRC and survival. Seven legacy Radiation Therapy Ooncology Group trials of chemoradiotherapy for locally advanced non-small cell lung cancer were analyzed. Two different definitions of LRC were studied: (1) freedom from local progression (FFLP-LRC), the traditional Radiation Therapy Oncology Group methodology, in which a failure is intrathoracic tumor progression by World Health Oorganization criteria; and (2) response-mandatory (strict-LRC), in which any patient not achieving at least partial response was considered to have failure at day 0. Testing for associations between LRC and survival was performed using a Cox multivariate model that included other potential predictive factors. A total of 1390 patients were analyzed. The LRC rate at 3 years was 38% based on the FFLP-LRC definition and 14% based on the strict-LRC definition. Performance status, concurrent chemotherapy, and radiotherapy dose intensity (biologically equivalent dose) were associated with better LRC (using either definition). With the strict-LRC definition (but not FFLP-LRC), age was also important. There was a powerful association between LRC and overall survival (p, 0.0001) on univariate and multivariate analyses. Age, performance status, chemotherapy sequencing, and biologically equivalent dose were also significantly associated with survival. Histology and gender were also significant if the strict-LRC model was used. LRC is associated with survival. The definition of LRC affects the results of these analyses. A consensus definition of LRC, incorporating functional imaging and/or central review, is needed, with the possibility of using LRC as a surrogate end point in future trials.
            Article 0 comments Cited 47 times – based on 0 reviews     Review now
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              Impact of brachytherapy on local recurrence rates after sublobar resection: results from ACOSOG Z4032 (Alliance), a phase III randomized trial for high-risk operable non-small-cell lung cancer.

              Hiran C Fernando, Rodney Landreneau, Sumithra Mandrekar … (2014)
              A major concern with sublobar resection (SR) for non-small-cell lung cancer (NSCLC) is high local recurrence (LR). Adjuvant brachytherapy may reduce LR This multicenter randomized trial compares SR to SR with brachytherapy (SRB).
              Article 0 comments Cited 25 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jingdong He: 86-0517-4907222 , hjddr1@163.com
                Journal
                Journal ID (nlm-ta): BMC Cancer
                Journal ID (iso-abbrev): BMC Cancer
                Title: BMC Cancer
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2407
                Publication date (Electronic): 6 October 2015
                Publication date PMC-release: 6 October 2015
                Publication date Collection: 2015
                Volume: 15
                Electronic Location Identifier: 656
                Affiliations
                Department of Oncology, Huai’an First People’s Hospital, Nanjing Medical University, 6 Beijing Road West, Huai’an, Jiangsu 223300 China
                Article
                Publisher ID: 1657
                DOI: 10.1186/s12885-015-1657-3
                PMC ID: 4596375
                PubMed ID: 26445227
                SO-VID: 391b03c9-3dc4-4b3b-819d-126b42c8286e
                Copyright © © Yu et al. 2015
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 10 July 2015
                Date accepted : 27 September 2015
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2015

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: brachytherapy,iodine-125,non-small cell lung cancer,recurrence
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: brachytherapy, iodine-125, non-small cell lung cancer, recurrence

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