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J. Zhang
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P1.07 - Poster Session/ Small Cell Lung Cancer (ID 221)
- Event: WCLC 2015
- Type: Poster
- Track: Small Cell Lung Cancer
- Presentations: 2
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.07-012 - Hypo- or Conventionally Fractionated Radiotherapy in Patients with Limited Stage Small Cell Lung Cancer (LS-SCLC): A Retrospective Analysis (ID 2565)
09:30 - 09:30 | Author(s): J. Zhang
- Abstract
Background:
Previous data from our institution showed that hypofractionated thoracic radiotherapy (HypoTRT) concurrently with etoposide/platinum chemotherapy yielded favorable survival in patients with LS-SCLC. The aim of the present study was to compare the survival outcomes, failure patterns and toxicities between groups of LS-SCLC patients treated with conventionally fractionated radiotherapy (ConvTRT) or HypoTRT combined with etoposide/platinum chemotherapy.
Methods:
Medical records of LS-SCLC patients between January 2010 and December 2013 at Fudan University Shanghai Cancer Center were retrospectively reviewed. All patients treated with chemotherapy and ConvTRT (2.0 Gy per faction daily, DT≥56Gy) or HypoTRT (2.5 Gy per faction daily, DT= 55Gy) were eligible for analysis. The progression-free survival (PFS) and overall survival (OS) were generated for different populations using the Kaplan-Meier method and compared by log-rank test. The comparison of failure patterns and toxicity were analyzed with the χ[2] test.
Results:
One hundred and seventy-nine patients were indentified. All patients received 1-6 cycles of Etoposide/Platinum chemotherapy. Except for nine patients who received hyperfractionated regimen, 170 of 179 patients treated with were eligible for analysis (median age 58 years; male 85.3%). Sixty-nine patients received HypoTRT and 101 patients received ConvTRT (median 60Gy/30Fx). PCI (25Gy/10Fx) was given to patients with partial or complete remission in chest tumor. PCI was administered to 46 (66.7%) and 48 (47.5%) patients in HypoTRT and ConvTRT cohorts (p=0.014), respectively. Except for PCI, the patient- or treatment-related variables were similar between the two cohorts. With a median follow-up of 23 months, the median OS was 26.7 months (95%CI: 23.2-30.2) in the ConvTRT cohort and 30.4 months (95%CI: 25.6-35.2) in the HypoTRT cohort (p=0.221). The 2-year OS for the ConvTRT and the HypoTRT cohort were 56.0% and 62.8%, respectively. The median PFS was 19.3 months for patients received HypoTRT, which was similar to that of the ConvTRT group (13.7 months, p=0.375). Sixty-three patients(62.4％) experienced disease progression in ConvTRT cohort, compared with 41 patients(59.4%) in HypoTRT cohort. The patterns of failure (stratified by local-regional recurrence, distant metastasis or both as first relapse) were also similar between the two dose cohorts (p=0.219, p=0.466, p=0.724). The 2-year local-regional progression free survival rates for the ConvTRT and HypoTRT cohorts were 59.7% and 70.6% (p=0.128), respectively. PCI reduced the incidence of brain metastasis by 31% at 20 months. Patients who received PCI had a significant longer survival with a 2-year OS rate of 69.8%, as comparing 44.4% of those who did not (p=0.000). Concurrent chemoradiotherapy was another predictor for favorable survival. However, patients who were treated with concurrent approach tended to be younger, receive early thoracic radiotherapy, more cycles of chemotherapy and PCI. No differences in treatment-related toxicity rates were demonstrated between the two dose-prescription cohorts (p=0.815). Grade ≥3 esophagitis and pneumonitis occurred in 9.9% and 9.9% in ConvTRT cohort, whereas 11.6% and 8.6% in HypoTRT cohort, respectively.
Conclusion:
In this retrospective analysis, HypoTRT or ConvTRT combined with etoposide/platinum chemotherapy yielded statistically similar survival, treatment failure outcomes, and toxicity profiles.
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P1.07-016 - Comparison of PET/CT, 99mTc-MDP Bone Scan and Serum Alkaline Phosphatase for Detecting Bony Metastasis in Patients with Small Cell Lung Cancer (ID 2107)
09:30 - 09:30 | Author(s): J. Zhang
- Abstract
Background:
The data on the diagnostic ability of 18F-FDG positron emission tomography/computed tomography (PET/CT) compared that of 99mTc-MDP bone scan (BS) or serum alkaline phosphatase (ALP) for the detection of bone metastasis in patients with small cell lung cancer (SCLC) was sparse. The aimed of this study was to compare the diagnostic accuracy and agreement among PET/CT, BS and serum ALP for detecting bone metastasis in SCLC patients.
Methods:
The database at Fudan University Shanghai Cancer Center was retrospectively reviewed to identify all patients with SCLC who underwent both integrated whole-body PET/CT and BS between January 2010 and December 2013. In addition, serum ALP concentration of all eligible patients was recorded. The interval between PET/CT and BS was less than two weeks. Bone metastasis was confirmed if any of the following criteria were met: histology or pathology, concordance between PET/CT and BS, results of supplemental examinations (magnetic resonance imaging) or progression of bony lesions seen on follow-up studies. The sensitivity, specificity and accuracy of each modality were calculated. The overall differences were analyzed using the McNemar’s paired-sample test. The comparison of sensitivity, specificity and accuracy were analyzed with the χ2 test or Fisher exact test. Agreement between PET/CT, BS and ALP was assessed by kappa statistic. The κ-value was categorized as follows: poor (< 0.30), good (0.31–0.60), and excellent (0.61–1.0).
Results:
Of 368 patients with SCLC, a total of 30 patients were enrolled in this retrospective analysis. Six (20%) of thirty eligible patients were confirmed with bone metastasis, while 24 patients (80%) were found free from bone metastasis. The corresponding sensitivity, specificity, accuracy, positive and negative predictive value of PET/CT in detecting bone metastasis were 66.7%, 100%, 93.3%, 100% and 96.2% as compared to those of BS which were 100.0%, 70.8%, 76.7%, 46.2% and 100%, respectively. PET/CT had much higher specificity than BS (p=0.009). No statistically significant differences in sensitivity and accuracy were demonstrated between PET/CT and BS (p=0.455; p=0.145). Elevated serum ALP alone has the lowest sensitivity in detecting bone metastasis (16.7%), with the specificity of 87.5% and the accuracy of 73.3%, respectively. Combining the results of ALP and BS will significantly improve the specificity as compare to BS alone (100% vs 70.8%, p=0.009), while the sensitivity remains low (16.7%) and the accuracy remain unchanged (83.3% vs 76.7%, p=0.519). The κ-values were 0.276 between PET/CT and BS, 0.092 between PET/CT and serum ALP, and 0.099 between BS and serum ALP, indicating poor agreement among the three modalities in detecting bony metastasis.
Conclusion:
PET/CT had statistically higher specificity and numerically higher accuracy than BS in detecting bone metastasis in this group of patients with SCLC. The addition of serum ALP to BS improved the detection specificity comparing BS alone. There was still controversy involving in the use of PET/CT in SCLC. The diagnostic value of PET/CT needed to be validated in prospective and larger clinical trials.
