Author of

• 10801

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  P1.11 - Poster Session 1 - NSCLC Novel Therapies (ID 208)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10811

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    P1.11-010 - Physical Targeting of Locally Advanced Non-Small Cell Lung Cancer (NSCLC): Proton Therapy (ID 1020)

    09:30 - 09:30  |  Author(s): J.D. Cox
    • Abstract

    Background
    Radiation therapy is a critical element in the potentially curative treatment of locally advanced NSCLC. Important developments have permitted more precise and effective physical targeting with radiations, an important complement to molecular targeting with drugs. Proton beam therapy (PBT) represents the most advanced physical targeting available thus far. A review of our experiences with proton therapy for NSCLC may serve as a benchmark for technically advanced radiation therapy.

    Methods
    Patients were enrolled on a protocol to investigate normal tissue effects of proton therapy between 2006 and December, 2010. Patients were excluded if they did not received concurrent chemotherapy, were treated on a phase II study of high dose PBT (JY Chang, PI) or were part of a randomized trial of PBT vs. intensity modulated radiation therapy (IMRT) (Z Liao, PI). They were evaluated before treatment with positron emission tomography (PET) and contrast enhanced computed tomography (CT), studies that were also used for planning treatment. Consultation with thoracic surgeons assured they were not candidates for resection. The mediastinal lymph nodes stations were evaluated with mediastinoscopy and/or fiberoptic bronchoscopy with ultrasound. Treatment planning consistently included motion management with 4D CT simulation and creation of an internal target volume (ITV). Patients were assessed for failure patterns and survival as well as normal tissue effects. Kaplan Meier estimates and Cox regression analysis were used to calculate survival outcomes.

    Results
    Of the 178 patients enrolled, the median age at diagnosis was 69 yrs (range 37.8 yrs to 94.9 yrs). KPS ranged from 60 to 100, median 80. 43% of patients had squamous carcinoma, and 57% had non-squamous histology. Stage distribution was 15% stage II, 65% III, 5% IV, 15% postoperative recurrence. The median tumor volume was 59 cc (range 4-753 cc) and the median total tumor dose was 74 Gy(RBE). Median follow-up time for living patients was 34.6 mos. Median survival was 32.7 mos. Three year survival rate was 46.5% (49.8% for squamous, 42.1% for non-squamous. Local failure at 3 years was 36.4% for squamous and 48.9% for non-squamous tumors. Distant metastasis-free survival at 3 years was 44.5% for squamous and 55.8% for non-squamous cell histology. Multivariate analysis found age, squamous histology and tumor size adversely affected survival.

    Conclusion
    Prognostic factors with PBT and concurrent chemotherapy are similar to those seen in series of patients treated with x-irradiation. Favorable median and 3 year survival rates with this relatively large data set suggest superior outcomes with PBT and quite possibly a new platform for physical targeting upon which to build chemical and molecular targeting strategies.