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F. Sert
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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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P2.05-011 - The Current Status of Radiotherapy in the Definitive Treatment of Lung Cancer in a Developing Country: Turkey (ID 4596)
14:30 - 14:30 | Author(s): F. Sert
- Abstract
Background:
To investigate the current status of radiotherapy (RT) trends in the definitive treatment of lung cancer in Turkey.
Methods:
A questionnaire consisting of 46 questions about the technical facilities, and indications regarding the definitive radiotherapy of lung cancer was sent to 62 centers in Turkey, and was answered by 47 centers.
Results:
RT centers were mostly gathered in Marmara, Central Anatolia, and Aegean region (15, 12 and 8 centers respectively). The median number of patients with non-small cell (NSCLC) and small-cell lung cancer (SCLC) treated definitively in one year were 55 and 15 respectively. The cases are discussed in a multidisciplinary tumor board in 75% of the centers. All of the centers use at least the minimum technological standard which is CT-planned 3D conformal RT (3D-CRT) in the definitive treatment of lung cancer; 33% has 4D-CT simulation facility, 94% use PET/CT in RT planning, 75% apply RT under image guidance; 41% has stereotactic body radiotherapy (SBRT) facility, and 53% use SBRT routinely in early-stage NSCLC patients who are medically inoperable or who refuse surgery. Ninety-eight percent of the centers apply concurrent chemoRT (87% starting RT with the first chemotherapy course) in locally advanced NSCLC. Concurrent chemoRT dose is 60-66 Gy in 96%. Chemotherapy was given by the radiation oncologists in 34% of the centers. In stage IIIA(N2) potentially resectable disease 56% of the centers apply neoadjuvant treatment (chemoRT 67%, chemo 33%). Besides main postoperative RT indications 27% of the centers apply RT to patients with inadequate mediastinal dissection, 37% apply to patients with suboptimal surgery. Regarding definitive treatment of SCLC 17% of the centers apply 45 Gy bid, 50% apply 50-60 Gy, 28% apply 61-66 Gy concurrent with cisplatin-etoposide, starting with the first or second course in 87%. In extensive-stage SCLC 89% of the centers apply thoracic RT (50-66 Gy in 62%, 30 Gy in 26%) after chemotherapy. Prophylactic cranial irradiation doses were 25 Gy in 71%, 30 Gy in 22%. The patients are followed with 3-month intervals in 89% of the centers, however there is no consensus regarding follow-up workup among the centers.
Conclusion:
At least minimum world standards can be applied in the definitive RT of lung cancer in Turkey. The problems regarding optimal RT dose and fractionation and concurrent chemotherapy regimen, postoperative RT indications are similar, but as a developing country we need more multidisciplinary workup and develop our own guidelines taking into account our own resources and patient characteristics.
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P2.05-026 - Postoperative Radiotherapy in Non-Small Cell Lung Cancer: 20 Years' Experience in a Single Centre (ID 6393)
14:30 - 14:30 | Author(s): F. Sert
- Abstract
Background:
The purpose of this study is to evaluate the long term outcomes of postoperative radiotherapy(PORT) in patients with NSCLC.
Methods:
A total of 130 patients with resected NSCLC who were treated with PORT between January 1994 and December 2014 were respectively evaluated. Among the whole group 86 patients(66%) were treated with Co60 machines till 2005, and 44 patients(34%) with 6-10 MV photons with linear accelerators. Median RT dose was 54 Gy(range, 48-66 Gy) with 2 Gy daily fractions. the treatment fileds covered the bronchial stump, ipsilateral hilum and mediastinum in 109patients(83.8%);bronchial stump,ipsilateral hilum, mediastinum and supraclavicular nodes in 15patients(11.5%);and bronchial stump and ipsilateral hilum in 6patients(4.6%).Cisplatinum-based chemotherapy was administered to 69(53%) patients. Chemoterapy was applied preoperatively in22 patients(17%), concomitantly in 27 patients(21%), and after PORT in 20patients(15%). Overall(OA) survival, locoregional-free(LRF) survival and distant-metastasis free(DMF) survival were calculated using the Kaplan-Meier method.
Results:
The median age of the patients was 59 years (range,35-75 years). The most frequently performed surgical procedure was lobectomy (64.6%), followed by pneumonectomy(19.2%), wedge resection (10%), and bilobectomy(6.2%). Stages included I(19.2%), II(42.3%), IIIA (30.8%), and IIIB(6,9%).Neoadjuvant chemotherapy was applied to 62% of stage III patients.The median overall survival was 48 months. The 5-year OA, LRF and DMF survival rates for whole group were 43%, 75%, and 63% respectively.Significant prognostic factors for OA survival were indicated in the table. Acute and subacute toxicities were Grade I to II esophagitis in 48 patients (37%), anemia in 11 patients(8%), pulmonary infection in 11 patients (8%),and Grade ≥II radiation pneumonitis in 11 patients(8%) Radiation-induced late toxicities including radiologic Grade I to II fibrosis were recorded in 22 patients (17%).The Prognostic Factors for Overall Survival
Characteristics 5-yearOA survival UnivariateAnalysis (Log-rank p value) Multivariate Analysis(Cox regression p value) Age(Years) <59 >=59 55 32 0.012 0.000 KPS 70-80 90-100 35 48 0.028 0.003 Laterality Left Right 31 54 0.011 0.005 Stage T1-T2 T3-T4 55 28 0.001 0.050 Dose <54 >=54 55 36 0.037 0.006
Conclusion:
Unfavorable prognostic factors for PORT were RT dose > 54 Gy, advanced T stage, poor Karnofsky performance status, advanced age, and left sided tumors. When irradiating left-sided tumors cardiac toxicity must be kept in mind.
