Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
Bellvitge Hospital, Barcelona/Spain, 5 Medical Physics Department, Catalan
Institute of Oncology -Ico Hospitalet, Barcelona/Spain, 6 Research Unit, Catalan
Institute of Oncology, Gran Via de L´hospitalet/Spain, 7 Nuclear Medicine-Idibell,
Bellvitge Hospital, Barcelona/Spain, 8 Department of Diagnostic Imaging, Catalan
Institute of Oncology, L’Hospitalet/Spain, 9 Thoracic Surgery, Hospital Universitari
de Bellvitge. Idibell, Institut D’Investigació Biomèdica de Bellvitge., L’Hospitalet de
Llobregat/Spain, 10 Radiation Oncology, Catalan Institute of Oncology, Gran Via de
L´hospitalet/Spain
Background: Isolated intrathoracic relapse is common across distinct tumors
and especially in lung cancer. Patients who received previous radiotherapy
treatment (PRT) are not suitable for salvage surgery and chemotherapy
provides poor local control. This study aimed to assess the toxicity and
outcome of SBRT re-irradiation (reRT) in patients with solid tumors who
developed an intrathoracic relapse. Methods: 35p treated with PRT who
received salvage SBRT were identified in our database and their medical
records were retrospectively reviewed. All patients underwent complete
pulmonary function tests (cPFTs) (including DLCO, FEV1 and FVC) and PET-CT
scan was performed before and after receiving lung reRT. Treatment planning
was based on image fusion with the previous treatment plan and calculating
the cumulative total nominal dose. Survival estimations were performed
using Kaplan-Meier and differences between PFTs prior and post-reRT were
analyzed using Student T-Test. Early toxicity was defined when it occurred
up to 6 months. Results: Median age: 68 (r53-81); 29p (83%) were male The
previous treatments SBRT in 17p (49%), 3D-RT 4p (11%) and CT+RT 14p (40%)
Mean RT dose 60,4Gy (r34-74). Primary tumors: lung 24 (69%), colorectal 9
(25%), oesophagus 2 (6%). For lung cancer p, the stage distribution was: IA 8
(23%), IB 2 (6%), IIA 2 (5.7%), IIB 1 (3%), IIIA 5 (4%), IIIb 4 (11%), IV 2 (6%). For
other primaries, 8p (23%) were non metastatic at diagnosis and developed
oligoprogressive disease in thorax which was treated with SBRT and 3 (8.5%)
were oligometastatic. The location of reRT site: same lobe 17 (48%), ipsilateral
different lobe 7 (20%), contralateral lobes 11 (32%). Median delivered dose of
salvage SBRT was 50Gy (50-60) in 10 fractions (r3-10). Median accumulated
dose in the lung was 81Gy (r60.10Gy-176Gy). With a median follow-up of
10m local control rate was 74% (IC95%; 0.59-0.9) and 1-year OS was 84% (IC
95%;0.67-1). The metabolic complete response rate was 23%. No differences in
the baseline and post re-irradiation PFTs were observed: FEV1, FVC and DLCO
difference and CI95% were 2.41 (-1.79-6.62); 65 (-125-257) and 12.5 (-95 - 121).
Asthenia GII in 12p (31%) was the most frequent acute toxicity, no long-term
toxicities were detected. Conclusion: Salvage SBRT for treating isolated
intrathoracic relapses achieved an outstanding local control and overall
survival in selected p . This treatment did not impair post-reirradiation PFT
and long-term toxicities were not observed.
Keywords: SBRT; Reirradiation
POSTER SESSION 2 – P2.05: RADIOTHERAPY
CLINICAL OUTCOME –
TUESDAY, DECEMBER 6, 2016
P2.05-019 STEREOTACTIC BODY RADIOTHERAPY (SBRT) FOR
CENTRAL LUNG TUMORS: THE EXPERIENCE OF FLORENCE
UNIVERSITY-CAREGGI HOSPITAL RADIOTHERAPY
Vieri Scotti 1 , Vanessa Di Cataldo 2 , Gabriele Simontacchi 1 , Alessio Bruni 3 ,
Ana Turkaj 1 , Giulio Alberto Carta 1 , Marco Perna 1 , Carlotta Becherini 1 , Camilla
Comin 4 , Katia Ferrari 5 , Benedetta Agresti 1 , Carla De Luca Cardillo 1 , Laura
Masi 2 , Raffaela Doro 2 , Lorenzo Livi 1
1 Oncology, Radiation Oncology Unit, Florence/Italy, 2 Cyberknife Center- I.F.C.A
(Istituto Fiorentino Di Cura Ed Assistenza), University of Florence, Florence/Italy,
3 Radiotherapy Unit, -Aou Policlinico of Modena, Modena/Italy, 4 Department of
Experimental and Clinical Medicine, University of Florence, Section of Surgery,
Histopathology and Molecular Pathology, Florence/Italy, 5 Cardiothoracic
Department, Pneumonology and Thoracic Phisiopathology Unit, Azienda
Ospedaliero-Universitaria Careggi, Florence/Italy
Background: Stereotactic body radiotherapy (SBRT) for central lung tumors,
defined as tumor within 2 cm or touching the zone of the proximal bronchial
tree or tumors immediately adjacent to the mediastinal or pericardial pleura
(Adebahr S. et al. BJR 2015) is debated because of toxicities to organs at risk.
No evidences from phase III trial are available. Methods: From 2010 to 2015,
45 central lesions in 40 pts were treated with SBRT. 14 lesions were primary
lung cancer (PLC), 31 were lymphoadenopathies (LAP). PLC were treated
with volumetric arc Therapy (VMAT) in 9 cases and 5 with Cyberknife®. LAP
were treated with VMAT in 12 cases, with IMRT (step and shoot) in 10 and
with Cyberknife® in 9 cases. Prescribed doses varied between 18 and 60 Gy
(1-8 fractions) with median BED of 65 Gy (37,5-105 Gy). We evaluated Overall
Survival (OS), Progression Free Survival (PFS) and Disease Specific Survival
(DSS) using Kaplan-Meier method and treatment related toxicities using
CTCAE version 4.0. Results: Median age was 62 years (48-86), 26 male and
14 female. PS was 0 in 9 pts, 1 in 21, 2 in 10 pts. Histology was available in all
series and consisted of primary NSCLC (32 adenocarcinoma, 12 squamous
cell carcinomas, 1 neuroendocrine tumour). 41 PLC were less than 2 cm from
proximal bronchial tree, 4 PLC were immediately adjacent to the mediastinal
or pericardial pleura. Tumor diameter was 10 to 60 mm with a median of 31
mm. Median follow up was 14,5 months. OS and DSS were 86.5% at 1 year,
55.6% at 2 years, and 49,4% at 3 years. PFS was 48,6% at 1 year, 24,1% at 2
years, and 12% at 3 years. 35 pts showed no acute toxicity; in 5 pts we recorded
grade 1-2 esophagitis, in 2 pts grade 2 cough, in 2 pts, grade 1 asthenia. Chronic
toxicity was present in 2 pts as grade 2 esophagitis. Conclusion: SBRT is
confirmed to be a safe and effective strategy for central lung tumors. The
majority of patients in the first part of our series was treated with low doses
compared to current doses. Nevertheless 23 patients had clinical benefit from
the treatment without life-threatening toxicities. Further studies are needed
to establish the efficacy and safety of SBRT in central lung lesions.
Keywords: central lung lesions, SBRT, Stereotactic body radiation therapy
POSTER SESSION 2 – P2.05: RADIOTHERAPY
CLINICAL OUTCOME –
TUESDAY, DECEMBER 6, 2016
P2.05-020 SURVIVAL OUTCOMES IN STAGE 1 NSCLC FOLLOWING
STEREOTACTIC ABLATIVE RADIOTHERAPY OR CONVENTIONAL
RADIOTHERAPY
Gerard Hanna 1 , Ruth Johnston 2 , Ruth Eakin 2 , Linda Young 2 , Jacqueline
Harney 2 , Jonathan Mcaleese 2
1 Radiation Oncology, Ccrcb, Queen’s University of Belfast, Belfast/United Kingdom,
2 Department of Clinical Oncology, Cancer Centre, Belfast City Hospital, Belfast/
United Kingdom
Background: Stereotactic ablative radiotherapy (SABR) is a radiotherapy
technique using ultra-hypofractionated treatment to deliver a high biological
dose to early stage lung cancers. It is believed that SABR is more effective
than conventional fractionated external beam radiotherapy (EBRT), however
definitive evidence of superior survival outcomes from controlled trial
comparisons is lacking. Across the UK access to SABR is not been uniform,
with only certain centres delivering the technique. Before the introduction
of a routine lung SABR service in 2013, patients from Northern Ireland were
referred to English Centres to have SABR. We compare the outcomes of
those patients who had SABR to those who had conventional fractionated
radiotherapy for early stage lung cancer. Methods: Using our institutional
electronic database, which includes all patients who had radiotherapy in
the treatment of lung cancer, we identified those patients who had received
SABR or who were eligible to receive it based on UK consortium guidelines
(tumor size 2cm from main airways, performance status 0-3).
The time period of 2009 to 2015 inclusive was chosen as SABR treatment was
funded from this time point onwards. Patient baseline demographics, lung
function, tumor size, the reason for the treatment received, details of the
treatment received (e.g. dose, use of respiratory compensation, IGRT and
Type B planning algorithm) and survival outcomes were recorded for each
patient. Results: Between 2009 and 2015, eighty patients received SABR and
an additional 63 were eligible to have SABR but received conventional EBRT
(62 patients received 55Gy in 20 fractions and 1 patient received 66Gy in 33
fractions). The main reason for eligible patients not receiving SABR was that
the patient did not want to travel or was not fit to travel to another country to
have treatment with SABR (43% of all non-SABR patients). The 2-year overall
survival for those receiving SABR was 68% versus 43% for those receiving
conventional radiotherapy (HR 2.3 (95% CI 1.4 – 3.8), p=0.0007). Both disease
free survival and metastasis free survival rates were superior in the SABR
group. On univariate analysis of the various patient and treatment factors,
only tumor size remained significant between the groups. Conclusion: In this
cohort of patients there is evidence of improved local control, disease free
survival and overall survival for SABR compared to conventional fractionated
radiotherapy. SABR should be available in all radiotherapy centres for the
treatment of early stage lung cancer.
Keywords: SABR, NSCLC, Radiotherapy, stereotactic
POSTER SESSION 2 – P2.05: RADIOTHERAPY
CLINICAL OUTCOME –
TUESDAY, DECEMBER 6, 2016
P2.05-021 STEREOTACTIC RADIOSURGERY FOR BRAIN METASTASIS
IN NON-SMALL CELL LUNG CANCER: PREDICTOR OF INTRACRANIAL
PROGRESSION
Yeon Sil Kim 1 , Yong Kyun Won 1 , Jin Hyoung Kang 2 , Seung Joon Kim 3 , So-Lyoung
Jung 4 , Sook Hee Hong 5
1 Radiation Oncology, Seoul St. Mary’s Hospital, the Catholic University of Korea,
Seoul/Korea, Republic of, 2 Medical Oncology, Seoul St. Mary’s Hospital,the Catholic
University of Korea, Seoul/Korea, Republic of, 3 Pulmonology, Seoul St. Mary’s
S546 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017