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Chenxue Jiang



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    OA01 - Improving Outcomes in Locoregional NSCLC I (ID 892)

    • Event: WCLC 2018
    • Type: Oral Abstract Session
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 10:30 - 12:00, Room 107
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      OA01.02 - The Estimate of Shrinking Field and SIB Radiotherapy Guided by 18F-FDG PET/CT in Locally Advanced NSCLC Patients: A Phase 2 Randomized Clinical (ID 14474)

      10:40 - 10:50  |  Author(s): Chenxue Jiang

      • Abstract
      • Presentation
      • Slides

      Background

      Tumor control remains suboptimal in locally advanced lung cancer. Radiation dose acceleration has a positive effect to local tumor control, but is limited by radiation-induced lung injury (RILI). The aim of this study was to evaluate the safety and efficacy of adaptive radiation therapy guided by functional imaging 18F-FDG PET/CT in patients with locally advanced non-small lung cancer.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A total number of 72 patients with locally advanced NSCLC were enrolled between November 2012 and June 2017. After signing the inform consent form, 36 patients were randomized into the shrinking field and simultaneous integrated boost radiotherapy group, others were in the conventional radiotherapy group. The Objective Response rate (ORR), progression-free survival (PFS) and overall survival (OS) were compared, as well as the safety of shrinking field and simultaneous integrated boost radiotherapy (radiological dosimetry parameters and the incidence of grade 2 or higher radiotherapy-related toxicity). T-test was utilized to compare the differences between the quantitative data of two groups, while chi-square test or Fisher exact test were utilized to compare the differences between the count data of two groups. Kaplan-Meier curve was utilized to show PFS and OS, and the log-rank test analysis was utilized to compare the survival difference between two groups. P value less than 0.05 was considered statistical difference.

      4c3880bb027f159e801041b1021e88e8 Result

      All the patients in both two groups had completed their treatment according to the study protocol. The shrinking field and simultaneous integrated boost radiotherapy group was significantly greater than the conventional radiotherapy group in ORR (77.8% vs. 52.8%, P=0.026). The median OS and PFS in shrinking field and simultaneous integrated boost radiotherapy group was 22.0 months (95%CI:18.1~25.9) and 12.4 months (95%CI:10.4~14.3), which is significantly longer than 18.1 months (95%CI:12.4~23.8) and 8.2 months (95%CI:5.2~11.2) in the conventional radiotherapy group (P=0.045 and P=0.013). There was no significant difference between the two groups in radiological metrological parameters and organ at risk (OAR). The incidence of grade 2 or higher RILI, radiation-induced esophagitis, radiation-related myocardial damage and myelosuppression between two groups has no statistically significant difference.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Shrinking field and simultaneous integrated boost radiotherapy guided by function imaging 18F-FDG PET/CT is a safe and operable technique in practice. It can improve ORR, OS and PFS without increasing the risk of radiotherapy-related toxicity in patients with locally advanced NSCLC.

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    P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.16-18 - Role of ERCC1/2 Single Nucleotide Polymorphism (SNP) on Treatment Response in Patients with Lung Cancer Undergoing Radiation Therapy (ID 14476)

      16:45 - 18:00  |  Author(s): Chenxue Jiang

      • Abstract

      Background

      Radiation therapy plays an important role in the treatment of lung cancer. The protein excision-repair cross-comlementation 1 (ERCC1) and protein excision-repair cross-comlementation 2 (ERCC2) are the key enzymes in NER pathway. Studies showed that ERCC1/2 were associated with susceptibility and efficacy of chemotherapy in lung cancer, but the association between ERCC1/2 SNPs and radiotherapy were seldom reported.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Eighty-seven peripheral blood samples were collected from patients with NSCLC before they received radiotherapy in our department from November 2014 to October 2017. The peripheral blood leukocyte DNA was isolated and SNP genotypes were detected by competitive allele-specific PCR. Seven SNPs in ERCC1/2 were analyzed. Data was collected both before and after radiotherapy from blood serum. Elisa was used to detect ERCC1 expression. The association between the changes of expression of ERCC1 during radiotherapy and efficacy, risk of RILI and SNPs in ERCC1 was analyzed.

      4c3880bb027f159e801041b1021e88e8 Result

      ERCC1 re3212961 minor allele A was associated with a better response to radiotherapy in NSCLC patients. Survival analyses showed that G/G genotype had favorable OS than A/A genotype (P=0.012). Cox regression analysis indicated that ERCC1 rs11615 G/G genotype was associated with decreased risk of death. Subgroup analyses indicated that patients with G/G genotype who received high BED radiotherapy had better OS (median not reached vs. 21.5 months, 95%CI:15.3-27.7,P=0.011) and PFS (median not reached vs. 19.9 months, 95%CI:8.6-31.2,P<0.001) than low BED subgroup. There was no significant association between ERCC1/2 SNPs and RILI. The ERCC1 expression in serum was significantly increased after radiotherapy. However, the changes of ERCC1 expression showed no association with efficacy of radiotherapy, risk of RILI or SNPs of ERCC1/2.

      8eea62084ca7e541d918e823422bd82e Conclusion

      ERCC1 rs3212961 was related with short-term curative efficacy. ERCC1 rs11615 was an independent prognostic factor in NSCLC, which could serve as biomarker, because G/G genotype had favorable OS and PFS, and was associated with decreased risk of death. There was no significant correlation between ERCC1/2 SNPs and RILI. The changes of ERCC1 expression after radiotherapy showed no association with efficacy of radiotherapy, risk of RILI or SNPs of ERCC1/2.

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    P2.04 - Immunooncology (Not CME Accredited Session) (ID 953)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.04-18 - The Association Between IDO Activity and Clinical Prognosis in Patients with Non-Small Cell Lung Cancer After Radiotherapy (ID 14394)

      16:45 - 18:00  |  Author(s): Chenxue Jiang

      • Abstract

      Background

      Immunity affects the efficacy of radiotherapy and prognosis of patients. indoleamine 2,3-dioxygenase (IDO), a limiting enzyme in the IDO/kynurenine pathway, could converts the tryptophan (T) into kynurenine (K), which promotes immune suppression and assist tumor cells in immune evasion. The aim of this study was to investigate the association between the IDO activity and kynurenine and clinical outcome in non-small cell lung cancer (NSCLC) patients who received radiotherapy.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Blood serum K and T in 114 NSCLC patients were measured by high performance liquid chromatography and mass spectrometer in time before and after radiotherapy. The ratio of K: T represents the activity of IDO. Kaplan-Meier curve and log-rank test were performed to evaluated the correlation with Overall survival (OS) or progression-free survival (PFS) and IDO activity. The Cox proportional hazards model was used for univariate and multivariate analyses.

      4c3880bb027f159e801041b1021e88e8 Result

      On average, both the K and the ratio of K: T were increased after radiotherapy (P<0.001 and P=0.006). The patients with reduced K: T after radiotherapy had better OS than who with increased K: T (not reached vs. 20.2 months,P=0.004). In subgroup of patients who received Stereotactic Body Radiation Therapy (SBRT), patients with reduced K: T after radiotherapy had better OS and PFS than who with increased K: T (median OS: not reached vs. 20.2 monthsP=0.008 and median PFS: not reached vs. 10.9 monthsP=0.006, respectively). Multivariate analysis also showed that IDO activity was a factor for OS and PFS HR=6.66795%CI1.515~29.411P=0.012 and HR=5.34895%CI1.427~20.000P=0.013, respectively).

      8eea62084ca7e541d918e823422bd82e Conclusion

      The change of IDO activity after radiotherapy is associated with prognosis in NSCLC. The patients with reduced IDO activity after radiotherapy had better OS than who with increased. Especially for patients who received SBRT, patients with reduced IDO activity had better OS and PFS than those increased after radiotherapy. IDO is a potential molecular marker of NSCLC to evaluated the prognosis after radiotherapy.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P2.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 966)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.17-03 - A Propensity-Matched Analysis of Neoadjuvant Chemoradiotherapy and Adjuvant Chemoradiotherapy for IIIA(N2) Non-Small Cell Lung Cancer (ID 14395)

      16:45 - 18:00  |  Author(s): Chenxue Jiang

      • Abstract

      Background

      Multidisciplinary treatment is the preferred treatment for patients with IIIA(N2) non-small cell lung cancer (NSCLC). A subset of patients with potentially resectable of this disease are managed with trimodality therapy (surgery combined with chemoradiotherapy). However, little data exist to guide which one is better between neoadjuvant chemoradiation followed by surgery and surgery followed by adjuvant chemoradiotherapy. Given that prospective comparative data on these two managements are limited, we compared the two treatments with a propensity-matched analysis.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      All patients undergoing treatment with trimodality therapy for clinical IIIA(N2) NSCLC between January 2012 and December 2016 were reviewed. Patients received individual chemotherapy (regimens depending on the different pathological types: squamous cell carcinoma: Docetaxel 30mg/m2 d1,d8, Cisplatines 25mg/m2 d1-3, repeated every 3 weeks for 2 cycles; non-squamous cell carcinoma: Pemetrexed 500mg/m2 d1, Cisplatin 25mg/m2 d1-3, repeated every 3 weeks for 2 cycles) plus radiotherapy (46-50 Gy/23-25 fractions) at preoperation or postoperation. Age, gender, tumor characteristics, pathological types, pulmonary function, disease-free survival (DFS), overall survival (OS) data were collected. A propensity-matched analysis was performed.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 31 patients underwent neoadjuvant chemoradiation followed by surgery, and 82 received surgery followed by adjuvant chemoradiotherapy. Median follow-up was 27 months. For the entire cohort, the median OS and DFS in neoadjuvant chemoradiation followed by surgery group was 24.0 months (95%CI17.1~29.2) and 16.6 months (95%CI10.9~21.5), which is shorter than 30.6 months (95%CI20.9~39.5) and 19.3months (95%CI11.4~25.7) in surgery followed by adjuvant chemoradiotherapy group (P=0.048 and P=0.037). A propensity matched comparison in a blinded manner (1:1 ratio, caliper distance=0.005) based on age, gender, WHO performance status, pulmonary function (forced expiratory volume in 1 second [FEV1] % and FEV1), pathological types, number of mediastinal lymph nodes and T stage resulted in 22 matched pairs. There were no significant differences between neoadjuvant chemoradiation followed by surgery and surgery followed by adjuvant chemoradiotherapy groups in the median OS (25.3 Vs. 25.0 months, P=0.747) and DFS (16.9 Vs. 17.4 months, P=0.941) respectively. Toxicities associated with chemoradiotherapy and death related with treatments were similar in both groups.

      8eea62084ca7e541d918e823422bd82e Conclusion

      This propensity-matched analysis found multidisciplinary treatment remains a suitable option for a subset of patients with IIIA(N2) disease. Upfront surgery without invasive staging, followed by adjuvant chemoradiotherapy, appears reasonable in resectable N2 disease, simplifying patient care and reducing cost. Participation in clinical trials is essential to define the indications and efficacy in a selected population.

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    P3.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 982)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.16-19 - Clinical Outcomes of Stereotactic Body Radiation Therapy for T2N0M0 Non-Small Cell Lung Cancer (ID 12543)

      12:00 - 13:30  |  Author(s): Chenxue Jiang

      • Abstract

      Background

      For patients with inoperable stage I non-small cell lung cancer (NSCLC), stereotactic body radiation therapy (SBRT) is considered standard. However, the effectiveness and safety of SBRT specifically for T2N0M0 NSCLC remains controversial. This retrospective study investigated the safety and efficacy of SBRT in T2N0M0 NSCLC.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The medical records of 29 patients with T2N0M0 NSCLC treated by SBRT were reviewed. The overall, progression-free, and cause-specific survival rates were determined.

      4c3880bb027f159e801041b1021e88e8 Result

      The mean follow-up was 20.1 months. At years 1, 2, and 3, the overall survival rates were 93.1, 93.1, and 89.7%, respectively; the corresponding cause-specific survivals were 96.6, 96.6, and 93.1%; the progression-free survivals were 75.9, 65.5, and 62.1%; the local control rates were 100, 96.6, and 96.6%; the regional control was 86.2, 79.3, and 75.9%; and distant control was 89.7, 82.8, and 79.3%. Twenty patients (69.0%) developed symptoms of grade 1 toxicity: dyspnea, chest pain, fatigue, cough, esophagitis, or pneumonia. Among these, 5 patients suffered grade ≥2 therapy-associated pneumonitis, and one patient experienced grade 4 adverse pulmonary effects.

      8eea62084ca7e541d918e823422bd82e Conclusion

      SBRT was efficient and safe for patients with inoperable T2N0M0 NSCLC, imposing tolerable toxicities. These results warrant a prospective study to develop the multidisciplinary criteria for SBRT in T2N0M0 NSCLC.

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