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G. Lin
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MINI 33 - Radiotherapy and Complications (ID 164)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
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MINI33.07 - A Restrospective Study of Shrinking Field Radiation Therapy in Chemoradiothrapy for Stage III Non-Small Cell Lung Cancer (ID 3195)
19:10 - 19:15 | Author(s): G. Lin
- Abstract
- Presentation
Background:
The study aimed at investigating the feasibility of shrinking field after complete or partial response during Chemoradiothrapy without surgery for stage III non-small cell lung cancer (NSCLC).
Methods:
This retrospective study was carried on 97 consecutive patients with stage III non-small cell lung cancer (NSCLC), who were good responders to cheomoradiation without surgery between September 2009 and November 2014. Computed tomography scans were performed after 40-50 Gy to evaluate the curative effect. Fifty three-dimensional-conformal treatment or intensity-modulated radiation therapy were redelineated to shrink the radiation volume once or twice during conventionally fractionated radiotherapy, leading to a boost of 6-20Gy delieverd to the shrunk PTV. The gross tumor volume (GTV) and planned target volume (PTV) were messured. The acute symptomatic irradiation-induced pneumonia(ASIP) as well as first progression patterns and overall survival were investigated through follow-up.
Results:
Among 97 patients who obtained complete or partial response with median total dose of 60.0 Gy (range, 46.0-70.0 Gy), 50 patients received shrinking field radiation therapy with a median 184.24 cm[3 ](range, 28.1- 449.7cm[3]) reduction of PTV between the first and last plan. The primary GTV and PTV in shrinking field group was greater than that in non-shrinking field group, as well as the 59Gy-greater radiation dose rate(GTV, 116.8 cm[3] vs 102.9 cm[3 ]; PTV, 493.0 cm[3 ]vs 458.0 cm[3]; 59Gy-greater dose rate, 70 % vs 61.7 %). The incidence of ASIP was 20.6%(20/97) for all the population, shrinking field group of 18%(9/50) and non-shrinking field group of 23.4%(11/47). Fifteen patients progressed locoregionlly, 12 distantly and 3 in both patterns in shrinking field group, while 22 locoregionlly, 16 distantly and 3 in both patterns in non-shrinking field group. Four regional-progression located out of PTV in both groups. The locoregion-progression rate and out-PTV rate were not significant difference(60% vs 61%, P=0.934; 63.3% vs 56.1%, p=0.54). As compared with non-shrinking field group, shrinking field had a similar overall survival(median OS, 29 mouths vs 30 mouths, P=0.546), an improved median progression free survival (median PFS, 19 mouths vs 14 mouths, P=0.945) and a lower incidence of acute irradiation-induced pneumonia, but they were all not statistically significant.
Conclusion:
Shrinking field and dose escalation for good responders during chemoradiotherapy seem safe with acceptable toxicity and outPTV relapse, especially for the lung cancer with a bulky mass. More prospective trials are needed to validate these results.
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P1.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 224)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.08-030 - Increasing the Interval between Neoadjuvant Chemoradiotherapy and Surgery in Esophageal Cancer. A Meta-Analysis of Published Studies (ID 2472)
09:30 - 09:30 | Author(s): G. Lin
- Abstract
Background:
Neoadjuvant chemordiotherapy followed by surgery was the most common approach for patients with resectable esophageal cancer. Operation was performed within 2 to 8 weeks after nCRT were completed. The aim of this meta-analysis was to clarify whether a longer interval between the end of neoadjuvant chemoradiotherapy (nCRT) and surgery was associated with a better overall survival in esophageal cancer.
Methods:
We performed a systematic literature search in MEDLINE, EMBASE, Cochrane Central Register of Contralled Trials (CENTRAL/CCTR), Clinical Trials from January 2000 to December 2014. Eligible studies were prospective or retrospective studies of esophageal cancer that assessed the effects of intervals longer or shorter than 7 to 8 weeks between the end of nCRT and surgery. The primary endpoint was the overall survival (OS) and pathologic complete response (pCR). Secondary endpoints were anastomotic leak, R0 resection and postoperative mortality rate. A meta-analysis was performed to estimate odds ratios (ORs) , using the fixed- or random-effects model, with review manager 5.2.
Results:
Five studies met the eligibility requirements, including 1016 patients, with 520 in the shorter interval group (≦7~8 weeks) and 496 in the longer interval group (＞7～8 weeks). The results of our meta-analysis showed that the longer interval between nCRT and surgery may be at a disadvantage in 2-year overall survival (OR =1.40 ,95% CI: 1.09–1.80, P=0.010) and R0 resection rate (OR =1.71, 95%CI:1.14-2.22, P=0.009 ). The pCR, anastomotic leak rate and postoperative morbidity were similar in the two groups.
Conclusion:
A longer waiting interval (more than the classical 6–8 weeks) from the end of preoperative CRT is not an increases the rate of pCR in esophageal cancer, with similar anastomotic leak rate and postoperative mortality rates. However, the longer interval between nCRT and surgery may be at a disadvantage in the long-term overall survival, thus it may be reasonable to perform surgery for patients at the esrliest opportunity after adequate recovery form nCRT, especially, who have clinical pCR. These results should be validated prospectively in a randomized trial.
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P2.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 225)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.08-026 - Molecular Markers of Resected Esophageal Squamous Cell Cancer and Its Correlation with Clinical Outcome (ID 2495)
09:30 - 09:30 | Author(s): G. Lin
- Abstract
Background:
The tumor related molecular markers in esophageal squamous cell cancer(ESCC) remains unknown and requires further investigation in order to promote effiicient and rapid development of therapeutic methods. The aim of our study was to evaluate if molecular markers of ESCC correlates with patients’ prognosis and the outcome.
Methods:
Protein expressions of EGFR, C-MET, HER2 were detected by immunohistochemistry (IHC) in 180 paraffin-embedded tissue samples from stage IIB-IIIC ESCC patients with esophagectomy at the Zhejiang Cancer Hospital between January 2007 and December 2012. Log-rank test was used for univariate analysis, and Cox’s proportional hazards model was used for multivariate analysis. Assessed factors were age, gender, somking, alcohol use , tumor location, stage, differentiation, venous or nerve invasion, radiation, chemotherapy and expressions of EGFR, C-MET, HER2.
Results:
The median survival of all patients was 46 months. Of the all 180 patients, the positive rates of EGFR, C-MET, HER2 were 94.4%, 87.2% and 11.1%, respectively. The high expression rates of EGFR and MET were 47.8% and 46.7%, respectively. On univariate analysis ( Tabel 1 ), stage and high expression MET were the statistically significant unfavorable factors for overall survival, meanwhile, a nonsignificant trend toward dcreased overall survival was found with non chemotherapy patients. The multivariate analysis indicated that independent prognostic risk factors included MET ( P=0.029 ) , chemotherapy (P=0.046) and late stage ( p=0.000 ) with very high statistical significance. In subgroub of the patients with MET high expression, tumor location ( p=0.029 ), non chemotherapy ( p=0.043 ) and late stage (p=0.014) had been the statistically significant unfavorable factors, analyzed by Cox proportional hazards model. In subgroub of the patients with C-MET low or negative expression, non chemotherapy ( p=0.043 ) and late stage ( p=0.014 ) had been the statistically significant unfavorable factors.Table.1 Prognostic factors for overall survival in univariate analyses
Factors Category P-value Age ≤65 (vs.＞65) 0.130 Gender Male (vs. Female) 0.486 Smoking Nonsmokers (vs. Smokers) 0.148 Alcohol use Non use (vs. Use) 0.977 Tumor location Upper and middle (vs. Lower) 0.193 Stage IIA-IIIA (vs. IIIB-IIIC) 0.000 Differentiation Well (vs. moderate and poor) 0.265 Venous or nerve in invasion Non invasion (vs. Invasion) 0.613 Radiation Non radiation (vs. Radiation) 0.957 Chemotherapy Non chemotherapy (vs. Chemotherapy) 0.090 EGFR >median (vs. ≦median) 0.347 C-MET >median (vs. ≦median) 0.018 HER2 Positive (vs. Negative) 0.142
Conclusion:
In the Chinese population, HER2 expression rate was very low. The high expressions of HER2 and EGFR was not correlated with prognosis. High expression of C-MET may be prognostic factors for IIB-IIIC ESCC patients who underwent esophagectomy. ESCC with high expression of C-MET might be a poorer prognosis than those with C-MET low expression. In conclusion, C-MET is a important molecular marker in esophageal squamous cell cancer(ESCC) and further studies are necessary to explore the role of C-MET.
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P3.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 214)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.03-026 - Analysis of Clinical and Dosimetric Factors Influencing Radiation-Induced Lung Injury in Patients with Lung Cancer (ID 3215)
09:30 - 09:30 | Author(s): G. Lin
- Abstract
Background:
Dose escalation of thoracic radiation is limited by the occurrence of radiation-induced lung injury (RILI). This study investigated the clinical and dosimetric factors influencing RILI in lung-cancer patients receiving chemoradiotherapy.
Methods:
A retrospective analysis was carried out on 161 patients with non-small-cell or small-cell lung cancer (NSCLC and SCLC, respectively), who underwent chemoradiotherapy between April 2010 and May 2011 with a median follow-up time of 545 days (range: 39–1453). Chemotherapy regimens were based on the histological type (squamous cell carcinoma, adenocarcinoma, or SCLC), and radiotherapy was delivered in 1.8–3.0 Gy fractions, once daily, to a total of 39–66 Gy (median, 60). Univariate analysis was performed to analyze clinical and dosimetric factors associated with RILI. Multivariate analysis using logistic regression identified independent risk factors correlated to RILI.
Results:
The incidence of symptomatic RILI (≥grade 2) was 31.7%. Univariate analysis showed that V5, V20, and mean lung dose (MLD) were significantly associated with RILI incidence (P=0.029, 0.048, and 0.041, respectively). The association was not statistically significant for histological type (NSCLC vs. SCLC, P = .092) or radiation technology (IMRT vs. 3DCRT, P = .095). Multivariate analysis identified MLD as an independent risk factor for symptomatic RILI (OR=1.249, 95%CI=1.055–1.48, P= .01). The incidence of bilateral RILI in cases where the tumor was located unilaterally was 22.7% (32/141) and all dosimetric-parameter values were higher (P< .05) for bilateral versus ipsilateral injury, but only for grade-1 (low) RILI. The RILI grade was higher in cases of ipsilateral lung injury than in bilateral cases (Mann-Whitney U test, z=8.216, P< .001).
Conclusion:
The dosimetric parameter, MLD, was found to be an independent predictive factor for RILI. Contralateral injury does not seem to be correlated with increased RILI grade under the condition of conventional radiotherapy treatment planning.
