RESUMEN
We report the case of a 50-year old women with an oncological history of metastatic breast carcinoma who underwent lung stereotactic body radiation therapy (SBRT) of 60Gy in 8 fractions for a left upper lobe metastatic lesion. Seven months later, she complains about hoarseness and weakness of voice. Tumoral relapse and other frequent etiologies were excluded. The diagnosis of radiation induced left recurrent laryngeal nerve paralysis causing left vocal cord paralysis (VCP) was made. The symptomatology did not improve till the disease progression and death of the patient 29 months after SBRT. VCP after lung SBRT is a rare adverse event that has not yet been well described in the medical literature.
Asunto(s)
Radiocirugia , Parálisis de los Pliegues Vocales , Humanos , Femenino , Persona de Mediana Edad , Parálisis de los Pliegues Vocales/etiología , Parálisis de los Pliegues Vocales/diagnóstico , Radiocirugia/efectos adversos , Recurrencia Local de Neoplasia , Ronquera/complicaciones , Ronquera/diagnóstico , PulmónRESUMEN
BACKGROUND: Brain metastases (BM) are common in patients with small cell lung cancer (SCLC). In recent years, the role of whole brain radiotherapy (WBRT) for brain metastases in lung cancer is being reevaluated, especially in the context of new systemic treatments available for SCLC. With this analysis, we investigate decision-making in SCLC patients with BM among European experts in medical oncology and radiation oncology. METHODS: We analyzed decision-making from 13 medical oncologists (selected by IASLC) and 13 radiation oncologists (selected by ESTRO) specialized in SCLC. Management strategies of individual experts were converted into decision trees and analyzed for consensus. RESULTS AND CONCLUSION: In asymptomatic patients, chemotherapy alone is the most commonly recommended first line treatment. In asymptomatic patients with limited volume of brain metastases, a higher preference for chemotherapy without WBRT among medical oncologists compared to radiation oncologists was observed. For symptomatic patients, WBRT followed by chemotherapy was recommended most commonly. For limited extent of BM in symptomatic patients, some experts chose stereotactic radiotherapy as an alternative to WBRT. Significant variation in clinical decision-making was observed among European SCLC experts for the first line treatment of patients with SCLC and BM.
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Neoplasias Encefálicas , Neoplasias Pulmonares , Radiocirugia , Carcinoma Pulmonar de Células Pequeñas , Neoplasias Encefálicas/radioterapia , Irradiación Craneana , Humanos , Carcinoma Pulmonar de Células Pequeñas/radioterapiaRESUMEN
Two prior surveys were carried out in 1995 and 1999 to evaluate the use of radiotherapy in the treatment of non-malignant disease. In 2016, the same questionnaire was used and sent to the 24 centers of the country: 22 responded. A major decrease was observed in the number of patients treated: 360 in 2016 in contrast to 954 in 1999 and 1113 in 1995. The most frequent indications remain the prevention of heterotopic bone formation, keloids or gynecomastia. A new indication was observed: trigeminal nevralgia treated with radiosurgery. Two frequent indications in the past disappeared: the prevention of coronary restenosis and the macular degeneration. A great agreement was observed regarding the possible indications for radiotherapy but also to avoid it for inflammatory pathologies.
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Pautas de la Práctica en Medicina/estadística & datos numéricos , Bélgica , Ginecomastia/radioterapia , Humanos , Queloide/radioterapia , Osificación Heterotópica/radioterapia , Encuestas y Cuestionarios , Neuralgia del Trigémino/radioterapiaRESUMEN
This review updates the radiotherapy indications for non-malignant diseases, except those treated by radiosurgery. Since the last 2005 review, there have been no major changes in the indications: the prevention of heteropic bone formation and keloids remain classical indications, while the treatment of macular degeneration or the prevention of coronary restenosis are now past history. Nevertheless, the radiation treatment for benign diseases should have the same criteria as for malignant diseases: information of the patient on risks, benefits and treatment quality.
Asunto(s)
Radioterapia , Antineoplásicos Hormonales/efectos adversos , Enfermedades Óseas/radioterapia , Contraindicaciones , Oftalmopatías/radioterapia , Femenino , Ginecomastia/inducido químicamente , Ginecomastia/prevención & control , Humanos , Artropatías/radioterapia , Masculino , Enfermedades Musculares/radioterapia , Traumatismos por Radiación/etiología , Traumatismos por Radiación/prevención & control , Radioterapia/efectos adversos , Radioterapia/normas , Enfermedades de la Piel/radioterapia , Enfermedades Vasculares/radioterapiaRESUMEN
Intensity modulated radiotherapy is increasingly used in non-small-cell lung cancers despite a low level of evidence. A literature review was conducted. Several critical physical and dosimetric uncertainties are however unsolved. Methods to circumvent these limitations are being developed. In several retrospective studies, survival rates were at least similar with intensity-modulated radiotherapy as those reported with three-dimensional irradiation. To date, intensity modulated radiotherapy might be authorized in complex anatomical situations such as tumours close to the spinal cord (such as Pancoast Tobias, paraspinal and paracardiac tumours) or with limited motion amplitudes. Dosimetric benefits should also account for 4D dose distribution issues. The reduction of intermediate and high doses in the organs at risk with intensity modulated radiotherapy is advantageous. However, the effect of low doses in large volumes (lung, bone, unspecified tissues along beam paths) and the effect of increasing integral dose are still poorly known. In conclusion, dose-volume correlations need to be better documented and prospective randomized trials should be encouraged.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares/radioterapia , Planificación de la Radioterapia Asistida por Computador/métodos , Radioterapia de Intensidad Modulada/métodos , Artefactos , Carcinoma de Pulmón de Células no Pequeñas/terapia , Quimioradioterapia , Estudios Epidemiológicos , Esofagitis/etiología , Esofagitis/prevención & control , Tomografía Computarizada Cuatridimensional , Humanos , Neoplasias Pulmonares/terapia , Movimiento (Física) , Órganos en Riesgo , Traumatismos por Radiación/etiología , Traumatismos por Radiación/prevención & control , Neumonitis por Radiación/etiología , Neumonitis por Radiación/prevención & control , Dosificación Radioterapéutica , Radioterapia de Intensidad Modulada/efectos adversos , Mecánica Respiratoria , Resultado del TratamientoRESUMEN
This article reviews and describes the progress made in the therapeutic management of patients suffering from a lung cancer, outlining the major improvements made and suggesting some perspectives for the future.
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Neoplasias Pulmonares/radioterapia , Oncología por Radiación/tendencias , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioradioterapia/tendencias , Cisplatino/administración & dosificación , Ensayos Clínicos como Asunto , Terapia Combinada , Manejo de la Enfermedad , Fraccionamiento de la Dosis de Radiación , Humanos , Neoplasias Pulmonares/terapia , Metaanálisis como Asunto , Terapia Neoadyuvante/tendencias , Aceleradores de Partículas , Neumonectomía , Radioterapia/instrumentación , Radioterapia/métodos , Radioterapia/tendencias , Radioterapia Guiada por Imagen , Terapias en Investigación/tendenciasRESUMEN
Objectives. The aim of this prospective phase II study is to evaluate the treatment of early-stage breast cancer (T1 N0) with intraoperative electron radiation therapy (IOERT) in terms of local control, early complications, and cosmesis. Patients and Methods. From February 2010 to February 2012, 200 patients underwent partial IOERT of the breast. Inclusion criteria were unifocal invasive ductal carcinoma, age ≥40 years, histological tumour size ≤20 mm, and no lymph node involvement. A 21 Gy dose was prescribed over the 90% isodose line in the tumour bed. Median follow-up is 23.3 months (7-37). Results. Acute toxicity was not frequent (Grade 1: 4.5%, Grade 2: 1%). The cosmetic result was considered to be very good or good in 92.5%. One ipsi lateral out-quadrant recurrence at 18 months was observed. The crude and actuarial local recurrence rates after median follow-up were 0.5% and 0.9%, respectively. Conclusion. The preoperative diagnostic work-up must be comprehensive and the selection process must be rigorous for this therapeutic approach reserved for small ductal unifocal cancers. After a 23.3-month median follow-up time, the clinical results of IOERT for selected patients are encouraging for the locoregional recurrence and the toxicity rates. The satisfaction of our patients in terms of quality of life was extremely high.
RESUMEN
The present systematic review was performed under the auspices of the European Lung Cancer Working Party (ELCWP) in order to determine the role of early intermediate criteria (surrogate markers), instead of survival, in determining treatment efficacy in patients with lung cancer. Initially, the level of evidence for the use of overall survival to evaluate treatment efficacy was reviewed. Nine questions were then formulated by the ELCWP. After reviewing the literature with experts on these questions, it can be concluded that overall survival is still the best criterion for predicting treatment efficacy in lung cancer. Some intermediate criteria can be early predictors, if not surrogates, for survival, despite limitations in their potential application: these include time to progression, progression-free survival, objective response, local control after radiotherapy, downstaging in locally advanced nonsmall cell lung cancer (NSCLC), complete resection and pathological TNM in resected NSCLC, and a few circulating markers. Other criteria assessed in these recommendations are not currently adequate surrogates of survival in lung cancer.
Asunto(s)
Biomarcadores de Tumor/metabolismo , Biomarcadores/metabolismo , Carcinoma de Pulmón de Células no Pequeñas/sangre , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Neoplasias Pulmonares/sangre , Neoplasias Pulmonares/diagnóstico , Oncología Médica/normas , Neumología/métodos , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Carcinoma de Pulmón de Células no Pequeñas/terapia , Supervivencia sin Enfermedad , Europa (Continente) , Medicina Basada en la Evidencia , Guías como Asunto , Humanos , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/terapia , Oncología Médica/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Induction chemotherapy has been suggested to impact on preoperative chemoradiation efficacy in locally advanced rectal cancer (LARC). To evaluate in LARC patients, the feasibility and efficacy of a short intense course of induction oxaliplatin before preoperative chemoradiotherapy (CRT). PATIENTS AND METHODS: Patients with T2-T4/N+ rectal adenocarcinoma were randomly assigned to arm A-preoperative CRT with 5-fluorouracil (5-FU) continuous infusion followed by surgery-or arm B-induction oxaliplatin, folinic acid and 5-FU followed by CRT and surgery. The primary end point was the rate of ypT0-1N0 stage achievement. RESULTS: Fifty seven patients were randomly assigned (arm A/B: 29/28) and evaluated for planned interim analysis. On an intention-to-treat basis, the ypT0-1N0 rate for arms A and B were 34.5% (95% CI: 17.2% to 51.8%) and 32.1% (95% CI: 14.8% to 49.4%), respectively, and the study therefore was closed prematurely for futility. There were no statistically significant differences in other end points including pathological complete response, tumor regression and sphincter preservation. Completion of the preoperative CRT sequence was similar in both groups. Grade 3/4 toxicity was significantly higher in arm B. CONCLUSIONS: Short intense induction oxaliplatin is feasible in LARC patients without compromising the preoperative CRT completion, although the current analysis does not indicate increased locoregional impact on standard therapy.
Asunto(s)
Adenocarcinoma/terapia , Antimetabolitos Antineoplásicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Fluorouracilo/administración & dosificación , Neoplasias del Recto/terapia , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Quimioradioterapia Adyuvante , Quimioterapia Adyuvante , Procedimientos Quirúrgicos del Sistema Digestivo , Femenino , Humanos , Leucovorina/administración & dosificación , Masculino , Persona de Mediana Edad , Compuestos Organoplatinos/administración & dosificación , Oxaliplatino , Dosificación Radioterapéutica , Neoplasias del Recto/patología , Resultado del Tratamiento , Carga Tumoral/efectos de los fármacos , Carga Tumoral/efectos de la radiación , Adulto JovenRESUMEN
Traditionally, the target volumes of curative-intent radiotherapy for non-small cell lung cancer include all uninvolved mediastinal nodes. However, an improvement in tumour control requires an increase of the total dose to the macroscopic target volume. This is only achievable if the irradiation of the organs at risk is reduced, i.e. elective irradiation of the mediastinum is omitted. The available data suggest that elective mediastinal irradiation may be safely omitted, provided that an adequate staging procedure, including FDG PET-CT, has been performed.
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Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Carcinoma de Pulmón de Células no Pequeñas/secundario , Neoplasias Pulmonares/radioterapia , Irradiación Linfática/métodos , Metástasis Linfática/radioterapia , Mediastino/efectos de la radiación , Radioisótopos de Flúor , Fluorodesoxiglucosa F18 , Humanos , Irradiación Linfática/efectos adversos , Metástasis Linfática/diagnóstico por imagen , Metástasis Linfática/prevención & control , Estadificación de Neoplasias/métodos , Órganos en Riesgo , Tomografía de Emisión de Positrones , Radiofármacos , Tomografía Computarizada por Rayos X , Procedimientos InnecesariosRESUMEN
Postoperative radiotherapy remains controversial in non-small cell lung cancer. The conclusions of several meta-analysis are still questioned, partly because of flaws in the randomized trials taken into account. The technological improvements of modern radiotherapy and several clinical observations have led to the launch of a new phase III trial.
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Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares/radioterapia , Radioterapia Adyuvante , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Ensayos Clínicos Fase III como Asunto , Terapia Combinada , Humanos , Neoplasias Pulmonares/cirugía , Metaanálisis como Asunto , Radioterapia Adyuvante/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Proyectos de Investigación , Resultado del TratamientoRESUMEN
The aim of the present study was to validate and compare published prognostic classifications for predicting the survival of patients with small cell lung cancer. We pooled data from phase III randomised clinical trials, and used Cox models for validation purposes and concordance probability estimates for assessing predictive ability. We included 693 patients. All the classifications impacted significantly on survival, with hazard ratios (HRs) in the range 1.57-1.68 (all p<0.0001). Median survival times were 16-19 months for the best predicted groups, while they were 6-7 months for the most poorly predicted groups. Most of the paired comparisons were statistically significant. We obtained similar results when restricting the analysis to patients with extensive disease. Multivariate Cox models for fitting survival data were also performed. The HRs for a single covariate were 8.23 (95% CI 5.88-11.69), and 9.46 (6.67-13.50), and for extensive disease were 5.60 (3.13-9.93), 12.49 (5.57-28.01) and 8.83 (4.66-16.64). Concordance probability estimates ranged 0.55-0.65 (overlapping confidence intervals). Published classifications were validated and suitable for use at a population level. As expected, prediction at an individual level remains problematic. A specific model designed for extensive-disease patients did not appear to perform better.
Asunto(s)
Neoplasias Pulmonares/diagnóstico , Oncología Médica/normas , Neumología/normas , Carcinoma Pulmonar de Células Pequeñas/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Oncología Médica/métodos , Persona de Mediana Edad , Probabilidad , Pronóstico , Modelos de Riesgos Proporcionales , Neumología/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
Small cell carcinoma of the esophagus (SCCE) is a rare and aggressive malignant tumor with a poor prognosis. The aims of this retrospective study were to analyze the epidemiology, clinical characteristics, and treatment outcomes of these patients. Between 1994 and 2004, 24 patients with SCCE from several centers were reviewed for data on demographics, presenting symptoms, diagnosis, disease stage, type of treatment, and outcome. SCCE occurs in the sixth decade: median age (interquartile range [IQR]): 65 (59-69) years with a male predominance (63%). The most common complaining symptoms were rapidly progressive dysphagia (79%), weight loss (54%), and retrosternal/epigastric pain (46%). The tumor arises primarily in the middle (52%) or in the lower (35%) third of the esophagus. History of tobacco and alcohol exposure was present in 90% and 70% of case, respectively. Extensive disease was present in 13 cases (54%) at initial diagnosis. The overall median survival (IQR) was 11 (8-20) months for all 24 patients, and the 2-year overall survival was 25.1%. Four patients were alive more than 2 years after treatment. Chemotherapy increased the survival compared with symptomatic management in extensive disease (median survival [IQR]: 9.5 [6-14] vs. 6 [4-7] months, P= 0.05). In limited disease, concurrent chemo-radiotherapy was more effective than non-concurrent treatment (median survival [IQR]: 36 [14-93] vs. 11 [9-15] months, P= 0.04). Two patients were treated by surgery and chemoradiation therapy with a survival of 35 and 66 months. Chemotherapy is the cornerstone of treatment of SCCE in all stage. For limited disease SCCE, concurrent chemo-radiotherapy is the primary choice compared with sequential approach. The role of surgery was not assessable in our study.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Pequeñas/tratamiento farmacológico , Neoplasias Esofágicas/tratamiento farmacológico , Anciano , Carcinoma de Células Pequeñas/patología , Carcinoma de Células Pequeñas/radioterapia , Terapia Combinada , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/radioterapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoAsunto(s)
Mesotelioma/terapia , Neoplasias Pleurales/terapia , Respiración , Sociedades Médicas , Cirugía Torácica , Europa (Continente) , Humanos , Mesotelioma/diagnóstico , Mesotelioma/etiología , Mesotelioma/patología , Neoplasias Pleurales/diagnóstico , Neoplasias Pleurales/etiología , Neoplasias Pleurales/patologíaRESUMEN
Malignant pleural mesothelioma (MPM) is a rare tumour but with increasing incidence and a poor prognosis. In 2008, the European Respiratory Society/European Society of Thoracic Surgeons Task Force brought together experts to propose practical and up-to-dated guidelines on the management of MPM. To obtain an earlier and reliable diagnosis of MPM, the experts recommend performing thoracoscopy, except in cases of pre-operative contraindication or pleural symphysis. The standard staining procedures are insufficient in approximately 10% of cases. Therefore, we propose using specific immunohistochemistry markers on pleural biopsies. In the absence of a uniform, robust and validated staging system, we advice use of the most recent TNM based classification, and propose a three step pre-treatment assessment. Patient's performance status and histological subtype are currently the only prognostic factors of clinical importance in the management of MPM. Other potential parameters should be recorded at baseline and reported in clinical trials. MPM exhibits a high resistance to chemotherapy and only a few patients are candidates for radical surgery. New therapies and strategies have been reviewed. Because of limited data on the best combination treatment, we emphasise that patients who are considered candidates for a multimodal approach should be included in a prospective trial at a specialised centre.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Resistencia a Antineoplásicos , Mesotelioma/tratamiento farmacológico , Neoplasias Pleurales/tratamiento farmacológico , Calidad de Vida , Terapia Combinada , Humanos , Mesotelioma/patología , Mesotelioma/cirugía , Estadificación de Neoplasias , Neoplasias Pleurales/patología , Neoplasias Pleurales/cirugía , Neumonectomía , Radioterapia AdyuvanteRESUMEN
PURPOSE: To assess the feasibility and activity of radio-chemotherapy with mitomycin C (MMC) and cisplatin (CDDP) in locally advanced squamous cell anal carcinoma with reference to radiotherapy (RT) combined with MMC and fluorouracil (5-FU). PATIENTS AND METHODS: Patients with measurable disease >4 cmN0 or N+ received RT (36Gy+2 week gap+23.4Gy) with either MMC/CDDP or MMC/5-FU (MMC 10mg/m(2) d1 of each sequence; 5-FU 200mg/m(2)/day c.i.v. daily; CDDP 25mg/m(2) weekly). Forty patients/arm were needed to exclude a RECIST objective response rate (ORR), 8 weeks after treatment, of <75% (Fleming 1, alpha=10%, beta=10%). RESULTS: The ORR was 79.5% (31/39) (lower bound confidence interval [CI]: 68.8%) with MMC/5-FU versus 91.9% (34/ 37) (lower bound CI: 82.8%) with MMC/CDDP. In the MMC/5-FU group, two patients (5.1%) discontinued treatment due to toxicity versus 11 (29.7%) in the MMC/CDDP group. Nine grade 3 haematological events occurred with MMC/CDDP versus none with 5-FU/MMC. The rate of other toxicities did not differ. There was no toxic death. Thirty-one patients in the MMC/5-FU arm (79.5%) and 18 in the MMC/CDDP arm (48.6%) were fully compliant with the protocol treatment (p=0.005). CONCLUSIONS: Radio-chemotherapy with MMC/CDDP seems promising as only MMC/CDDP demonstrated enough activity (RECIST ORR >75%) to be tested further in phase III trials; MMC/5-FU did not. MMC/CDDP also had an overall acceptable toxicity profile.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Ano/tratamiento farmacológico , Neoplasias del Ano/radioterapia , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/radioterapia , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias del Ano/cirugía , Carcinoma de Células Escamosas/cirugía , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Terapia Combinada , Supervivencia sin Enfermedad , Estudios de Factibilidad , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Mitomicina/administración & dosificación , Mitomicina/efectos adversos , Cooperación del Paciente , Resultado del TratamientoRESUMEN
As concomitant chemoradiotherapy for stage III NSCLC is associated with survival advantage in comparison to a sequential approach, we conducted a phase III randomised study aiming to determine the best sequence and safety of chemotherapy (CT) and chemoradiotherapy (CT-RT), using a regimen with cisplatin (CDDP), gemcitabine (GEM) and vinorelbine (VNR). Unresectable stage III NSCLC patients received CDDP (60 mg/m(2)), GEM (1g/m(2), days 1 and 8) and VNR (25mg/m(2), days 1 and 8) with reduced dosage of GEM and VNR during radiotherapy (66Gy). Two cycles of CT with radiotherapy followed by two further cycles of CT alone were administered in arm A or the reverse sequence in arm B. The study was prematurely closed for poor accrual due to administrative problems. Forty-nine eligible patients were randomised. Response rates and median survival times were, respectively 57% (95% CI: 36-78%) and 17 months (95% CI: 9.3-24.6 months) in arm A and 79% (95% CI: 64-94%) and 23.9 months (95% CI: 13.3-34.5 months) in arm B (p>0.05). Chemotherapy dose-intensity was significantly reduced in arm A. Grade 3-4 oesophagitis occurred in 5 patients. One case of grade 5 radiation pneumonitis was observed. In conclusion, chemoradiotherapy with CDDP, GEM and VNR appears feasible as initial treatment or after induction chemotherapy. Consolidation chemoradiotherapy seems less toxic with a better observed response rates and survival although no valid conclusion can be drawn from the comparison of both arms.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/radioterapia , Adulto , Anciano , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Terapia Combinada , Desoxicitidina/administración & dosificación , Desoxicitidina/efectos adversos , Desoxicitidina/análogos & derivados , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Radioterapia/efectos adversos , Radioterapia/métodos , Vinblastina/administración & dosificación , Vinblastina/efectos adversos , Vinblastina/análogos & derivados , Vinorelbina , GemcitabinaRESUMEN
The most important progress made during the last years in the management of small cell lung cancer is certainly the recognition of the impact of chest radiotherapy for limited disease and prophylactic cranial irradiation (PCI) for patients in complete response. How to optimize chemotherapy and radiotherapy is the topic of this paper. The current trend is to deliver thoracic radiation concurrently with the first cycles of chemotherapy (cisplatine and etoposide). The total dose is still not defined and the subject of phase III trials. PCI is delivered at the end of the chemotherapy with moderate doses. The place of PCI in extensive disease is still debate even if there is a clear benefit in quality of life.