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M. Snee
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P2.01 - Advanced NSCLC (ID 618)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:00 - 16:00, Exhibit Hall (Hall B + C)
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P2.01-060 - Outcomes Following Gamma Knife Radiosurgery in Patients with Non-Small Cell Lung Cancer with Brain Metastases (ID 8056)
09:00 - 09:00 | Author(s): M. Snee
- Abstract
Background:
Gamma knife (GK) radiosurgery is a common treatment for brain metastases from non-small cell lung cancer (NSCLC). This study reports outcome results for patients with synchronous brain metastases and delayed brain metastases from NSCLC at Leeds Cancer Centre (LCC).
Method:
Data was obtained by retrospective case note review for 72 patients, who were all treated with GK from 2009 until 2014. Radical thoracic therapy (surgery, chemoradiotherapy or stereotactic ablative radiotherapy) was also undertaken for 58 patients. Statistical analysis using Kaplan-Meier curves was performed to estimate time to intracranial progression, survival from diagnosis of brain metastases, and overall survival.
Result:
Demographic data identified a median age of 65 years (range 43 – 83 years). For patients with delayed brain metastases (47 patients), TNM stage at diagnosis was stage I (7 patients), stage II (11 patients), stage IIIA (12 patients) or stage IIIB/IV (17 patients). Histology was majority adenocarcinoma (50%) or squamous cell carcinoma (22%). The median time to intracranial progression for all patients treated with GK was 9 months. In patients treated with radical thoracic therapy, of which 88% completed treatment, the median survival from diagnosis of brain metastases was 15 months for those with synchronous brain metastases (18 patients), and 14 months for those with delayed brain metastases (40 patients). In those with synchronous brain metastases, 83% received GK prior to radical thoracic therapy (median survival 18 months vs. 14 months for delayed GK). In those with intracranial progression following GK prior to death, 25% were treated with salvage GK with a median survival of 23 months. This compares to 18 months for those treated with salvage whole brain radiotherapy and 8 months for those not suitable for salvage treatment. The overall median survival for patients treated with combination radical thoracic therapy and GK at LCC was 21 months (median survival in synchronous brain metastases at diagnosis = 16 months vs. median survival in delayed brain metastases = 27 months).
Conclusion:
In conclusion, GK radiosurgery is an effective treatment for brain metastases in NSCLC. Beneficial effects are seen in patients with synchronous and delayed brain metastases, demonstrating its role in a wide subset of patients with advanced NSCLC. Use of GK, in combination with radical thoracic therapy, therefore has the potential to dramatically improve survival in patients who may not have previously been suitable for radical treatment.
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P2.08 - Locally Advanced Nsclc (ID 709)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.08-003 - An Audit of Concurrent Chemoradiotherapy for Non-Small Cell Lung Cancer at the Leeds Cancer Centre (LCC) (ID 9547)
09:30 - 09:30 | Author(s): M. Snee
- Abstract
Background:
Concurrent chemoradiotherapy is the standard non surgical management of locally advanced NSCLC. Radiation pneumonitis is a well recognized complication of lung radiotherapy. This retrospective study examines the clinical outcomes and treatment toxicities of patients treated with chemoradiotherapy(CRT) for NSCLC in 2014 at the LCC in UK.
Method:
Data was retrospectively collected from patients with locally advanced NSCLC treated with concurrent CRT from 1/1/14-31/12/14 at LCC. Patients received 3-D conformal radiotherapy to a dose of 60-66Gy/30-33# over 6-6.5 weeks. Individual patient’s clinical data was reviewed on Patient Pathway Manager for tumour and patient demographics. Radiotherapy dosimetric data were studied with V20, mean lung dose(MLD) and PTV volume. Treatment associated haematological toxicities and radiation pneumonitis were analysed. Overall and progression free survival were calculated. In addition, correlations between clinical/dosimetry parameter and clinical diagnosis of radiation pneumonitis were analysed.
Result:
58 patients were included in the study. Median follow up was 18.6 months. 66% of patients received weekly carboplatin/paclitaxel and the rest received 3 weekly cisplatin or carboplatin with etoposide. 78% of patients completed both chemotherapy and radiotherapy. For all radiotherapy plans, median V20 was 20.9Gy (range 3.4-29.8Gy), median MLD was 12.8Gy (range 2.3-16.5Gy) and median PTV was 395cc (range 73-819cc). 34% of patients developed grade 3-4 neutropenia, 64% grade 3-4 lymphopenia and 5% grade 3-4 thrombocytopenia. Neutropenic sepsis occurred in 10% of patients with one grade 5 toxicity. Radiation pneumonitis was diagnosed in 17% of patients, all below grade 3. Median time to pneumonitis was 133 days post radiotherapy. Radiation pneumonitis correlated strongly with V20(r = 0.93). Correlations with MLD and PTV were less. There were no correlations with neutropenia, lymphopenia or thrombocytopenia during treatment. 2/3 of the recurrences were distant metastases. 90 day mortality was 5%(three patients died from oesophageal perforation, colitis and pneumonia). The median progression free survival was 20.1 months. The median overall survival was not reached.
Conclusion:
At the LCC, chemoradiotherapy has been a safe and effective treatment for locally advanced lung cancer. Consistent with existing evidence, V20 remains the most powerful predictor of radiation pneumonitis following lung radiotherapy.
