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M. Hatton
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P2.05 - Poster Session with Presenters Present (ID 463)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiotherapy
- Presentations: 3
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.05-032 - CT-Based Surrogates of Pulmonary Ventilation in Lung Cancer: A Voxel-Level Comparison with HP Gas MRI (ID 5872)
14:30 - 14:30 | Author(s): M. Hatton
- Abstract
Background:
Image registration of paired inspiratory & expiratory CT is a potential method for generating surrogates of regional ventilation by assuming that local lung expansion & density changes of corresponding parenchymal voxels equate to ventilation. Potential lung cancer applications include functional lung avoidance radiotherapy planning and longitudinal assessment of treatment response. However, the physiological accuracy of the technique has yet to be validated. The aim of this study was to compare the spatial correlation of ventilation CT & [3]He MRI in a cohort of lung cancer patients.
Methods:
5 patients underwent expiration & inspiration breath-hold CT. [3]He & [1]H MRI were also acquired in the same breath and at the same inflation state as inspiratory CT. Expiration CT was deformably registered to inspiration CT for calculation of ventilation CT from voxel-wise differences in Hounsfield units. Registration accuracy was validated using a reference CT dataset for 6 patients with 100 expert anatomical landmarks defined on both images. Inspiration CT was registered to [3]He MRI via the same-breath anatomical [1]H MRI to enable direct comparison of [3]He MRI & CT ventilation in corresponding regions of interest located within the lungs as defined by a [1]H MRI lung mask (see figure). Spearman’s rank coefficients were used to assess voxel-level correlation. Figure 1
Results:
The mean registration error for the reference dataset was 1.1±0.2mm (mean±SD). Successful registration enabled computation of ventilation CT images at the inspiratory state and direct comparison of ventilation CT with MRI. The median (range) Spearman’s coefficient was 0.68 (0.45-0.76).
Conclusion:
This work demonstrates a method of acquiring CT & [3]He MRI in similar breath-holds to enable direct spatial comparison of ventilation maps. Initial results show moderate correlation between ventilation CT & [3]He MRI. Further large-scale clinical trials are required before clinical implementation of the technology.
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P2.05-041 - Accelerated Radical Radiotherapy for Non Small Cell Lung Cancer: Single Centre Experience of Two Fractionations (ID 5348)
14:30 - 14:30 | Author(s): M. Hatton
- Abstract
Background:
Radical radiotherapy (RT) regimens for NSCLC vary considerably. In routine practice our centre has predominantly used continuous hyperfractionated accelerated radiotherapy (CHART, 54Gy in 36 fractions over 12 days)) and accelerated hypofractionated RT (55 Gy in 20 fractions over 4 weeks) since 1997. This report updates previous data presentation [1] including patients treated between 2005 - 2011.
Methods:
Case notes and radiotherapy records for all patients receiving radical radiotherapy were retrospectively reviewed. Patient demographics, tumour characteristics, RT and survival data were collected. Descriptive statistical analysis and Cox regression analysis was performed using SSPS.
Results:
516 patients received radical radiotherapy, over 95% received CHART (237 patients) or hypofractionated RT (257). Median age was 70 yrs, and 60% percent were male. PET staging was performed in 81%, and 26%, 17% and 51% were stage 1, 2, 3 respectively. 81% were WHO performance status 0-1. 44% were squamous carcinomas, 21% non-squamous, 20% not otherwise specified ,with 14% without histological diagnosis. Prior chemotherapy was given to 36%, of whom 84% had stage III disease. 99.6% completed their prescribed radiotherapy treatment. 2 year survival was 47.5% and median overall survival from time of diagnosis was 23 months. Univariate analysis showed statistically significant association of survival with gender, stage and histology, but not age, PS or RT regime.
Conclusion:
Discussion: This single centre experience reflects the outcome of unselected consecutively treated NSCLC patients. Patient selection for the two radiotherapy regimens was largely down to patient preference for in- or out-patient treatment. Encouragingly, CHART outcomes seem a little better than those reported in the original CHART paper [2] and our previous cohort [1]. We feel this probably reflects improved patient selection following the introduction of PET staging into routine practice. Conclusions: The outcome for patients treated with accelerated radiotherapy fractionations in routine practice remains encouraging, and randomised trials comparing these approaches with conventionally fractionated chemoradiotherapy regimes are needed. 1. Pemberton LS, Din OS, Fisher PM, Hatton MQ. Accelerated radical radiotherapy for non-small cell lung cancer (NSCLC) using two common regimens: a single centre audit of outcome. Clinical Oncology 2009;21:161-7 2. Saunders M et.al. Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small-cell lung cancer: a randomised multicentre trial. CHART Steering Committee. Lancet. 1997 Jul 19;350(9072):161-5
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P2.05-045 - Accelerated Radical Radiotherapy for Non Small Cell Lung Cancer: Single Centre Experience of Two Schedules in the Treatment of Elderly Patients (ID 5682)
14:30 - 14:30 | Author(s): M. Hatton
- Abstract
Background:
Radical radiotherapy (RT) regimens for NSCLC vary considerably and there is little data on outcomes for elderly patients, who are underrepresented in clinical trials. Our centre has routinely used continuous hyperfractionated accelerated radiotherapy (CHART, 54Gy in 36 fractions over 12 days) and accelerated hypofractionated RT (55 Gy in 20 fractions over 4 weeks) since 1997. We have examined outcomes for patients over the age of 80 treated between 2005 – 2011.
Methods:
Case notes and radiotherapy records for all patients receiving radical radiotherapy were retrospectively reviewed. Patient demographics, tumour characteristics, RT and survival data were collected. Descriptive statistical analysis and Cox regression analysis was performed using SSPS.
Results:
516 patients received radical radiotherapy: 73 were over 80 years old; 71 % were male; and 85% WHO performance status 0-1. PET staging was performed in 87%, with 41%, 22% and 32% being stage 1, 2, 3 respectively. 51% were squamous carcinomas, 18% non-squamous, 12% unspecified, and 19% without a confirmed histological diagnosis. 2 patients received primary chemotherapy. 40% received CHART, and 56% hypofractionated RT. All patients completed their prescribed radiotherapy treatment. 2 year survival was 67% and median overall survival from time of diagnosis was 22 months. Univariate analysis suggested stage was the only statistically significant variable associated with survival.
Conclusion:
Discussion: Our results confirm that accelerated radiotherapy schedules are deliverable in elderly populations with NSCLC who are generally not considered suitable for standard treatment with chemo-radiotherapy. The outcomes are similar to those reported in our younger patient cohorts [1] and appear to be as good as those reported in the original CHART paper [2]. Conclusions: The use of accelerated radiotherapy fractionations for the radical treatment of elderly patients with NSCLC is a feasible and well tolerated treatment for those patients not suitable for a chemo-radiotherapy approach. Outcomes are encouraging, but trials specific to this population are needed to define the optimal radiotherapy regimen. Ref: Pemberton LS, Din OS, Fisher PM, Hatton MQ. Accelerated radical radiotherapy for non-small cell lung cancer (NSCLC) using two common regimens: a single centre audit of outcome. Clinical Oncology 2009; 21:161-7 2. Saunders M et.al. Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small-cell lung cancer: a randomised multicentre trial. CHART Steering Committee. Lancet. 1997 Jul 19; 350(9072):161-5
