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Dose escalation to ...
Dose escalation to 84 Gy with concurrent chemotherapy in stage III NSCLC appears excessively toxic: Results from a prematurely terminated randomized phase II trial
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- Hallqvist, Andreas, 1973 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för onkologi,Institute of Clinical Sciences, Department of Oncology,Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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- Bergstrom, S. (author)
- Department of Oncology, Gävle Hospital, Gävle, Sweden
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- Bjorkestrand, H. (author)
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
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- Svärd, Anna-Maja (author)
- Umeå universitet,Onkologi
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- Ekman, S. (author)
- Karolinska Institutet
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- Lundin, Erik, 1970- (author)
- Örebro universitet,Institutionen för medicinska vetenskaper,Department of Oncology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden
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- Holmberg, Erik, 1951 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för onkologi,Institute of Clinical Sciences, Department of Oncology,Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Regional Cancer Center in Western Sweden, Göteborg, Gothenburg, Sweden
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- Johansson, Mikael (author)
- Umeå universitet,Onkologi
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- Friesland, S. (author)
- Karolinska Institutet,Umeå universitet,Onkologi
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- Nyman, Jan, 1956 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för onkologi,Institute of Clinical Sciences, Department of Oncology,Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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(creator_code:org_t)
- Elsevier BV, 2018
- 2018
- English.
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In: Lung Cancer. - : Elsevier BV. - 0169-5002 .- 1872-8332. ; 122, s. 180-186
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https://gup.ub.gu.se...
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https://doi.org/10.1...
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Abstract
Subject headings
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- Objectives: Concurrent chemoradiotherapy is the mainstay treatment for NSCLC stage III disease. To investigate whether radiation dose escalation based on individual normal tissue constraints can improve outcome, the Swedish lung cancer study group launched this randomized phase II trial. Materials and Methods: NSCLC patients with stage III disease, good performance status (0-1) and adequate lung function (FEV1 > 1.0 L and CO diffusion capacity > 40%) received three cycles of cisplatin (75 mg/m(2) day 1) and vinorelbine (25 mg/m(2) day 1 and 8) every third week. Radiotherapy started concurrently with the second cycle, with either 2 Gy daily, 5 days a week, to 68 Gy (A) or escalated therapy (B) based on constraints to the spinal cord, esophagus and lungs up to 84 Gy by adding an extra fraction of 2 Gy per week. Results: A pre-planned safety analysis revealed excessive toxicity and decreased survival in the escalated arm, and the study was stopped. Thirty-six patients were included during 2011-2013 (56% male, 78% with adenocarcinoma, 64% with PS 0 and 53% with stage IIIB). The median progression-free survival (PFS) and overall survival (OS) were 11 and 17 months in arm B compared to the encouraging results of 28 and 45 months in the standard arm. The 1- and 3-year survival rates were 56% and 33% (B) and 72% and 56% (A), respectively. There were seven toxicity-related deaths due to esophageal perforations and pneumonitis: five in the escalated group and two with standard treatment. Conclusion: Dose-escalated concurrent chemoradiotherapy to 84 Gy to primary tumor and nodal disease is hazardous, with a high risk of excessive toxicity, whereas modern standard dose chemoradiotherapy with proper staging given in the control arm shows a promising outcome with a median survival of 45 months and a 3-year survival of 56% (NCT01664663).
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Lungmedicin och allergi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Respiratory Medicine and Allergy (hsv//eng)
Keyword
- NSCLC
- Stage III
- Dose escalated chemoradiotherapy
- Phase II
- Randomized
- cell lung-cancer
- 3-dimensional conformal radiotherapy
- high-precision
- radiotherapy
- body radiation-therapy
- european organization
- survival
- cetuximab
- boost
- recommendations
- chemoradiation
- Oncology
- Respiratory System
- NSCLC
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Hallqvist, Andre ...
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Bergstrom, S.
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Bjorkestrand, H.
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Svärd, Anna-Maja
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Ekman, S.
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Lundin, Erik, 19 ...
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show more...
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Holmberg, Erik, ...
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Johansson, Mikae ...
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Friesland, S.
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Nyman, Jan, 1956
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cancer and Oncol ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Respiratory Medi ...
- Articles in the publication
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Lung Cancer
- By the university
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University of Gothenburg
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Örebro University
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Umeå University
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Karolinska Institutet