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Qamar Ghafoor
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P2.14 - Radiotherapy (ID 715)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiotherapy
- Presentations: 4
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.14-012 - Clinical Outcomes of the Largest UK Cohort of Cyberknife-Delivered Stereotactic Ablative Body Radiotherapy (SABR) for Primary Lung Cancers (ID 8719)
09:30 - 09:30 | Presenting Author(s): Qamar Ghafoor
- Abstract
Background:
SABR is a definitive treatment option in patients diagnosed with an early stage lung cancer. It is a suitable alternative for patients of poor performance status who may be medically inoperable. The Cyberknife (CK) machine delivers high dose, hypofractionated regimes using extensive non-coplanar beams of radiation. This enables lesions to be treated with radiobiologically higher doses, maximising local tumour control. University Hospital Birmingham has delivered the most CK-based lung SABR for any stage lung cancer in the UK. Limited data exists for outcomes following CK treated lung cancers. At our institute we reviewed a cohort of patients with early stage lung cancer treated with CK over a 30 month period looking at overall survival and local control rates to ensure this was comparable to accepted SABR outcome statistics.
Method:
A retrospective analysis was performed on 88 patients with primary lung cancer treated with CK from June 2014 to December 2016.
Result:
From the 88 patients reviewed, 1 was excluded due to lack of follow-up data. Demographic data is presented in table 1. Median follow-up was 14 months (range 0.5 to 36). Local control (LC) was achieved in 93% of patients. The median progression free survival (PFS) interval was 15 months. Overall survival (OS) at 1 year was 90% and at 3 years 72%. The median overall survival was 14 months (range 0.5 to 36). During follow-up, 14 patients progressed. However, only 6 of these progressed within the treated lesion. There were no treatment-related deaths, nor grade 3 or 4 adverse toxicities documented. Table 1 DemographicsSEX Male 52 (59%) Female 36 (41%) AGE Mean: 72 Years Range : 55- 87 ECOG PERFORMANCE STATUS 1 : 21 2: 33 3: 2 Not available: 32 TNM STAGING T1aN0M0 : 4 T1bN0M0 : 32 T2aN0M0 : 46 T2bN0M0 : 6 HISTOLOGY Adenocarcinoma : 8 Squamous: 9 NSCLC not differentiated: 2 Radiological diagnosis: 69 DOSE FRACTIONATION 50Gy/ 5# : 2 51Gy/ 3# : 1 54Gy/ 3# : 15 54Gy/ 5# : 1 55Gy/ 5# : 58 60Gy/ 8# : 11
Conclusion:
These results have proven Cyberknife radiotherapy to be a safe and effective treatment for acquiring local disease control in early lung cancers. LC rates are in line with previously published outcomes for lung SABR. OS appears better at 3 years, but this does warrant further follow up.
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P2.14-013 - Effect of Stereotactic Radiotherapy (SABR) on Pulmonary Function and Quality of Life: Results from a Tertiary Oncology Unit (ID 9076)
09:30 - 09:30 | Presenting Author(s): Qamar Ghafoor
- Abstract
Background:
Surgical resection is generally accepted as the gold standard for managing early stage lung cancer. There remains, however, a subset of patients who do not proceed to surgery. Many of these patients are ‘medically inoperable’ due to comorbidities. Others may decline surgery or their tumour is deemed inoperable due to technical difficulties. In this subset, SABR has been shown to be an effective alternative treatment option. SABR involves multiple beams, which together deliver an ablative dose of radiation to a precise area. There is rapid dose fall-off which ensures sparing of nearby structures. Evidence suggests that SABR is not associated with a clinically relevant deterioration in quality of life (QoL). The negative impact on pulmonary function is also minimal. This audit aims to assess the effect of SABR on both pulmonary function and QoL of a cohort of patients undergoing treatment in the West Midlands.
Method:
The Queen Elizabeth Hospital, Birmingham delivers SABR to patients across the West Midlands. We followed a cohort of 45 patients who received SABR between September 2016 and April 2017 for early stage lung cancer. If patients had baseline PFTs, these were repeated between 3-13 weeks post treatment. Patients had their QoL assessed using the EORTC Quality of Life Questionnaire (QLQ-C30 version 3). This was recorded at baseline, early and late follow up (defined as 13-28 days and 30-75 days post treatment respectively).
Result:
To date, twenty patients have had baseline FEV1 and FVC which was repeated post treatment. Median baseline FEV1 was 1.52 (range 0.56-2.92) and median baseline FVC was 2.63 (range 1.25-4.89). Post treatment median FEV1 was 1.34 (range 0.60-2.61) and median FVC was 2.42 (range 1.40- 3.95). Using a Wilcoxon Signed Ranks test, there was no significant difference between pre and post treatment FEV1 or FVC (Z=-0.78,p=0.43 and Z=-1.0,p=0.31 respectively). Similarly, there was no difference in DLCO pre and post treatment (Z= -0.27,p=0.79) Thirty nine patients had their baseline QoL assessed. Of these, 36 had this repeated at early follow-up and 31 at late follow up. Median QoL score at baseline, early and late follow up was 66/100, 54/100 and 50/100 respectively. There was no significant difference in either early or late QoL compared to baseline (Z=-0.49,p=0.63 and Z=-0.15,p=0.88).
Conclusion:
Overall this study shows no significant difference in either PFTs or QoL in this cohort of patients undergoing SABR in Birmingham. These results compare favourably with other published data and are reassuring for our practice
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P2.14-014 - Does Histological Subtype Affect Outcomes in Stereotactic Ablative Body Radiotherapy (SABR) for Lung Tumours? (ID 9542)
09:30 - 09:30 | Presenting Author(s): Qamar Ghafoor
- Abstract
Background:
The majority of patients offered lung SABR have a radiological diagnosis of primary lung cancer only. This is commonly due to poor performance status, multiple co-morbidities, poor lung function or medical inoperability rendering them unsuitable for lung biopsy. Local control rates (LCR) for SABR-treated lung lesions are in the order of > 90% at 12 months. Little data exists on whether histological subtype affects this or overall survival (OS).
Method:
We retrospectively analysed local control and survival data on all patients treated for primary lung cancer with SABR (using volumetric modulated arc therapy (VMAT) technique) at our tertiary centre over a 4-year period from May 2013 until February 2017.
Result:
153 patients in total were treated, with follow-up data available for 135 patients. Baseline demographic data and analysis are presented in table 1. Median follow-up was 13 months (range 0.5 to 45). The LCR in treated lesions for all patients was 95.2%. Squamous cell carcinomas (SCC) had a better LCR when compared to adenocarcinomas (100% vs 92.8%). Median OS for all patients was 13 months (range 0.5 to 45). By histological subtype, SCC had better OS when compared to adenocarcinomas (15.5 months vs 12.5 months). 35.7% of adenocarcinomas progressed either within the thorax or at distant sites compared to only 12.5% of SCC. However, in 93% of adenocarcinomas and 100% of SCC the original treated lesion did not progress. Those with no histology had LCR of 95% with a median OS of 12 months respectively.Table 1
SEX Male – 82 (53.6%) Female – 71 (46.4%) AGE Mean – 73 Range – 48-92 PERFORMANCE STATUS (PS) PS 0 – 4 (2.6%) PS 1 – 66 (43.1%) PS 2 – 60 (39.2%) PS 3 – 6 (3.9%) Not recorded – 17 (11.1%) DISEASE T-STAGE T1a – 100 (63.4%) T1b – 29 (18.9%) T2a – 24 (15.7%) HISTOLOGY Adenocarinoma – 15 (9.8%) Squamous cell – 8 (5.2%) NSCLC not specified – 2 (1.3%) Large cell – 1 (0.7%) Carcinoid – 1 (0.7%) No histology – 126 (82.3%) DOSE/FRACTIONATION 54Gy/3 – 38 (24.9%) 55Gy/5 – 103 (67.3%) 60Gy/8 – 12 (7.8%) MEDIAN OVERALL SURVIVAL BY HISTOLOGY Adenocarcinoma – 12.5 months (range 3 to 38) Squamous cell – 15.5 months (range 1 to 43) NSCLC not specified – no follow-up data available Large cell – 18 months (1 patient only) Carcinoid – 14 months (1 patient only) No histology – 12 months (range 0.5 to 45) LOCAL CONTROL RATE BY HISTOLOGY Adenocarcinoma – 92.8% Squamous cell – 100% NSCLC not specified – no follow-up data available Large cell – 100% Carcinoid – 100% No histology – 95.0%
Conclusion:
Our data suggests a trend towards slightly better OS and LCR with SCC over adenocarcinomas. More adenocarcinomas progressed both locally and at distant sites than SCC did. This information may be useful prognostically and it suggests adenocarcinomas may need closer follow-up post-SABR. Overall, our LCR is in line with published data.
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P2.14-015 - Outcomes for Stereotactic Ablative Body Radiotherapy (SABR) for Early Primary Lung Cancers: Cyberknife Versus VMAT Platform (ID 9550)
09:30 - 09:30 | Presenting Author(s): Qamar Ghafoor
- Abstract
Background:
SABR has become a commonly used treatment for early stage lung cancers, particularly in patients not suitable for radical surgery. It provides excellent local tumour control and is well-tolerated. At our institute, we have two platforms to deliver SABR; Linac-based volumetric modulated arc therapy (VMAT) and Cyberknife (CK). Little data exists directly comparing these two in terms of local control (LC) and overall survival (OS), thus, we performed an analysis to ascertain whether one platform outperforms the other. We have conducted lung SABR using VMAT since June 2013 and CK since June 2014.
Method:
We retrospectively analysed data on all early stage primary lung cancer patients treated with lung SABR from June 2013 to February 2017. Demographic and survival data was collected.
Result:
241 patients were treated in total, 153 using VMAT and 88 using CK. 19 patients were excluded from analysis due to lack of follow-up data (18 VMAT, 1 CK). Median follow-up for all patients was 13 months (range 0.5 to 45). Age, sex and histological breakdown were similar for the two groups. The majority in both groups were treated based on a radiological diagnosis. In terms of staging, there were more T1 tumours treated with VMAT than CK due to our local departmental policy excluding tumours less than 2cm being considered for CK. LC was 95.2% for VMAT compared to 93% for CK at median follow-up. Median OS was 13 months for VMAT compared to 14 months for CK. We saw a higher proportion of disease progression (local or distant) in the VMAT group (25.8% versus 17.0%). Lung cancer related deaths were equal in both groups (8.9% VMAT versus 8.0% CK). Neither platform had any grade 3 or higher toxicities reported.
Conclusion:
We demonstrated both treatment modalities were well tolerated by patients and produced similar LC and OS outcomes. In those where the disease progressed, within the CK group a higher proportion of them progressed within the treated lesion, whereas in the VMAT group it was at other sites (ie new lung nodules or distant metastases). This could be due to staging and the fact the CK group featured significantly more T2 tumours. Overall, both treatment modalities gave comparable outcomes to surgery when looking at LC.
