Mono-institutional phase 2 study of innovative Stereotactic Body RadioTherapy targeting PArtial Tumor HYpoxic (SBRT-PATHY) clonogenic cells in unresectable bulky non-small cell lung cancer: profound non-targeted effects by sparing peri-tumoral immune microenvironment.

Autor: Tubin S; KABEG Klinikum Klagenfurt, Institute of Radiation Oncology, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria. slavisa.tubin@kabeg.at., Khan MK; Department of Radiation Oncology, Emory University School of Medicine, Winship Cancer Institute, 1365-C Clifton Road, 30322, Atlanta, NE, Georgia., Salerno G; Department of Neurosciences, Mental Health and Sensory Organs / Department of Clinical and Molecular Medicine, Universita' La Sapienza Roma, Ospedale Sant' Andrea, Via di Grottarossa, 1035, 00189, Rome, RM, Italy., Mourad WF; Markey Cancer Center, Department of Radiation Medicine, University of Kentucky Lexington ky, UK Medical Center MN 150, Lexington, KY, 40536-0298, USA., Yan W; Department of Radiation Oncology, Thomas Jefferson University, 111 S 11th St, Philadelphia, PA, 19107, USA., Jeremic B; BioIRC, R&D Center for Biomedical Research, Kragujevac, SERBIA and Research Institute of Clinical Medicine, 13 Tevdore Mgvdeli St, 0112, Tbilisi, Georgia.
Jazyk: angličtina
Zdroj: Radiation oncology (London, England) [Radiat Oncol] 2019 Nov 26; Vol. 14 (1), pp. 212. Date of Electronic Publication: 2019 Nov 26.
DOI: 10.1186/s13014-019-1410-1
Abstrakt: Background: Radiotherapy-induced lymphopenia may be limiting the success of therapy and could also negatively affect the ability of immune system in mediating the bystander (BE) and abscopal effects (AE). A novel SBRT-based PArtial Tumor irradiation of HYpoxic clonogenic cells (SBRT-PATHY) for induction of the tumoricidal BE and AE by sparing the peritumoral immune microenvironment and regional circulating lymphocytes has been developed to enhance the radiotherapy therapeutic ratio of advanced lung cancer. The aim of this retrospective review of prospectively collected mono-institutional phase 2 study was to compare the outcomes between unconventional SBRT-PATHY and standard of care in unresectable stage IIIB/IV bulky NSCLC.
Materials and Methods: Sixty patients considered inoperable or unsuitable for radical radio-chemotherapy were enrolled and treated using the following 3 regimens: SBRT-PATHY (group I, n = 20 patients), recommended standard of care chemotherapy (group II, n = 20 patients), and institutional conventional palliative radiotherapy (group III, n = 20 patients).
Results: Median follow-up was 13 months. The 1-year overall survival was 75, 60, and 20% in groups 1, 2 and 3, respectively (p = 0.099). The 1-year cancer specific survival was 90, 60, and 20% in groups 1, 2, and 3, respectively (p = 0.049). Bulky tumor control rate was 95% for SBRT-PATHY compared with 20% in the other two groups. BE and AE were seen by SBRT-PATHY in 95 and 45% of patients, respectively. Multi-variate analysis for cancer specific survival was significant for treatment effect with SBRT-PATHY (p < 0.001) independent of age, sex, performance status, histology, stage, treated bulky site and tumor diameter. SBRT-PATHY resulted in lower toxicity (p = 0.026), and improved symptom control (p = 0.018) when compared to other two treatment options.
Conclusion: SBRT-PATHY improved treatment outcomes in unresectable NSCLC and should be investigated in larger trials. Present study has been retrospectively registered on 8th of August 2019 by the ethic committee for Austrian region "Kärnten "in Klagenfurt (AUT), under study number A 31/19.
Databáze: MEDLINE
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