Current treatment landscape for oligometastatic non-small cell lung cancer.

The management of patients with advanced non-small cell lung carcinoma (NSCLC) has undergone major changes in recent years. On the one hand, improved sensitivity of diagnostic tests, both radiological and endoscopic, has altered the way patients are staged. On the other hand, the arrival of new drugs with antitumoral activity, such as targeted therapies or immunotherapy, has changed the prognosis of patients, improving disease control and prolonging survival. Finally, the development of radiotherapy and surgical and interventional radiology techniques means that radical ablative treatments can be performed on metastases in any location in the body. All of these advances have impacted the treatment of patients with advanced lung cancer, especially in a subgroup of these patients in which all of these treatment modalities converge. This poses a challenge for physicians who must decide upon the best treatment strategy for each patient, without solid evidence for one optimal mode of treatment in this patient population. The aim of this article is to review, from a practical and multidisciplinary perspective, published evidence on the management of oligometastatic NSCLC patients. We evaluate the different alternatives for radical ablative treatments, the role of primary tumor resection or radiation, the impact of systemic treatments, and the therapeutic sequence. In short, the present document aims to provide clinicians with a practical guide for the treatment of oligometastatic patients in routine clinical practice.

Influence of hemoglobin levels on survival after radical treatment of esophageal carcinoma with radiotherapy.

INTRODUCTION: The objective was to investigate the possible prognostic value of blood hemoglobin concentration in the outcome of radical treatment for locally advanced esophageal carcinoma. MATERIALS AND METHOD: This was a retrospective analysis of data for 85 patients treated for locally advanced esophageal carcinoma between January 1991 and January 1997 with chemoradiotherapy alone or as neoadjuvant therapy. All patients received chemotherapy (4 cycles of cisplatin 100 mg/m2 on day 1, and continuous infusion 5-fluorouracil 1 g/m2 per day on days 1-5) with concomitant radiotherapy (40 Gy at 2 Gy/session to the esophageal tumor and mediastinum). The response was evaluated after 4 weeks. 69 patients continued to receive chemoradiotherapy only to a total dose of 60-64 Gy to the esophageal tumor with a 2-cm margin. Sixteen patients underwent radical surgery. Hemoglobin levels were measured before combined treatment in all patients. The prognostic value of hemoglobin concentration was analyzed statistically, along with other patient-, tumor- and treatment-related factors. RESULTS: Mean follow-up time: 82 months (range 60- 99 months). Chemoradiotherapy was followed by an overall clinical response of 69.4%, with complete clinical response in 24.7% of the patients. Mean survival time was 12 months, and overall likelihood of survival after 3 years was 13%. Mean time to progression: 5 months. Median survival time was 12 months in the 69 patients who underwent chemoradiotherapy alone, and 26 months in patients who underwent radical surgery. Univariate analysis showed a hemoglobin value of > 13 g/dl to be a prognostic factor for better survival, along with performance status according to the ECOG classification, weight loss < 10%, tumor stage, tumor length, and complete response to chemoradiotherapy. Multivariate analysis showed that only hemoglobin concentration was an independent prognostic factor: for each unit increase in hemoglobin level, the risk of death from esophageal carcinoma decreased by 5%. In the subgroup of patients who did not undergo surgery, hemoglobin concentration was also an independent prognostic factor along with complete clinical response. CONCLUSIONS: As found for other solid tumors, hemoglobin level was a determining factor in the prognosis for treatment outcome in patients with esophageal carcinoma. Our findings require confirmation in randomized studies and further documentation of the probable benefits of correcting hemoglobin levels.

Hemoglobin levels and acute radiotherapy-induced toxicity.

AIMS AND BACKGROUND: To analyze the possible correlation between hemoglobin concentration and the appearance of acute radiotherapy-induced toxicity. METHODS: We prospectively studied hemoglobin levels and acute radiotherapy-induced toxicity in 86 patients treated for 3 months. Both sexes were considered to have anemia if their hemoglobin level was < or = 12 g/dL. No patient received corrective treatment for hemoglobin levels. Acute toxicity was analyzed weekly during radiotherapy and 45 days after therapy ended. The possible relationship between anemia and toxicity was analyzed, as was the correlation between hemoglobin values and the degree of toxicity. RESULTS: The findings were similar for all prognostic factors in patients with and without anemia. Hemoglobin concentration was < or = 12 g/dL in 24 patients (27.9%; mean, 10.93 +/- 0.78 g/dL). At the end of radiotherapy, hemoglobin levels were < or = 12 g/dL in 18 patients (20.9%; mean, 11.26 +/- 1.06 g/dL). The correlation between pretherapy and posttherapy hemoglobin concentration was significant at r = 0.729 (P = 0.01). The correlation between absolute hemoglobin values and the degree of toxicity, and the possible relationship between hemoglobin concentration and the appearance or the degree of toxicity after radiotherapy, was not significant. CONCLUSIONS: The relationship between hemoglobin concentration and oxygenation of the tumor and healthy tissues was not linear. This may account for the influence of hemoglobin levels on control of the disease as reported in earlier studies, but it does not account for their influence on acute toxicity after radiotherapy.

Influence of hemoglobin levels on survival after radical treatment of esophageal carcinoma with radiotherapy

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Introduction. The objetive was to investigate thepossible prognostic value of blood hemoglobin concentrationin the outcome of radical treatment forlocally advanced esophageal carcinoma.Materials and method. This was a retrospectiveanalysis of data for 85 patients treated for locallyadvanced esophageal carcinoma between January1991 and January 1997 with chemoradiotherapyalone or as neoadjuvant therapy. All patients receivedchemotherapy (4 cycles of cisplatin 100mg/m2 on day 1, and continuous infusion 5-fluorouracil1 g/m2 per day on days 1-5) with concomitantradiotherapy (40 Gy at 2 Gy/session to theesophageal tumor and mediastinum). The responsewas evaluated after 4 weeks. 69 patients continuedto receive chemoradiotherapy only to a total dose of60-64 Gy to the esophageal tumor with a 2-cm margin.Sixteen patients underwent radical surgery. Hemoglobinlevels were measured before combinedtreatment in all patients. The prognostic value ofhemoglobin concentration was analyzed statistically,along with other patient-, tumor- and treatmentrelatedfactors.Results. Mean follow-up time: 82 months (range 60-99 months). Chemoradiotherapy was followed byan overall clinical response of 69.4%, with completeclinical response in 24.7% of the patients. Mean survivaltime was 12 months, and overall likelihood ofsurvival after 3 years was 13%. Mean time to progression:5 months. Median survival time was 12months in the 69 patients who underwent chemoradiotherapyalone, and 26 months in patients whounderwent radical surgery. Univariate analysisshowed a hemoglobin value of > 13 g/dl to be a prognosticfactor for better survival, along with performancestatus according to the ECOG classification,weight loss < 10%, tumor stage, tumor length, andcomplete response to chemoradiotherapy. Multivariateanalysis showed that only hemoglobin concentrationwas an independent prognostic factor:for each unit increase in hemoglobin level, the riskof death from esophageal carcinoma decreased by5%. In the subgroup of patients who did not undergosurgery, hemoglobin concentration was also anindependent prognostic factor along with completeclinical response.Conclusions. As found for other solid tumors, hemoglobinlevel was a determining factor in theprognosis for treatment outcome in patients withesophageal carcinoma. Our findings require confirmationin randomized studies and further documentationof the probable benefits of correcting hemoglobinlevels