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C. Fontaine-Delaruelle
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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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MINI33.06 - Prospective Monitoring of Lung Function Test with CO and NO Diffusion during Thoracic Radiotherapy: Preliminary Results of the CONORT Study (ID 2402)
19:05 - 19:10 | Author(s): C. Fontaine-Delaruelle
- Abstract
- Presentation
Background:
Thoracic radiotherapy is a usual treatment for lung cancer; either at early-stages (stereotactic mode) or at locally advanced stages (conventional radiotherapy mode). Thoracic irradiation appears to have little impact on lung volume such as forced expiratory volume in one second (FEV1) or forced vital capacity (FCV). By contrast, carbon monoxide diffusing capacity (TLCO) may be altered under thoracic radiotherapy. Pulmonary diffusion may be also evaluated by the NO (azote monoxide) diffusion capacity (TLNO). Moreover, double assessment of NO and CO diffusing capacities open the way to understand if alteration of lung diffusion is due to alveolar membrane and/or a pulmonary capillary alteration. CONORT aims at measuring pulmonary function tests (PFTs), in particular the CO and NO diffusing capacity, during thoracic radiotherapy.
Methods:
Prospective multicenter study. CONORT study was approved by the Lyon Sud-Est IV ethics committee and the database was declared to the national information registry authority as required by French laws. Overall 112 patients must be included to estimate a difference of 15% in diffusing capacity test, with a 90% power and a 5% alpha risk. All consecutive patients treated by thoracic radiotherapy in Lyon Sud Hospital were included regardless of histology and radiotherapy technique. PFTs including double diffusion are performed by the same operator and using the same technic, before-, during-, at the end-, six weeks after- and six months after- thoracic irradiation. All included patients gave their consent. Results at PFTs were expressed in % of theoretical value (%th), and were compared using Student t test.
Results:
Between 1[st] February 2014 and 14 April 2015, 88 patients were included and 62 have been analyzed. Patients were male in 73%, mean age was 67.4 years. Radiotherapy technique was intensity-modulated radiation therapy (IMRT) in 61%, stereotactic radiotherapy (SBRT) in 32%, and 3D conformal radiotherapy in 7%. Mean pretreatment FEV1 was 2.06L (78.9% of the standard), mean FCV was 3.17L (94.9%), mean TLCO was 16.5 (64.7%) and mean TLNO was 72.7 (60.3%). FEV1 and FCV were stable during and after radiotherapy. However, mean TLCO decreased by 4.4% (P=0.01) between first and fourth PFT, mean DLNO decreased by 4% (P=0.001) between first and second PFT, mean VC (capillary lung volume) decreased by 6.24% between first and fourth PFT (P=0.011), and DM (membrane diffusing capacity) decreased by 3.6% between first and second PFT (P=0.001).
Conclusion:
CONORT is the first study evaluating the potential impact of thoracic radiotherapy on double measurement of lung diffusing capacity. These preliminary results showed that thoracic radiotherapy has little impact on lung volumes. However, lung diffusion decreases, initially by membrane alteration and then by capillary alteration. Results at 6 months showed that this alteration is fully recovered. Updated data will be presented at meeting.
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P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.01-058 - Factors Predicting Long Duration of Pemetrexed Maintenance Therapy: A Retrospective Cohort of 65 Patients (ID 2111)
09:30 - 09:30 | Author(s): C. Fontaine-Delaruelle
- Abstract
Background:
BACKGROUND: The Paramount trial demonstrated a significant survival benefit with pemetrexed continuation maintenance therapy for non-squamous NSCLC. This retrospective work aims to study predictive factors for a long duration of maintenance therapy and its toxicities.
Methods:
METHOD: All patients who received pemetrexed maintenance between 1st January 2009 and 1st July 2013 in Centre Léon Bérard (France) were included. Patients were classified in two groups: “long maintenance” if they received ≥ 5 cycles of maintenance with pemetrexed and “short maintenance” if they received ≤ 4 cycles. We retrospectively collected data about patients (age, gender, smoking status, PS), histological subtype, number of metastatic sites, number of induction and maintenance cycles, response to induction chemotherapy, bevacizumab use, reason for discontinuation, and toxicities. Proportions of patients or disease characteristics in each group were compared with univariate test (Fisher exact and Wilcoxon).
Results:
RESULTS: 65 patients were included, 33 in “short maintenance” group and 32 in “long maintenance” group, with 60% male and a mean age of 61.13 (±7,78). 55% of patients had ≥ 2 metastatic sites with PS 0, 1 or 2 in 21%, 67%, and 13% out of patients, respectively. Induction cycles were initiated with cisplatin in 71% and carboplatin in 29% of patients; median number of induction cycles was 4 [3-6]. 39% of patients achieved partial response to induction chemotherapy and 61% stable disease. Median number of maintenance cycles was 4 [1-28]. 19 patients (29%) received bevacizumab in combination to pemetrexed during induction and maintenance therapy. Maintenance discontinuation was due to progressive disease in 61%, toxicity in 19% and local treatment in 16% of patients, respectively. Significant predictive factors of a long duration of maintenance therapy were female gender (27% vs 53%; p=0.044) and ≥ 2 metastatic sites (42% vs 70%; p=0,046). Age, smoking status, histological subtype, response to induction therapy, bevacizumab use, and PS were not significantly related to maintenance duration. Grade 3-5 adverse events occurred in 20 patients (31%) including 5 treatment-related deaths (8%) (including 4 infectious-related deaths). There was a similar rate of grade 3-5 toxicities in both groups. Toxicities were mainly infectious (n= 13; 65%) including 4 febrile neutropenia. Predictive factors of grade 3-5 toxicities were age > 70 years (35% vs 9%; p=0.026) and carboplatin use (50% vs 20%; p=0,020). At the end of the study, maintenance therapy was ongoing in 3 patients. Among the 62 other patients, 81% received subsequent systemic therapy with a similar duration of treatment between “short” and “long” maintenance groups.
Conclusion:
CONCLUSION: Univariate analysis identified female gender and ≥2 metastatic sites as only predictive factors for a long duration of pemetrexed maintenance therapy. Patients with single metastasis frequently stopped maintenance treatment for administration of local therapy. Predictive factors for severe toxicities were age > 70 years and carboplatin use whereas addition of bevacizumab to pemetrexed did not result in an increase of toxicity.
