Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
outcomes were retrospectively evaluated through medical records Statistical
analysis was performed with software SPSS 22. Results:
lung cancer with oligo-brain metastases. Current available prognostic scores
provide good estimation of survival. Patients with EGFR activating mutation
had superior survival after SRS compared with non-mutational NSCLC group.
Keywords: Oligo-brain metastases, Stereotactic Radiosurgery, Lung Cancer,
EGFR activating mutation
POSTER SESSION 2 – P2.05: RADIOTHERAPY
CLINICAL OUTCOME –
TUESDAY, DECEMBER 6, 2016
Patient characteristics N = 68 (%)
Age, (Mean)
60,22 years
Gender, No. (%) Men Women 43 (63,2%) 25 (36,7%)
Race, No (%) White 54 (79,4%)
AJCC stage, No (%) I II III 5 (7,3%) 26 (38,2%) 37 (54,4%)
PS ECOG, No (%) 0-2 3-4 44(64,7%) 24 (35,3%)
Between 2010 and 2015, 68 patients were treated with radiation therapy
alone. Most of patients were male and white. The median age at diagnosis was
60,22 years. AJCC Stage III disease was the most prevalent one. The median
survival for all stages was 8.055 months (95% CI 5.796 to 10.313 months).
Overall survival at 5 years was 11.7 % Conclusion: Radiotherapy alone resulted
in very poor survival in this cohort. Our data is original in Brazil. Most of lung
cancer patients who may not tolerate surgery or a chemoradiation regim die.
New alternatives for the management of these patients are neceessary.
Keywords: definitive radiotherapy, lung cancer
POSTER SESSION 2 – P2.05: RADIOTHERAPY
CLINICAL OUTCOME –
TUESDAY, DECEMBER 6, 2016
P2.05-013 STEREOTACTIC BRAIN RADIOSURGERY IN LUNG CANCER
PATIENTS IN THE ERA OF PERSONALIZED THERAPY: A REVIEW OF
OUTCOMES AND PROGNOSTIC SCORES EVALUATION
Florence Siu-Ting Mok 1 , Michael K.M. Kam 1 , Wai Kong Tsang 1 , Darren Ming
Chung Poon 1 , Herbert H. Loong 2
1 Clinical Oncology, Prince of Wales Hospital, Hong Kong/Hong Kong Prc, 2 Clinical
Oncology, The Chinese University of Hong Kong, Hong Kong/Hong Kong Prc
Background: Stereotactic brain radiosurgery (SRS) was demonstrated to
provide good local control in patients with oligo-brain metastases (commonly
defined as 4 or less). The discovery of different targeted therapies provided
significant improvement in survival in the past decade. We reviewed the
effectiveness of SRS in lung cancer patients with oligo-brain metastases
and identified prognostic factors which potentially can aid better patient
selection. Methods: Medical records of patients with brain metastases
treated with SRS in Prince of Wales Hospital, Hong Kong in Jan 2010-July 2015
were reviewed. Outcomes including local control rate (LCR), distant brain
control rate (BCR) and overall survival (OS) were analyzed. Prognostic factors
were identified with univariate and multivariate analyses. Correlation with
available prognostic scorings including RTOG Recursive Partitioning Analysis,
Basic Score for Brain Metastases, the Score Index for Radiosurgery and
Graded Prognostic Assessment was evaluated. Results: Forty-eight patients
with 66 lesions were treated with LINAC-based SRS with single dose of 12-
24Gy (mean dose 18.1Gy). The distribution of different subtypes is as follows:
Non-small cell lung cancer (NSCLC)/adenocarcinoma NOS n=18 (37.5%), EGFR
mutation n=17 (35.4%), ALK IHC+ n=3 (6.3%), adenocarcinoma of unknown
subtype n=2 (4.2%), squamous cell carcinoma n=5 (10.4%), small cell carcinoma
n=2 (4.2%) and unknown subtype n=1 (1.8%). The median follow up time was
11.0 months (0.4-71.4 months). Five patients (9.4%) were symptomatic with
acute brain edema. Seven patients (14.6%) had delayed seizure after a mean
time of 10.1month (2.0-33.5 months). Six patients (12.5%) became steroid
dependent. The median OS was 13.0 months. One year actuarial LCR was 73%
and distant BCR was 67%. OS correlated significantly with all four scoring
systems. Among NSCLC patients, those with activating EGFR mutation (exon
19 deletion or exon 21 L858R mutation) (n=12) had superior OS compared
with non-mutational group (p=0.036, HR 2.811 95% CI 1.072-7.369), but there
was no statistically significant difference on local or distant brain control.
Concomitant whole brain radiotherapy (WBRT) did not significantly affect
OS, local and brain control in the whole group and in EGFR activating mutant
subgroup. Conclusion: SRS provided good control in patients with primary
P2.05-014 SITES OF RECURRENT DISEASE IN SCLC PATIENTS
TREATED WITH RADIOCHEMOTHERAPY - IS SELECTIVE NODAL
IRRADIATION SAFE?
Calogero Gumina 1 , Chiara Valentini 1 , Rebecca Buetof 1 , Steffen Appold 1 ,
Michael Baumann 1 , Esther Troost 2
1 Department of Radiation Oncology, Medical Faculty and University Hospital
Carl Gustav Carus, Dresden/Germany, 2 Helmholtz-Zentrum Dersden-Rossendorf,
Institute of Radiooncology, Dresden/Germany
Background: Concurrent radiochemotherapy (CCRT) is the standard
treatment in locally advanced small cell lung cancer (SCLC) patients. Even
though elective nodal irradiation (ENI) had been advocated, its use in routine
clinical practice is still limited [1]. Therefore, the purpose of this study is
to assess the sites of recurrent disease in SCLC patients and to evaluate
the feasibility of selective nodal irradiation (SNI) versus ENI. Methods: A
retrospective single-institution study was performed in stage I-III SCLC
patients treated with CCRT. After state-of-the-art staging, all patients
underwent three-dimensional conformal radiotherapy to a total dose of
45 Gy in twice-daily fractions of 1.5 Gy starting concurrently with the first
or second chemotherapy cycle (etoposide, cisplatinum). The gross tumor
volume (GTV) consisted of the primary tumor and SNI visualized on CT and/
or FDG-PET, or confirmed by cytology. The clinical target volume (CTV) was
obtained by expanding the GTV, adjusting it for anatomical boundaries,
and electively adding the supraclavicular lymph node stations. Thereafter,
the CTV was expanded to a planning target volume based on institutional
guidelines. After CCRT, prophylactic whole-brain irradiation (WBI; 30 Gy in
15 fractions) was administered to patients with a (near-complete) response.
Follow-up consisted of a CT-thorax 6-8 week after completing treatment,
followed by a 3-monthly chest x-ray or CT-scan. For this retrospective analysis,
we reviewed all imaging data used for radiation treatment planning and
during follow-up. The site of loco-regional relapse was correlated to the initial
site and dose delivered. Results: Between April 2004 and December 2013, 54
patients underwent CCRT (followed by WBI in 63%). After a median time of
11.5 months, 17 patients (31.5%) had relapsed locally or regionally: six within
the initial primary tumor volume, five within the initially affected lymph
nodes, three metachronously within the primary tumor and initially affected
lymph nodes, and three inside and outside of the initial nodal disease. Only
one patient developed isolated supraclavicular lymph node metastases in the
electively treated volume. All sites of loco-regional recurrence had received
92%-106% of the prescribed dose. Thirty-seven patients (69%) developed
distant metastases (37.8% liver, 35% brain). Conclusion: In this retrospective
analysis, most patients recurred in the initially affected primary tumor or
lymph nodes, or distantly. So, in order to reduce toxicity and potentially
increase dose in GTV/CTV, one may consider omitting irradiation of the
supraclavicular lymph node stations in those patients with affected lymph
nodes in the lower hilar and mediastinal lymph node stations.
POSTER SESSION 2 – P2.05: RADIOTHERAPY
CLINICAL OUTCOME –
TUESDAY, DECEMBER 6, 2016
P2.05-015 LONG-TERM OUTCOMES OF PROSPECTIVE PHASE П
CLINICAL TRIAL FOR STEREOTACTIC ABLATION RADIOTHERAPY IN
RECURRENT NSCLC
Joe Chang 1 , Bing Sun 1 , Zhongxing Liao 1 , Melenda Jeter 1 , James Welsh 1 , Peter
Balter 2 , Reza Mehran 3 , John Heymach 4 , Ritsuko Komaki 1 , Jack Roth 5
1 Department of Radiation Oncology, The University of Texas MD Anderson Cancer
Center, Houston/TX/United States of America, 2 Radiation Physics, The University of
Texas MD Anderson Cancer Center, Houston/TX/United States of America, 3 Thoracic
& Cardiovasc Surgery, The University of Texas MD Anderson Cancer Center,
Houston/TX/United States of America, 4 Thoracic Head and Neck Medical Oncology,
The University of Texas MD Anderson Cancer Center, Houston/TX/United States of
America, 5 Thoracic & Cardiovascular Surgery, The University of Texas MD Anderson
Cancer Center, Houston/TX/United States of America
Background: To evaluate the long-term efficacy, pattern of failure, and
toxicity of stereotactic ablative radiotherapy (SABR) for recurrent or
multiple primary non-small-cell lung cancer (NSCLC). Methods: Patients
S544 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017