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W. Van Elmpt
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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): W. Van Elmpt
- 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.
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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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P3.14-011 - Mean Heart Dose Is an Independent Risk Factor for Early Mortality After Chemoradiotherapy Treatment for Lung Cancer (ID 10342)
09:30 - 09:30 | Author(s): W. Van Elmpt
- Abstract
Background:
Early mortality after (chemo)radiotherapy can be caused by treatment-related toxicities and thus by delivered doses to normal lung and heart tissues. However, prediction models for mortality incorporating dosimetry are lacking. This study explores the prognostic value of common dosimetric features.
Method:
Two prospective cohorts containing 218 and 181 curatively treated stage I-III lung cancer patients from 2003-2007 and 2013-2016 periods, respectively, were studied. Prescribed dose was 66Gy/2Gy (concurrent chemotherapy), 66Gy/2.75Gy (sequential or no chemotherapy) or a similar schedule. Clinical (WHO performance status, age, T stage, N stage and primary gross tumor volume (GTV)) and dosimetric (mean lung dose (MLD) and mean heart dose (MHD)) covariates were analysed. Cox regression models of survival and a logistic regression model for the 12 month mortality endpoint were optimized using forward stepwise selection (p<0.05).
Result:
Median follow-up time was 80.2 and 20.2 months in dataset 1 and 2, respectively. MHD (HR=1.023, p=0.001) and WHO performance status (HR=1.25, p=0.03) were selected in the Cox model for dataset 1. Tumor volume (HR=1.0015, p=0.001), WHO performance status (HR=1.023, p=0.02) and MHD (HR=1.0030, p=0.03) were selected in dataset 2. Adding time-dependent covariates revealed a decreasing GTV HR over time in dataset 1 (p=0.02), while MHD risk did not significantly change with time. Worse survival observed in a high MHD subgroup indeed only starts after 8 months (Figure 1). 12 month survival modeling included the covariates MHD (optimal cut-off 22Gy) and GTV (AUC=0.71). In dataset 2, these covariates and cut-off resulted in a model with AUC=0.63. Figure 1
Conclusion:
Mean heart dose is an independent risk factor for early mortality in two cohorts with different treatment periods and techniques. The best classifier for 12 month mortality risk was obtained with the MHD<22Gy constraint, which could be used in model-based implementation of proton therapy.
