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M. Tong
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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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P2.05-008 - Stereotactic Body Radiotherapy (SBRT) for Early Stage I Lung Cancer: A Review from an Oncology Center in Hong Kong (ID 10552)
09:30 - 09:30 | Author(s): M. Tong
- Abstract
Background:
Traditionally, patients with medically inoperable early stage non-small-cell lung cancer (NSCLC) were treated with conventional radiotherapy of 60 Gray (Gy) over 6 weeks. comparable results as surgery. Primary objective of this review was to evaluate the clinical outcomes of stage I NSCLC patients after SBRT, including 1-year, 3-year and 5-year local control, overall survival and cancer-specific survival rates. Secondary objectives were acute and late toxicities.
Method:
Patients with stage I NSCLC (tumor size ≤5cm), ECOG performance status ≤2, who were not surgical candidates (either inoperable or patient refusal) were treated by SBRT in our hospital since 2012. Tumor motions with respiratory cycles were accounted for by using four-dimensional computerized tomography. A margin of 5mm (1cm superior-inferior) was used to generate the planning target volume. A total dose of 50 or 60 Gy in 5 fractions over 2 weeks was given, depending on the location of tumors. Survival plots were produced by Kaplan-Meier estimate.
Result:
A total of 40 patients were included (male=23, 57.5%; female=17, 42.5%). Median age was 75 (range: 42-85). Half (n=20) of patients had stage Ia disease. Median gross tumor volume and planning target volume were 15.80cm3 (range:2.80-56.80cm3) and 47.6cm3 (range:12.50-117.70cm3) respectively. No concomitant systemic therapies were used. After a median follow-up of 23.6 months (range:3.5-68.6 months), twelve patients died (4 were non-cancer related). Median overall survival (OS) was 35.5 months (range:3.5-68.6 months). The 1-year, 3-year and 5-year OS was 92.4%, 48.2% and 37.2, while the cancer-specific survival was 94.7%, 53% and 40.9% respectively. Nine (22.5%) had local progressions, giving rise to the 1-year and 5-year local control rate of 87.2% and 75.3%. Acute and late toxicities occurred in 35% (n=14) and 17.5% (n=7) of patients but all are grade 1 only.
Conclusion:
SBRT in early stage I NSCLC achieves high local control rate and overall survival comparable to radical surgery. Comparing to conventional radiotherapy, SBRT is better tolerated and reduces the treatment period from 6 to 2 weeks. SBRT should be the preferred treatment for early stage NSCLC when radical surgery is not to be considered.
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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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P3.14-017a - Extra-Cranial Oligo-Progression upon 1st Line EGFR TKI in Advanced Non-Small Cell Lung Cancer Patients: Outcomes of Local Ablative Radiotherapy (ID 10096)
09:30 - 09:30 | Author(s): M. Tong
- Abstract
Background:
Continuation of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors (EGFR TKI) in stage IV Non-small cell Lung cancer (NSCLC) patients harboring sensitive mutation (Exon 19 deletion /Exon 21 L858R mutation) upon first progression according to RECIST criteria were shown to be effective in ASPIRATION study and can prolong the use of EGFR TKI for 3 months till frank disease progression. Local ablative radiotherapy (LAR) on oligo-progression is increasingly advocated but the actual effect is to be determined.
Method:
Medical and radiotherapy records of patients given LAR from 2012-2017 were screened at a single centre. Patients with stage IV NSCLC harboring sensitive epidermal growth factor receptor (EGFR) activating mutations having extra-cranial oligo-progression and given LAR were included in the study. Patients’ demographics, site of oligo-progression, radiotherapy sites and dose/fractionation schedules were captured. Durations from starting of first line EGFR TKI to LAR was calculated (PFS1). Local progression free survival (L-PFS), overall progression free survival from LAR to further progression that led to stop of EGFR TKI (O-PFS) and overall survival (OS) were analyzed with Kaplan-Meier method.
Result:
There were 15 eligible patients with total 17 sites of oligo-progressive sites treated. There were 6 male and 9 female patients. The mean age was 59.6 years (36.5-82 years). All were treated with first-generation EGFR TKIs. The median duration PFS1 was 13.0 months (6.0-36.1 months). Treatment sites included 13 lung lesions and 4 bone lesions. The mean equivalent dose (2Gy) was 105Gy (64.5-122Gy). The median follow up time was 13.3 months. Ten out of 15 patients had CEA drop after treatment, with the median duration from treatment to first drop of CEA being 1.7 months. The median L-PFS and OS were not reached. The median PFS2 was 9.7 months (2.2-15.1 months). Eight out of 10 patients had second line/ third line treatment with either afatinib/ osimertinib chemotherapy or immunotherapy. Toxicities of radiotherapy were minimal and only grade 1 pneumonitis or pain flare documented. Duration of PFS1 was not found to affect duration of O-PFS.
Conclusion:
LAR appears to be a reasonable treatment approach in the event of oligo-progression in patients with advanced NSCLC harboring activating EGFR mutations. Longer follow-up and a larger cohort are underway to assess its impact on survival.
