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    Targeted therapy combined with thoracic radiotherapy for non-small cell lung cancer
    (SPRINGER HEIDELBERG, 2019) Yavas, Guler.; Yavas, Cagdas.
    IntroductionIn recent years, there has been undoubted progress in the evaluation and development of targeted agents for non-small cell lung cancer (NSCLC). At the same time, remarkable progress in radiation therapy (RT) has been developed largely due to our ability to more effectively focus and deliver radiation to the tumor target volume. Both developments brought the idea of combining the radiation with molecularly targeted agents in order to improve outcomes in NSCLC patients who have limited survival times with standard chemoradiotherapy.MethodsWe identified patients with gastric cancer treated with post-operative radiation at our institution between 2002 and 2016. Acute and late toxicities were evaluated per RTOG/EORTC Radiation Toxicity Grading Scale. Statistical analysis was performed using Chi-square tests, t tests, log-rank, and logistic regression.ResultsCetuximab has no survival benefit, and it seems to be toxic in this patient population. Bevacizumab has severe toxicity including tracheoesophageal fistulae formation in addition to its ineffectiveness. It is difficult to have an opinion about TKIs when combined with RT since most of the studies were conducted on unselected patients. For oligometastatic/oligoprogressive NSCLC patients, it seems to be reasonable to use a combined regimen since combined regimen resulted in superior survival time; however, the patients should be followed up closely with respect to the toxicity. In patients with brain metastases, the use of concomitant RT + TKIs increased survival with acceptable toxicity levels.ConclusionsIn this review, we summarize the recent literature about the use of molecularly targeted agents with concurrent RT in NSCLC patients.
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    Thoracic radiotherapy for extensive-stage small-cell lung cancer: What is the optimal dose and timing
    (SPRINGER HEIDELBERG, 2019) Yavas, Guler.; Yavas, Cagdas.
    Small-cell lung cancer (SCLC) is a neuroendocrine tumor that represents about 12-20% of all lung cancers. Most of the SCLC patients present with extensive-stage (ES) disease. Primary therapy for ES-SCLC is 4-6 cycles of platinum-based chemotherapy (CT) followed by prophylactic cranial irradiation (PCI) in selected cases. Although the response rate to CT is approximately 60-70%, median survival times are very limited. The main problem of ES-SCLC patients after CT is intra-thoracic tumor recurrence since 75% of the patients had persisting intra-thoracic disease after CT, and approximately 90% of the patients had intra-thoracic progressive disease within the first year after diagnosis. Such high rate of intra-thoracic disease progression explains the need of local treatment in selected patients. There are three randomized studies and two meta-analyses evaluating the role of thoracic radiotherapy (TRT) in patients with ES-SCLC who responded to CT. Two of the randomized trials and one of the meta-analyses showed survival benefit of TRT. According to the results of relevant studies, the patients who responded to CT and have intra-thoracic residual disease after CT, who had limited metastatic sites (<= 2), and who have good performance status and limited weight loss have more benefit from TRT. We need novel studies evaluating the optimal dose fractionation schedules, optimal timing of RT, impact of time interval between RT and CT, immunotherapy and RT combinations, and number of CT cycles.