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V. Navarro
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P2.02 - Poster Session with Presenters Present (ID 462)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.02-010 - Prognosis Impact of Oligoprogression Following Definitive Chemo-Radiotherapy in Stage III Non-Small Cell Lung Cancer (ID 4456)
14:30 - 14:30 | Author(s): V. Navarro
- Abstract
Background:
The influence of recurrence pattern on outcome in stage III NSCLC following definitive chemo-radiotherapy (CRT) has been scarcely addressed in the literature. Our aim was to analyze the relevance of oligoprogression (OP) in this clinical setting.
Methods:
Patients (pts) with stage III NSCLC who underwent concurrent CRT from 2010 to 2014 at the Catalan Institute of Oncology were retrospectively reviewed (n=170). Recurrence pattern at first progression was recorded. OP was defined as a single metastatic organ with up to 3 lesions. Overall Survival (OS) and Progression-Free Survival (PFS) were plotted using Kaplan Meier method, and multivariate Cox proportional hazards model was developed.
Results:
Median age 64 (37-87); male 87%; ECOG-PS≤1 92%; histology: adenocarcinoma 34%, squamous 43%, NOS+large cell 23%; cN0-1 21%, cN2 60%, cN3 19%. Platinum doublet: cisplatin 62%, carboplatin 38%. RT between 60-70 Gy (2Gy/fr): 94%. At a median follow-up of 38 months (m), 108 of 170 pts relapsed (63%) and 66% died. mPFS was 13m (95% CI 10-16), mOS was 28m (95% CI 22-34). Twenty-five of pts who relapsed (23%) developed OP. Sites involved: visceral 17, brain 4, lymph nodes 3, bone 1. Treatments delivered: local therapy with curative intent 9; palliative intention 12; no treatment 4 (table 1). Among pts who relapsed, mOS was longer in those with OP (32m) compared to pts without OP (18m, p=0.007). Pts with OP who received treatment, mOS according to curative or palliative intention was 53m versus 32m (p=0.1), respectively. In the multivariate Cox analysis of post-progression OS, OP remained a favourable prognostic factor (HR=0.36, 95% CI 0.17-0.74) independently of age, PS, stage, histology, smoking history, and platinum doublet.
Conclusion:
OP was associated with substantial better prognosis in this cohort of pts treated with concurrent CRT. Local ablative therapies in the context of OP yielded promising results in terms of survival and warrants further investigation.
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P2.05 - Poster Session with Presenters Present (ID 463)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiotherapy
- Presentations: 2
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.05-018 - Re-Irradiation Using SBRT: A Good Option as a Salvage Treatment in Pulmonary Lesions (ID 5936)
14:30 - 14:30 | Author(s): V. Navarro
- Abstract
Background:
Isolated intrathoracic relapse is common across distinct tumors and especially in lung cancer. Patients who received previous radiotherapy treatment (PRT) are not suitable for salvage surgery and chemotherapy provides poor local control. This study aimed to assess the toxicity and outcome of SBRT re-irradiation (reRT) in patients with solid tumors who developed an intrathoracic relapse.
Methods:
35p treated with PRT who received salvage SBRT were identified in our database and their medical records were retrospectively reviewed. All patients underwent complete pulmonary function tests (cPFTs) (including DLCO, FEV1 and FVC) and PET-CT scan was performed before and after receiving lung reRT. Treatment planning was based on image fusion with the previous treatment plan and calculating the cumulative total nominal dose. Survival estimations were performed using Kaplan-Meier and differences between PFTs prior and post-reRT were analyzed using Student T-Test. Early toxicity was defined when it occurred up to 6 months.
Results:
Median age: 68 (r53-81); 29p (83%) were male The previous treatments SBRT in 17p (49%), 3D-RT 4p (11%) and CT+RT 14p (40%) Mean RT dose 60,4Gy (r34-74). Primary tumors: lung 24 (69%), colorectal 9 (25%), oesophagus 2 (6%). For lung cancer p, the stage distribution was: IA 8 (23%), IB 2 (6%), IIA 2 (5.7%), IIB 1 (3%), IIIA 5 (4%), IIIb 4 (11%), IV 2 (6%). For other primaries, 8p (23%) were non metastatic at diagnosis and developed oligoprogressive disease in thorax which was treated with SBRT and 3 (8.5%) were oligometastatic. The location of reRT site: same lobe 17 (48%), ipsilateral different lobe 7 (20%), contralateral lobes 11 (32%). Median delivered dose of salvage SBRT was 50Gy (50-60) in 10 fractions (r3-10). Median accumulated dose in the lung was 81Gy (r60.10Gy-176Gy). With a median follow-up of 10m local control rate was 74% (IC95%; 0.59-0.9) and 1-year OS was 84% (IC 95%;0.67-1). The metabolic complete response rate was 23%. No differences in the baseline and post re-irradiation PFTs were observed: FEV1, FVC and DLCO difference and CI95% were 2.41 (-1.79-6.62); 65 (-125-257) and 12.5 (-95 - 121). Asthenia GII in 12p (31%) was the most frequent acute toxicity, no long-term toxicities were detected.
Conclusion:
Salvage SBRT for treating isolated intrathoracic relapses achieved an outstanding local control and overall survival in selected p . This treatment did not impair post-reirradiation PFT and long-term toxicities were not observed.
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P2.05-035 - Interim Analysis of the Phase II Trial Dose Risk Adapted FFF Using SBRT in Stage I NSCLC and Lung Metastases (NCT01823003) (ID 4368)
14:30 - 14:30 | Author(s): V. Navarro
- Abstract
Background:
This study is a phase II, prospective, pilot feasibility study designed to evaluate the safety of SBRT in selected patients with stage I NSCLC or metastatic lung cancer lesions using an ablative dose-adapted scheme with Free Flattening Filters (FFF) beams. An interim analysis was planned after enrollment of the first 27 patients. We present our results of this interim analysis.
Methods:
Medically inoperable patients or medically operable patients who refuse surgery with a life expectancy >12 months with lung lesions were candidates. All patients will be treated using FFF beams and the following schedule:
Physical examination, toxicity and clinical response will been performed every three months for the first year and 6 months thereafter. Follow up will include Thoracic CT, pulmonary function, quality of life survey and blood test.Topographical Criteria Dose Distance to Chest Wall Size Distance to main Bronchus Patients A. 34Gy single fr. >1cm < 2cm >2cm 5p (18.5%) C. 50Gy (12 x 5 fr.s)Peripheral <1cm <5cm >2cm 13p (48%) D. 60Gy (7.5Gy x 8fr.)Central >1cm <5cm <2cm 9p (33.3%)
Results:
After median of follow up of 33 months (r 10-45) we analyzed 27p, with median age of 74y (r 83-58), 21 males (78%). Main reasons for inoperability were: 7 (26%) poor respiratory function, 10 (37%) with multiple comorbidities and 6 (22%) who refused surgery. Location was RUL 9 (33%), RLL 6 (22%), LUL 7 (26%), LLL 4 (15%). Lung primaries in 19p (70%) and the main histologies were Squamous Carcinoma (7, 26%) and Adenocarcinoma (7, 26%). T1a (9 , 33%), T1b (7, 26%),T2a (5, 18%) and T3 (2, 7%). Maximum grade of acute toxicity was GIII 1p(asthenia), and for chronic toxicity was GII (asthenia) 4p (15%). Local Control at 30 months was 84% (three local failures, two from metastasis) and overall survival was 100% at this time.
Conclusion:
FFF beams using dose risk adapted schedule seem to be a safe approach with a good response profile. Further analysis with the entire cohort of the trial is needed in order to confirm these early results.
