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B. Meduri
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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: 2
- 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): B. Meduri
- 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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P2.02-058 - Moderately Hypofractionated Radiotherapy in Locally Advanced Non Small Cell Lung Cancer: A Single Institution Retrospective Analysis (ID 4450)
14:30 - 14:30 | Author(s): B. Meduri
- Abstract
Background:
Radiation dose escalation using hypofractionation might improve clinical outcomes. Aim of the study was to evaluate outcomes, safety and feasibility of a moderately hypofractionated Radiotherapy (Hypo-RT) regimen for pts with LA-NSCLC
Methods:
Between 2008 and 2015 44 consecutive pts with LA-NSCLC were treated using a HYPO-RT regimen.Thirty-two pts were male,12 female. Mean age was 66.2 years. Primary tumor was adenocarcinoma in 16 pts, SCC in 27, Giant Cell neurendocrine Carcinoma in 1 pt.Three pts had clinical stage IIA-IIB, 19 pts IIIA and 22 IIIB. Chemotherapy was administered before Hypo-RT in 37 pts, 7 pts underwent exclusive RT. Mean total RT dose delivered to site of persistent disease was 61 Gy (range 45-66Gy) and mean total treatment time was 40 days in 5,7 weeks(range 3-8) . Daily fraction ranged between 2.2 and 3 Gy. RT was temporarily interrupted in 3 pts due to acute toxicity.
Results:
After a median follow up of 17.3 months, 19 pts were alive, whereas 25 pts had died (18 pts due to disease progression and 7 from other causes). Complete response was achieved in 6 pts, partial response in 16 and stable disease in 10 with an overall response rate (ORR) equal to 72,7%. Twenty-one pts showed locoregional relapse;17 pts distant metastasis and 6 pts both of them. Median overall survival (OS) was 41.7 months while 1,3- and 5-year OS were 68.9%(±7,2%SE), 44.9%(±8.3%SE) and 25.1 (±9.0SE), respectively. At univariate analysis local failure, stage and response to CHT-RT treatment showed a statistically significant impact on OS with better prognosis for pts in stage IIIA, achieving a complete response and not experiencing locoregional relapse ( p< 0.04, <0.05, <0.02 respectively). At the same interval progression free survival was 52.3%(ES±7.8),17.8%(ES±6.6) and 11.9 (ES±6.5) while 3- and 5-years locoregional control was 24.6%(ES±5,5) and 11.7%(ES±4,7%).Acute toxicities were reported in 27 pts: 4 pts had G1-G2 skin dermatitis, 16 pts G1-G2 esophagitis and 4 pts G1-G2 pneumonitis. About late toxicities 7 pts experienced G1-G2 pneumonitis while 3 pts had G1-G2 esophagitis. No deaths related to the treatment were recorded.
Conclusion:
Hypo-RT proved to be a feasible and well tolerated treatment for pts with LA-NSCLC showing very promising results in terms of overall response rate and clinical outcomes. Further studies are needed to confirm these results and introduce HYPO-RT in the clinical routine
