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P. Vasilyeva
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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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P2.02-020 - Pattern of Care of Inoperable Locally Advanced (LA) NSCLC in Elderly Patients: Analysis of the Experience of Two Academic Italian Hospitals (ID 6038)
14:30 - 14:30 | Author(s): P. Vasilyeva
- Abstract
Background:
Optimal treatment in LA NSCLC patients is still debated. In fit patients concomitant radio-chemotherapy (RCT) seems to be the best treatment in terms of local control (LC), progression free survival (PFS) and overall survival (OS) while sequential RCT is a good alternative in unfit patients. Moderately hypofractionated radiotherapy improve OS in recent studies. Elderly patients often cannot be offered multimodality treatments. We report our experience with over 70 years old LA NSCLC patients deemed unfit for surgery.
Methods:
Characteristics of patients and treatments are summarized in table 1. All patients were treated with a platinum based doublet of chemotherapy (CT). RT target volumes included the primary lung tumor and involved mediastinal lymphnodes as defined on pre-treatment contrast enhanced CT scan. Elective nodal irradiation was not performed. Acute/late toxicities were reported in accordance to 4.0 CTCAE scale. Clinical response was evaluated according to RECIST criteria.Patients' Characteristics Age Median 75 Range 70-83 Gender Male 50 (70%) Female 21 (30%) Performance Status (ECOG) 0 29 (41%) 1 36 (51%) 2 6 (8%) Histology Adenocarcinoma 31 (44%) Squamous Cell Carcinoma 39 (55%) Large Cell Carcinoma 1 (1%) Stage IIa/IIb 12 (17%) IIIa 39 (55%) IIIb 20 (28%) Chemotherapy Concomitant 9 (13%) Sequential 62 (87%) Cycles: median 4 Cycles: range 1-8 Radiotherapy Median Dose 62,3 Gy Moderate hypofractionation 26 (37%) Conventional fractionation 45 (63%)
Results:
At a median follow up of 10 months clinical response was evaluable in 69/71 patients obtaining a partial response in 35 of them, stable disease in 17, progressive disease in 17 patients. Twenty six patients experienced a local relapse within RT primary tumor volume, while 13 on nodal volume (5 patients both tumor and nodal relapse). 22 patients developed metastatic disease. One and 3-year OS was 62.3%(SE±6.2%) and 24,5%(SE±7.8%) respectively, while 1- and 3 year PFS was 45.1%(SE±6.9%) and 9,7%(SE±5.7%) respectively. At univariate analysis, tumor dimension (p<0,002) was the only prognostic factor statistically significant for OS. G1-G2 acute toxicity was observed in 45 patients: 36/62 in sequential CRT (3/36 developed also chronic toxicities) and 9/9 in concomitant CRT; most events were G1 oesophagitis (27 patients) and G1 cough (17 patients). No G3-4 event was reported.
Conclusion:
CRT is feasible in elderly patients; multidisciplinary evaluation is needed in order to reserve CRT to very fit patients.
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P2.04 - Poster Session with Presenters Present (ID 466)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.04-021 - Role of Adjuvant Radiotherapy and Prognostic Factor Analysis in Thymic Malignancies: A Retrospective Analysis of 129 Consecutive Patients (ID 5004)
14:30 - 14:30 | Author(s): P. Vasilyeva
- Abstract
Background:
To evaluate the impact of histological subtypes, stage and therapeutic approaches on outcomes of a retrospective consecutive series of patients (pts) treated in 2 different Radiation Oncology Italian Centers
Methods:
One-hundred twenty nine pts were treated between 1982 and 2012.Sixty-six pts were male,63female;mean age was 58 years.The series was reclassified according to WHO 2004 staging:42 pts had epithelial/ mixed thymoma(type A/AB),72pts had cortical/medullary/atypical thymoma(B1/B2/B3) and 15 thymic carcinoma(type C).All pts were also staged using Masaoka classification(MKc) resulting in 43pts in stage I,30 stage IIA,13 stage IIB,24 stage III and 19 stage IVA.Radical surgery(thymectomy +/- mediastinal nodes sampling)was performed in all pts,30 of whom had positive margins,while 80 were also submitted to adjuvant thoracic RT(ART)due to their final pathological stage and/or surgical margins status. All pts were evaluated for clinical outcomes(overall survival-OS,progression free survival-PFS and local control-LC) and secondary malignancies incidence.
Results:
After a median follow up of 9.6 years,at time of analysis 103 pts were alive with a 5- and 10 year OS of 90.1%(SE±2,7)and 81.7(SE±3.7) respectively and a PFS of 84.8(SE±3.2) and 77.3(SE±4.0). Finally,5- and 10-year LC were respectively 94,1% (SE±2,2) and 89.2%(SE±3.2).In terms of OS, MKc advanced stage was found as a negative prognostic factors(p<0.0001) such as Performance Status (PS) with a p<0.0001, Tstage (p< 0,0001), aggressive histology (p=0.0001) and surgical positive margins (p< 0,0001) at univariate analysis. Regarding PFS,advanced MK stage,T stage, positive surgical margins and aggressive histology were confirmed as negative prognostic factor (p< 0,0001, p<0,0001, p<0,01, p<0,0001). Using Cox regression analysis ART seems to have a protective effect if stratified by MKc clinical stage (p< 0,03) just in terms of OS.Concerning local recurrence, a significant difference was found by T stage(p<0,001), surgical margins (p<0,03) and WHO classification(p=0.0001). At multivariate analysis PS, Surgical Margins and histology were statistically significant (p<0.0001, p<0.002 and p<0,001 respectively) with a negative impact on OS for PS>1, positive margins and thymic carcinoma differentiation. At the same analysis only thymic carcinoma differentiation influenced PFS when compared with PS, T and MKc stage, surgical margins and ART. During follow up secondary/methacronous neoplasms were diagnosed in 29 pts (22.5%)
Conclusion:
PS, surgical margins and WHO classification seems to be the most important indicators for long term survival. ART showed positive impact in terms of OS in advanced MKc clinical stage (Stage II-III) pts.
