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Olfred Hansen
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MA 17 - Locally Advanced NSCLC (ID 671)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:S. Jheon, Georgios Stamatis
- Coordinates: 10/17/2017, 15:45 - 17:30, F203 + F204 (Annex Hall)
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MA 17.15 - Discussant - MA 17.10, MA 17.11, MA 17.12, MA 17.13, MA 17.14 (ID 10792)
17:15 - 17:30 | Presenting Author(s): Olfred Hansen
- Abstract
- Presentation
Abstract not provided
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OA 01 - The New Aspect of Radiation Therapy (ID 652)
- Event: WCLC 2017
- Type: Oral
- Track: Radiotherapy
- Presentations: 1
- Moderators:M. Hiraoka, S.H. Kim
- Coordinates: 10/16/2017, 11:00 - 12:30, F201 + F202 (Annex Hall)
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OA 01.02 - Stereotactic Radiotherapy as Salvage Treatment After Surgery and Curative Intended Radiotherapy for Patients with NSCLC (ID 9618)
11:10 - 11:20 | Presenting Author(s): Olfred Hansen
- Abstract
- Presentation
Background:
Stereotactic radiotherapy (SBRT) is an efficient treatment for early stages of inoperable NSCLC. SBRT may, however, also be used as salvage treatment for recurrent disease. This retrospective study reports and compares the outcome of patients initially treated with surgery and patients initially treated with curative radiotherapy (RT).
Method:
All cases of NSCLC treated with RT with curative intent at our institution are prospectively recorded. We here report the results of 114 cases treated at our institution July 2009 to June 2016 with SBRT as salvage therapy. The doses used for peripheral located tumors have been 45-66 Gy (central doses) in 3 fractions (F) while centrally located tumors have been treated with 50-78.4 Gy/ 5-8 F. The patients have been treated with IMRT or VMAT. A group of 80 patients had surgery initially (Surg-Grp): Resection 19 (24%), lobectomy 56 (70%), bi-lobectomy 1 (1%), and pneumonectomy 4 (5%). Another group of 34 patients was initially treated with RT (RT-Grp): SBRT 30 (88%) and conformal chemo-RT 4 (12%). All patients had more than 1 year of potential follow-up.
Result:The patient characteristics
The median, 1, 2, 3, and 4 year overall survival was 50.5 mo, 85%, 72%, 59%, and 59 % in the Surg-Grp and 31.3 mo., 71%, 55%, 46%, and 46% in the RT-Grp, (p=.13).Surg-Grp RT-Grp p-value Age (yr.) 72.6 (55.1; 89.3) 71.7 (53.5; 87.1) 0.56 Female /Male 45 / 35 18 /16 0.91 PS 0-1 55 (69%) 15 (44%) PS 2 21 (26%) 15 (44%) PS 3 4 (5%) 4 (12%) Median FEV1 (L/sec) 1.54 (.39-2.72) 1.37 (.42-2.75) 0.59 Time from initial treatment to salvage treatment (mo) 22.4 (0.6; 272) 20.7 (4.4; 100) Salvage RT 45 Gy/3 F 10 (13%) 9 (26%) 66 Gy/3 F 54 (68%) 18 (53%) 50 Gy /5 F 3 (4%) 0 78.4 Gy /8 F 13 (16%) 7 (21%)
Conclusion:
SBRT gives excellent survival used as salvage therapy after surgery and curative intended radiotherapy.
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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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P2.05-001 - Does CGA Impact QoL and Overall Survival in NSCLC Patients Treated with SBRT - Results of a Randomized Pilot Study (ID 7970)
09:30 - 09:30 | Author(s): Olfred Hansen
- Abstract
Background:
Overall survival ﴾OS﴿ for medically inoperable patients with localized non‐small cell lung cancer ﴾NSCLC﴿ treated with stereotactic body radiotherapy ﴾SBRT﴿ is poorer than for patients undergoing surgery. A possible explanation is contribution of comorbidities to the mortality. Klement et al. demonstrated that comorbidity did not predict the risk of early death for patients with localized NSCLC treated with SBRT. However, it was suggested that a comprehensive geriatric assessment (CGA) could improve OS. We have performed a randomized study to investigate whether CGA added to SBRT impact quality of life ﴾QoL﴿ and OS.
Method:
From January 2015 to June 2016 51 patients diagnosed T1‐2N0M0 NSCLC were enrolled. The patients were randomized 1:1 to receive SBRT +/‐CGA. EQ‐5D QoL health-index and VAS-scores were assessed at start of SBRT, at 5 weeks, and every third months for a year after SBRT. Repeated measures ANOVA compared EQ‐5D overall scores and changes from baseline. OS was analyzed by Kaplan‐Meier methods and compared with log‐rank test.
Result:
26 vs. 25 patients were randomized in the groups +/-CGA, respectively. 4 patients dropped out. There were no differences in patient characteristics between groups. In both groups QoL decreased from baseline but with no differences between groups. VAS scores decreased significantly in the no-CGA group (Table 1). The 1-year and potential 2-year OS was 92% vs. 73% and 72% vs. 57% for the groups +/-CGA, respectively (p=0.24). Figure 1
Conclusion:
In patients treated with SBRT for a localized NSCLC, a CGA did improve the subjective opinion (VAS-score) of QoL at 12 months follow up. A CGA did not statistically improve the health index of QoL and OS. However, more patients deceased within the first 12 months after SBRT in the group without a CGA performed. This study suggests that CGA may prevent early death and improve the patients’ subjective opinion of QoL after SBRT.
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P3.13 - Radiology/Staging/Screening (ID 729)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 2
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.13-015 - 18F-FDG-PET/CT after Induction Chemotherapy for Prediction of Survival after Radical Chemo-Radiotherapy in Locally Advanced NSCLC Patients (ID 8914)
09:30 - 09:30 | Author(s): Olfred Hansen
- Abstract
Background:
The use of 18F-FDG-PET/CT is increasing for radiotherapy planning. We wanted to investigate whether 18F-FDG-PET/CT scans at this time-point can be a tool for selecting patients with locally advanced NSCLC who are likely not to benefit from radical chemo-radiotherapy in order to avoid the potentially harmful side effects in patients undergoing futile treatment, by predicting progression free survival (PFS) and overall survival.
Method:
18F-FDG-PET/CT scans before and after 2 cycles of induction chemotherapy (carboplatin/vinorelbine) from 91 patients enrolled in a Danish randomized controlled multicenter study (the NARLAL study) was retrospectively evaluated using visual evaluation. Following the induction chemotherapy patients received radical radiotherapy (66 or 66 Gy) with concomitant vinorelbine treatment as according to the NARLAL protocol. Estimates of median OS and PFS was calculated with Kaplan-Meier analysis for the response categories resulting from the visual evaluation, both considering all four response categories and separate analyses for the SMD and PMR groups. Statistical significance was tested using the log rank test, and a significance level of 0.05 was applied.
Result:
The median OS was 25.3 months (95% CI: 21.0-29.6 months), median PFS was 8.6 months (95% CI: 7.9-9.4 months). Overall survival did not differ for PFS or OS when considering all four response categories (p = 0.424 for PFS and p= 0.245 for OS). Considering only partial metabolic response (PMR) and stable metabolic disease (SMD) no difference for PFS, but we found a median OS of 22.6 (95% CI: 18.9-26.3) months for PMR and 32.4 (28.4-36.3) months for SMD (p=0.036). Stratified by histology, the effect was seen in the adenocarcinomas only.
Conclusion:
The median overall survival in patients with a partial response by 18F-FDG-PET/CT evaluation is shorter than for patients with stable disease, in adenocarcinomas. This is surprising and may suggest a differentiation of the treatment for patients with locally advanced NSCLC.
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P3.13-016 - 18F-FDG-PET/CT for Prediction of Survival after Induction Chemotherapy in Locally Advanced NSCLC – a Comparison of Methods (ID 8915)
09:30 - 09:30 | Author(s): Olfred Hansen
- Abstract
Background:
In patients with inoperable, locally advanced NSCLC, radical chemo-radiotherapy is the preferred treatment, and 18F-FDG-PET/CT is increasingly used for radiotherapy planning. Despite the introduction of the PERCIST criteria for evaluation of response with 18F-FDG-PET/CT, various methods are being used making comparisons of studies a difficult task. The aim of this study was to investigate which method for analyses of 18F-FDG-PET/CT provided the best prediction of survival.
Method:
18F-FDG-PET/CT scans before and after 2 cycles of chemotherapy from 91 patients enrolled in a Danish randomized controlled multicenter study was retrospectively evaluated using four different methods. The change in 18F-FDG-uptake was measured in a single lesion a) SULpeak (according to PERCIST) and b) SULmax (according to the EORTC criteria), c) total disease evaluation qualitatively (visual), and d) total lesion glycolysis measured in all involved measurable lesions with a 45% decrease as cut-off for response and 75% increase as cut-off for progression as according to PERCIST (%TLG). Univariate cox regression was used to evaluate a direct correlation between 18F-FDG uptake at baseline, follow-up and %change and survival (PFS and OS). Estimates of median OS and PFS was calculated with Kaplan-Meier analysis for the response categories from all four methods and, a log rank test performed for evaluation of the statistical significance. A Bonferroni correction for comparison of four methods was applied rendering a p < 0.013 the considered level for statistical significance.
Result:
There was no clear correlation between survival (neither PFS nor OS) and % change in FDG-uptake (independent of analysis method), but TLG at baseline showed the strongest correlation to both PFS (p= 0.02) and OS (p= 0.03). %TLG was the only method to show a statistically significant difference in OS, (p=0.004). Visual evaluation and change in SULpeak both succeeded in discriminating between the two largest response groups, PMR and SMD, with median OS for visual evaluation: PMR: 22.6 (95% CI: 18.9-26.3) months versus 32.4 (95% CI: 28.4-36.3) months for SMD; SULpeak: PMR: 20.6 (95% CI: 18.0-23.2) months versus 29.7 (95% CI: 24.2-35.1) months for SMD. Change in SUL max and TLG showed no difference.
Conclusion:
There was no clear correlation between PFS or OS and percentage change in FDG-uptake. The response categories for SULpeak and TLG (PERCIST criteria for cut-off), and visual evaluation predicts OS at various levels. SULmax categories as according to the EORTC criteria did not successfully predict OS. None of the methods predicts PFS.
