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T. Conrad
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P3.14 - Radiotherapy (ID 730)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiotherapy
- Presentations: 2
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.14-002 - Multimodality Management of Pancoast Tumors; Does Surgical Resection Need to Be Included? (ID 9654)
09:30 - 09:30 | Author(s): T. Conrad
- Abstract
Background:
Tri-modality management using chemoradiotherapy followed by surgical resection is the current standard of care for patients with pancoast tumors. Surgical resection is considered the key element to improve patient outcomes, however it involves a lengthy operative procedure with surgical/anesthetics related side effects, long period of rehabilitation, and significant additional cost. In the era of image-guided radiotherapy, we are able to paint the dose around the tumor, targeting it with a high dose of radiotherapy, while avoiding sensitive organs such as spinal cord and brachial plexus. Here we present our institutional experience treating advanced pancoast tumors with chemoradiotherapy.
Method:
Patients are usually staged with chest-abdomen CT scan, upper chest/brachial plexus MRI (if needed), brain MRI and a PET scan. Patients are treated in a supine position, using head and neck mask as the immobilization device; and cone beam image guidance. The radiation dose is 45-70 Gy in 25-35 fractions concurrent with at least 2 cycles of chemotherapy. Patients with resectable tumors have surgery done within 4-6 weeks upon completion of chemoradiotherapy. Patients are followed every 3-6 months with CT scan and/or upper chest MRI for 3 years, then yearly after.
Result:
Of 205 consecutive patients with stage 3-4 NSCLC treated with radical dose radiotherapy at Southlake regional cancer center, 9 patients with pancoast tumor were detected. Two patients (2/9) died; one from a heart attack before completion of his treatment, and the other one from tumor progression (6 months after completion of tri-modality management). All the other 7 patients are still alive and free of disease (table 1).Patients Gender Age (year) Tumor size (cm) Tumor pathology Tumor invasion Sugery RT (Dose/fraction) Date of completion RT (D/M/Y) Date of last FU 1 F 61 6.2 Squamous carcinoma T2, vessels, bone marrow No 66 Gy/33 fr 06/02/2010 13/10/2016 2 M 62 11.3 Adenocarcinoma C6-T3 ribs No 70 Gy/35 fr 05/10/2010 25/01/2017 3 M 72 9 Adenocarcinoma rib, vessels, neck No 70 Gy/35 fr 25/01/2011 29/06/2016 4 M 66 9 Squamous carcinoma C7-T5 vessels No 66 Gy/33 fr 26/01/2015 11/01/2017 5 F 58 5.6 Adeno carcinoma ribs Yes 45 Gy/25 fr 21/03/2016 25/04/2017 6 F 55 6.6 Squamous carcinoma T2-T4 rib chest wall soft tissue No 66 Gy/33 fr 04/04/2016 08/06/2017 7 F 74 4.3 Adenocarcinoma T3-T4 rib Yes 66 Gy/33 fr 26/05/2016 20/06/2017
Conclusion:
Selected patients with pancoast tumors treated with high dose radiotherapy, using image guidance, concurrent with chemotherapy may have long term disease free survival. A multi-institutional study is warranted to conclude the management recommendation for these rare tumors.
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P3.14-013 - Outcomes According to Marginal Tumor Dose Prescription for Small- to Medium-Sized Brain Metastases from Lung Cancer (ID 10416)
09:30 - 09:30 | Author(s): T. Conrad
- Abstract
Background:
At our institution, we commonly treat brain metastases (BM) adjacent to critical structures with a smaller dose prescription (DP) to reduce the likelihood of toxicity. We sought to evaluate the impact of DP on LF and RN for small- to medium-sized BM (≤ 2 cm) from lung cancer.
Method:
A prospective registry of BM patients treated with gamma knife SRS between 2008 and 2016 was interrogated to determine per lesion rates of LF and RN. Each lesion was followed until LF or RN or at last MRI follow-up. Defined criteria were used to differentiate LF from RN. Whole brain irradiation (WBI) was a censoring event.
Result:
From 1,465 potential subjects, 345 small- to medium-sized BM from 151 lung cancer patients were evaluated. Median radiographic follow-up was 10.2 months. Median lesion volume and diameter were 0.17 cm[3], and 0.81 cm, respectively. The DP for 71 lesions (21%) was 15 Gy, and ≥ 20 Gy (median 21 Gy; 20-24Gy) for 274(79%). Most lesions were ≤ 1 cm (65%). Median number of SRS was 2 (1-4) and 36 patients received salvage WBI. Sixteen lesions (4%) developed LF and 12 (3%) developed RN. Freedom from local failure at 1 year (FFLF) for 15 Gy, and ≥ 20 Gy, was 80%, and 95%, respectively (p=0.02). FFLF for lesions ≤1cm, and >1 cm, was 95%, and 78%, respectively (p<0.01). Freedom from RN at 1-year (FFRN) for DP 15 Gy, and ≥ 20 Gy, was 98%, and 96%, respectively (p=0.3). FFRN for lesions ≤ 1cm, and > 1 cm, was 98%, and 93%, respectively (p=0.01). FFLF and FFRN for lesions ≤1 cm and >1 cm, according to DP, are shown in Table 1.Lesion size ≤1 cm P value >1 cm P value DP DP 15 Gy ≥20 Gy 15 Gy ≥20 Gy FFLF 88.8% 96.4% 0.42 53.4% 88.2% 0.08 FFRN 100% 98% -- 98% 92% 0.43
Conclusion:
Our results suggest that, particularly for lesions >1 cm, DP ≥ 20 Gy correlates with improved FFLF, and similar FFRN rates, compared to DP 15 Gy.
