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B. Reymen
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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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P2.08-007 - Five-Year Results of Concurrent Chemotherapy and Isotoxic Radiotherapy Dose-Escalation with IMRT in Stage III NSCLC (NCT01166204) (ID 9261)
09:30 - 09:30 | Author(s): B. Reymen
- Abstract
Background:
Previous studies by our group showed that that increasing the radiotherapy (RT) dose in an overall treatment time (OTT) of less than 6 weeks on basis of the isotoxic principle is feasible and could potentially increase the overall survival (OS) with non-concurrent chemo-RT without increasing the toxicity. No data were yet available for IMRT treated patients.
Method:
From 04-05 2009 until 26-04-2012, 185 patients with stage III NSCLC, treated with concurrent chemo-RT were included in this single center phase II trial. OS update was done on June 7, 2017. The primary endpoint of this study was OS, with in-field nodal failures (INF) and toxicity as secondary endpoints. Patients received 1 cycle of cisplatin-etoposide followed by two cycles of the same chemotherapy with concurrent radiotherapy (IMRT, 45 Gy BID followed by 2 Gy QD to the maximal organ at risk constraint).
Result:
Patient characteristics: Gender: Male: 61.1 %, Female: 38.9 %. Age 63.9 ± 8.9 years (44-86). Smoking: Never 2.9 %, current 36.8 %, former 60.3 %. WHO performance status: 0 (36.2 %) 1 (56.8 %), 2 11 (5.9 %), 3: 1 pt , 4:1 pt. Histology: Squamous 55 (29.7 %), Adenocarcinoma 49 (26.9 %), Large cell 26 (14.1 %), NSCLC-NOS 55 (29.7 %). GTV (T+N) 120.4 ± 132 ml (16.8-708.5), Total Tumor Dose 66.0 ± 12.8 Gy (36.0-73.0).Number of fractions: 39.7 ± 3.4 (24-44). OTT 38.2 ± 26.8 days (16-93) MLD 17.3 ± 3.0 Gy (4.9-21,2). Mean Esophageal Dose 29.0 ± 9.3 Gy (6.3-54.1). OS: stage IIIA (n=42), median 16.7 Mo (8.7-24.7), 5-year 16.7 %; stage IIIB (n=143) 20.3 (16.2-24.4), 5-year 27.3 % (P=0.10). INF: 3/185 (1.6 %). Loco-regional failures: 59/185 patients (31.8 %) Toxicity: Dyspnea Grade Baseline Maximal score 0 102 (55.1 %) 71 (38.4 %) 1 68 (36.8 %) 103 (55.7 %) 2 15 (8.1 %) 5 (2.7 %) 3 0 6 (3.2 %) 88% of patients experienced any grade of dysphagia: 22% experienced grade 1 dysphagia, 44% grade 2, while 22% experienced grade 3 dysphagia.
Conclusion:
Isotoxic accelerated radiotherapy delivered with IMRT and concurrently with chemotherapy leads to low INF and toxicity is comparable to the best series using standard fractionation schedules. Long term OS remains low and therefore other strategies are needed.
