No abstract available.
Drug Therapy, Combination* ; Necrosis* ; Radiotherapy* ; Small Cell Lung Carcinoma*

Radiation therapy has played a key role, together with surgery and systemic chemotherapy, in treating in all stages of non-small cell lung cancer. We have witnessed remarkable improvements in radiation therapy techniques, with the innovations in hardware and software. Stereotactic ablative radiation therapy, which can deliver high radiation dose focused to small target volume, represents one of the state-of-the-art radiation therapy techniques. The technical development of radiation therapy and the role of stereotactic ablative radiation therapy in treating inoperable stage I non-small cell lung cancer are briefly reviewed.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy ; Radiotherapy ; Stereotaxic Techniques

The retrospective analysis was performed on 37 patients with stage III non small cell lung cancer who received the radiotherapy from Feb. 1986 to Dec. 1990 at the Dept. of Radiation Oncology, National Medical Center. This analysis, with 29 patients (78.4%) having been followed from 10 to 60 months, was done to know the survival rate and significant prognostic factor. The actuarial 2, 5-year survival rates were 20.6%, 6.9% in our all patients and Median survival time was 10 months. Of patients with KPS(Karnofsky performance status) greater than 80%, the 2, 5 year survival rate and median survival time were 29.2%, 9.7% and 13 months, respectively. The 2-year survival rate and median survival time of patients with KPS less than 80% were 13.7% and 7 months, respectively. The survival difference according to performance status was statistically significant(29.2% vs. 13.7%)(p<0.05). In stage IIIa, the 2, 5-year survival rate and median survival rate and median survival time were 29.2%, 9.7% and 12 months, respectively. The 2-year survival rate and metian survival time of stage IIIb were 8.6% and 10 months, respectively. The survival difference between stage IIIa and IIIb did not show statistical significance(p>0.1). Of the prognostic factors, the difference of survival rate by initial performance status was statistically significant (p<0.05). But the difference of survival rates by pathologic cell type, stage, total radiation dose, radiotherapy response, and combination with chemotherapy were not statistically significant.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy ; Humans ; Radiation Oncology ; Radiotherapy ; Retrospective Studies ; Small Cell Lung Carcinoma ; Survival Rate

The majority of non-small cell lung cancer patients present with locally advanced disease that may not be resectable. A single modality treatment such as thoracic radiotherapy often results in an inferior outcome when compared to combined modality treatment. Various combinations of radiotherapy, chemotherapy, and surgery have been tested in patients with locally advanced non-small-celllung cancer with promising results. The favorable results of the combined modality treatment are accompanied by a corresponding increase in treatment related morbidity. In this article, the results of the application of combined modality treatments in the management of locally advanced non-small cell lung cancer are reviewed.
Carcinoma, Non-Small-Cell Lung* ; Combined Modality Therapy* ; Drug Therapy ; Humans ; Radiotherapy

Non-small cell lung cancer: As most patients with non-small cell lung cancer present with nonsurgically curable diseae, major efforts have been made in the treatment of advanced non-small cell lung cancer (NSCLC) with chemotherapy. Controlled studies of platinum-based chemotherapy vs. supportive care showed statistically significant improvements in survival. During the last several years, the introduction of several new chemotherapeutic agents, such as the taxanes, gemcitabine, vinorelbine, and irinotecan has resulted in improved survival and quality of life for patients with advanced NSCLC. However, the superiority of a regimen in terms of improved survival, quality of life, and toxicity profile has still remained unclear. Newer, targeted therapies hold promise to improve outcome without adding a great deal of additional toxicity. Small cell lung cancer: Small cell lung cancer (SCLC) is characterized by early dissemination and a rapid, aggressive clinical course. The role of combination chemotherapy in patients with SCLC was well established since 1970's; however, no trend toward longer survival has been observed during the last decade. Even if the use of adjunctive radiation therapy does not help in extending survival in extensive-disease, the use of chemotherapy without radiation therapy is to be discouraged in patients with limited-disease, because randomized trials showed a definite survival advantage for combined modality therapy. In terms of the choice of chemotherapy, etoposide/cisplatin or etoposide/carboplatin have emerged as the regimens of choice because they offer a good therapeutic index and can be combined with radiotherapy. Recently, several active agents such as taxanes, topotecan, vinorelbine, and irinotecan have been used in SCLC.
Carcinoma, Non-Small-Cell Lung ; Combined Modality Therapy ; Drug Therapy* ; Drug Therapy, Combination ; Humans ; Lung Neoplasms* ; Lung* ; Quality of Life ; Radiotherapy ; Small Cell Lung Carcinoma ; Taxoids ; Topotecan

Locally advanced NSCLC is a heterogenous group of bronchogenic malignancies that are traditionally thought to be unresectable without overt distant metastasis or malignant pleural effusion. The mainstay of treatment for this class of diseases until the early 1990s was radiation alone, which resulted in a dismal outcome. The new technologies in radiation therapy (e.g. 3D-CRT) and the shift in paradigm (e.g. omission of ENI) have enabled the dose-escalation, which translated to improved outcome compared to the conventional radiotherapy using 2-D planning. The trials combining chemotherapy with radiotherapy, first sequentially, then concurrently, have changed the standard of care for patients with good functional status to concurrent chemoradiation. Some studies have shown survival benefits to adding consolidative systemic therapy with concurrent chemoradiation. We will outline the development of the current treatment standard of locally advanced NSCLC and present selected topics undergoing active research to forecast the next generation of NSCLC therapy
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy ; Humans ; Neoplasm Metastasis ; Pleural Effusion, Malignant ; Radiotherapy ; Standard of Care

No abstract available.
Carcinoma, Non-Small-Cell Lung* ; Cisplatin* ; Drug Therapy, Combination* ; Etoposide* ; Radiotherapy*

In one case of cancer-associated Lambert-Eaton myasthenic syndrome (LEMS), treatment with cytotoxic chemotherapy and radiotherapy resulted in remission of both cancer and neuromuscular disorder. Serial repetitive nerve stimulation (RNS) findings showed that the typical RNS features of LEMS returned to normal in the orders of dramatic postexercise facilitation, an incremental response in high rate stimulation, and a decremental response in low rate stimulation with clinical improvement.
Drug Therapy* ; Lambert-Eaton Myasthenic Syndrome* ; Radiotherapy* ; Small Cell Lung Carcinoma*

PURPOSE : To evaluate clinical and three dimensional (3D) dosimetric parameters associated with esophageal injury after radiotherapy for non-small cell lung cancer (NSCLC). MATERIALS AND METHODS : The records of 254 patients treated for NSCLC between 1992 and 2001 were reviewed. A variety of metrics describing the esophageal dose were extracted. Chemotherapy was given in 143 patients (56%). The RTOG toxicity criteria for grading of esophageal injury were used. The median follow-up time of all patients was 43 months with the range of 0.5~120 months. Logistic regression, contingency table analyses and Fisher's exact tests were used for statistical analysis. RESULTS : Acute toxicity occurred in 78% patients (199/254); grade 1,138; grade 2, 38; grade 3, 22 and grade 4, 1. For acute toxicity> or =Grade 2, BID-RT, age, nodal stage> or =N2, and most dosimetric parameters were predictive. Late toxicity occurred in 17 (7%) of 238 patients; grade 1, 5; grade 2, 4; grade 3, 5 and grade 4, 3. The median and maximum time to onset of late toxicity was 5 and 40 months after radiotherapy, respectively. Late toxicity occurred in 2%, 3%, 17%, 26%, and 100% of patients with acute grade 0, 1, 2, 3 and 4 toxicity, respectively. For late toxicity, the severity of acute toxicity was most predictive. CONCLUSION : A variety of dosimetric parameters are predictive for acute and late esophageal injury. A strong correlation between the dosimetric parameters prevented a comparison between the predictive abilities of these metrics. The presence of acute injury was the most predictive factor for the development of late injury. This suggests that late injury may be "consequential" and that aggressive treatment of acute effects may reduce the risk of late injury. Additional studies to better define predictors of RT-induced esophageal injury are needed
Carcinoma, Non-Small-Cell Lung ; Drug Therapy ; Follow-Up Studies ; Humans ; Logistic Models ; Radiotherapy

PURPOSE: We retrospectively analyzed the patients who received curative radiotherapy for unresectable stage III NSCLC to investigate the impact of chemotherapy. MATERIALS AND METHODS: From 1998 to 2001, the records of 224 patients who completed curative radiotherapy for NSCLC were reviewed. There were 210 males and 14 females, and their median age was 64 years (range 38 ~83). 54 patients had stage IIIA disease and 170 patients had stage IIIB disease. Conventional radiotherapy was given and the radiation dose ranged from 50~70 Gy with a median of 60 Gy, and chemotherapy was combined for 116 patients (52%). RESULTS: The median survival, the 2-year, and 5-year actuarial survival rates of all 224 patients were 15 months, 30%, and 7%, respectively. The median survival of the patients with stage IIIA and IIIB disease were 21 months and 13 months, respectively (p=0.14). The median survival of patients who received chemoradiation was 18 months compared to 14 months for the patients who received RT alone (p=0.02). Among the chemoradiation group of patients, the median survival time of the patients who received 1 to 3 cycles of chemotherapy was 16 months and that for the patients who received more than 3 cycles was 22 months (p=0.07). We evaluated the effects of the timing of chemoradiation in 57 patients who received more than 3 cycles of chemotherapy. The median survival of the patients with the concurrent sequence was 25 months and that for the patients with the sequential chemotherapy was 19 months (p=0.81). CONCLUSIONS: For advanced stage III non-small cell lung cancer patients who completed the curative radiotherapy, the addition of chemotherapy improved the survival compared to the patients who received radiotherapy alone.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy* ; Female ; Humans ; Male ; Radiotherapy ; Retrospective Studies ; Survival Rate