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Fabio Y Moraes
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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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P2.14-003 - Clinical Outcomes of SBRT in Inoperable Elderly Patients with NSCLC: Experience from a Developing Country (ID 8568)
09:30 - 09:30 | Presenting Author(s): Fabio Y Moraes
- Abstract
Background:
Stereotactic body radiation therapy (SBRT) has emerged as a treatment option for patients with early-stage lung cancer, especially in the medically inoperable population. As most reported data are from developed countries, the purpose of this study was to report clinical outcomes and toxicity for SBRT in these patients from a single academic institution from Brazil.
Method:
Between January 2007 and September 2015, 102 consecutives lung lesions at Hospital Sírio–Libanês, São Paulo, were treated with SBRT, of which 59 primary non-small cell lung cancer (NSCLC) (biopsy-proven) lesions from 54 inoperable patients were reviewed from a specific registry (43 lesions were excluded: metastatic or with no biopsy). For patient immobilization, semi-rigid (vaclok based) system was used. The CTV was delineated based on CT data from 3 phases superimposed on 3-dimensional radiation treatment planning systems to obtain an internal target volume (ITV). A median dose of 54Gy (45-60Gy) was prescribed in 3 – 5 fractions per lesion and image guidance was mandatory. Treatment outcomes for in-field local control (LC) per lesions, progression free survival (PFS) and overall survival (OS) were assessed with Kaplan-Meier estimates. Toxicities were graded according to Common Terminology Criteria for Adverse Events version 4.0
Result:
Of the 54 patients analyzed, the majority were elderly (average age 75.7 years; SD ±8.8 years). More than 90% were PET/CT staged with Stage IA 40 (68%) and adenocarcinoma 46 (78,0%) representing the most common stage and histology, respectively. Median follow-up was 21,3 months (4 -55 months) for LC, 22.3 months (4 -55,8 months) for PFS, and 18.7 months (4.2 - 56,4 months) for OS. The 2-year rates of LC, PFS and OS were 89.1%, 79%, and 80.3%. Median LC, PFS, OS was 48.5 months, not reached, 41,8 months, respectively. Histology, size and stage of the primary were not a significant predictor for LC (P = 0.58; P = 0.26; P= 0.64, respectively), PFS (P = 0.81; P = 0.86; P = 0.64, respectively), or OS (P=0.21; P = 0.62; P = 0.94, respectively). Grade 3+ toxicities were observed in 2 patients (3.7%), of which 1 was grade 3 pneumonitis and one was grade 4 skin toxicity.
Conclusion:
Our data also show that SBRT is effective and feasible in a predominantly elderly and medically inoperable patient population in Brazil.
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P3.14 - Radiotherapy (ID 730)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.14-013 - Outcomes According to Marginal Tumor Dose Prescription for Small- to Medium-Sized Brain Metastases from Lung Cancer (ID 10416)
09:30 - 09:30 | Presenting Author(s): Fabio Y Moraes
- Abstract
Background:
At our institution, we commonly treat brain metastases (BM) adjacent to critical structures with a smaller dose prescription (DP) to reduce the likelihood of toxicity. We sought to evaluate the impact of DP on LF and RN for small- to medium-sized BM (≤ 2 cm) from lung cancer.
Method:
A prospective registry of BM patients treated with gamma knife SRS between 2008 and 2016 was interrogated to determine per lesion rates of LF and RN. Each lesion was followed until LF or RN or at last MRI follow-up. Defined criteria were used to differentiate LF from RN. Whole brain irradiation (WBI) was a censoring event.
Result:
From 1,465 potential subjects, 345 small- to medium-sized BM from 151 lung cancer patients were evaluated. Median radiographic follow-up was 10.2 months. Median lesion volume and diameter were 0.17 cm[3], and 0.81 cm, respectively. The DP for 71 lesions (21%) was 15 Gy, and ≥ 20 Gy (median 21 Gy; 20-24Gy) for 274(79%). Most lesions were ≤ 1 cm (65%). Median number of SRS was 2 (1-4) and 36 patients received salvage WBI. Sixteen lesions (4%) developed LF and 12 (3%) developed RN. Freedom from local failure at 1 year (FFLF) for 15 Gy, and ≥ 20 Gy, was 80%, and 95%, respectively (p=0.02). FFLF for lesions ≤1cm, and >1 cm, was 95%, and 78%, respectively (p<0.01). Freedom from RN at 1-year (FFRN) for DP 15 Gy, and ≥ 20 Gy, was 98%, and 96%, respectively (p=0.3). FFRN for lesions ≤ 1cm, and > 1 cm, was 98%, and 93%, respectively (p=0.01). FFLF and FFRN for lesions ≤1 cm and >1 cm, according to DP, are shown in Table 1.Lesion size ≤1 cm P value >1 cm P value DP DP 15 Gy ≥20 Gy 15 Gy ≥20 Gy FFLF 88.8% 96.4% 0.42 53.4% 88.2% 0.08 FFRN 100% 98% -- 98% 92% 0.43
Conclusion:
Our results suggest that, particularly for lesions >1 cm, DP ≥ 20 Gy correlates with improved FFLF, and similar FFRN rates, compared to DP 15 Gy.
