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Yukinori Matsuo
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MS 24 - Management of GGO-Containing Nodule (ID 546)
- Event: WCLC 2017
- Type: Mini Symposium
- Track: Radiology/Staging/Screening
- Presentations: 1
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MS 24.04 - Possibility of Radiotherapy for GGO-Containing Tumors (ID 7757)
15:50 - 16:10 | Author(s): Yukinori Matsuo
- Abstract
- Presentation
Abstract:
Purpose/Objective(s): The popularization of computed tomography (CT) in clinical practice have increased a frequency of discovering ground-glass opacity (GGO)-containing tumor in lung. Surgery has been regarded as the general treatment including a purpose of histological examination for such tumors and its prognosis is better than that of solid-type tumors. Stereotactic body radiation therapy (SBRT) is a rapidly prevailing treatment modality in the radical treatment of mainly inoperable or high risk operable cases with stage I non-small cell lung cancer (NSCLC), but the most tumors treated with SBRT were solid type because SBRT has been performed principally for the pathology-proven tumors and it is generally difficult to acquire histological specimen in the tumors composed of GGO. Therefore a prognosis of the stage I NSCLC cases treated with SBRT when their tumors contained GGO has not been clear. The purpose of this presentation is to review the treatment outcomes for SBRT for the patients with GGO-containing tumor in our multi-institutional SBRT study group of Japanese Radiological Society (JRS-SBRTSG), and to discuss how we consider the validity of SBRT for them. Materials/Methods: GGO was defined as hazy opacity that does not obscure underlying bronchial structures or pulmonary vessels at high-resolution computed tomography. We have reviewed 174 patients (89 men, 85 women; mean age, 74 years) treated with SBRT whose lung tumor showed appearance of GGO accompanying solid component ratio to the whole tumor (S/T ratio) less than 50 % in diameter of the tumor and no metastases. SBRT was done because of the pathological proof, positive accumulation on PET study or growth of the tumor. In histology, 69 tumors were adenocarcinoma, 8 were squamous cell carcinoma, 5 were unclassified carcinoma and 92 cases were histology-unproven. The median tumor size was 23 mm (range, 9-53 mm). SBRT was performed using non-coplanar multiple static ports or dynamic arcs. A total dose of 40 -70 Gy (6-15 Gy / fraction) was prescribed in 4-10 fractions. Median biological effective dose (BED) was 108 Gy (range, 72-150 Gy) based on alpha/beta = 10 Gy. Survival, recurrence, and metastases rates were calculated using Kaplan-Meier method. Results: Median follow-up was 32 months. The 3-year local recurrence, regional lymph-node metastases, and distant metastases rates were 3.8%, 4.1%, and 8.6%, respectively. Mean S/T ratios of the subgroup with any recurrences and the subgroup with no recurrence were 22% and 4%, respectively. The rates of cause-specific and overall survival (OS) at 3 years were 98.1% and 85.6%, respectively. The 3-year OS rates of medically operable and inoperable subgroups were 96.2% and 85.6%, respectively. The 3-year OS rate of medically operable and histology-proven subgroup was 88.1%. The 3-year OS of female subgroup was 95.0% and it was significantly better overall survival rate than male. The treatment-related pneumonitis of grade 3 or more was observed in 3.4% of the total patients. Summary and Discussion: Natural course of GGO-containing tumor is much better than that of solid-type tumors. Sublober limited resection would be acceptable in the subgroup of stage I NSCLC if the tumor appears GGO for the most part because they have mostly no invasion nor metastases. SBRT is a so localized treatment only for the tumor that a study comparing SBRT versus limited surgery without regional lymph node resection might have a rationale of randomization for such candidates, however, we have to demonstrate the prognosis and risk factors regarding recurrence, survival, and late toxicity after SBRT with longer follow-up (more than 10 years). In conclusion, the outcomes of SBRT for patients with GGO-containing tumor (solid component was less than 50 % in total diameter) were excellent but some cases had local recurrence or metastases. GGO-containing in most of the tumor seldom produced local progression, lymph node metastases, or distant metastases after SBRT. Although more cases and longer follow up are mandatory, SBRT may be one of the radical treatment options for stage I NSCLC patients with GGO-containing tumor. We hope to have a further discussion regarding the validity of SBRT for them.
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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 01.08 - Discussant - OA 01.05, OA 01.06, OA 01.07 (ID 10840)
12:15 - 12:30 | Presenting Author(s): Yukinori Matsuo
- Abstract
- Presentation
Abstract not provided
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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 | Author(s): Yukinori Matsuo
- 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): Yukinori Matsuo
- 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.
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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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P2.14-007 - Histological Difference in Outcomes of Definitive Chemoradiotherapy for non-small cell Lung Cancer (ID 8921)
09:30 - 09:30 | Author(s): Yukinori Matsuo
- Abstract
Background:
[Background] Chemoradiotherapy is the standard treatment for locally advanced non-small cell lung cancer. Histological difference has not been taken into account in the chemoradiotherapy unlike in chemotherapy for metastatic disease. The purpose of this study is to evaluate the results and relapse pattern difference between squamous cell carcinoma (Sq) and adenocarcinoma (Ad) histology.
Method:
[Methods] We retrospectively analyzed the outcomes and relapse pattern in patients who received definitive chemoradiotherapy for locally advanced non-small cell lung cancer in our institute between 2003 and 2012
Result:
[Results] There were 74 Sq patients and 36 Ad patients. Sq patients had more advanced T Stage, and less female ratio. Other factors were well balanced. Median follow-up time in all patients and surviving patients were 21.3 and 79.6 month, respectively. Median survival time was not significantly different between Sq and Ad patients (P=0.61; 20.8 and 26.7 month, respectively). Relapse pattern was different between the two histologies (P=0.0149). Locoregional, distant, and simultaneous relapse of locoregional and distant sites were observed in 32 (55.2 %), 23 (39.8 %) and 3 (5.2 %) for Sq patients; and 7(22.6 %), 20(64.5 %) and 4(12.9 %) for Ad patients, respectively. The time from relapse to death in Sq patients were shorter than Ad patients (median, 8.9 months and 14.9 months; P=0.046). Numbers of patients surviving without any relapse for 5 years or more were 9 (12.2 %) in Sq and 1 (2.8 %) in Ad. Figure 1
Conclusion:
[Conclusion] More than 10% of Sq patients could achieve relapse-free survival longer than 5 years. However, in relapsed patients, prognosis was poorer in Sq patients compared to Ad patients. Dominant pattern of relapse was locoregional in the Sq patients. More aggressive local treatment such as combination with surgery or dose escalation of radiotherapy may improve survival in Sq patients.
