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M.K. Behera



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    P1.07 - Poster Session 1 - Surgery (ID 184)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P1.07-015 - Dysphagia palliation in locally advanced carcinoma esophagus: Role of Intraluminal brachytherapy. (ID 1308)

      09:30 - 16:30  |  Author(s): M.K. Behera

      • Abstract

      Background
      About 60-70 % patients present with advanced disease in carcinoma oesophagus with limited curative option. There are high local recurrence rate of 32%-45% when treated with surgery alone and 77% when radiation therapy only. So, the results of the treatment of ca oesophagus have been poor inspite of advances in various treatment modalities. A high tumour dose is needed to achieve adequate local control, which is possible by an intraluminal boost following teletherapy. The advantage of intraluminal brachytherapy as a means of dose escalation following EBRT based on inverse square law and quick dose fall off which results in relative sparing of surrounding normal tissues, and potentially improving the therapeutic ratio. Dysphagia is a potential problem. Brachytherapy is effective in palliation of dysphagia by delivering high tumoricidal dose may achieve excellent local control rate and disease free survival with acceptable toxicities.

      Methods
      Total of 40 atients with histologically proven carcinoma, tumour ≤ 5 cm in length, KPS > 50 with no prior malignancy or N0 status and unfit for surgery were taken in to the study. Intraluminal high dose rate (HDR) brachytherapy treatment was performed with the remote after loading HDR microselecton unit which contained a single cylindrical high-activity 192Ir source. Dose fractionation used 15 Gy in 3 # at 1 week interval. The prescription point was 0.5 cm from mucosal surface from the mid source. The improvement in dysphagia free scores, patterns of failure and treatment related toxicities were assessed. After treatment all patients were followed up with UGIE, barium swallow and chest X-ray at 2 months.

      Results
      Out of 40 cases analyzed, the lesion was present in mid 1/3[rd] in 18 patients, upper 1/3[rd] in 12 and involving GE junction in 10 cases. The median length of treatment was 5 cm. Gr II dyspahagia was in 34% and Gr III in 66% patients were seen. After treatment 40% of patients had improvement in dyspahgia. Stricture was found in 4 patients, ulceration in 7 and bleeding in 3 and 2 patient had trachea-esophageal fistula. Eight patients lost to follow up. Patients who had Gr II dysphagia initially had no progression in the complain. The median overall survival is 12.1 months and the median PFS was 18 months. who had initially Gr II dysphagia had no progression of dysphagia.

      Conclusion
      With dose fractionation of 5 Gy / # for 3 # and CT based planning enabled good optimisation along with decreased risk of high dose to mucosa by using 6 Fr tube, this schedule has shown effective palliation in dysphagia and few complication rates and comparable survival benefits. However a larger number of cases and a longer follow up is required.

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    P3.09 - Poster Session 3 - Combined Modality (ID 214)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
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      P3.09-001 - NSCLC in elderly patients with brain mets: Role of combined Erlotinib and Temozolomide with radiation therapy. (ID 56)

      09:30 - 16:30  |  Author(s): M.K. Behera

      • Abstract

      Background
      Non small cell lung cancer with brain metastases are usually associated with poor outcomes and survival and about 40-50% of all patients with lung cancer develop brain metastases during the course. The poor outcomes and relapses following WBRT alone indicate a need for new therapeutic options. As some patients with NSCLC have mutations in the EGFR and treating with WBRT with the anti-EGFR agent erlotinib in patients of NSCLC with brain metastases may benefit the patients in terms of disease regression and possible improvement in quality of life. Temozolomide has been already used alone or in combination with radiotherapy in the treatment of primary brain tumors and there are few studies showing its benefits in metastatic brain with WBRT. In this study we test the feasibility and efficacy of both of the drugs with WBRT.

      Methods
      A total of 12 elderly patients of biopsy proven adenocarcinoma lung with brain metastases (on MRI) were analyzed from July 2010 to March 2012. All the patients were planned for palliative radiation of 30 Gy/10#/2 weeks to local disease with WBRT of 20 Gy/5#/1 week with concurrent Temozolomide@ 75mg/m[2] followed by assessment for further therapy after 3 weeks of radiation. All the patients were evaluated 3 weekly for assessment of symptom relief and improvement or progression. After 3 weeks all the patients were started on Erlotinib@ 150 mg, daily and Temozolamide@ 150-200 mg/m[2], D1-5, 4 weekly.

      Results
      The patient's age ranged from 58 to 75 years. All the patients completed the scheduled radiation with oral steroids. Five patients progressed and died between 3 and 10 months. One patient defaulted during the radiation therapy and another after completion of 6 cycles of oral chemotherapy. Only 5 patients could complete the 12 cycles of oral chemotherapy with Temozolamide and Erlotinib, 4 weekly. Only two patient needed dose reduction of Erlotinib to 100 mg due to grade III rashes in 3rd cycle. The patients who improved after local and brain RT have shown to tolerate the further oral chemotherapy. These patients are still alive with the metastatic disease.

      Conclusion
      The combination of Erlotinib with temozolomide appears to be a promising therapy for treating brain metastases in NSCLC in terms of tolerability and efficacy. Further studies need to be done in our set up of patients.