Prophylactic Cranial Irradiation vs Observation in Patients With Locally Advanced Non-Small Cell Lung Cancer: A Long-term Update of the NRG Oncology/RTOG 0214 Phase 3 Randomized Clinical Trial.

IMPORTANCE: Brain metastasis (BM) rates are high in locally advanced non-small cell lung cancer (LA-NSCLC), approaching rates seen in small cell lung cancer, where prophylactic cranial irradiation (PCI) is standard of care. Although PCI decreases the incidence of BM in LA-NSCLC, a survival advantage has not yet been shown. OBJECTIVE: To determine if PCI improves survival in LA-NSCLC. DESIGN, SETTING, AND PARTICIPANTS: Radiation Therapy Oncology Group (RTOG) 0214 was a randomized phase 3 clinical trial in stage III NSCLC stratified by stage (IIIA vs IIIB), histologic characteristics (nonsquamous vs squamous) and therapy (no surgery vs surgery). The study took place at 291 institutions in the United States, Canada, and internationally. Of 356 patients with stage III NSCLC entered onto this study, 16 were ineligible; therefore, 340 patients were randomized. INTERVENTION FOR CLINICAL TRIALS: Observation vs PCI. MAIN OUTCOMES AND MEASURES: The primary outcome was overall survival (OS). The secondary end points were disease-free survival (DFS) and incidence of BM. RESULTS: Of the 340 total participants, mean (SD) age was 61 years; 213 of the participants were men and 127 were women. The median follow-up time was 2.1 years for all patients, and 9.2 years for living patients. The OS for PCI was not significantly better than observation (hazard ratio [HR], 0.82; 95% CI, 0.63-1.06; P = .12; 5- and 10-year rates, 24.7% and 17.6% vs 26.0% and 13.3%, respectively), while the DFS (HR, 0.76; 95% CI, 0.59-0.97; P = .03; 5- and 10-year rates, 19.0% and 12.6% vs 16.1% and 7.5% for PCI vs observation) and BM (HR, 0.43; 95% CI, 0.24-0.77; P = .003; 5- and 10-year rates, 16.7% vs 28.3% for PCI vs observation) were significantly different. Patients in the PCI arm were 57% less likely to develop BM than those in the observation arm. Younger patients (<60 years) and patients with nonsquamous disease developed more BM. On multivariable analysis, PCI was associated with decreased BM and improved DFS, but not improved OS. Multivariable analysis within the nonsurgical arm suggests that PCI effectively prolongs OS, DFS, and BM. CONCLUSIONS AND RELEVANCE: In patients with stage III LA-NSCLC without progression of disease after therapy, PCI decreased the 5- and 10-year rate of BM and improved 5- and 10-year DFS, but did not improve OS. Although this study did not meet its primary end point, the long-term results reveal many important findings that will benefit future trials. Identifying the appropriate patient population and a safe intervention is critical. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00048997.

Ruthenium mediated C-H activation of 2-(arylazo)phenols: characterization of an intermediate and the final organoruthenium complex.

Reaction of 2-(arylazo)phenols with [Ru(PPh(3))(2)(CO)(2)Cl(2)] affords a family of organometallic complexes of ruthenium(II) of type [Ru(PPh(3))(2)(CO)(CNO-R)], where the 2-(arylazo)phenolate ligand (CNO-R; R = OCH(3), CH(3), H, Cl, and NO(2)) is coordinated to the metal center as tridentate C,N,O-donor. Another group of intermediate complexes of type [Ru(PPh(3))(2)(CO)(NO-R)(H)] has also been isolated, where the 2-(arylazo)phenolate ligand (NO-R) is coordinated to the metal center as bidentate N,O-donor. Structures of the [Ru(PPh(3))(2)(CO)(NO-OCH(3))(H)] and [Ru(PPh(3))(2)(CO)(CNO-OCH(3))] complexes have been determined by X-ray crystallography. All the complexes are diamagnetic and show characteristic (1)H NMR signals and intense MLCT transitions in the visible region. Both the [Ru(PPh(3))(2)(CO)(NO-R)(H)] and [Ru(PPh(3))(2)(CO)(CNO-R)] complexes show two oxidative responses on the positive side of SCE.

Rhodium assisted C-H activation of benzaldehyde thiosemicarbazones and their oxidation via activation of molecular oxygen.

The benzaldehyde thiosemicarbazones are found to undergo oxidation at the sulfur center upon reaction with [Rh(PPh3)3Cl] in refluxing ethanol in the presence of a base (NEt3). A group of organorhodium complexes are obtained from such reactions, in which the oxidized thiosemicarbazones are coordinated to rhodium as tridentate CNS donors, along with two triphenylphosphines and a hydride. From the reaction with para-nitrobenzaldehyde thiosemicarbazone, a second organometallic complex is obtained, in which the thiosemicarbazone is coordinated to rhodium as a tridentate CNS donor, along with two triphenylphosphines and a hydride. Reaction of the benzaldehyde thiosemicarbazones with [Rh(PPh3)3Cl] in refluxing ethanol in the absence of NEt3 affords another group of organorhodium complexes, in which the thiosemicarbazones are coordinated to rhodium as tridentate CNS donors, along with two triphenylphosphines and a chloride. Structures of representative complexes of each type of complexes have been determined by X-ray crystallography. In all of the complexes, the two PPh3 ligands are trans. All of the complexes show intense MLCT transitions in the visible region. Cyclic voltammetry on these complexes shows a Rh(III)-Rh(IV) oxidation on the positive side of SCE. Redox responses of the coordinated thiosemicarbazones are also displayed by all of the complexes.

Unprecedented chemical transformation of semicarbazones mediated by Wilkinson's catalyst.

para-Nitrobenzaldehyde semicarbazone undergoes an unusual chemical transformation upon reaction with [Rh(PPh(3))(3)Cl] in the presence of trialkyl and dialkylamines (NR(2)R'; R = Et,(i)Pr, (n)Bu; R' = H or R' = R) via dissociation of the C-NH(2) bond and formation of a new C-NR(2) bond (where the NR(2) fragment is provided by the amine). The transformed semicarbazone ligand binds to rhodium as a dianionic C,N,O-donor to afford complexes of type [Rh(PPh(3))(2)(CNO-NR(2))Cl] (CNO-NR(2) = the coordinated semicarbazone ligand). Another group of semicarbazones (viz. salicylaldehyde semicarbazone, 2-hydroxyacetophenone semicarbazone, and 2-hydroxynaphthaldehyde semicarbazone) has also been observed to undergo a similar chemical transformation upon reaction with [Rh(PPh(3))(3)Cl] under similar experimental conditions as before, and these transformed semicarbazones bind to rhodium as dianionic O,N,O-donors affording complexes of the type [Rh(PPh(3))(2)(ONO(n)-NR(2))Cl] (ONO(n)-NR(2) = the coordinated semicarbazone ligand; n = 1-3). The structure of the [Rh(PPh(3))(2)(CNO-NEt(2))Cl] and [Rh(PPh(3))(2)(ONO(2)-NR(2))Cl] complexes has been determined. All the complexes show characteristic (1)H NMR signals. They also show intense absorptions in the visible and ultraviolet region. Cyclic voltammetry on the complexes shows an oxidative response within 0.52-0.97 V versus SCE and a reductive response within -1.00 to -1.27 V versus SCE, where both the responses are believed to be centered on the semicarbazone ligand.