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H. Onishi
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OA12 - SBRT and Other Issues in Early Stage NSCLC (ID 383)
- Event: WCLC 2016
- Type: Oral Session
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:D. De Ruysscher, M.R. Mueller
- Coordinates: 12/06/2016, 11:00 - 12:30, Strauss 2
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OA12.02 - Excellent Survival Achieved by Stereotactic Body Radiotherapy for Medically Operable and Young (< 75 Years) Patients with Stage I Lung Cancer (ID 5019)
11:10 - 11:20 | Author(s): H. Onishi
- Abstract
- Presentation
Background:
Stereotactic body radiotherapy (SBRT) has been sometimes used as a curative treatment for both of medically operable patients with stage I non-small cell lung cancer (NSCLC). However, most of these patients are comparatively high-aged and not similar to the patients cohort generally operated with surgery. So, the purpose of this study was to collect results of SBRT for operable and young (70 years old or younger) patients with stage I NSCLC from multiple Japanese institutions.
Methods:
We organized a multi-institutional SBRT study group in Japanese Radiological Society (JRS-SBRTSG) and conducted a study for SBRT for stage I non-small cell lung cancer (NSCLC). This is a retrospective analysis to review 252 patients (male 168, female 84) who were medically operable and 70 years old or younger (range,40-74; median, 67 years) with stage I (IA 211, IB 41) NSCLC treated with curative intent by SBRT in 20 institutions of JRS-SBRTSG. Histology was proven in 177 patients (adenocarcinoma 121, squamous cell carcinoma 41, others 15), and the others were diagnosed clinically. Median tumor size was 22mm (range, 5-49mm). A total dose of 40 -70 Gy mainly was prescribed in 4-10fractions. Median calculated biological effective dose (BED) was 107 Gy (range, 75-134 Gy) based on alpha/beta = 10Gy).
Results:
The median follow-up period for all patients was 37 months. Overall survival rate (OS) at three and five year was 83.3% and 76.6%, respectively. Radiation pneumonitis of grade 3 or more was noted in 0.8% of the total patients. In the total patients, local control rate (LC) at three year was 89.5%, and LC was significantly better in the subgroup of adenocarcinoma than that of squamous cell carcinoma. According to univariate analysis, female, adenocarcinoma, no emphysema, and no pulmonary interstitial change were better prognostic factors for OS. According to multivariate analysis, pulmonary interstitial change was only a worse survival factor for OS. OS at three and five year in the subgroup of patients without pulmonary interstitial change was 89.7% and 84.0%, respectively.
Conclusion:
The outcomes of SBRT for the medically operable and young (75 years or younger) patients with stage I NSCLC in the Japanese large database of practice level was excellent and the overall survival rate would be comparable to that of surgery. The results will support a rationale of applying SBRT for younger and operable patients with operable stage I NSCLC.
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P1.05 - Poster Session with Presenters Present (ID 457)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.05-031 - Primary Results of Dose Escalated Stereotactic Body Radiotherapy for Stage IA Non-Small Cell Lung Cancer (ID 4606)
14:30 - 14:30 | Author(s): H. Onishi
- Abstract
Background:
JCOG 0403 showed excellent overall survival in stereotactic body radiotherapy (SBRT) for stage IA non-small cell lung cancer (NSCLC). In Japan, 48Gy/4Fr for isocenter have been the standard dose fractionation of SBRT for stage IA NSCLC. JCOG0702 showed that dose escalation of 55Gy for PTVD~95%~ was feasible in SBRT for peripheral small (PTV volume 100cc or less) NSCLC. Intensification of local treatment with dose escalation is considered to be one of the measures for improvement of overall survival. In 2011, we adopted dose escalated regimen (50Gy/4Fr for PTVD~95%~) for SBRT for stage IA NSCLC, expected improvement of local control and overall survival. The purpose of this study was to review and report the primary results of dose escalated SBRT for stage IA NSCLC.
Methods:
From August 2011 to April 2015, 31 patients with stage IA NSCLC were treated with dose escalated SBRT at the University of Yamanashi. The patients' ages ranged from 61 to 86 (median 79) years. Twenty two patients were male, 9 were female. Performance status was 0 in 26, 1 in 5 patients. Tumor histology was squamous cell carcinoma in 6 and adenocarcinoma in 23, other NSCLC in 2 patients. Clinical stage was T1a in 19, T2b in 12 patient. A multiple static ports radiation planned by a radiation treatment planning system (Pinnacle[3] Version 9.2-9.8) was performed with linac using 6MV x-ray beams. The Breath hold technique and CT image guided set-up were used in all cases. A total dose of 50Gy was delivered in 4 fractions over 4-5days. Radiation doses were prescribed to the 95% of planning target volume (PTVD~95%~). A superposition algorithm with heterogeneity correction was used for dose calculations.
Results:
The follow-up period for all patients was 3.3-43.1 (median 23.7) months. The overall survival rate at one year and two years were 87.1%, 79.3%, respectively. The local control rate at one year and two years were both 96.4%. Local recurrence, regional lymph node metastases, and distant metastases were observed in 1, 4 and 3 patients, respectively. Regarding to the toxicities, grade 3 radiation pneumonitis were observed in 3 patients. Grade 2 rib fracture were observed in 3 patients. There were no Grade 4 or greater adverse events in the follow-up period.
Conclusion:
The toxicity was considered to be acceptable. The local control effect was considered to be sufficient. Longer follow- up durations are needed to validate the clinical benefits of dose escalated SBRT for stage IA NSCLC.
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P2.05 - Poster Session with Presenters Present (ID 463)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.05-050 - Impact of Inflammation and Sarcopenia on Outcomes after Stereotactic Body Radiotherapy for T1N0M0 Non-Small Cell Lung Cancer (ID 4059)
14:30 - 14:30 | Author(s): H. Onishi
- Abstract
Background:
The purpose was to evaluate impact of systemic inflammation and sarcopenia on outcomes after stereotactic body radiotherapy (SBRT) for T1N0M0 non-small cell lung cancer (NSCLC) as a supplementary analysis of Japan Clinical Oncology Group (JCOG) study JCOG0403.
Methods:
Pretreatment serum C-reactive protein (CRP) was used as a marker for systemic inflammation. Patients were divided into high and low CRP groups with a threshold value of 0.3 mg/dL. Paraspinous musculature area (PMA) at a level of the 12th thoracic vertebra was measured on simulation CT with thresholding Hounsfield Units between -29 and 150. When PMA was lower than the gender-specific median, the patient was classified as sarcopenia. Toxicities, overall survival (OS) and cumulative incidence of cause-specific death were compared between groups. Kaplan-Meier method and cumulative incidence function were applied to estimate proportion of OS and cumulative incidence of cause-specific death, respectively.
Results:
Of 169 patients enrolled into JCOG0403, 60 operable and 92 inoperable patients were included into this study after excluding 5 patients ineligible for JCOG0403 and 12 patients whose simulation CT images were unavailable or unsuitable for the PMA measurement. Forty-two patients were classified as high CRP. Medians of PMA were 31.6 cm[2] (range, 12.6-52.9) and 25.1 cm[2] (range, 3.4-38.5) in male and female, respectively. Proportions of toxicities Grade 3-4 were 19.1% and 10.9% in the high and low CRP groups; and 17.1% and 9.2% in the sarcopenia and non-sarcopenia groups, respectively. In the operable patient cohort, OS significantly differed between the CRP groups (log-rank test P=0.009; hazard ratio of high CRP 2.43, 95% confidence interval 1.23-4.80; 3-year OS of 58.8% and 83.6% for high and low CRP, respectively). This difference in OS was mainly contributed by difference in lung cancer death (Gray’s test P=0.070; 3-year cumulative incidence of 29.4% and 7.1%, respectively). No impact of sarcopenia on OS was observed in operable patients. In the inoperable patient cohort, OS did not differ between the CRP groups (log-rank test P = 0.925). No significant difference was observed in OS between the sarcopenia groups, either.
Conclusion:
The present study suggests that systemic inflammation may provide prognostic information for operable patients receiving SBRT for early-stage NSCLC. Further studies are warranted to confirm these findings.
