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Suresh Senan
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MS 11 - Combined Modality Treatment for Superior Sulcus Tumors (ID 533)
- Event: WCLC 2017
- Type: Mini Symposium
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:G.D. Castro, Philip Bonomi
- Coordinates: 10/17/2017, 11:00 - 12:30, Room 503
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MS 11.04 - Radiation Therapy for Superior Sulcus Tumor (ID 8121)
11:45 - 12:00 | Presenting Author(s): Suresh Senan
- Abstract
- Presentation
Abstract:
In 2003, an IASLC Consensus Report recommended that ‘superior sulcus tumors (Pancoast tumors, T3 or T4) should preferentially undergo trimodality treatment, including chemoradiation and surgery’ [Eberhardt WE, Lung Cancer 2003]. This recommendation was based on the early results of the phase II Intergroup Trial 0160) trial, findings which have been subsequently updated [Rusch VW, J Clin Oncol 2007]. Results of two other prospective phase II trials, namely the JCOG 9806 and the SWOG-Intergroup Trial S0220, support the use of the trimodality approach in superior sulcus tumors [Kunitoh H, J Clin Oncol 2008; Kernstine KH, Ann Thorac Surg 2014]. Between 30-40% of patients with a locally-advanced NSCLC can develop local disease recurrence following full-dose chemoradiation [Baker S, Radiat Oncol 2016]. As the impact of a local recurrence for patients with superior sulcus tumors can be great, the role of surgery remains relevant for this site. Recent ESMO guidelines have identified this patient subgroup as having an increased risk of an incomplete resection [Eberhardt WE, Ann Oncol 2015], and consequently, the role of concurrent CT-RT as an induction scheme is considered standard at centers with the available surgical expertise. This overview will address radiation-related topics such as dose and fractionation schemes, treatment fields, newer radiation delivery techniques (MRI-guided radiotherapy, protons), salvage radiotherapy for small volume recurrences, and the treatment of second primary lung tumors.
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OA 16 - Treatment Strategies and Follow Up (ID 686)
- Event: WCLC 2017
- Type: Oral
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:Jun Nakajima, T. Demmy
- Coordinates: 10/18/2017, 14:30 - 16:15, Room 315
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OA 16.01 - Stereotactic Ablative Radiotherapy Versus Surgery in Early Lung Cancer: A Meta-analysis of Propensity Score-Adjusted Studies (ID 8066)
14:30 - 14:40 | Author(s): Suresh Senan
- Abstract
- Presentation
Background:
There is currently no completed randomized controlled trial data comparing stereotactic ablative radiotherapy (SABR) and surgery in operable patients with early-stage non-small cell lung cancer (ES-NSCLC). Propensity score methods are increasingly utilized in oncology to balance the baseline characteristics of non-randomized cohorts, mimicking the setting of a clinical trial. No previous meta-analysis of propensity score analyses comparing a surgical and non-surgical modality has been conducted. Our goal was therefore to perform a systematic review and meta-analysis of all propensity score analyses comparing SABR and surgery in patients with ES-NSCLC.
Method:
A systematic review was carried out according to PRISMA guidelines by querying the MEDLINE and Embase databases from inception until December 2016. Hazard ratios (HR) with confidence intervals (CI) for overall survival (OS) and disease-specific survival (DSS) were directly extracted, if available, or estimated from Kaplan-Meier curves. Meta-analysis was carried out with inverse variance-weighted random-effects models.
Result:
After reviewing 1039 records, 17 PS-adjusted studies with a total of 20151 patients were included in the final analysis. Overall survival (OS) favoured surgery over SABR (HR = 1.52 [95% CI: 1.33-1.74], p < 0.001). However, the rate at which patients died from lung cancer (DSS) was not significantly different (HR = 1.13 [95% CI: 0.86-1.49], p = 0.38). On subgroup analysis, OS was superior for both lobectomy (HR = 1.61 [95% CI: 1.27-2.03], p < 0.001) and sublobar resection (HR = 1.33 [95% CI: 1.15-1.55], p < 0.001) versus SABR while DSS again did not significantly differ (HR = 1.35 [95% CI: 0.70-2.62] and HR = 1.18 [95% CI: 0.84-1.67], respectively). On secondary analysis, meta-analysis of proportions revealed a lymph node upstaging rate of 16.0% (95% CI: 13.6%-18.6%) and adjuvant chemotherapy usage rate of 11.5% (95% CI: 8.6%-14.8%) among patients who received surgery. On meta-regression, with every increase of 0.1 in the maximum allowable difference in propensity score within a matched pair - representing increases in imbalance between cohorts, DSS outcomes increasingly favoured surgery by 1.36-fold. Critical appraisal revealed inconsistent reporting of propensity score methods.
Conclusion:
Overall survival favoured surgery over SABR in this meta-analysis of 17 propensity score analyses. However, the effectiveness of SABR was reflected in a similar DSS to surgery, supporting ongoing clinical equipoise. A direct relationship between propensity score methodology and DSS outcomes were demonstrated. Whether this observed benefit in OS for surgery is real or due to limitations in the propensity score methodology requires confirmation through randomized data.
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P2.14 - Radiotherapy (ID 715)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.14-019 - Magnetic Resonance (MR)-Guided Adaptive Stereotactic Ablative Radiotherapy for Adrenal Metastases (ID 9196)
09:30 - 09:30 | Presenting Author(s): Suresh Senan
- Abstract
Background:
Stereotactic ablative radiotherapy (SABR) can result in high local control rates for adrenal metastases when biological doses of at least 100 Gy~BED10~ are delivered [Chance WW, 2017]. SABR is technically challenging due to respiration-induced displacements of the adrenals and adjacent organs at risk (OAR), both of which are poorly visualised using imaging techniques currently available at linear accelerators. MR imaging enables superior anatomical imaging of both the adrenals and OAR’s. We implemented stereotactic MR-guided adaptive radiotherapy (SMART) using daily on-table re-optimization of pretreatment SABR plans using the anatomy-of-the-day. We studied the impact such daily plan re-optimization for adrenal metastases.
Method:
Since mid-2016, 13 patients with adrenal metastases from lung cancer have undergone video-assisted, respiratory-gated SMART delivery on the MRIdian system (ViewRay Inc.). This entails using visual feedback involving projection of both target volume and safety margins onto a monitor visible to patients. The radiotherapy system automatically shuts-off delivery when the target is outside pre-specified safety margins (3mm). The commonest fractionation scheme delivered was 5-fractions of 10 Gy (in 9 patients). Prior to each fraction, a 17-second MR scan in shallow breath-hold was performed with patient in treatment position, in which the GTV was rigidly registered to that on the baseline MR scan. Setup was performed on the gross tumor volume (GTV), and contour deformation was used to automatically generate OAR’s according to the anatomy-of-the-day. Baseline SABR plans were recalculated on the anatomy-of-the-day (defined as ‘predicted plans’), before being routinely re-optimized.
Result:
The median planning target volume (PTV = GTV + 3mm) was 35.1 cc (range 6.5 – 69.8 cc). Online plan adaptation improved PTV coverage in 78% of all fractions. Re-optimized plans exhibited significantly better sparing of OAR and achieved a reduction in volumes of stomach, bowel and duodenum receiving 33Gy, with respect to predicted plans. All patients completed the planned treatments using repeated breath-holds. The total on-table duration was approximately 50 minutes for each fraction.
Conclusion:
Breath-hold SABR delivery under MR-guidance is advantageous for adrenal tumors. Substantial variations in OAR’s positions were observed at imaging prior to delivery of each fraction, leading to improved target coverage and OAR sparing when on-table plan re-optimization was performed.
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YI 01 - Young Investigator and First Time Attendee Session (ID 588)
- Event: WCLC 2017
- Type: Young Investigator
- Track: Education/Publication/Career Development
- Presentations: 1
- Moderators:Peter Goldstraw, Giorgio Vittorio Scagliotti
- Coordinates: 10/15/2017, 08:00 - 11:30, F201 + F202 (Annex Hall)
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YI 01.12 - Making the Most of the WCLC: A Guide for First Time Attendee - From an Expert Perspective (ID 7855)
10:45 - 11:00 | Presenting Author(s): Suresh Senan
- Abstract
- Presentation
Abstract not provided
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