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M. Scorsetti



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    P2.05 - Poster Session with Presenters Present (ID 463)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Radiotherapy
    • Presentations: 1
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      P2.05-008 - Can Stereotactic Body Radiation Therapy (SBRT) Be an Effective Treatment for Lung Metastases From "Radioresistant" Histologies? (ID 4419)

      14:30 - 14:30  |  Author(s): M. Scorsetti

      • Abstract

      Background:
      Metastasis from “radioresistant” histologies are commonly regarded as less responsive to SBRT. Almost no data are available in Literature to evaluate the impact of these histologies on the outcome of patients with lung metastases treated with Stereotactic Body Radiation Therapy (SBRT). Therefore, we conducted this analysis on patients with lung metastases from renal cell carcinoma, hepatocellular carcinoma, adenoid cystic carcinoma and melanoma treated with SBRT in our Institution.

      Methods:
      Oligometastatic patients with lung metastases from renal cell carcinoma, hepatocellular carcinoma, adenoid cystic carcinoma and melanoma who received SBRT and with a discrete follow up time were included in this analysis. Kaplan Meyer analysis was used to calculate Overall Survival, Progression Free Survival, Local Control. Crude rates were used to calculate the response and distant failure rates. Toxicity was scored according to CTCAE v. 4.03

      Results:
      Sixty patients were included in the study. Most common primary histologies were renal cell carcinoma and hepatocellular carcinoma. Most of patients had 1 or 2 metastatic sites. Half patents did not receive any systemic therapy during their history before SBRT. Different RT doses and number of fractions were utilized according to site, number and volume of lung metastases, 48 Gy in 4 fractions was the most commonly prescribed schedule. The best local responses obtained were complete response in 13 patients (21.7%), partial response in 28 patients (46.7%) and stable disease in 14 patients (23.3%). Five patients (8.3%) had a local progression. With a median follow up of 24.3 months (range 4.1-118.6 months), local control was 93.7% and 86.1% at 1 and 2 years respectively. OS and PFS at 1 and 2 year were 89.5%, 64.6%, 87.7% and 70.1%, respectively. None of the analyzed parameters showed a statistically significant impact on any outcome. Treatment was well tolerated. None but one patients experienced acute toxicity of any grade. During follow up in 10 cases G1-2 toxicity (mostly pneumonia) were recorded.

      Conclusion:
      SBRT for lung metastases is an effective treatment for oligometastatic patients with lung metastases from “radioresistant” histologies. The treatment is safe and well tolerated and the outcomes are equivalent to the results obtainable with SBRT for lung metastases from more favourable histologies.

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    P3.03 - Poster Session with Presenters Present (ID 473)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
    • Presentations: 1
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      P3.03-029 - EPP Followed by Hemithoracic IMRT - A Multicenter Study on Behalf of the Italian Association for Radiation Oncology Lung Cancer Study Group (ID 4684)

      14:30 - 14:30  |  Author(s): M. Scorsetti

      • Abstract

      Background:
      The treatment of MPM is not well defined. Although it has been shown that extrapleural pneumonectomy (EPP) followed by hemithoracic RT may improve survival in early-stage disease, this therapeutic approach is declining. This might be due to the recent publication of a randomized trial (SAKK 17/04) which assessed the effect of high-dose hemithoracic RT after EPP. The study reported poor outcomes and the results did not support the use of hemithoracic RT. The major weakness of the SAKK study is the heterogeneity of the radiation techniques and schedules, and that only 12 patients received IMRT. On this background we conducted the present study to assess the outcome of MPM patients treated with EPP and adjuvant IMRT.

      Methods:
      This is a retrospective multicenter study, including 5 academic centers in Italy. Seventy patients treated with EPP and adjuvant IMRT were enrolled. The majority (95%) of patients had an epithelioid histology. Sixty patients were affected by stage III-IVA disease. Fifty-four (77%) patients received neoadjuvant/adjuvant chemotherapy. The IMRT dose ranged between 50-60 Gy in 25-27 fractions. Radiation was interrupted in two patients due to systemic progression of disease.

      Results:
      Median follow-up was 14 months (range, 0-83 months). Rates of local control, loco-regional control, distant-metastases free survival (DMFS) and overall survival (OS) at 2 years were 73%, 63%, 39%, and 63%, respectively. Patients with stage I-II had a better 2-year OS and DMFS than those with advanced disease: 60% vs. 40% (p=0.09), and 78% vs. 32% (p=0.03), respectively. Three fatal pneumonitis were reported. Other major toxicities were: Grade 2-3 pneumonitis in 2 cases, 1 bronchial fistula, and 1 Grade 3 esophagitis.

      Conclusion:
      This multicenter study showed that EPP followed by hemithoracic IMRT is associated with high rate of local and loco-regional control, and showed that long-term survival can be achieved, even if some patients may experienced life-threatening lung toxicity. Distant metastasis represent the predominant pattern of failure.