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Advanced squamous cell lung carcinoma in elderly patients has a limited chance of cure with first, second line chemotherapy and radiotherapy. Radiotherapy in advanced non-small-cell lung cancer can be used with curative intent for localized or oligometastatic disease using standard or altered fractionations. Current evidence indicates that radiotherapy via diverse cascade mechanisms is able to invoke both local and systemic immunoresponses promoting tumor cell death through an in situ vaccination effect. Moreover, the advancement in immunotherapies is changing the scenario. The combination of radiotherapy and immunotherapy could be a crucial strategy to overcome cancer immunoresistance and improve patient survival, as we found in this case report of an elderly, refractory advanced lung cancer patient who has achieved complete remission after this therapeutic combination.

Ying Tong,1,2 Yong Yin,1 Jie Lu,1 Tonghai Liu,1 Jinhu Chen,1 Pinjing Cheng,2 Guanzhong Gong1 1Department of Radiation Physics, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, 2School of Nuclear Science and Technology, University of South China, Hengyang, People’s Republic of China Purpose: The purpose of this study was to quantify variations in the heart, pericardium, and left ventricular myocardium (LVM) caused by cardiac movement using the breath-hold technique. Patients and methods: In this study, the electrocardiography-gated four-dimensional computed tomography (CT) images of 22 patients were analyzed, which were sorted into 20 phases (0–95%) according to the cardiac cycle. The heart, pericardium, and LVM were contoured on each phase of the CT images. The positions, volume, dice similarity coefficient (DSC) in reference to 0% phase, and morphological parameters (max 3D diameter, roundness, spherical disproportion, sphericity, and surface area) in different phases of the heart, pericardium, and LVM were analyzed, which were presented as mean ± standard deviation. Results: The mean values of displacements along the X, Y, and Z axes respectively were as follows: 1.2 mm, 0.6 mm, and 0.6 mm for the heart; 0.5 mm, 0.4 mm, and 0.8 mm for the pericardium; and 1.0 mm, 4.1 mm, and 1.9 mm for the LVM. The maximum variations in volume and DSC respectively were 16.49%±3.85% and 10.08%±2.14% for the heart, 12.62%±3.94% and 5.20%±1.54% for the pericardium, and 24.23%±11.35% and 184.33%±128.61% for the LVM. The differences in the morphological parameters between the maximum and minimum DSC phases for the heart and pericardium were not significantly different (p>0.05) but were significantly different for the LVM (p

Tao Qin,1,* Ningning Zhou,1,* Yin-duo Zeng,2 Xiaoxiao Dinglin,2 Yuanyuan Zhao,1 Huai Liu,3,4 Likun Chen1 1Department of Medical Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 2Breast Tumor Center, Sun Yat-sen University Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, 3Department of Radiotherapy, Hunan Cancer Hospital, 4Department of Radiotherapy, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Key Laboratory of Translational Radiation Oncology, Changsha, Hunan, People’s Republic of China *These authors contributed equally to this work Background: High lactate dehydrogenase (LDH) is associated with a large tumor burden in extensive-disease small-cell lung cancer (ED-SCLC). This study evaluated the benefit of additional thoracic radiotherapy (TRT) in patients with ED-SCLC with elevated LDH.Methods: We analyzed 94 patients with ED-SCLC and evaluated LDH at Sun Yat-sen University Cancer Center during the period between January 2000 and March 2010. Patients were divided into two groups according to whether TRT was received. Survival was evaluated by the Kaplan–Meier method and Cox’s regression analysis.Results: The median age of the 94 patients with ED-SCLC was 58.5years. The main metastatic sites included the liver, bone, brain, and adrenal glands. The response rate in the TRT group was 46.9%. There were 32 patients (34.04%) receiving TRT and 5.3% receiving prophylactic cranial irradiation. The median survival time reached 10months (95% confidence interval: 8.22, 11.78months), and the 1-, 2-, and 5-year survival rates were 43.6%, 11.7%, and 2.1%, respectively. There was a significant difference in the median progression-free survival (PFS) and overall survival (OS) between the TRT group and the no TRT group (PFS: 9.0months vs 6.0months, P=0.018; OS: 13.0months vs 9.0months, P=0.006).Conclusion: The use of TRT improves the survival of patients with ED-SCLC. Future studies should use the LDH level for categorizing patients for treatment. Keywords: small-cell lung cancer, extensive stage, thoracic radiotherapy, LDH

Ying Tong,1,2 Yong Yin,1 Jie Lu,1 Tonghai Liu,1 Jinhu Chen,1 Pinjing Cheng,2 Guanzhong Gong1 1Department of Radiation Physics, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, 2School of Nuclear Science and Technology, University of South China, Hengyang, People’s Republic of China Purpose: The purpose of this study was to quantify variations in the heart, pericardium, and left ventricular myocardium (LVM) caused by cardiac movement using the breath-hold technique. Patients and methods: In this study, the electrocardiography-gated four-dimensional computed tomography (CT) images of 22 patients were analyzed, which were sorted into 20 phases (0–95%) according to the cardiac cycle. The heart, pericardium, and LVM were contoured on each phase of the CT images. The positions, volume, dice similarity coefficient (DSC) in reference to 0% phase, and morphological parameters (max 3D diameter, roundness, spherical disproportion, sphericity, and surface area) in different phases of the heart, pericardium, and LVM were analyzed, which were presented as mean ± standard deviation. Results: The mean values of displacements along the X, Y, and Z axes respectively were as follows: 1.2 mm, 0.6 mm, and 0.6 mm for the heart; 0.5 mm, 0.4 mm, and 0.8 mm for the pericardium; and 1.0 mm, 4.1 mm, and 1.9 mm for the LVM. The maximum variations in volume and DSC respectively were 16.49%±3.85% and 10.08%±2.14% for the heart, 12.62%±3.94% and 5.20%±1.54% for the pericardium, and 24.23%±11.35% and 184.33%±128.61% for the LVM. The differences in the morphological parameters between the maximum and minimum DSC phases for the heart and pericardium were not significantly different (p>0.05) but were significantly different for the LVM (p

Hongqing Zhuang,* Hailing Hou,* Zhiyong Yuan, Jun Wang, Qingsong Pang, Lujun Zhao, Ping WangDepartment of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, and Tianjin Lung Cancer Center, Tianjin, People's Republic of China*These authors contributed equally to this workPurpose: The aim of this study was to investigate radiation pneumonitis and its associated risk factors in patients with non-small-cell lung cancer treated with concurrent erlotinib and thoracic radiotherapy.Materials and methods: We conducted an analysis of patients with nonoperable stage IIIA–IV non-small-cell lung cancer who were treated with concurrent thoracic radiotherapy and erlotinib (ClinicalTrials.gov identifier: NCT00973310). The Common Terminology Criteria for Adverse Events version 3.0 grading system was applied to evaluate the incidence of radiation pneumonitis. The lung dosimetric parameters were recorded in accordance with the treatment plan, and the study endpoint was radiation pneumonitis at grade 2 or more.Results: Among the 24 selected clinical cases, nine were identified with radiation pneumonitis of grade 2 or above (37.5%). This included four cases with grade 2 (16.7%), two cases with grade 3 (8.3%), and three cases with grade 5 (12.5%). The results showed that the planning target volume was a significant factor affecting the incidence of radiation pneumonitis. All lung dosimetric parameters exhibited statistically significant differences between patients with pneumonitis and patients without pneumonitis. The receiver operating characteristic (ROC) curve analysis showed that all lung dosimetric parameters were useful in predicting the incidence of radiation pneumonitis. In addition, the threshold values of V5, V10, V15, V20, V30, and mean lung dose were >4%, >29%, >27%, >22%, >17% and >1,027 cGy, respectively.Conclusion: Special attention should be paid to the adverse effects of radiation pneumonitis in concurrent thoracic radiotherapy and erlotinib treatment. Lung dosimetric parameters are important predictive factors in radiation pneumonitis.Keywords: erlotinib, thoracic radiotherapy, radiation pneumonitis, dosimetric parameter, threshold value for lung radiation