• Management of unresectable stage III non-small-cell lung cancer with combined-modality therapy: a review of the current literature and recommendations for treatment.

      Bayman, Neil A; Blackhall, Fiona H; Jain, Pooja; Lee, Lip W; Thatcher, Nick; Faivre-Finn, Corinne; Department of Clinical Oncology, Christie Hospital, Manchester, UK. neil.bayman@christie.nhs.uk (2008-03)
      Lung cancer remains the most common cause of cancer deaths in the United Kingdom, and long-term survival from lung cancer has hardly improved over the past 30 years. The benefit of combined-modality therapy with chemotherapy and radiation therapy in improving survival for patients with inoperable non-small-cell lung cancer (NSCLC) was discovered over 10 years ago. In this comprehensive literature review, we discuss the current status of combined-modality therapy for unresectable stage III NSCLC. The efficacy and toxicity of different chemoradiation therapy regimens are presented. The potential role of novel and targeted therapies and radiation dose escalation is also considered. Finally, recommendations are made for the treatment of unresectable stage III NSCLC.
    • Primary diffuse large B-cell lymphoma of the breast: prognostic factors and outcomes of a study by the International Extranodal Lymphoma Study Group.

      Ryan, G; Martinelli, Giovanni; Kuper-Hommel, M; Tsang, R; Pruneri, G; Yuen, K; Roos, D; Lennard, A; Devizzi, L; Crabb, S; et al. (2008-02)
      BACKGROUND: Primary diffuse large B-cell lymphoma (DLBCL) of breast is rare. We aimed to define clinical features, prognostic factors, patterns of failure, and treatment outcomes. PATIENTS AND METHODS: A retrospective international study of 204 eligible patients presenting to the International Extranodal Lymphoma Study Group-affiliated institutions from 1980 to 2003. RESULTS: Median age was 64 years, with 95% of patients presenting with unilateral disease. Median overall survival (OS) was 8.0 years, and median progression-free survival 5.5 years. In multifactor analysis, favourable International Prognostic Index score, anthracycline-containing chemotherapy, and radiotherapy (RT) were significantly associated with longer OS (each P < or = 0.03). There was no benefit from mastectomy, as opposed to biopsy or lumpectomy only. At a median follow-up time of 5.5 years, 37% of patients had progressed--16% in the same or contralateral breast, 5% in the central nervous system, and 14% in other extranodal sites. CONCLUSIONS: The combination of limited surgery, anthracycline-containing chemotherapy, and involved-field RT produced the best outcome in the pre-rituximab era. A prospective trial on the basis of these results should be pursued to confirm these observations and to determine whether the impact of rituximab on the patterns of relapse and outcome parallels that of DLBCL presenting at other sites.
    • Radiotherapy for small-cell lung cancer-Where are we heading?

      Bayman, Neil A; Sheikh, Hamid Y; Kularatne, B; Lorigan, Paul C; Blackhall, Fiona H; Thatcher, Nick; Faivre-Finn, Corinne; Department of Clinical Oncology, Christie Hospital NHS Foundation Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK. (2009-03)
      Radiotherapy has an established role in the management of limited-disease small-cell lung cancer. However, essential questions related to the optimisation of thoracic radiotherapy remain unanswered including (i) optimal total dose, (ii) fractionation, (iii) timing and sequencing of radiation, (iv) volume of irradiation, and (v) concurrent chemotherapy combinations. The role of thoracic radiotherapy for extensive-disease small-cell lung cancer is more poorly understood but evidence suggests radiotherapy may have an important role in this setting. This review highlights the need for well-designed multi-national trials aimed at the optimisation and standardisation of radiotherapy for SCLC.
    • Targeting blood vessels for the treatment of non-small cell lung cancer.

      Amir, Eitan; Hughes, Sarah; Blackhall, Fiona H; Thatcher, Nick; Ostoros, Gyula; Timar, Jozsef; Tovari, Jozsef; Kovacs, Gabor; Dome, Balazs; Department of Medical Oncology, Christie Hospital NHS Trust, Manchester, United Kingdom. (2008-08)
      Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality worldwide. Although modest survival benefit has been observed with surgery, radiotherapy and platinum-based chemotherapy, an efficacy plateau has been reached. It has become obvious, therefore, that additional treatments are needed in order to provide an improved survival benefit for these patients. The use of molecular targeted therapies, particularly those against tumor capillaries, has the potential to improve outcomes for NSCLC patients. Bevacizumab, a recombinant humanized monoclonal antibody against vascular endothelial growth factor (VEGF), is the first targeted drug that has shown survival advantage when combined with chemotherapy in NSCLC. Other antivascular agents, including vascular disrupting agents (VDAs) and different small-molecule receptor tyrosine kinase inhibitors, have also shown promise in phase I and II trials in NSCLC. The aim of this study is to describe the clinical properties of these drugs and to discuss the evidence that supports their use in the treatment of NSCLC. Furthermore, we plan to review the main pitfalls of antivascular strategies in NSCLC cancer therapy as well as assess the future direction of these treatment methods with an emphasis on clarifying the molecular background of the effects of these drugs and defining the biomarkers.
    • The UK national breast cancer screening programme for survivors of Hodgkin lymphoma detects breast cancer at an early stage.

      Howell, Sacha J; Searle, C; Goode, Valerie; Gardener, T; Linton, Kim M; Cowan, Richard A; Harris, Maggie A; Hopwood, Penelope; Swindell, Ric; Norman, Alison; et al. (2009-08-18)
      BACKGROUND: Supradiaphragmatic radiotherapy (SRT) to treat Hodgkin's lymphoma (HL) at a young age increases the risk of breast cancer (BC). A national notification risk assessment and screening programme (NRASP) for women who were treated with SRT before the age of 36 years was instituted in the United Kingdom in 2003. In this study, we report the implementation and screening results from the largest English Cancer Network. METHODS: A total of 417 eligible women were identified through cancer registry/hospital databases and from follow-up (FU) clinics. Screening results were collated retrospectively, and registry searches were used to capture BC cases. RESULTS: Of the 417 women invited for clinical review, 243 (58%) attended. Of these 417 women, 23 (5.5%) have been diagnosed with BC, a standardised incidence ratio of 2.9 compared with the age-matched general population. Of five invasive BCs diagnosed within the NRASP, none involved axillary lymph nodes compared with 7 of 13 (54%) diagnosed outside the programme (P<0.10). The mean latency for BC cases was 19.5+/-8.35 years and the mean FU duration for those unaffected by BC was 14.6+/-9.11 years (P<0.01), suggesting that those unaffected by BC remain at high risk. Recall and negative biopsy rates were acceptable (10.5 and 0.8%, respectively). CONCLUSIONS: The NRASP appears to detect BC at an early stage with acceptable biopsy rates, although numbers are small. Determination of NRASP results on a national basis is required for the accurate evaluation of screening efficacy in women previously treated with SRT.