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Y.C. Ahn



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

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Radiation Oncology + Radiotherapy
    • Presentations: 1
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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): Y.C. Ahn

      • 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.

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    P3.09 - Poster Session 3 - Combined Modality (ID 214)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
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      P3.09-015 - The role of adjuvant treatment in N2 positive non-small cell lung cancer patients treated with neoadjuvant chemoradiation followed by surgery: A retrospective single center experience. (ID 2673)

      09:30 - 09:30  |  Author(s): Y.C. Ahn

      • Abstract

      Background
      The optimal management of locally advanced N2 positive non-small cell lung cancer (NSCLC) is still controversial. Some studies have shown promising results of neoadjuvant concurrent chemoradiotherapy (CCRT) followed by surgical resection in terms of survival benefit without increasing morbidity and mortality. However, the role of adjuvant treatment after completion of neoadjuvant CCRT followed by surgery in N2 positive NSCLC patients has not defined yet.

      Methods
      From March 2006 to December 2011, 249 N2 positive NSCLC patients received neoadjuvant CCRT (weekly docetaxel/cisplatin with 45Gy/25Fx of thoracic radiotherapy) followed by curative surgery. Patients who died with post-operative complications within a month after surgery (n=5) were excluded to minimize selection bias.

      Results
      Among 244 patients, 80 patients (32.8%) receieved adjuvant radiotherapy alone, 26 patients (10.7%) received adjuvant chemotherapy alone, 57 patients (23.4%) received both of adjuvant radiotherapy/chemotherapy, and 80 patients (32.8%) did not receive adjuvant treatment. Survival was compared according to adjuvant treatment (any kind of adjuvant treatment [n=164, 67.2%] vs. no adjuvant treatment [n=80, 32.8%]). There was no significant differences between two groups in age over 60 years, ECOG performance, initial T stage, initial multistation N2 disease, completion of neoadjuvant CCRT, R0 resection, and pathologic down staging of N2 disease. In the univariate analysis, median overall survival (OS) and progression-free survival (PFS) were 54.1 months vs. 37.9 months (P=0.016) and 23.4 months vs. 17.7 months (P=0.239) in adjuvant treatment group and no adjuvant treatment group, respectively. In subgroup analysis, adjuvant treatment group showed significantly better OS than no adjuvant treatment group in patients who achieved N2 down staging by neoadjuvant CCRT (n=146, 59.8%) (78.1 months vs. 44.7 months, P=0.027) but not in patients who did not achieve pathologic N2 down staging (n=98, 40.2%) (32.3 months vs. 21.6 months, P=0.125).

      Conclusion
      This results suggest that adjuvant treatment may contribute survival benefit even after completion of neoadjuvant CCRT following curative surgery in N2 positive NSCLC. The role of adjuvant treatment should be seeked further in carefully selected patients who benefit most, such as CCRT sensitive patients who achieved pathologic N2 down staging.