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J. Sonke
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MA 13 - New Insights of Diagnosis and Update of Treatment (ID 674)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:S. Ishikura, H. Nakayama
- Coordinates: 10/17/2017, 15:45 - 17:30, Room 311 + 312
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MA 13.09 - Toxicity and Second Primary Lung Cancers in Late Survivors Following Lung SBRT (ID 8410)
16:30 - 16:35 | Author(s): J. Sonke
- Abstract
- Presentation
Background:
There is a paucity of data on the long-term outcomes following lung SBRT. This impacts our understanding of late toxicity, relapse patterns and rates of second lung cancers. We report our multi-institutional outcomes of those who survived ≥5 years from lung SBRT treatment.
Method:
1192 patients were treated for primary non-small cell lung cancer, T1/2N0 from 5 international institutions. For those who survived ≥5 years from lung SBRT treatment details of patient factors, treatment and outcome factors were extracted from the multi-institutional database. All events were calculated from the end of radiotherapy. Local (LR), regional (RR), and distant metastases (DM) and toxicity events after 5 years are reported. New cases of metachronous lung cancers after 5 years are reported. Univariable analyses was performed to determine factors associated with survival ≥5 years.
Result:
Of 1192 patients there were 182 (14%) ≥5 year survivors. Only 52 (8%) survived ≥ 7 years and 2 (0.2%) ≥10 years. Those surviving ≥5 years were younger (74.3 vs 71.5 years; p<0.01) and had better FEV1 (55% vs 65%; p<0.01) than those that did not survive 5 years. The Charleston Comorbidity Score was 1.4 (0-12) vs 2.1 (0-7) (p<0.001) in those who survived < vs ≥5 years. Those who survived <5 years had a trend to larger tumors (2.4cm vs 2.3 cm; p=0.07). Of the 182 patients 23 (13%) were operable, 67 (37%) were <70 years old at treatment, 115 (63%) were ECOG 0-1 and 156 (86%) had peripheral tumor location at time of initial diagnosis. 84 (46.2%) were T1a, 60 (33%) T1b, 33 (18.1%) T2a and 5 (2.7%) T2b. After 5 years there were 13 new events of grade ≥ 2 toxicity. These toxicities were 4 grade 2 fatigue, 1 grade 2 rib fracture, 7 grade 2 chronic myositis and 1 patient with grade 2 chronic myositis and fatigue. In this 182 patient cohort, after 5 years, there were 3 local recurrences, 2 regional failures and 5 distant failures. After 5 years follow-up there were 22 (12%) new primary lung tumors in the 182 patients (and 20 had a subsequent lung SBRT treatment).
Conclusion:
Late survivors after SBRT require dedicated follow-up as they remain at risk for second lung cancer, tumor recurrence and toxicity. Second cancers in these late survivors can be considered for SBRT treatments.
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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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P3.14-005 - Treatment Response Measured on Conebeam-CT During Concurrent Chemoradiation for NSCLC Patients (ID 9814)
09:30 - 09:30 | Author(s): J. Sonke
- Abstract
Background:
The management of NSCLC-patients has evolved towards a more personalized care approach. Currently, the outcomes of concurrent chemoradiation (CCRT) in NSCLC patients are evaluated after the end of treatment, while individual treatment response during treatment is not taken into account. To pursue adaptive radiotherapy, it is important to distinguish responses during treatment and correlate this with outcome. Therefore, the aim was to identify subgroups that show a distinct treatment response during CCRT and correlate this with treatment outcome.
Method:
NSCLC-patients treated with CCRT between 2007-2013 were included. Treatment consisted of 66Gy/24 fractions with concurrent daily Cisplatin. Deformable image registration of the planning-CT to all Conebeam-CTs acquired during treatment was performed, and the gross tumor volumes on the ConeBeam-CTs were measured. Latent Class Growth Modeling was used to identify subgroups showing a distinct treatment response of the primary tumor during CCRT. Cox survival analysis was performed to assess the association of subgroup ‘membership’ with overall survival (OS) and progression free survival (PFS).
Result:
402 patients were included. Median follow-up was 63 months and median OS was 23 months (95%CI 20-26 months) and median PFS was 18 months (95%CI 15–21 month). Six different patterns of treatment response were identified (Figure1). Group 1&2 showed a relatively stable pattern during treatment. Group 5 showed tumor progression in the first week followed by sharp decrease in tumor volume. All other groups showed a decrease in tumor volume from start of treatment. Remarkably, the groups 1&5, that didn’t show a decrease in tumor volume from the beginning of treatment, had a significantly improved OS and PFS. Figure 1
Conclusion:
Six groups showing a distinct treatment response during CCRT were identified. This is an important finding to be able to pursue adaptive radiotherapy. First analyses revealed an association between tumor response during treatment and OS and PFS. In-depth analyses are warranted.
