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Z. Wang



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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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      P2.08-026 - Prospective Study of Stage I Non-Small-Cell Lung Cancer Treated with Hypofractionated SIB IMRT (ID 3026)

      09:30 - 09:30  |  Author(s): Z. Wang

      • Abstract

      Background
      To analyze the effects of hypofractionated-simultaneous integrated boost-intensity modulated radiation therapy (Hypo-SIB-IMRT) on medically inoperable patients with stage I non–small-cell lung cancer (NSCLC).

      Methods
      65 qualified patients from December 2003 to November 2012 at three centers in China were included, with a median follow-up time of 39 months. Hypo-SIB-IMRT was delivered in 15 fractions with iGTV 75Gy, CTV 60Gy, and PTV 45Gy in 3 weeks. The slow computer tomography (CT) scan, conventional planning CT scan with active breath control (ABC), [18]fluorodeoxyglucose-position emission tomography ([18]FDG-PET) scan, or four dimensional CT scan (4D CT) were employed to do simulation. During the treatment, electrical port imaging device (EPID) or cone beam CT (CBCT) were performed 2-3 times per week to verify the reproducibility of the targets. All IMRT plans were optimized with Pinnacle or Eclipse systems using heterogeneity correction.

      Results
      The 1-, 3- and 5-year overall survivals (OS) were 100%, 87% and 58%, respectively with a median survival of 66.5 months. The 1-, 3- and 5-year progression free survivals (PFS) were 98%, 83% and 74%, while cancer-specific survivals (CSS) were 100%, 92% and 73%, respectively. The distant metastasis-free survivals (DMFS) were 98%, 85% and 76%, meanwhile local control (LC) were 100%, 93%, and 91%, respectively. There were no significant differences in OS, PFS, CSS, DMFS and LC compared with stage (I~A~ vs. I~B~) or gross tumor volume (GTV＞20 cm[3] vs.≤20 cm[3]). However, patients with T~1~ tumors (stage I~A~) were inclined to better survivals than those with T~2a~ (stage I~B~) ones, and local relapses were more frequent for larger GTVs. 18.5% (12/65) had grade 1or 2 radiation pneumonitis (RP), and only 1.5% (1/65) grade 1 esophagitis. Of 12 patients with RP, 10.8% (7/65) developed grade 1 radiation pulmonary fibrosis (RPF).

      Conclusion
      Due to the favorable long-term OS, PFS, CSS, DMFS, LC in addition to the minimal toxicities for medically inoperable stage I NSCLC patients, Hypo-SIB-IMRT presented in this prospective study may be an option to stereotactic body radiotherapy.

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    P2.09 - Poster Session 2 - Combined Modality (ID 213)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
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      P2.09-017 - Phase III study of concurrent cisplatin with pemtrexed versus vinorelbine and LCAHRT for unresectable stage III NSCLC (ID 3031)

      09:30 - 09:30  |  Author(s): Z. Wang

      • Abstract

      Background
      To evaluate pemetrexed in combination with cisplatin in these patients, a randomized phase III study of concurrent cisplatin with pemtrexed or vinorelbine and late course accelerated hyperfractionated radiotherapy (LCAHRT) was performed.

      Methods
      Patients with unresectable stage III non–small cell lung cancer （NSCLC） were randomly assigned to two concurrent regimens. Arm1 included cisplatin at 25 mg/m2 on days 1-3, 22-24 and vinorelbine at 25 mg/m2 on days 1,8 and 22,29 with concurrent LCAHRT. Arm 2 used cisplatin at 25 mg/m2 on days 1-3, 22-24 and pemtrexed at 500 mg/m2 on days 1 and 22 with the same radiotherapy protocol. The primary endpoint was progression free survival (PFS), and secondary endpoints included overall survival (OS ) and toxicities. Kaplan–Meier analyses were used to assess survival, and toxic effects were examined using the Pearson Chi-Square test. All statistical tests were two-sided.

      Results
      A total of 104 patients were enrolled with 100 ones analyzed for 3 in arm 1 and 1 in arm 2 were not finished treatment according to the protocol. The characteristics of study population between the two arms were well balanced. The median PFS were 15 and 23 months , respectively （p=0.014）, while median OS were 25 and 25.5 months for arms 1–2, respectively （p= 0.270）. In arms 1 and 2, the median OS of squamous cell carcinoma was 22.5m and 23m, while non-squamous cell carcinoma 27m and not reached, respectively (p=0.216). The median PFS of squamous cell carcinoma was 17m and 20m, while non-squamous cell carcinoma 15m and not reached, respectively (p=0.020). Compared with lower radiation doses, patients treated with more than or equal to 70 Gy had a better OS and PFS (p=0.002) for both arms. Concerning toxicities, for arms 1 and 2, grade 3-4 depression of white blood cell was 20/48 and 11/52 (p=0.027), grade 2-3 hemotoblatin 8/48 and 5/52 (p=0.047), grade 1-3 radiation induced pneumonitis 40/48 and 31/52 (p=0.032). The differences of other adverse events including esophagitis, nausea, vomiting, platelet were not statistical difference.

      Conclusion
      Comparing with NP, concurrent pem/DDP at full systemic doses and LCAHRT was well tolerated, with promising activity and milder side effects in a Chinese population with inoperable stage III NSCLC in spite of histology types.