Objective: To compare the incidence of radiation-related toxicities between conventional and hypofractionated intensity-modulated radiation therapy (IMRT) for limited-stage small cell lung cancer (SCLC), and to explore the risk factors of hypofractionated radiotherapy-induced toxicities. Methods: Data were retrospectively collected from consecutive limited-stage SCLC patients treated with definitive concurrent chemoradiotherapy in Cancer Hospital of Chinese Academy of Medical Sciences from March 2016 to April 2022. The enrolled patients were divided into two groups according to radiation fractionated regimens. Common Terminology Criteria for Adverse Events (CTCAE, version 5.0) was used to evaluate the grade of radiation esophagus injuries and lung injuries. Logistic regression analyses were used to identify factors associated with radiation-related toxicities in the hypofractionated radiotherapy group. Results: Among 211 enrolled patients, 108 cases underwent conventional IMRT and 103 patients received hypofractionated IMRT. The cumulative incidences of acute esophagitis grade ≥2 [38.9% (42/108) vs 35.0% (36/103), P=0.895] and grade ≥ 3 [1.9% (2/108) vs 5.8% (6/103), P=0.132] were similar between conventional and hypofractionated IMRT group. Late esophagus injuries grade ≥2 occurred in one patient in either group. No differences in the cumulative incidence of acute pneumonitis grade ≥2[12.0% (13/108) vs 5.8% (6/103), P=0.172] and late lung injuries grade ≥2[5.6% (6/108) vs 10.7% (11/103), P=0.277] were observed. There was no grade ≥3 lung injuries occurred in either group. Using multiple regression analysis, mean esophageal dose ≥13 Gy (OR=3.33, 95% CI: 1.23-9.01, P=0.018) and the overlapping volume between planning target volume (PTV) and esophageal ≥8 cm(3)(OR=3.99, 95% CI: 1.24-12.79, P=0.020) were identified as the independent risk factors associated with acute esophagitis grade ≥2 in the hypofractionated radiotherapy group. Acute pneumonitis grade ≥2 was correlated with presence of chronic obstructive pulmonary disease (COPD, P=0.025). Late lung injuries grade ≥2 was correlated with tumor location(P=0.036). Conclusions: Hypofractionated IMRT are tolerated with manageable toxicities for limited-stage SCLC patients treated with IMRT. Mean esophageal dose and the overlapping volume between PTV and esophageal are independently predictive factors of acute esophagitis grade ≥2, and COPD and tumor location are valuable factors of lung injuries for limited-stage SCLC patients receiving hyofractionated radiotherapy. Prospective studies are needed to confirm these results.
Humans ; Small Cell Lung Carcinoma/pathology* ; Lung Neoplasms/pathology* ; Radiotherapy, Intensity-Modulated/methods* ; Retrospective Studies ; Lung Injury ; Radiotherapy Dosage ; Radiation Injuries/epidemiology* ; Esophagitis/epidemiology* ; Risk Factors ; Pulmonary Disease, Chronic Obstructive/complications*

BACKGROUND: The incidence and the mortality of lung cancer rank first among all malignant tumors and it seriously affects human health. The common types of non-small cell lung cancer (NSCLC) are adenocarcinoma and squamous carcinoma with clinical research and more attention, while adenosquamous carcinoma is a rare pathological subtype of lung cancer, which clinical features and prognostic factors are not yet fully understood. The purpose of this study is to analyze the clinical features and prognosis of lung adenosquamous carcinoma, and construct a nomogram to predict the patients' prognosis. METHODS: We obtained the data of adenosquamous carcinoma patients diagnosed between 2010 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database of the United States, and compared their clinical features and prognosis with those of lung adenocarcinoma and lung squamous cell carcinoma patients in the same period. Then we used univariate and multivariate analyses to explore the independent prognostic factors of adenosquamous carcinoma. Finally, we constructed and validated a nomogram to visually predict the outcomes of lung adenosquamous carcinoma. RESULTS: 1,453 patients with lung adenosquamous carcinoma were finally included. Compared with patients with lung adenocarcinoma and lung squamous cell carcinoma, the distributions of lung adenocarcinoma patients in most of the variables were medium between lung adenocarcinoma and squamous cell carcinoma. The prognosis of adenosquamous carcinoma was better than that of lung squamous cell carcinoma, but worse than that of lung adenocarcinoma. Multivariate analysis showed that age, differentiation, tumor-node-metastasis (TNM), surgery, and chemotherapy were independent prognostic factors (all P were less than 0.001). We constructed a nomogram with a C-index of 0.783 (0.767-0.799). The distinction test and consistency test showed that the nomogram could predict the patient's prognosis effectively. CONCLUSIONS Lung adenosquamous carcinoma has unique clinical, pathological, and prognostic characteristics. Age, differentiation, T, N, M, surgery, and chemotherapy status are independent predictors of prognosis in patients with adenosquamous carcinoma. Our nomogram can efficiently predict the prognosis of patients.
Aged ; Aged, 80 and over ; Carcinoma, Adenosquamous ; diagnosis ; epidemiology ; pathology ; therapy ; Databases, Factual ; Female ; Humans ; Lung Neoplasms ; diagnosis ; epidemiology ; pathology ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Survival Analysis

Xuanwei district in Yunnan Province of China has pretty high incidence of lung cancer in China, even a- round the world. Studies have shown that there exists a close relationship between lung cancer and local indoor air pollution caused by Bituminous coal. Considering that the indoor air pollution in Xuanwei District is caused by "open fireplace", an indoor air pollution simulation system was designed, and an F344 rats lung damage model was estab- lished for this indoor air pollution fireplace. The model is based on indoor air pollution simulation system with signal multiplexer control and multi-channel acquisition, and mining PID algorithm was used for polynomial fitting to each test point, and a relatively constant PM2. 5 air pollution status was simulated. The results showed that the system could simulate a variety of states of air pollution, provide a new test method for evaluation of human injury caused by indoor air pollution and a new idea for the study of the incidence of lung cancer in Xuanwei district and other places.
Air Pollution, Indoor ; analysis ; Animals ; China ; Coal ; adverse effects ; Humans ; Incidence ; Lung ; drug effects ; pathology ; Lung Neoplasms ; epidemiology ; Models, Biological ; Particulate Matter ; analysis ; Rats ; Rats, Inbred F344

To better understand the outcomes of small cell lung cancer (SCLC), we examined the clinical features and prognostic factors of SCLC in this study. A total of 148 patients who were diagnosed as having SCLC between January 2009 and December 2013 in Cancer Center of Union Hospital, Wuhan, China, were enrolled and their clinical features and prognostic factors were retrospectively analyzed. Log-rank test and Cox regression model were employed for analysis of prognostic factors. The 1- and 2-year overall survival (OS) rates were 59.7% and 25.7%, respectively, for limited disease (LD) patients whose median survival time (MST) was 16 months. The 1- and 2-year OS rates were 29.5% and 5.3%, respectively, for extensive disease (ED) patients whose MST was 10 months. The univariate analysis and multivariate analysis revealed that age, tumor stage, serum CEA and Ki-67 antigen were significantly correlated to the outcomes of SCLC, and they were significant prognostic factors for SCLC.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Ki-67 Antigen ; blood ; Lung Neoplasms ; blood ; epidemiology ; pathology ; Male ; Middle Aged ; Neoplasm Staging ; Small Cell Lung Carcinoma ; blood ; epidemiology ; pathology ; Survival Analysis

OBJECTIVETo evaluate the effect of comprehensive treatment and examine the impact of clinical factors on the survival outcome of limited-stage small cell lung cancer.

METHODSThe clinical records of 335 patients with limited-stage small cell lung cancer treated in the Cancer Hospital of Chinese Academy of Medical Sciences between January 1996 and December 2006 were analyzed retrospectively in this study. Kaplan-Meier method was used for survival analysis, and log-rank test and Cox regression were used for univariate and multivariate analyses of prognostic factors.

RESULTSThe median follow-up time was 54 months for all patients, the median survival time was 23.8 months, and progression-free survival was 12.5 months. The 2-, 3-, and 5-year overall survival rates were 47.3%, 32.9%, and 22.9%, respectively. The acute toxicity during comprehensive treatment was tolerable. The incidence of ≥grade 3 hematological toxicity, ≥grade 3 gastrointestinal toxicity, ≥grade 2 radiation pneumonitis and ≥grade 2 acute esophagitis were 37.0%, 14.9%, 11.0%, and 38.8%, respectively. The univariate analysis showed that KPS<80, smoking and high LDH level significantly reduced the overall survival time in patients with limited-stage SCLC. The multivariate analysis showed that KPS and weight loss were independent factors affecting the prognosis for the limited stage SCLC patients (P<0.05 for all).

CONCLUSIONSSequential chemoradiotherapy can be safely and effectively performed in limited-stage small cell lung cancer. Krnofsky performance status and weight loss are independent prognostic factors for the overall survival of LS-SCLC.

Chemoradiotherapy ; Disease-Free Survival ; Esophagitis ; Humans ; Lung Neoplasms ; diagnosis ; epidemiology ; pathology ; Multivariate Analysis ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Small Cell Lung Carcinoma ; diagnosis ; epidemiology ; pathology ; Survival Analysis ; Survival Rate

INTRODUCTIONMorbidity and mortality from malignant diseases are usually the result of metastasis. The bone is the third most common site of metastasis.

METHODSThis is a retrospective study of patients with metastatic bone disease who were referred to the Orthopaedic Department of University Malaya Medical Centre, Malaysia, between January 2004 and October 2009.

RESULTSA total of 151 patients (51.0% men, 49.0% women) had metastatic bone disease, with the highest incidence at the age range of 50-59 years. The commonest primary cancer was breast (23.3%), followed by lung (21.2%), prostate (9.3%), thyroid (7.3%) and renal cell carcinoma (5.3%); unknown primary cancer was 6.6%. There was long bone involvement in 52.7% of cases, axial bone in 44.5%, and both long and axial bones in 2.8%. The majority (90.1%) were symptomatic, with pain as the commonest symptom. 106 (70.2%) patients had pathological fractures. Neurological deficit was reported in 90.7% of patients, with 41.1% having extraskeletal metastases. 67.8% of the lesions were osteolytic, 24.3% were sclerotic, and 7.9%, mixed. Palliative and therapeutic interventions were undertaken for 62.0% of patients. The mean survival times were: breast 21.0; thyroid 20.7; prostate 20.3; lung 16.0; and unknown primary cancer 32.6 months.

CONCLUSIONIn our study, breast and lung cancers were the commonest primary cancers in metastatic bone disease. Most patients had more than one site of involvement, pain at presentation and pathological fractures. Surgery is beneficial to relieve pain and improve function and neurology. Duration of survival depends on the type of primary cancer and whether systemic metastasis is present.

Academic Medical Centers ; statistics & numerical data ; Adult ; Age Distribution ; Aged ; Bone Neoplasms ; epidemiology ; secondary ; Breast Neoplasms ; pathology ; Female ; Humans ; Incidence ; Lung Neoplasms ; pathology ; Malaysia ; epidemiology ; Male ; Middle Aged ; Retrospective Studies

With the growing threat of malignancy to health, it is necessary to analyze cancer incidence and patient survival rates among the residents in Pudong New Area of Shanghai to formulate better cancer prevention strategies. A total of 43,613 cancer patients diagnosed between 2002 and 2006 were recruited from the Pudong New Area Cancer Registry. The incidence, observed survival rate, and relative survival rate of patients grouped by sex, age, geographic area, and TNM stage were calculated using the Kaplan-Meier, life table, and Ederer II methods, respectively. Between 2002 and 2006, cancer incidence in Pudong New Area was 349.99 per 100,000 person-years, and the 10 most frequently diseased sites were the lung, stomach, colon and rectum, liver, breast, esophagus, pancreas, brain and central nervous system, thyroid, and bladder. For patients with cancers of the colon and rectum, breast, thyroid, brain and central nervous system, and bladder, the 5-year relative survival rate was greater than 40%, whereas patients with cancers of the liver and pancreas had a 5-year relative survival rate of less than 10%. The 1-year to 5-year survival rates for patients grouped by sex, age, geographic area, and TNM stage differed significantly (all P < 0.001). Our results indicate that cancer incidence and patient survival in Pudong New Area vary by tumor type, sex, age, geographic area, and TNM stage.
Adult ; Age Factors ; Aged ; Breast Neoplasms ; epidemiology ; pathology ; China ; epidemiology ; Colorectal Neoplasms ; epidemiology ; pathology ; Female ; Humans ; Incidence ; Liver Neoplasms ; epidemiology ; pathology ; Lung Neoplasms ; epidemiology ; pathology ; Male ; Middle Aged ; Neoplasm Staging ; Neoplasms ; epidemiology ; pathology ; Pancreatic Neoplasms ; epidemiology ; pathology ; Rural Population ; Sex Factors ; Stomach Neoplasms ; epidemiology ; pathology ; Survival Rate ; Urban Population

OBJECTIVETo compare the effectiveness and safety of different treatment modes for limited-stage small cell lung cancer(SCLC).

METHODSThe clinical data of 171 SCLC patients who had received different therapies were retrospectively analyzed.

RESULTSOf these 171 patients,55 had received concurrent radiochemotherapy,66 received sequential radiochemotherapy,and 50 received chemotherapy alone. For these 171 patients,the overall response rate(ORR)was 73.1%,overall survival(OS)and progression-free survival(PFS)were 23.5 months and 15.2 months,respectively,and the 1-,3-,and 5-year survival rates were 76.2%,30.4%,and 16.3%,respectively. For the concurrent group,sequential group,chemotherapy alone group,the median OS were 30.6,23.1,and 19.1 months,the median PFS were 19.7,13.3,and 11.5 months,and the 5-year survival rate was 28.7%,13.6%,and 9.4%,respectively(all P<0.05). The main toxic effects were myelosuppression,radiation pneumonia,and radiation esophagitis. The incidences of 1-2 grade myelosuppression were 92.7%,89.4%,and 92% in the concurrent group,sequential group,and chemotherapy alone group(P=0.25). For concurrent group and sequential group,the incidence of 1 grade radiation pneumonia were 47.2% and 50%,respectively(P=0.61),whereas the incidence of 1-2 grade radiation esophagitis were 94.5% and 75.8%(P=0.02). Multivariate analysis showed that gender,ECOG score,TNM stage,and thoracic radiation therapy were the independent prognostic factors for SCLC.

CONCLUSIONConcurrent radiochemotherapy is the treatment of choice for SCLC patients because it can improve the survival with tolerable toxicities.

Adult ; Aged ; Chemoradiotherapy ; methods ; Drug Therapy ; methods ; Esophagitis ; epidemiology ; Female ; Humans ; Lung Neoplasms ; mortality ; pathology ; therapy ; Male ; Middle Aged ; Neoplasm Staging ; Radiation Pneumonitis ; epidemiology ; Retrospective Studies ; Small Cell Lung Carcinoma ; mortality ; pathology ; therapy ; Survival Rate

OBJECTIVE: To explore the relation between diabetes mellitus and clinicopathological factors and the incidence of radiation pneumonitis in patients with non-small cell lung cancer. METHODS: The data of 332 patients with non-small cell lung cancer, who were admitted to the Department of Oncology of Third Xiangya Hospital of Central South University between January 2007 and August 2009, were collected retrospectively. The patients were divided into a diabetes mellitus (DM) group (n=45) and a non-diabetes mellitus (NDM) group (n=287). The clinicopathological factors were compared between the two groups. The patients who received radiotherapy were further divided into a diabetes mellitus (DMR) group (n=33) and a non-diabetes mellitus group (NDMR) group(n=287), and the incidence of radiation pneumonitis was compared. RESULTS: A total of 45 patients (13.55%)developed diabetes mellitus. There was significant difference in the body-weight, age and hypertension (P<0.05), while no significant difference in the pathologic factors, such as tumor pathological type, degree of differentiation, and classification of malignant tumors (TNM) stage between the two groups(P>0.05). No significant difference in the irradiation area was found between the DM group and the NDM group(P>0.05). The incidence of radiation pneumonitis in the DMR group was 42.42%(14 out of 33), while 21.31%(39 out of 183) in the NDMR group, with significant difference in the incidence of radiation pneumonitis between the DMR group and the NDMR group(P<0.05). The risk value in the DMR group was 2.721 folds (95%CI, 1.253-5.910) that in the NDMR group in patients with non-small cell lung cancer companied with diabetes mellitus. CONCLUSION Diabetes mellitus is the risk factor of radiation pneumonitis for patients with nonsmall cell lung cancer who receive radiotherapy.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung ; complications ; pathology ; radiotherapy ; China ; epidemiology ; Diabetes Mellitus, Type 2 ; complications ; radiotherapy ; Female ; Humans ; Lung Neoplasms ; complications ; pathology ; radiotherapy ; Male ; Middle Aged ; Radiation Pneumonitis ; complications ; epidemiology

OBJECTIVETo summarize the effectiveness of Chinese and Western integrative medicine in treating medium and advanced lung cancer, and to provide guidelines for clinical application.

METHODSFor this metaanalysis, a comparative search of Chinese medicine data in Chinese National Knowledge Infrastructure (CNKI) and Chinese BioMedical Literature Database (CBM) was undertaken to identify articles related to randomized comparative research of Chinese and Western integrative medicine in treating medium and advanced lung cancer between 1996 to 2006. Quality of life (QOL) was estimated using RevMan 4.2 software for data processing, adopting the odd ratio (OR) and the 95% confidence interval (CI).

RESULTSThrough meta-analysis of 10 qualified articles, the results were as follows: the merging effectiveness of QOL [OR=3.80, 95% CI (2.65, 5.47)]; the rate of survival [OR=3.44, 95% CI (2.04, 5.80)]; the tumor response rate [OR=1.88, 95% CI (1.37, 2.58)]; the tumor developing rate [OR=0.33, 95% CI (0.23, 0.48)]. Significant differences existed between the Chinese and Western integrative medicine treatment group and the Western treatment group (P<0.01).

CONCLUSIONSChinese and Western integrative medicine treatment of medium and advanced lung cancer has shown to improve patients' QOL and survival rate; it also can control tumor development in the short term.

Carcinoma ; epidemiology ; pathology ; therapy ; Combined Modality Therapy ; Disease Progression ; Humans ; Integrative Medicine ; methods ; Lung Neoplasms ; epidemiology ; pathology ; therapy ; Medicine, Chinese Traditional ; methods ; Neoplasm Staging ; Publication Bias ; statistics & numerical data ; Randomized Controlled Trials as Topic ; statistics & numerical data ; Treatment Outcome ; Western World