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W. Uyterlinde



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    ED 12 - Caring for the Lung Cancer Patient (ID 12)

    • Event: WCLC 2015
    • Type: Education Session
    • Track: Nursing and Allied Professionals
    • Presentations: 1
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      ED12.05 - Overcoming the Challenges of Getting Patients Through Chemo and XRT (ID 1822)

      15:25 - 15:38  |  Author(s): W. Uyterlinde

      • Abstract
      • Presentation

      Abstract:
      Due to toxicity during chemoradiation, patients are at risk for discontinuation of treatment and might not benefit optimally from this treatment.Small intervention trials are a possible tool to reduce toxicity within limited time. Toxicity and discontinuation of treatment were scored in 188 NSCLC patients treated with concurrent chemoradiotherapy. Literature based small intervention studies were performed for the reduction of toxicity Severe toxicity was seen in 33% of the patients; discontinuation of treatment in 20%. Esophagitis, gastro-intestinal toxicity and renal impairment were the most prominent toxicities. Intervention studies led to a reduction of nausea, weight loss, nephro toxicity and dysphagia CCRT for NSCLC is the treatment of choice at the cost of severe toxicity. Small intervention studies have shown to be benificial in reducing severe toxicity, enabling patients to accomplish CCRT en thus benifit optimal from this treatment.

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    ORAL 20 - Chemoradiotherapy (ID 124)

    • Event: WCLC 2015
    • Type: Oral Session
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
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      ORAL20.03 - Radiation Dose Escalation in Patients with Locally Advanced Non-Small Cell Lung Cancer; 60 Month Follow-Up of a Randomized Phase II Trial (ID 1190)

      11:07 - 11:18  |  Author(s): W. Uyterlinde

      • Abstract
      • Presentation
      • Slides

      Background:
      Concurrent chemoradiotherapy imposes beneficial effects on overall survival (OS) in patients with locally advanced non-small cell lung cancer (NSCLC). Nonetheless, the optimal radiation scheme still needs to be identified. The RTOG 0617 trial showed that patients receiving a high dose radiation scheme (37 x 2 Gy) had a significant shorter median OS (22.9 months) as compared to patients receiving a conventional 30 x 2 Gy radiation scheme (28.7 months). Dose escalation using hypo-fractionation however seems promising and might contribute to a better OS. We investigated long term OS in locally advanced NSCLC patients treated with concurrent chemoradiotherapy, using a hypo-fractionation scheme of 24 x 2.75 Gy +/- Cetuximab.

      Methods:
      A 2-armed phase II, multi-center study (NTR2230) was performed with the initial aim to assess the effect of the addition of Cetuximab to concurrent chemoradiotherapy in locally advanced NSCLC patients. Arm A received high dose radiotherapy (24 x 2.75 Gy) and concurrent daily low-dose cisplatin (6 mg/m[2]). Arm B received an identical treatment regimen with the addition of weekly Cetuximab (400 mg/m[2] loading dose one week prior to radiotherapy followed by weekly 250 mg/m[2]). Mortality follow-up information was completed until January 2015. Overall survival (OS) rates were calculated as time from randomization until death from any cause. Kaplan-Meier survival curves were plotted and 1-, 2- and 5-year OS proportions were calculated.

      Results:
      Between February 2009 and May 2011, 102 patients were randomly allocated in two arms; 51 patients (50%) in arm A and 51 patients (50%) in arm B. Follow-up information was available for 101 patients (99%). Median OS was 33.0 months (interquartile (IQ) range 20.0 to 46.0) and did not significantly differ between the two arms; 33.0 months (IQ-range 13.8 to 52.2) in Arm A and 30.0 months (IQ-range 15.3 to 44.7) in Arm B (Figure 1). 1-,2- and 5-year OS was 75.5%, 59.8% and 36.6%, respectively. Figure 1



      Conclusion:
      In this 2-armed phase II trial in NSCLC patients receiving concurrent chemoradiotherapy, the addition of Cetuximab to concurrent chemoradiotherapy did not improve 60-month OS in unselected patients with locally advanced NSCLC, in line with the RTOG 0617. However, the median OS was remarkably high when compared to the RTOG 0617: 30 and 33 months versus 23 and 29 months, respectively. Furthermore, 5-year OS was still 36.6%. Dose escalation using hypo-fractionation of 2.75 Gy per fraction might be one of the factors contributing to extended OS in patients with locally advanced NSCLC.

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