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P.F. Haan De



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    P3.08 - Poster Session 3 - Radiotherapy (ID 199)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Radiation Oncology + Radiotherapy
    • Presentations: 1
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      P3.08-017 - High-dose, conventionally fractionated thoracic reirradiation for second primary lung tumors or recurrent disease (ID 2335)

      09:30 - 09:30  |  Author(s): P.F. Haan De

      • Abstract

      Background
      Although loco-regional recurrences and second primary lung tumors are not uncommon following prior high-dose thoracic radiotherapy, only a minority of patients undergo reirradiation. Reirradiation performed at short intervals, and to low total doses, is generally associated with median overall survival (OS) of only 5-7 months. Few studies report outcomes following high-dose reirradiation. We describe institutional experience after high-dose, conventionally fractionated reirradiation.

      Methods
      High-dose conventional reirradiation was defined as fraction sizes of 2-3Gy and minimum total dose of 39Gy. A retrospective chart review of patients treated between Feb 2004-Feb 2013 was performed. Where possible, overlap in planning target volumes (PTV) and radiation doses were determined. New primary tumors were defined as new histology or reirradiation interval ≥5 years.

      Results
      24 patients were identified, 13 (54%) had recurrent disease, and 46% a new primary. Most (63%) had stage III NSCLC at initial and second treatments; median reirradiation interval was 51 months, and median follow-up from reirradiation 19.1 months. Median overall survival (OS) after reirradiation was 13.5 months, with 1-year survival 51%, median local progression-free survival (LPFS) 14.1 months and median distant progression-free survival (DPFS) 18.5 months. One-year disease-free survival was 47%. Three patients died from bleeding (2/3 had high-dose overlap in the mediastinum, of whom one had prior hemoptysis and was anticoagulated, the 3rd patient had extensive endobronchial therapy prior to reirradiation). Other post-retreatment toxicity was uncommon. The size of the second PTV (median 250cc) was prognostic. OS was 17.4 versus 8.2 months for patients with a 2nd PTV <300cc and >300cc respectively (p=0.02). Differences in DPFS (p=0.007) and for DFS (p=0.03) were also significant. LPFS was shorter when reirradiation interval was <24 months (p=0.02), however it was not different when groups were defined by the median interval of 51 months. Magnitude of PTV and dose overlap between the two treatments did not influence survival. Figure 1 Figure 1: Example of reirradiation for a new primary lung cancer. Planning target volume (PTV) and dose-cloud shown from treatment in 2004 (A, 23 fractions of 2.6Gy) and 2010 (B, 33 fractions of 2Gy) and the overlap of both treatments (C).

      Conclusion
      High-dose, conventionally fractionated reirradiation for new primary or recurrent lung cancer can deliver meaningful survival, especially for patients with a smaller PTV at the time of reirradiation. A shorter reirradiation interval may be associated with less chance of loco-regional control. Prospective studies are needed to confirm these findings, and establish reliable normal tissue tolerances for reirradiation.

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    P3.12 - Poster Session 3 - NSCLC Early Stage (ID 206)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P3.12-013 - Radical treatment of synchronous oligometastatic non-small cell lung carcinoma (NSCLC): patient outcomes and prognostic factors. (ID 2315)

      09:30 - 09:30  |  Author(s): P.F. Haan De

      • Abstract

      Background
      In general, metastatic NSCLC has a poor prognosis and systemic therapy is the cornerstone of treatment. However, extended survival has been reported in some patients presenting with a limited number of metastases, termed oligometastatic disease. The goal of this study was to assess outcomes for patients presenting with NSCLC and synchronous oligometastases, treated with radical intent, and to determine predictors of long-term survival.

      Methods
      A retrospective chart review was undertaken at two cancer centres, on patients with NSCLC presenting with 1-3 metastasis, who received radical intent treatment (surgery and/or radiotherapy (RT) ± chemotherapy) to the primary lung tumor including the pathological regional nodes and all sites of metastatic disease. Overall survival (OS), progression-free survival (PFS) and survival after first progression (SAPF) were evaluated. Recursive partitioning analysis (RPA) was performed based on significant factors from univariable analysis to identify different risk groups.

      Results
      Between 1999 and 2012, 61 patients were treated with a total of 74 metastases. Median follow-up was 26 months. Patients had a median age of 62 years, a median performance status of 1 and intrathoracic disease that was predominately stage III (n=38). The majority of patients had a solitary metastasis (n=50). Common sites of metastases were brain (n=47 lesions), bone (n=11), adrenal (n=4), contralateral lung (n=4) and extrathoracic lymph nodes (n=4). Treatment of the primary tumor consisted of RT ± chemotherapy in 52 patients and surgery alone or in combination with other modalities in 9 patients. Metastases were treated with stereotactic or high-dose RT (n=39) or surgery (n=22). Median OS was 13.5 months, 2-year OS was 38%. Median PFS was 6.6 months and median SAFP was 4.9 months. Predictors of improved survival were surgery for the primary lung tumor (p<0.001), and intrathoracic PTV size in patients receiving RT (p<0.03). These factors were used for RPA (Figure 1). No significant differences in outcomes were observed between the two centers. Figure 1 Figure 1. RPA flowchart for OS showing characteristics of risk groups (A) with accompanying Kaplan-Meier curves of OS by RPA risk groups (B)

      Conclusion
      Radical treatment of selected NSCLC patients presenting with 1-3 synchronous metastases can result in favorable 2-year survival, although progression in the first year was common. Outcomes were strongly associated with intra-thoracic disease status: patients with small radiotherapy treatment volumes or resected disease had the best OS. Prospective clinical trials, ideally randomized, should evaluate the role of radical treatment strategies in patients with oligometastases.