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K. See



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    P1.08 - Poster Session 1 - Radiotherapy (ID 195)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Radiation Oncology + Radiotherapy
    • Presentations: 1
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      P1.08-010 - NSCLC and radiation pneumonitis post radiotherapy (ID 1132)

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

      • Abstract

      Background
      Lung cancer is the main cause of cancer deaths in the developed world and non-small cell lung cancer (NSCLC) accounts for 80-85% of all lung cancers [1]. Of these with NSCLC, 30-40% have locally advanced or inoperable disease, for which the mainstay of treatment remains thoracic irradiation. Radiation pneumonitis (RP) is one of the major dose limiting toxicities. The aim of this study is to retrospectively analyse the incidence and risk factors for RP in NSCLC patients treated with radiotherapy at Royal Hobart Hospital and to determine suitable dose restriction parameters.

      Methods
      273 patients with NSCLC who had radiotherapy treatment between 2006 and 2012 were retrospectively reviewed. For each patient, all records were examined for documented evidence of RP using the Common Terminology Criteria for Adverse Events (CTCEA 4.0 [2]) grading criteria at least six months post treatment. In addition, radiation dose, dose per fraction, planning target volume (PTV), total lung volume, mean lung dose, v5, v10, v20 and v30 values were obtained and a comparable biological effective dose (BED) for each treatment was calculated. Previous chemotherapy treatments, smoking status, performance status, use of ACE inhibitors, existing cardiovascular disease, established chronic obstructive pulmonary disease (COPD) and pulmonary function tests were also obtained.

      Results
      Out of the 273 NSCLC patients treated with radiotherapy at Royal Hobart Hospital, 25 (9%) had stage 1, 15 (5%) had stage 2, 75 (27%) had stage 3 and 129 (47%) had stage 4 NSCLC. 29 (11%) patients had no staging documented. 41 patients (15%) had documented evidence of RP. Of these 41 patients, 24 patients had level 1 RP, 14 patients had level 2, 1 patient had level 3, 1 patient had level 4 and 1 patient had level 5 (death). The mean BED (normalised to 2 Gy per fraction) was 64.9 +/- 21.0 Gy and the mean lung dose was 10.3 +/- 10.50 Gy. Twenty out of the 41 patients had been treated with radical intent and 21 with palliative intent.

      Conclusion
      In this study, RP has been documented in 15% of patients. More than half of these patients received palliative radiation dose. This could be explained by their advanced disease, poor lung function, and poor performance status. References: 1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin 2008;58:71–96. 2. Common Terminology Criteria for Adverse Events (CTCEA 4.0), http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm

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    P1.22 - Poster Session 1 - Epidemiology, Etiology (ID 166)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      P1.22-003 - Lung Cancer Survival in Southern Tasmania (ID 684)

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

      • Abstract

      Background
      Lung cancer incidence and mortality are high in Tasmania; Incidence Mortality Australia (AIHW 2007) 43/100 000 34/100 000 Tasmania (Cancer Registry 2007) 58/100 000 54/100 000 There is limited published data looking at 5 year survival for primary Non-Small Cell Lung Cancer (NSCLC) particularly from Australian cohorts.

      Methods
      Local clinical practice information was collected in a prospective database. Cases presented at a multidisciplinary lung cancer meeting over a 24 month period (April 2006 -March 2008) were analysed. Patients with NSCLC were identified (n=181). Survival data was obtained for all NSCLC cases (n=181/181) via hospital and general practitioner records as well as the Registry of Births, Deaths and Marriages. Lung cancer stage was based on the 6[th] edition IASLC TNM classification. Mortality data and survival times were calculated according to clinical stage.

      Results
      Five year survival was 10.5% (19/181) for all stages of NSCLC. Stratified by stage, 5 year survival was: Stage I 25% (13/52), Stage II 25% (3/12), Stage III 6% (3/52), and Stage IV 0% (0/65). Overall median survival was 7 months and when stratified by stage was: 30 months for Stage I, 5.5 months for Stage II, 9.1 months for Stage III and 3 months for stage IV disease. Patients who underwent surgical resection with curative intent had a 60% 5 year survival (13/22) which is in keeping with other published Australian data.

      Conclusion
      The five year survival rates for Stage II, III and IV NSCLC were comparable with that of internationally published cohorts. In contrast, all-cause mortality rates for Stage I NSCLC appear higher than expected however rates of surgical cure are in keeping with published data.

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    P3.24 - Poster Session 3 - Supportive Care (ID 160)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P3.24-053 - Cause of death in early stage Non-small cell lung cancer treated with curative intent (ID 3464)

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

      • Abstract

      Background
      Lung cancer is the main cause of cancer death in men and women in Australia. Cure can be achieved by identifying patients with early (i.e. stage I and II) disease, treating them with surgery or radical radiotherapy. Despite this, the 5 year survival for stage I and II patients is reported at 60%. We looked at the cause of death in patients treated with curative intent over a 2 year period.

      Methods
      Local clinical practice information was collected in a prospective database. Cases presented at a multidisciplinary lung cancer meeting over a 24 month period (April 2006 -March 2008) were analysed. Patients with early stage NSCLC (stage I and stage II) based on the 6[th] edition IASLC TNM classification were identified (n=62). Treatment data was obtained for all identified cases (n=62/62) via hospital records. Cause of Death was determined via the death certificate as submitted to the Registry of Births, Deaths and Marriages.

      Results
      Five year survival was 25% (16/62) for early stage NSCLC. Cause of death of obtained for all but 3 patients (43/46). 74% (46/62) of patients received treatment with curative intent, 37% (23/62) surgery and 20% (13/62) radical radiotherapy. Of all patients who underwent radical treatment, lung cancer was the primary cause of death in 16% (10/46). Respiratory conditions were the second most common cause of death with 13% (6/46) attributed. The main cause was reported as pneumonia in 7 patients, COPD, IPF and Respiratory failure being others. The loss of lung from surgery or radiotherapy could be hypothesised to be a factor in these deaths due to reduce lung volume. Cardiac disease was the cause of death in 5 patients and 3 patients died due to bladder cancer, both diseases strongly associated with smoking. 1 patient died due to colonic cancer and 1 due to vascular dementia. Patients who underwent surgical resection had lower mortality rates than those who underwent radiotherapy with a 5 year survival in the surgical cohort of 60% (14/23) vs 7% (1/13) in the radical radiotherapy cohort as well as lower rates of lung cancer related death 17% (4/23) vs 46% (6/13).

      Conclusion
      Mortality in early stage lung cancer remains high in our cohort with recurrence of the lung cancer being the main cause of death. All patients were staged with PETCT prior to treatment. Diseases strongly associated with smoking were a common cause of disease as may be expected. Patients with radical therapy presenting with pneumonia are at high risk of death.