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A. Warner



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    O10 - Stereotactic Ablative Body Radiotherapy (ID 104)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Radiation Oncology + Radiotherapy
    • Presentations: 1
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      O10.05 - Blinded assessment of radiological changes after stereotactic ablative radiotherapy for early-stage lung cancer: local recurrences versus fibrosis. (ID 1416)

      16:15 - 17:45  |  Author(s): A. Warner

      • Abstract
      • Presentation
      • Slides

      Background
      Stereotactic ablative radiotherapy (SABR) is now a guideline-recommended treatment for early-stage lung cancer (ES-NSCLC), achieving 5-year local control rates of approximately 10%. The timely detection of local recurrence (LR) and early salvage following SABR is impaired by fibrotic changes, which occur commonly. Seven high-risk CT features (HRFs) that suggest LR include; enlarging opacity, cranio-caudal growth, sequential enlarging opacity, enlarging opacity after 12 months, bulging margin, loss of linear margin and loss of air bronchograms. We validated these, performing blinded clinician assessment in patients with and without LR.

      Methods
      ES-NSCLC patients treated with SABR, who developed pathology-proven LR (n=12), were matched 1:2 to patients without clinical LR (n=24), based on tumor location, SABR fractionation, PTV size and follow-up duration. Three radiation oncologists assessed serial follow-up CT images for HRFs, while blinded to outcomes. The sensitivity and specificity of HRFs and combinations of these were determined.

      Results
      The median follow-up was 24 months (range 6-67) and both cohorts were well matched. All HRFs were significantly associated with LR (p≤0.002), Table 1. The best individual predictor of LR was opacity enlargement after 12 months (100% sensitivity, 83% specificity), however this was detected slowest, at a median 22 months. The earliest HRF detected was cranio-caudal growth detected at a median 13 months. The HRFs enlarging opacity and cranio-caudal growth were each detected at least 3 months prior to the actual diagnosis of LR 42% of the time. The odds of LR increased 4-fold for each additional HRF detected (p<0.001). The sensitivity and specificity of detecting multiple HRFs is shown in Table 2, with ≥3 HRFs being the best predictor of LR (sensitivity 92%, specificity 92%). Figure 1 Figure 2

      Conclusion
      LR following SABR can be accurately predicted by the presence of HRFs on surveillance CT scans. This approach may reduce unnecessary confirmatory procedures, and facilitate earlier salvage treatment.

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    P3.12 - Poster Session 3 - NSCLC Early Stage (ID 206)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P3.12-013 - Radical treatment of synchronous oligometastatic non-small cell lung carcinoma (NSCLC): patient outcomes and prognostic factors. (ID 2315)

      09:30 - 16:30  |  Author(s): A. Warner

      • Abstract

      Background
      In general, metastatic NSCLC has a poor prognosis and systemic therapy is the cornerstone of treatment. However, extended survival has been reported in some patients presenting with a limited number of metastases, termed oligometastatic disease. The goal of this study was to assess outcomes for patients presenting with NSCLC and synchronous oligometastases, treated with radical intent, and to determine predictors of long-term survival.

      Methods
      A retrospective chart review was undertaken at two cancer centres, on patients with NSCLC presenting with 1-3 metastasis, who received radical intent treatment (surgery and/or radiotherapy (RT) ± chemotherapy) to the primary lung tumor including the pathological regional nodes and all sites of metastatic disease. Overall survival (OS), progression-free survival (PFS) and survival after first progression (SAPF) were evaluated. Recursive partitioning analysis (RPA) was performed based on significant factors from univariable analysis to identify different risk groups.

      Results
      Between 1999 and 2012, 61 patients were treated with a total of 74 metastases. Median follow-up was 26 months. Patients had a median age of 62 years, a median performance status of 1 and intrathoracic disease that was predominately stage III (n=38). The majority of patients had a solitary metastasis (n=50). Common sites of metastases were brain (n=47 lesions), bone (n=11), adrenal (n=4), contralateral lung (n=4) and extrathoracic lymph nodes (n=4). Treatment of the primary tumor consisted of RT ± chemotherapy in 52 patients and surgery alone or in combination with other modalities in 9 patients. Metastases were treated with stereotactic or high-dose RT (n=39) or surgery (n=22). Median OS was 13.5 months, 2-year OS was 38%. Median PFS was 6.6 months and median SAFP was 4.9 months. Predictors of improved survival were surgery for the primary lung tumor (p<0.001), and intrathoracic PTV size in patients receiving RT (p<0.03). These factors were used for RPA (Figure 1). No significant differences in outcomes were observed between the two centers. Figure 1 Figure 1. RPA flowchart for OS showing characteristics of risk groups (A) with accompanying Kaplan-Meier curves of OS by RPA risk groups (B)

      Conclusion
      Radical treatment of selected NSCLC patients presenting with 1-3 synchronous metastases can result in favorable 2-year survival, although progression in the first year was common. Outcomes were strongly associated with intra-thoracic disease status: patients with small radiotherapy treatment volumes or resected disease had the best OS. Prospective clinical trials, ideally randomized, should evaluate the role of radical treatment strategies in patients with oligometastases.