Download Stefan Starup Jeppesen, MD, PhD stud. Stereotactic body radiation

Stefan Starup Jeppesen, MD, PhD stud.
Stereotactic body radiation therapy for patients with localized non-small cell lung cancer –
comorbidity, efficacy and toxicity of treatment
•
Background
Lung cancer is a frequent type of malignant disease. In Denmark 4.300 patients are diagnosed with
this malignant disease every year the standard treatment for patients diagnosed with localized nonsmall cell lung cancer (NSCLC) is surgery. Some patients are considered medical inoperable due to
age, poor lung function, or other comorbidity. During the last 10 years stereotactic radiotherapy
(SBRT) has been widely used as an alternative treatment for medical inoperable patients. SBRT is
radiation therapy given with large doses per radiation directed at the tumor with a precision that
spares the surrounding tissue. The use of stereotactic radiotherapy for localized lung cancer varies
widely within the world of radiotherapy. No randomized studies have been conducted comparing
SBRT with no treatment for patients with localized NSCLC.
The most common reason for patients considered medical inoperable is chronic obstructive
pulmonary disease (COPD). COPD is associated with severe morbidity and mortality. The patients
with COPD generally have poorer survival compared to citizens with similar age without comorbidity.
It is not known if the prognosis of COPD patients is so poor that diagnosed localized lung cancer
may only have little impact on survival.
•
•
The average age of patients with lung cancer increases worldwide. It is expected that the proportion
of patients with one or more comorbidities who cannot undergo surgery increases. The
Comprehensive Geriatric Assessment (CGA) was developed by geriatricians as a multidimensional
interdisciplinary diagnostic process focused on determining a frail older person in order to develop a
coordinated and integrated plan for treatment and long-term follow-up. No randomized study of the
effect of a CGA for patients with localized NSCLC has been performed. However, the
recommendation by the International Geriatric Oncology Society is to perform a CGA to optimize the
elderly patients’ condition when receiving cancer treatment.
Aim
The aim of the PhD project is to investigate the efficacy and toxicity of the highly specialized
treatment of stereotactic body radiation therapy to patients with localized NSCLC. Furthermore, to
investigate if comorbidity status in patients treated with SBRT has influence on quality of life and
overall survival.
Methods
1) a comparison of SBRT versus no treatment in medical inoperable patients with localized NSCLC
T1-2N0M0 – a retrospective study.
2) a comparison of medical inoperable patients diagnosed localized NSCLC treated with SBRT with
patients with COPD without any cancer diagnosis – a retrospective study.
3) to illustrate if there is a difference in local control rates, survival rates and toxicity comparing two
different dose regimens of SBRT – a descriptive study.
4) to investigate the impact of an upfront Comprehensive Geriatric Assessment on Quality of Life
and overall survival after treatment for patients with localized NSCLC treated with SBRT - a
randomized pilot study.