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J.S.K. Au
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P1.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 212)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.03-031 - Concurrent Chemoradiotherapy Using Advanced Radiotherapy Technologies for Inoperable Stage III Non-Small-Cell Lung Cancer (ID 1351)
09:30 - 09:30 | Author(s): J.S.K. Au
- Abstract
Background:
Concurrent chemoradiotherapy with the standard regimen of docetaxel plus cisplatin/carboplatin for inoperable stage III non-small-cell lung cancer (NSCLC) demonstrates good synergistic activity and radiosensitizing properties but toxicities are of major concerns. This phase II noncomparative trial was conducted to determine the use of newer radiotherapy technologies including IMRT planning with PET-CT to ensure dose conformity and SPECT-CT to define functional lung volume for avoidance in reducing radiation-induced toxicity and in improving treatment outcome in patients with NSCLC.
Methods:
Patients with locally advanced, inoperable stage III NSCLC received weekly docetaxel (20mg/m2) and cisplatin/carboplatin (20mg/m[2]) for 6 weeks with concurrent IMRT (66Gy/6.5 weeks over 33 fraction) followed by a resting period of two weeks before administration of 2 cycles of every 3 week adjuvant chemotherapy with docetaxel (35mg/m2) and cisplatin/carboplatin (35mg/m2) at Day 1 & 8.
Results:
A total of thirty-four patients were recruited in the study as intent-to-treat (ITT) population. Of the twenty-seven patients (as per-protocol population, PPP) evaluable for treatment response, the overall response rate was 77.8%. Median overall survival was 35.5 months (95% CI: 21.3 – 49.7 months) (Figure 1) and progression free survival was 20.8 months (95% CI: 15.3 – 26.2 months) (Figure 2). Tolerability was evaluated in the ITT population with the majority of adverse events to be predominantly grade 1 or 2. Three (8.8%) deaths occurred, two due to fulminant chest infection and one due to disease progression. Fifteen (44.1%) had emergent severe adverse events (SAE). The incidence rates of severe oesophagitis and pneumonitis were 8.8% and 5.9% respectively.Figure 1Figure 2
Conclusion:
Concurrent chemoradiotherapy using advanced radiotherapeutic technologies and docetaxel-cisplatin followed by adjuvant chemotherapy for inoperable stage III non-small-cell lung cancer demonstrated good response rates, overall survival and progression free survival. The treatment protocol was generally safe and well tolerated. Adverse events are less common than reported in the literature.
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P3.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 211)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.02-038 - Survival Outcomes of Stereotactic Body Radiotherapy for Early-Staged Non-Small Cell Lung Cancer: A Comparison between Different Doses (ID 913)
09:30 - 09:30 | Author(s): J.S.K. Au
- Abstract
Background:
Stereotactic body radiotherapy (SBRT) is a definitive local treatment option for patients with early stage non-small cell lung cancer (NSCLC) who are considered unfit for surgical treatment either due to poor lung function or medical comorbidities. The purpose of this work is to report on the outcomes of stage I and II non-small cell lung cancers treated with SBRT in a tertiary oncology centre in Hong Kong.
Methods:
One hundred and five patients diagnosed with Stage I-II NSCLC underwent treatment with SBRT between January 2006 and December 2014. Data were collected and analyzed retrospectively. Overall survival (OS) and local control (LC) were calculated using the Kaplan-Meier method.
Results:
Median follow-up was 28 months (range 5-100 months) with a median age of 77 years. The median size of treated lesion was 2.7cm (range 1.2-7cm). The median SBRT dose was 50Gy (range 40-60 Gy) delievered in a median of 4 fractions (range 4-10). The median biological equivalent dose (BED10) was 105.6 Gy (range 39 -180Gy). The overall median OS was 28 months. The overall LC was 86.5% and 43.7% at 1 and 3 years, the overall OS was 91% and 51.3% at 1 and 3 years, respectively. Patients with stage T1 (n=60) disease had better LC and OS when compared with T2 (n=42). Median OS was 30.5 months (T1) and 18 months (T2; P=0.006). 1-year LC was 89% (T1) and 83% (T2; p=0.45), 1-year OS was 96.3% (T1) and 83.8% (T2; p=0.006), 3-year LC was 57.8% (T1) and 37.5% (T2; p=0.045), 3-year OS was 60.4% (T1) and 38.7% (T2; p=0.006). A higher BED10 of more than 105Gy was associated with improvement in OS and LC. For tumors treated with BED10<105 Gy and BED10>=105 Gy, overall LC at 2 year was 71.8% and 86% (p= 0.017), 2-year OS was 69.4% and 79%, respectively (p=0.026). T2, but not T1 tumors was associated with improved LC with higher BED10. 2-year LC at 2 years for T2 tumors treated with BED10<105 Gy and BED10>=105 Gy were 40 % and 75% respectively (p=0.002). Median OS for T2 tumors treated with BED10<105 Gy and BED10>=105 Gy were 28 months and 31 months respectively (p=0.14). Toxicity was graded based on Common Terminology Criteria for Adverse Events (CTCAE v4.02). Two patients (1.9%) developed grade 3 toxicity of esophagus. There were no grade 4 or above toxicity. Eight patients developed asymptomatic rib fracture, all of these patients had peripheral lesions ( defined as < 2.5cm from chest wall), of which three patients had lesions touching chest wall, median time to development of rib fracture was 19 months (range 9-40 months).
Conclusion:
SBRT is an effective treatment option for early-stage-non-small cell lung cancer with limited toxicity. Overall survival and local control were greater for patients with T1 tumors compared to T2 tumors. Higher doses (BED10>105 Gy) were associated with improvement in local control and overall survival. Significant improvement in local control was observed in patients with T2 tumors treated with BED10>105 Gy.
