Author of

• 11645

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  P2.08 - Poster Session 2 - Radiotherapy (ID 198)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Radiation Oncology + Radiotherapy
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11668

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    P2.08-023 - Intensity-modulated radiation therapy for inoperable non-small cell lung cancer: Experience at Samsung Medical Center (ID 2746)

    09:30 - 09:30  |  Author(s): J.M. Kim
    • Abstract

    Background
    Intensity-modulated radiation therapy (IMRT) is not covered by national health insurance in Korea until yet. This study is to retrospectively evaluate the clinical outcomes following IMRT in the patients with inoperable non-small cell lung cancer (NSCLC).

    Methods
    From May 2010 to November 2012, 43 patients with newly diagnosed, pathologically confirmed NSCLC, who seemed to be at excessive risk of pulmonary toxicity if treated with conventional radiation therapy (RT) techniques based on their disease extent and pulmonary function status, received IMRT. The median age was 58 (35~80) years. Clinical stages were IIIA in 7 (16.3%) and IIIB in 36 (83.7%) patients, where 26 patients (65.1%) had supraclavicular nodal metastases. Thirty-six (83.7%) received concurrent chemotherapy during IMRT. The most common chemotherapy regimen was weekly docetaxel plus cisplatin (N=18), followed by weekly paclitaxel plus cisplatin (N=11). Simulation with 4-dimensional CT was done in 27 patients (62.8%). RT was delivered with 6-MV photon beams using step-and-shoot IMRT method. The median RT dose was 66 Gy in 33 fractions. The median clinical target volume was 357.5 (89.3~881.2) cm[3], and elective irradiation to the uninvolved lymphatics was not added. Normal tissue constraints were as follow: maximum spinal cord dose was <46 Gy; relative lung volumes receiving 20 Gy/5 Gy were <35%/65%; and mean lung dose was <20 Gy. Early toxicities including treatment-related pneumonitis (TRP) and esophagitis were graded using the CTCAE version 4.0. In-field locoregional control (LRC), progression-free survival (PFS), and overall survival (OS) were estimated by the Kaplan-Meier method.

    Results
    At median follow-up of 11.6 (2.3~39.6) months, 30 patients (69.8%) experienced disease progression: distant metastases in 23 patients (53.5%); and locoregional relapse in 13 patients (30.2%) (Figure). Among 13 patients who experienced locoregional relapse, ten patients (23.3%) had in-field or marginal failure, while three (7.0%) had recurrence at initially uninvolved lymphatic regions. Grade 3 TRP and esophagitis occurred in one (2.3%) and ten (23.3%) patients. The one-year LRC, PFS, and OS rates were 75.0%, 33.7%, and 81.7%, respectively. Figure 1

    Conclusion
    The early experience of IMRT for the patients with advanced NSCLC, who are poor candidates for conventional RT techniques, seems favorable with respect to locoregional control and toxicity. Further studies will be directed to address the issues on the elective lymphatic irradiation extent, radiation dose escalation, long-term clinical outcomes, and comparison with conventional RT techniques. Authors hope to develop optimal clinical indications of IMRT that can be reimbursed by the national insurance system in Korea.