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A.J. Ward



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    P2.03b - Poster Session with Presenters Present (ID 465)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P2.03b-007 - Palliative Whole Brain Radiotherapy in Advanced Non-Small Cell Lung Cancer (NSCLC), the University College London Hospital Experience (ID 4365)

      14:30 - 14:30  |  Author(s): A.J. Ward

      • Abstract

      Background:
      Brain metastases occur in 30-40% of patients with Non-Small Cell Lung Cancer (NSCLC) [(1)]. Whole Brain Radiotherapy (WBRT) has been standard treatment in those with multiple metastases although this has been challenged by the Quartz trial. This suggested there was no advantage over supportive care in terms of survival (median 66 days in the RT arm) or quality of life. [(1) (2)] In our centre Quartz has divided opinions and practice. We thus decided to review our data of 163 patients who were treated with WBRT in the context of advanced NSCLC.

      Methods:
      Radiotherapy database information was used to identify patients receiving WBRT for metastatic NSCLC between 2007 and 2015. Patients with completely resected brain metastasis were excluded. Notes were reviewed retrospectively. Data were collected on demographics, performance status (PS), histology, disease status, further treatment following WBRT and survival.

      Results:
      163 patients were identified of which 153 had complete follow up data to review. The demographics are presented in the table below. The median survival across all patients was 104 days. Longer survival was seen in those with PS0/1(median=225 days) vs. PS3 (median =44 days) Of the 19 patients surviving longer than 1 year, 95% were PS 1 and all went on to receive further treatment for NSCLC upon completion of WBRT. Conversely 26 patients had a survival of less than 30 days. 70% were PS2 or 3. None of them received further treatment following WBRT.

      N=163 Number % Median Survival (days)
      Female 72 44%
      Male 91 56%
      Median Age 65
      HISTOLOGY
      Adenocarcinoma EGFR WT 104 64%
      Adenocarcinoma EGFR Mutant 10 6%
      Adenocarcinoma ALK rearrangement 1 <1%
      Squamous cell Carcinoma 20 12%
      Other Inc. NSCLC NOS 28 17%
      PERFORMANCE STATUS
      PS0/1 72 44% 225
      PS2 56 34% 80
      PS3 28 17% 44
      DISEASE STATUS
      Brain metastasis as 1[st] presentation of NSCLC 77 47% 146
      Brain metastasis in known NSCLC 86 53% 85
      Extracranial metastasis 125 78% 89
      No Extracranial metastasis 35 22% 160
      Further treatment following WBRT 55 34% 313
      OVERALL SURVIVAL 104 days


      Conclusion:
      In our series survival was seen to be favourable when compared to the radiotherapy arm of Quartz. Performance status and the option for further treatment seemed to improve outcome. Whilst lacking QOL data and a supportive care control group, our data would suggest that for selected patients, especially those of good PS there remains a role for WBRT in NSCLC.

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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
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      P2.04-010 - Survival after Surgery and Radiotherapy for Thymic Epithelial Tumours: A Single-Centre Experience from the United Kingdom (ID 5334)

      14:30 - 14:30  |  Author(s): A.J. Ward

      • Abstract

      Background:
      Thymic epithelial tumours are rare thoracic tumours primarily treated with surgical excision. Adjuvant radiotherapy has been shown to be beneficial in locally advanced disease. There is limited published data on thymoma outcomes in the United Kingdom.

      Methods:
      We retrospectively reviewed records of patients who underwent thoracic surgery for thymic tumours between July 2005 and December 2015. Imaging, pathology reports and follow-up clinic records were evaluated. Kaplan-Meier curves were generated for overall survival, and the log-rank test was used for univariate survival analysis.

      Results:
      79 patients were identified. The median age was 58 years (range 16 - 83 years). 58% were female. 24% of patients had associated myasthenia gravis. Masaoka Stage 1 disease was most common (48%), with Stage 2a disease (27%) next in frequency. The most common histological grading was WHO B3 (33%) followed by AB (25%). 58% had surgical margins < 1 mm, with tumour at margin in 24%. 39 patients (51%) had adjuvant radiotherapy, with median follow-up of 5.1 years for these patients. A radiotherapy dose of 45 – 50.4 Gy in 1.8 Gy fractions was used. 5-year survival for the whole cohort was 68% after surgery alone, and 86% with adjuvant radiotherapy, but the difference was not statistically significant. There were no deaths during follow-up in patients who had clear surgical margins, with or without radiotherapy. If surgical margins < 1 mm, there was a trend towards improved overall survival with adjuvant radiotherapy (5-year survival 88%), compared to surgery alone (5-year survival 50%) (log-rank test chisquare 3.7, p = 0.056) (Fig. 1). Figure 1



      Conclusion:
      The long-term outcomes of thymic epithelial tumours are excellent after complete surgical excision. There is a trend towards improved overall survival with adjuvant radiotherapy in patients with surgical margins less than 1 mm. Routine referral of patients with close surgical margins for consideration of radiotherapy is recommended.