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J. Macphee
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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: 2
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.05-034 - Neutrophil-To-Lymphocyte and Platelet-To-Lymphocyte Ratios as Prognostic Biomarkers in Early NSCLC Patients Treated with SABR (ID 6102)
14:30 - 14:30 | Author(s): J. Macphee
- Abstract
Background:
Inflammation may play an important role in cancer progression. High Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte ratio (PLR) have been reported to be poor prognostic indicators in several malignancies. In this study we quantify the prognostic impact of these biomarkers for overall survival (OS) among early stage NSCLC patients treated with Stereotactic Ablative Body Radiotherapy (SABR).
Methods:
102 consecutive patients who received SABR between October 2011 and May 2014 at the Beatson West of Scotland Cancer Centre (BWoSCC) were identified from a prospectively maintained electronic database. NLR and PLR were derived from blood results obtained within 60 days prior to SABR. Receiver Operator Characteristic (ROC) curves were generated to calculate the optimal thresholds for NLR and PLR.
Results:
The median age of patients was 72 (range 47-91) years. 60 (59%) were female. Maximum tumour diameter ranged from 10-42mm (median 18mm). Median follow up was 37.1 months. Overall survival at 2 and 4 years was 75.5% (95%CI 65.9-82.7%) and 51.4% (38.8-62.6%) respectively. There was strong association between NLR and PLR levels (r=0.803, p<0.001). ROC Curves indicated a threshold value for NLR of 3.155 (AUC 0.74) and PLR of 155.15 (AUC 0.70) respectively. Median OS for ‘low’ NLR and PLR was not yet reached compared with 33.9 months for ‘high’ NLR (p<0.0001) and 35.4 months for ‘high’ PLR (p=0.002). Multi-variable analysis indicated a stronger independent effect of NLR (p<0.0001), whilst taking account of gender, age, tumour size, histological confirmation and performance status. No association was found between elevated NLR or PLR and loco-regional or distant recurrence.
Conclusion:
Neutrophil-to-Lymphocyte Ratio appears to be a prognostic biomarker for patients with early stage NSCLC receiving SABR. Platelet-to-Lymphocyte ratio acts as a linear co-variant. We found no association between elevated NLR or PLR and loco-regional or distant recurrence.
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P1.05-035 - SABR for Medically Inoperable Early Stage NSCLC at the Beatson West of Scotland Cancer Centre: Outcomes and Toxicity (ID 4798)
14:30 - 14:30 | Author(s): J. Macphee
- Abstract
Background:
SABR is now an established therapeutic option for patients with medically inoperable early stage NSCLC. It is well tolerated and associated with low rates of Grade 3+ toxicity. Here we present the outcomes and toxicity data for the SABR service based at the Beatson West of Scotland Cancer Centre (BWoSCC).
Methods:
All 102 consecutive patients (median age 72 (range 47-91) years, 60 (59%) female) who received SABR between October 2011 and May 2014 at the BWoSCC were identified from a prospectively maintained electronic database. Toxicity data was collected at pre-determined intervals in a dedicated follow-up clinic. Radiological evidence of pneumonitis was scored on follow-up CT imaging at 3 months post-SABR. Outcomes were collated from electronic records.
Results:
Median and minimum follow-up were 37.1 and 24.1 months respectively. Histological confirmation of NSCLC was available for 33 (32.4%) patients. Local and regional control rates at 2 years were 95.1% and 94.1% respectively. 8.8% of patients developed metastases within 2 years with a median time to detection of metastases of 6.9 months. Overall survival (OS) at 1, 2, 3 and 4 years post-SABR was 88.2% (95%CI 80.2-93.1%), 75.5% (65.9-82.7%), 59.8% (48.2-69.7%) and 51.4% (38.8-62.7%) respectively. No difference in OS was apparent between histologically confirmed and unconfirmed subgroups (p=1.0). On multi-variable analysis, tumour size >= 20mm was negatively associated with OS (p=0.003) whilst gender, age, performance status, deprivation index and histological confirmation were not associated. Radiological scoring of post-SABR pneumonitis was available for 69 patients. A total of 33 of these patients (48%) had radiological evidence of pneumonitis. No association between V5 or V20 and radiological pneumonitis was identified. One death occurred that was potentially related to radiation pneumonitis. Otherwise, only 1 patient experienced grade 4 toxicity (fatigue) and 5 patients (4.9%) reported grade 3 toxicity (4x dyspnoea, 1x fatigue) within 12 months of SABR. There were 4 instances of rib fracture with no association with maximum chest wall dose.
Conclusion:
Within the Beatson West of Scotland Cancer Centre the use of SABR for early stage NSCLC is associated with high rates of loco-regional control. Our overall survival and toxicity data compare favourably with published series.
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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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P2.05-049 - Radical Treated NSCLC Radiotherapy Patients: A Prospective Study of Toxicities and Outcomes (ID 5492)
14:30 - 14:30 | Author(s): J. Macphee
- Abstract
Background:
Radical radiotherapy is widely used in the treatment of non-small cell lung cancer (NSCLC) among patients ineligible for surgery. Although side effects of radical radiotherapy have been well documented in clinical studies there is little real world prospective data describing their course, severity and effect on patient experience following treatment.
Methods:
NSCLC patients from the Beatson West of Scotland Cancer Centre (a specialised cancer care centre serving a population of 2.4m), treated with radical radiotherapy between September 2014 to December 2015, were offered followed up by a specialist nurse led clinic. This consisted of a telephone consultation at 2 weeks and clinic attendance at 2 and 6 months. Patient and tumour demographics were collected. Side effects were recorded at each visit and graded using the Common Terminology Criteria for Adverse Events (CTCAE). Descriptive statistical analysis was performed using Stata 14.0
Results:
92 consecutive patients attended the clinic, 50% were male and the median age was 70 (IQR 63.5-78) years. 48 patients had squamous carcinoma and all were performance status 0 – 2. The breakdown was 16% 23% and 56% for stage I, II and III respectively. A total of 62 (67%) of patients received 55Gy in 20 fractions. Overall one-year survival was 59.7% (95%CI 47.0-70.3%). Information from 75% was obtained by telephone at 2 weeks and in clinic at 8 weeks post treatment. At 6 months 54% attended for assessment. The most commonly reported side effects at week 2 were fatigue (90%), dyspnoea (70%), oesophagitis (70%), anorexia (26%) and cough (21%). At week 8 side effects were similar except that oesophagitis had decreased to 23% (p<0.001), and cough increased to 30% (p=0.07). All side-effects were graded 2 or less with the exception of one patient with grade 3 oesophagitis at week 8.
Conclusion:
This study confirmed a high level of patient engagement with a nurse led follow up protocol which was able to capture detailed information about frequency and severity of side effects following radical thoracic radiotherapy. This confirmed that the side effects patients experience were temporary and manageable.
