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Cancers 2017, 9(9), 120; https://doi.org/10.3390/cancers9090120

Acute and Late Toxicities of Concurrent Chemoradiotherapy for Locally-Advanced Non-Small Cell Lung Cancer

1
Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE 68106, USA
2
Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD 21201, USA
3
Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Samuel C. Mok
Received: 31 July 2017 / Revised: 4 September 2017 / Accepted: 5 September 2017 / Published: 8 September 2017
View Full-Text   |   Download PDF [762 KB, uploaded 8 September 2017]   |  

Abstract

For patients with unresectable locally-advanced non-small cell lung cancer (LA-NSCLC), concurrent chemoradiotherapy improves overall survival as compared to sequential chemotherapy and radiation therapy, but is associated with higher rates of toxicities. Acute, clinically significant esophagitis or pneumonitis can occur in one in five patients. The risks of esophagitis and pneumonitis can impact the decision to deliver concurrent therapy and limit the total dose of radiation therapy that is delivered. Hematologic toxicities and emesis are common toxicities from systemic therapies for LA-NSCLC and can result in delaying chemotherapy dosing or chemotherapy dose reductions. Late treatment morbidities, including pulmonary fibrosis and cardiac toxicities, can also significantly impact quality of life and potentially even survival. Recent advances in radiation therapy treatment delivery, better knowledge of normal tissue radiotherapy tolerances and more widespread and improved uses of supportive care and medical management of systemic therapy toxicities have improved the therapeutic ratio and reduced the rates of chemoradiotherapy-induced toxicities. This review details the acute and late toxicities associated with definitive chemoradiotherapy for LA-NSCLC and discusses toxicity management and strategies to mitigate the risks of treatment-related toxicities. View Full-Text
Keywords: non-small cell lung cancer; chemoradiotherapy; toxicity; esophagitis; pneumonitis; pulmonary fibrosis; hematologic toxicity; cardiac toxicity non-small cell lung cancer; chemoradiotherapy; toxicity; esophagitis; pneumonitis; pulmonary fibrosis; hematologic toxicity; cardiac toxicity
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).
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Verma, V.; Simone, C.B., II; Werner-Wasik, M. Acute and Late Toxicities of Concurrent Chemoradiotherapy for Locally-Advanced Non-Small Cell Lung Cancer. Cancers 2017, 9, 120.

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