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L.M. Nott



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    P1.08 - Poster Session 1 - Radiotherapy (ID 195)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Radiation Oncology + Radiotherapy
    • Presentations: 1
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      P1.08-010 - NSCLC and radiation pneumonitis post radiotherapy (ID 1132)

      09:30 - 09:30  |  Author(s): L.M. Nott

      • Abstract

      Background
      Lung cancer is the main cause of cancer deaths in the developed world and non-small cell lung cancer (NSCLC) accounts for 80-85% of all lung cancers [1]. Of these with NSCLC, 30-40% have locally advanced or inoperable disease, for which the mainstay of treatment remains thoracic irradiation. Radiation pneumonitis (RP) is one of the major dose limiting toxicities. The aim of this study is to retrospectively analyse the incidence and risk factors for RP in NSCLC patients treated with radiotherapy at Royal Hobart Hospital and to determine suitable dose restriction parameters.

      Methods
      273 patients with NSCLC who had radiotherapy treatment between 2006 and 2012 were retrospectively reviewed. For each patient, all records were examined for documented evidence of RP using the Common Terminology Criteria for Adverse Events (CTCEA 4.0 [2]) grading criteria at least six months post treatment. In addition, radiation dose, dose per fraction, planning target volume (PTV), total lung volume, mean lung dose, v5, v10, v20 and v30 values were obtained and a comparable biological effective dose (BED) for each treatment was calculated. Previous chemotherapy treatments, smoking status, performance status, use of ACE inhibitors, existing cardiovascular disease, established chronic obstructive pulmonary disease (COPD) and pulmonary function tests were also obtained.

      Results
      Out of the 273 NSCLC patients treated with radiotherapy at Royal Hobart Hospital, 25 (9%) had stage 1, 15 (5%) had stage 2, 75 (27%) had stage 3 and 129 (47%) had stage 4 NSCLC. 29 (11%) patients had no staging documented. 41 patients (15%) had documented evidence of RP. Of these 41 patients, 24 patients had level 1 RP, 14 patients had level 2, 1 patient had level 3, 1 patient had level 4 and 1 patient had level 5 (death). The mean BED (normalised to 2 Gy per fraction) was 64.9 +/- 21.0 Gy and the mean lung dose was 10.3 +/- 10.50 Gy. Twenty out of the 41 patients had been treated with radical intent and 21 with palliative intent.

      Conclusion
      In this study, RP has been documented in 15% of patients. More than half of these patients received palliative radiation dose. This could be explained by their advanced disease, poor lung function, and poor performance status. References: 1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin 2008;58:71–96. 2. Common Terminology Criteria for Adverse Events (CTCEA 4.0), http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm

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    P2.24 - Poster Session 2 - Supportive Care (ID 157)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-050 - Treatment pathways of patients diagnosed with non-small cell lung cancer - an audit of practice at a regional teaching hospital. (ID 3058)

      09:30 - 09:30  |  Author(s): L.M. Nott

      • Abstract

      Background
      Lung cancer is the main cause of cancer death for both men and women in Australia. Non-small cell lung cancer (NSCLC) usually presents late in the disease when treatment options are limited. Surgery remains the main stay of curative treatment with definitive radiotherapy or chemoradiotherapy used in some patients unfit for surgery or with locally advanced disease. Increasing use of chemotherapy with introduction of new targeted therapies has broadened the therapeutic choices for patients. We wished to look at what happened to patients with NSCLC in our hospital (RHH)

      Methods
      An audit was performed of patients presenting at our MDT (at which all patients with lung cancer in southern Tasmania are discussed) in 2010 and 2011 with a diagnosis of NSCLC. We looked at the type of therapy assigned (or not) and where they had chemotherapy the number of lines and types of treatment given.

      Results
      177 patients presented with NSCLC. Histology showed 99 adenocarcinomas, 48 squamous cell, 20 NSCLC-NOS, 5 large cell neuroendocrine, 3 adenosquamous cell and 2 with synchronous primaries. 48 (27%) patients received no treatment beyond palliative care. Mostly this was due to comorbidities or patient wishes (8) but 13 (7%) patients died around the time of diagnosis. 38 (21%) patients underwent surgery (3 pneumonectomies, 31 lobectomies and 4 wedge resections). 3 had adjuvant radiotherapy and 5 had adjuvant chemotherapy. 79 (45%) patients under went radiotherapy: 59 had palliative radiotherapy, 12 chemoradiotherapy, 4 definitive radiotherapy, 1 brachytherapy and 3 had adjuvant radiotherapy to surgery. 84 (47%) were reviewed by medical oncologist of whom 56 (32% of total, 67% of those reviewed) received some form of 1[st] line chemotherapy. There were 13 different regimens of first line therapy, most common being carboplatin/gemcitabine (n=19) and carboplatin/vinorelbine (n=10). The reason for choice of therapy was not usually stated and varied between specialists but individual specialists also varied regimens used. 22 patients had 2nd line therapy, 12 patients had 3[rd] line and 5 patients had 4[th] line. 16 patients had pemetrexed maintenance therapy (1 in combination with carboplatin) of which 9 received 3 or less cycles, 1 patient received 26 cycles. 13 (7%) patients received erlotinib. The patients were reviewed by 7 different specialists (3 were seen elsewhere in the state) with one specialist seeing 36 patients but 4 seeing less than 10 over the 2 year period.

      Conclusion
      The majority of our patients received some form of therapy. Our radiotherapy usage is below expected numbers and chemotherapy usage is particularly low. This may reflect our patients’ demographics. The wide variety of first line regimens used makes over all conclusions about the effect of chemotherapy difficult. A number of medical oncologists treat less than 5 patients with lung cancer a year. Consolidation of care to a smaller number of specialists should be considered.