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Combination of Brachytherapy with Iodine-125 Seeds and Systemic Chemotherapy versus Systemic Chemotherapy Alone for Synchronous Extracranial Oligometastatic Non-Small Cell Lung Cancer.

ABSTRACT: Background:A proportion of patients with synchronous oligometastatic non-small cell lung cancer (NSCLC) have poor survival, and currently no standard treatment is available, which poses a great challenge to physicians. This study aimed to assess and compare the efficacy and safety of the combination of brachytherapy with iodine-125 seeds and systemic chemotherapy versus systemic chemotherapy alone for synchronous extracranial oligometastatic NSCLC. Materials and Methods:After a systematic retrospective review of the case database between 1st Mar 2014 and 30th Mar 2018, data were obtained on 69 NSCLC patients with extracranial oligometastatic NSCLC. Among them, 32 patients received brachytherapy with iodine-125 seeds combined with systemic chemotherapy (group A), and the remaining 37 patients received chemotherapy alone (group B). The primary endpoint was overall survival (OS), and the secondary endpoints included progression-free survival (PFS), objective response rate (ORR), and complications. Results:The demographic and clinical characteristics were not significantly different between the groups (all p>0.05). The overall 3-month ORR was significantly higher in group A (65.6% vs 37.8%, p=0.030) than in group B. With a median follow-up time of 23 months, the PFS and OS were 11.6 (95% CI: 7.0-16.2) months vs 6.3 (95% CI: 3.4-9.2) months (p=0.036) and 17.6 (95% CI: 13.9-21.3) months vs 11.2 (95% CI: 7.7-14.7) months (p=0.042) in groups A and B, respectively. Furthermore, in Cox regression analysis, local brachytherapy was an independent prognostic factor for both PFS (HR=0.416, 95% CI: 0.246-0.702, p=0.001) and OS (HR=0.375, 95% CI: 0.216-0.653, p=0.001). Severe complications were not observed in either of the groups. Conclusion:The combination of brachytherapy with iodine-125 seeds and systemic chemotherapy is superior to chemotherapy alone for synchronous extracranial oligometastatic NSCLC.

SUBMITTER: Li H

PROVIDER: S-EPMC7494957 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Combination of Brachytherapy with Iodine-125 Seeds and Systemic Chemotherapy versus Systemic Chemotherapy Alone for Synchronous Extracranial Oligometastatic Non-Small Cell Lung Cancer.

Li Huzi H Duan Zhendong Z Zhao Cheng C Fang Wenyan W Jia Yingjie Y Li Xiaojiang X Kong Fanming F Zhao Lujun L

Cancer management and research 20200909

<h4>Background</h4>A proportion of patients with synchronous oligometastatic non-small cell lung cancer (NSCLC) have poor survival, and currently no standard treatment is available, which poses a great challenge to physicians. This study aimed to assess and compare the efficacy and safety of the combination of brachytherapy with iodine-125 seeds and systemic chemotherapy versus systemic chemotherapy alone for synchronous extracranial oligometastatic NSCLC.<h4>Materials and methods</h4>After a sy ...[more]

PMID: 32982417

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Project description:BackgroundThere is currently no widely-accepted consensus for the management of hepatocellular carcinoma with portal vein tumor thrombus. We evaluate the safety and efficacy of ultrasound-guided percutaneous brachytherapy with iodine-125 seeds for the treatment of hepatocellular carcinoma with portal vein-branch tumor thrombus (PVBTT).MethodsSixty-nine hepatocellular carcinoma patients with PVBTT were enrolled; 34 received transarterial chemoembolization (TACE) combined with iodine-125 seeds implanted in the PVBTT; 35 were treated with TACE alone. Adverse events, objective response rate, disease control rate, progression-free survival, and overall survival were compared between the two groups. Tumor responses of PVBTT and intrahepatic tumor were correlated. Multivariate and subgroup analyses were conducted for overall survival.ResultsNo grade 3 or 4 adverse events were recorded, and there was no difference in grade 1 or 2 adverse events between the two groups. Objective response rate and disease control rate for PVBTT were 58.9 and 91.2%, respectively, in the combined treatment group, which were significantly greater than the 5.7 and 54.3% rates, respectively, in the TACE-alone group (both p's ≤ 0.001). Intrahepatic tumor response was positively correlated with the PVBTT response (γ = 0.782, p < 0.01). Survival outcomes were better in the combined treatment group than in the TACE-alone group: the median progression-free survival for PVBTT was 9 months versus 3 months (HR = 0.187 [95% CI: 0.101, 0.345], p < 0.001), and the median overall survival was 11 months versus 7 months (HR = 0.448 [95% CI: 0.265, 0.758], p = 0.003). Multivariate analysis revealed that application of brachytherapy and lower grade PVBTT (Vp1 + Vp2 vs. Vp3) were protective predictors of overall survival. In stratified analysis, the benefit of overall survival was more significant in the subgroup of PVBTT Vp1 + Vp2 rather than in Vp3.ConclusionsThe combination of iodine-125 seed brachytherapy guided by ultrasound and TACE is a convenient, safe, and effective treatment for patients with HCC and PVBTT, conferring a better survival benefit than TACE alone.

Project description:Purpose:To investigate chronological changes in lower urinary tract symptoms (LUTS) in patients who received iodine-125 brachytherapy (BT) for prostate cancer. Methods:We enrolled 706 patients who received BT. Of these, 265 (38%) received BT combined with external beam radiation therapy (EBRT). An International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QOL) score, and overactive bladder symptom score (OABSS) were recorded before BT (baseline, BL), and 1, 3, 6, 12, 24, 36, 48, and 60?months after BT. The sum of frequency (2), urgency (4) and nocturia (7) of the IPSS questionnaire was defined as the storage symptoms score, whereas the sum of emptying (1), intermittency (3), weak stream (5), and hesitancy (6) was defined as the voiding symptom score. Results:Total IPSS significantly increased at 3?months following BT compared with BL (mean score: 17.1 vs. 7.99, P?<?0.001) and returned to BL by 36?months. The storage symptom score did not return to BL 36?months after BT. Total OABSS significantly increased 3?months after BT compared with BL (mean score: 6.52 vs. 3.45, P?<?0.001), and returned to BL 48?months after BT. The IPSS-QOL score was the highest score (mean score: 2.46 vs. 3.9, P?<?0.001) 3?months after BT and returned to BL 48?months after BT, however the IPSS-QOL score was lower than BL (mean score: 2.01 vs 2.46, P?<?0.001) at 60?months. The risk factors for LUTS within 1?year after BT were BL IPSS (P?<?0.001) and PV (P?<?0.001). Patients who received combined EBRT experienced transient storage symptoms 24 and 36?months after BT, whereas those who received BT alone did not. However, the storage symptom score of the patients who received combined EBRT was improving 48?months after BT and eventually showed no significant difference compared with those treated with BT alone. Conclusion:Three months after BT, LUTS, including storage symptoms, deteriorated the most but improved with time. The urinary symptom in patients who received combined EBRT can potentially flare again in 24 and 36?months after BT. Knowledge of changes in LUTS associated with BT may influence treatment recommendations and enable patients to make better-informed decisions.

Dataset Information

Combination of Brachytherapy with Iodine-125 Seeds and Systemic Chemotherapy versus Systemic Chemotherapy Alone for Synchronous Extracranial Oligometastatic Non-Small Cell Lung Cancer.

Publications

Combination of Brachytherapy with Iodine-125 Seeds and Systemic Chemotherapy versus Systemic Chemotherapy Alone for Synchronous Extracranial Oligometastatic Non-Small Cell Lung Cancer.

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