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W. Cho
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P2.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 210)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.02-036 - Radiation Therapy Alone in cT1-3N0 Lung Cancer Patients Who Are Unfit for Surgery or Stereotactic Ablative Radiation Therapy (ID 3144)
09:30 - 09:30 | Author(s): W. Cho
- Abstract
Background:
High dose radiation therapy (RT) alone is recommended to cT1-3N0 lung cancer patients, who are unfit for surgical resection or stereotactic RT based on medical comorbidity, tumor size and location. This study is to evaluate clinical outcomes and costs following definitive RT alone using 2 modest hypo-fractionated dose schemes.
Methods:
Retrospective review on 116 patients who received high dose RT alone from January 2001 till December 2013 was done. Median age was 74 years and 91 patients (78.4%) were male. All had cT1-3N0 disease and 65 patients (56.0%) had squamous cell carcinoma, followed by adenocarcinoma in 35 (30.2%). Dose-fractionation scheme of 60 Gy in 20 fractions over 4 weeks was applied to 79 patients from 2001 till 2010 (68.1%, Group I). Meanwhile, 2 dose-fractionation schemes were used from 2011 till 2013: 60 Gy in 20 fractions to 17 patients (14.7%, Group II); and more hypo-fractionated scheme of 60 Gy in 15 fractions over 3 weeks to 20 patients (17.2%, Group III). 60 Gy in 15 fractions was chosen on individual basis if RT-related acute side effects (bronchitis, esophagitis) could be avoided based on tumor location and geometry. Group I/II patients had central tumors (defined as within 2 cm from lobar bronchi) more frequently (78.5% vs. 64.7% vs. 35.0%, p<0.0001), and larger mean tumor size (4.2 cm vs. 5.0 cm vs. 3.8 cm, p=0.0725) than Group III. Elective nodal irradiation to regional lymphatics (median 30 Gy/10 fractions) was delivered to 30 patients: 23 in Group I (29.1%); seven in Group II (41.2%); and none in Group III (0%), respectively (p=0.0341). Local control (LC), progression free survival (PFS), overall survival (OS), and RT-related toxicity profile were estimated and compared.
Results:
After median 19.3 (1.2-119.5) months’ follow-up, 68 patients (58.6%) experienced disease progression, and 66 (56.9%) died. 2-year LC and PFS rates of all patients were 62.0% and 39.3%, respectively, which were not different between Groups (59.3% and 36.1% vs. 52.1% and 26.9% vs. 78.8% and 61.6%, p=0.3010 and 0.1620, respectively). 2-year OS rate of all patients was 57.5%, and was significantly better in Group III (51.3% vs. 69.1% vs. 83.0%, p=0.0232). Grade ≥2 pneumonitis developed in 27 patients (23.3%), and was not different between Groups (19.0% vs. 35.3% vs. 30.0%, p=0.1908), while Grade ≥2 esophagitis developed in 22 patients (19.0%), however, none in Group III (22.8% vs. 23.5% vs. 0%, p=0.0373). Good performance status (ECOG 0-1 vs. 2-3) and low cT-stage (T1-2 vs. T3) were significantly favorable factors affecting LC, PFS, and OS, however, central location of tumor was not. Costs incurred by RT under Korean Health Insurance Policy were 6,080,000 KW in Groups I and II and 4,707,500 KW in Group III, respectively.
Conclusion:
Hypo-fractionated RT delivering 60 Gy in either 15 or 20 fractions could lead to reasonably favorable and comparable clinical outcomes in cT1-3N0 lung cancer. 60 Gy in 15 fractions in selective cases as in Group III, however, seems more cost-effective and attractive by virtue of shorter RT duration, lower cost, and increased patients’ convenience.
