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Takashi Shintani
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MA 09 - The Current Status of Radiation Oncology (ID 666)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:Tomoki Kimura, Yong Chan Ahn
- Coordinates: 10/17/2017, 11:00 - 12:30, Room 316
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MA 09.06 - Pulmonary Oligometastases Treated by Stereotactic Body Radiation Therapy (SBRT): A Nationwide Survey of 1,378 Patients (ID 8014)
11:35 - 11:40 | Author(s): Takashi Shintani
- Abstract
- Presentation
Background:
The treatment outcomes of patients with pulmonary oligometastases treated by SBRT were evaluated; the oligometastases were classified into three groups (oligo-recurrence, sync-oligometastases, and unclassified oligometastases) and the outcomes compared.
Method:
This study was limited to patients who had a BED10 ≥75 Gy. Oligo-recurrence was defined as a primary lesion that was controlled, the number of metastases or recurrences in the lung was one to five, and the disease-free interval (DFI), the interval between initial therapy of the primary lesion and the date of recurrence in the lung, was ≥6 months. Sync-oligometastases were defined as: the primary lesion was active; the number of metastases or recurrences in the lung and the active primary lesion was one to five; and the DFI was zero. The definition of unclassified oligometastases was similar to that of oligo-recurrence, but the DFI was <6 months. All oligomtastases in this study were treated by local therapy for all active lesions including primary and metastatic lesions.
Result:
Between 2004 and 2015, 1378 patients (male/female = 893/485; PS 0/1/2/3 = 746/474/85/17) meeting the study definition of pulmonary oligometastases were treated by SBRT in 68 institutions in Japan. Their median age was 72 years (16-93 years). The primary region was lung in 421, colorectal in 348, head and neck in 113, and others in 618. Histopathology showed adenocarcinoma in 761, squamous cell carcinoma in 358, and others in 186. Oligostatus was oligo-recurrence in 1013, sync-oligometastases in 118, and unclassified oligometastases in 122. The median maximum tumor diameter (MTD) was 1.5 cm (0.3-6.5 cm). The number of target tumors was solitary in 1037 and multiple in 341. The median BED10 was 105.6 Gy (75-289.6 Gy). The median DFI was 17.9 months (0-424 months). The median follow-up time was 24.3 months (0.1-143.7 months). The 3-year overall survival (OS), relapse-free survival, and local control rates were 60.3% (95%CI: 57.1-63.3%), 32.6% (95%CI: 29.7-35.5%), and 81.4% (95%CI: 78.8-83.7%). Univariate analysis showed only oligostatus, sex, PS, DFI, MTD, primary region, and histopathology were significant. The 3-year OS was 64.0% (95%CI: 60.4-67.5%) for oligo-recurrence and 50.6% (95%CI: 42.9-57.8%; p<0.001) for the others. Multivariate analysis of OS showed that only oligostatus (others/oligo-recurrence: HR 1.43), MTD (>2 cm/<2 cm, HR 1.45), histopathology (others/adenocarcinoma: HR: 1.47), and sex (male/female: HR 1.38) were significant.
Conclusion:
Pulmonary oligometastases, oligo-recurrence, female sex, adenocarcinoma, and small-sized tumor could be factors associated with longer survival.
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P1.14 - Radiotherapy (ID 700)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.14-015 - Local Recurrence Rate and Timing after Stereotactic Body Radiotherapy for Lung Cancer: Need for Long-term Follow-up (ID 8377)
09:30 - 09:30 | Presenting Author(s): Takashi Shintani
- Abstract
Background:
Local control rate by stereotactic body radiotherapy (SBRT) for stage I non-small cell lung cancer (NSCLC) has been reported to be approximately 90%. But, most studies had relatively short follow-up time, and our group has previously published preliminary report that late local recurrence (LR) might not be negligible. Thus, the aim of this study was to assess LR rate and timing after SBRT, using long-term follow-up data of large cohorts from single institution.
Method:
Eligible patients were those who were treated with SBRT (isocenter prescription of 48Gy/4fr) between April 1998 and August 2014 for primary/recurrent NSCLC < 5cm and with > 6 months follow-up time.
Result:
Figure 1A total of 213 patients (229 tumors) were analyzed. Tumor and treatment characteristics are shown in Table. Median follow-up time was 7 years [95% confidence interval (CI) 6.2–7.8]. 5-year overall survival and progression-free survival rate was 47%[95% CI 40–54] and 32%[95% CI 26–39], respectively. The number of LR was 45, and 5- and 10-year cumulative incidence of LR was 18%[95% CI 13–23] and 26%[95% CI 18–33], respectively. Clinical T stage, histology, tumor location, overall treatment time and use of cone-beam CT for patient set-up did not impact LR rate, as shown in Table. Median time to LR was 1.7 years (range: 0.6–9.5, interquartile range: 1.0–3.2) and time to LR was significantly longer in adenocarcinoma (Adeno) than in squamous cell carcinoma (SqCC) (median: 2.7 vs. 1.1 years, p=0.04). The number of late LR > 5 years after SBRT was six. The histology of tumors with late LR was Adeno/SqCC/unknown=3/1/2 (one of two unknown cases was proven to be Adeno by salvage surgery). Five of six late LRs were isolated LR as the first progression site.
Conclusion:
Late LR was not uncommon. Long-term follow-up after SBRT is needed, especially for adenocarcinoma.
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P2.05 - Early Stage NSCLC (ID 706)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.05-002 - A Pilot Study on the Safety and the Efficacy of Dose Escalation in Stereotactic Body Radiotherapy for Peripheral Lung Tumor (ID 8164)
09:30 - 09:30 | Author(s): Takashi Shintani
- Abstract
Background:
Stereotactic body radiation therapy (SBRT) is an important treatment option of solitary lung tumor. A total dose of 48Gy in 4 fractions (fr.) at the isocenter has been most widely used in Japan, however, local recurrences were observed in the long term follow-up study in 10% or more. To improve local control rates after SBRT, the most promising treatment strategy will be dose escalation. Then we started a pilot study to evaluate the safety and efficacy of dose escalation in SBRT for peripheral lung tumor.
Method:
We designed to enroll 35 patients treated with SBRT prospectively. The primary endpoint was the incidence of adverse effects within 1 year after SBRT. Adverse effects were evaluated by the CTCAE ver. 4.0. In this study, the prescription dose was 70 Gy in 4 fr. at the isocenter, covering the planning target volume (PTV) surface with 70%-isodose line.
Result:
A total of 35 patients were enrolled between October 2014 and January 2016. Patient and tumor characteristics are shown in the table. The median follow-up duration was 21.0 months (range, 4.2–31.2 months). Grade 2 radiation pneumonitis and Grade 2 rib fractures were observed in 5 patients (14.3%) and 5 (14.3%), respectively. There was no other Grade 3 or more adverse effect. Local recurrence was observed in one patient, and it was a recurrence of metastatic lung tumor. Out of 32 primary lung cancers, no local recurrence was observed.Patient and tumor characteristics
Characteristics Number % Patients 35 100 Age (y) Median (range) 77 (58-92) Gender Male 23 66 Female 12 34 ECOG performance status 0 10 28 1 22 63 2 3 9 Disease Primary lung cancer 32 91 Histology Adenocarcinoma 10 28 Squamous cell carcinoma 3 9 Clinically diagnosed 19 54 T-stage T1a 15 43 T1b 11 31 T2a 6 17 Lung metastasis 3 9 Target location Upper/middle 26 74 Lower 9 26
Conclusion:
We confirmed that the treatment method is feasible in the acute and subacute phases. It was also suggested that this method can obtain excellent local control rate.
