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C. Le Pechoux
Moderator of
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Advances in radiation (ID 14)
- Event: ELCC 2018
- Type: Specialty session
- Track:
- Presentations: 4
- Moderators:J. Bradley, C. Le Pechoux
- Coordinates: 4/12/2018, 11:00 - 12:30, Room X
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MRI guided radiation therapy (ID 59)
11:00 - 12:30 | Presenting Author(s): S. Senan
- Abstract
- Presentation
Abstract not provided
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Role of carbon therapy for lung cancer (ID 61)
11:00 - 12:30 | Presenting Author(s): Y. Nakayama
- Abstract
- Presentation
Abstract not provided
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Role of proton therapy for lung cancer (ID 60)
11:00 - 12:30 | Presenting Author(s): J. Bradley
- Abstract
- Presentation
Abstract not provided
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Stereotactic radiotherapy (SBRT/SABR): State of the art in 2018 (ID 58)
11:00 - 12:30 | Presenting Author(s): F. Mornex
- Abstract
Abstract not provided
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How to prioritise the use of biomarkers (ID 29)
- Event: ELCC 2018
- Type: Educational session
- Track:
- Presentations: 4
- Moderators:C. Le Pechoux, M. Tsao
- Coordinates: 4/13/2018, 16:45 - 18:15, Room C
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Clinical oncologist’s perspective on biomarker testing by next generation sequencing (ID 117)
16:45 - 18:15 | Presenting Author(s): J.C. Yang
- Abstract
Abstract not provided
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Lung cancer biomarkers relevant to thoracic surgery practice (ID 119)
16:45 - 18:15 | Presenting Author(s): P. Van Schil
- Abstract
- Presentation
Abstract not provided
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Pathologist’s challenges in biomarker testing (ID 120)
16:45 - 18:15 | Presenting Author(s): M. Tsao
- Abstract
- Presentation
Abstract not provided
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The value of circulating tumour DNA testing in radiotherapy (ID 118)
16:45 - 18:15 | Presenting Author(s): C. Le Pechoux
- Abstract
- Presentation
Abstract not provided
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Limitations and advances of thoracic radiotherapy (ID 58)
- Event: ELCC 2018
- Type: Proffered Paper session
- Track:
- Presentations: 4
- Moderators:C. Le Pechoux, S. Senan
- Coordinates: 4/12/2018, 15:00 - 16:00, Room B
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Invited Discussant 110O, 111O and 131O (ID 688)
15:00 - 16:00 | Presenting Author(s): C. Le Pechoux
- Abstract
- Presentation
Abstract not provided
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- Abstract
Background:
RTOG0617 found higher radiation dose does not benefit patients with unresectable stage III non-small cell lung cancer (NSCLC). To investigate the potential benefit of individual isotoxic dose escalation based on normal tissue constraints (NTC), hypothesizing that high-dose radiation therapy would be superior to standard-dose in concurrent chemoradiotherapy for unresectable stage III NSCLC.
Methods:
Data from two prospective clinical trials were merged for analysis. Individually prescribed radiation doses were calculated based on NTC. Patients with total radiation doses ≥66 Gy were assigned to the high-dose group (H-D, ≥66 Gy), and all other patients were assigned to the standard-dose group (S-D, <66 Gy). Intensity modulated radiation therapy plans were optimized to minimize the volumes of organs at risk exposed to radiation. The primary endpoint was overall survival.
Results:
From March 2006 to September 2012, 140 patients were enrolled and assigned to one of two groups: 71 patients into the H-D group and 69 patients into the S-D group. The median survival time (MST) was significantly higher in the H-D group (33.5 months) than in the S-D group (17 months), (p < 0.0001). Overall 5-year survival rates were significantly higher in the H-D group than in the S-D group (38.0% vs. 12.3%). Median progression-free survival was 19 months in the H-D group and 11 months in the S-D group (p < 0.0001). No difference in severe (grade 3–5) toxic effects was noted between the two groups.
Conclusions:
The dose-escalated radiation concurrent with chemotherapy showed an significant advantage in MST and survival rates over standard-dose. This individualized isotoxic dose chemoradiotherapy strategy may be a promising method for unresectable stage III NSCLC patients.
Clinical trial identification:
Legal entity responsible for the study:
Shandong Cancer Hospital
Funding:
This study was supported in part by National Nature Science Foundation of China (Grant NO. 81530060), and The National Key Research and Development Plan (Grant NO. 2016YFC0105106).
Disclosure:
All authors have declared no conflicts of interest.
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111O - Impact of cardiac doses on survival of non-small cell lung cancer (NSCLC) patients following radical accelerated radiotherapy (ID 559)
15:00 - 16:00 | Presenting Author(s): M. Hatton | Author(s): S. Robinson, J. Bradshaw, S. Riley, T. Das, C. Lee, P. Fisher, E. Bates, S. Tozer-Loft, B. Tahir
- Abstract
- Presentation
Background:
RTOG 0617 identified cardiac dose-volume metrics as independent predictors of survival for locally advanced NSCLC patients following chemoradiotherapy with conventional and dose escalated regimes. Accelerated radiotherapy schedules such as continuous hyperfractionated accelerated radiotherapy (CHART) are widespread in the UK. In this single-centre retrospective analysis, we study the impact of cardiac dosimetry on survival of early stage and locally advanced patients radically treated with accelerated radiotherapy.
Methods:
We reviewed the records of all stage I-III NSCLC patients treated at our institution with radical accelerated radiotherapy (CHART, 54 Gy/36# over 12 days; hypofractionated, 55 Gy/20# over 4 weeks) between 2010 and 2015. Patient demographics, tumour characteristics, survival and dosimetric data were recorded. Cardiac dosimetric parameters included heart V5, V30, V33, V50, V67, V100 and mean dose. The impact of these metrics on survival was assessed using Cox regression.
Results:
We identified 563 patients treated of whom 294 had cardiac dosimetric data for analysis. For these patients, 55% were male with a mean age of 72. The percentage of patients with stage I, II and III disease were 33%, 16% and 51%, respectively. 60% had a WHO performance status of 0–1. 124 received CHART and 171 received hypofractionated radiotherapy. 2 year overall survival was 48% with a median overall survival of 22.5 months. On univariate analysis, gender, stage, tumour recurrence, PTV volume and all cardiac dosimetric parameters were significantly associated with survival. However, multivariate analysis identified only PTV volume and heart V30, V33, V50 and mean dose as independent predictors of survival with mean heart dose being the most predictive (HR = 1.027, 95% CI = 1.002–1.053, p = 0.032).
Conclusions:
We identified several cardiac dosimetric parameters as independent predictors of survival following accelerated radiotherapy. Consequently, minimising cardiac dose may improve outcomes and warrants further study.
Clinical trial identification:
Legal entity responsible for the study:
Weston Park Hospital
Funding:
Sheffield Hospital Charity
Disclosure:
All authors have declared no conflicts of interest.
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- Abstract
- Presentation
Background:
The survival advantage of radiotherapy (RT) for patients with stage IV non-small cell lung cancer (NSCLC) has not been adequately evaluated.
Methods:
We analyzed stage IV NSCLC patients enrolled from the Surveillance, Epidemiology, and End Results (SEER) registry through January 2010 to December 2012. Propensity score (PS) analysis with 1:1 nearest neighbor matching method was used to ensure well-balanced characteristics of all comparison groups by histological types and metastatic sites. Kaplan-Meier and Cox proportional hazardous model were used to evaluate the overall survival (OS) and cancer-specific survival (CSS).
Results:
There was a trend towards improved OS and CSS using radiotherapy to stage IV NSCLC patients for any metastatic sites and for any histological types except AD. Radiotherapy significantly improved the survival of NSCLC patients with metastasis to brain (P < 0.001), especially for adenocarcinoma (AD) (P < 0.001). For stage IV lung cancer patients with squamous cell carcinoma (SQC), radiotherapy for any metastatic sites could universally improve the OS (P < 0.001) and CSS (P < 0.001). In particular, radiotherapy also was associated with improved OS (P < 0.001) and CSS (P = 0.012) for stage IV patients with metastases of two or more site, i.e., poly-metastatic disease. Furthermore, for those stage IV SQC patients without metastasis, radiotherapy, most likely to the primary site, also significantly improved the survival (P < 0.001).
Conclusions:
The results support the idea that radiotherapy might improve the survival of patients with metastatic NSCLC in a PS-matched patient cohort from the large SEER database. It is prudent to carefully select patients for radiotherapy in metastatic NSCLC.
Clinical trial identification:
Legal entity responsible for the study:
Dr. Zhenming Fu, Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
Funding:
National Science Foundation of China (NSFC)
Disclosure:
All authors have declared no conflicts of interest.
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Author of
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How to prioritise the use of biomarkers (ID 29)
- Event: ELCC 2018
- Type: Educational session
- Track:
- Presentations: 1
- Moderators:C. Le Pechoux, M. Tsao
- Coordinates: 4/13/2018, 16:45 - 18:15, Room C
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The value of circulating tumour DNA testing in radiotherapy (ID 118)
16:45 - 18:15 | Presenting Author(s): C. Le Pechoux
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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Immunotherapy and next-generation TKIs: From second to frontline treatment (ID 55)
- Event: ELCC 2018
- Type: Poster Discussion session
- Track:
- Presentations: 1
- Moderators:P. Garrido Lopez, S. Ekman, S. Ortiz-Cuaran, E. Wauters
- Coordinates: 4/12/2018, 07:45 - 09:00, Room A
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144PD - Leptomeningeal metastases in EGFR-mutated non-small cell lung carcinoma: Management after tyrosine kinase inhibitors (ID 611)
07:45 - 09:00 | Author(s): C. Le Pechoux
- Abstract
Background:
Leptomeningeal metastases (LM) in non-small-cell lung carcinoma (NSCLC) are associated with poor outcome. Tyrosine kinase inhibitors (TKIs) are active in LM+ EGFR mutated (EGFRm) patients (pts), but optimal patient's management after failure of TKIs is unknown.
Methods:
We included consecutive pts with EGFRm NSCLC who had LM progression during first-line EGFR TKI, defined as diagnosis of LM during TKI treatment or progression of known LM after first-line TKI, treated in our institution. Clinical and pathological data were retrospectively collected. We evaluated overall survival (OS), progression-free survival (PFS), clinical response rate (CRR), and disease control rate (DCR) defined as clinical response or stable disease >2 months.
Results:
We included 66 pts treated between Apr. 2003 and Sept. 2016, with a median age of 54 years [26–79]; 51 (77%) were females; 56 (85%) non-smokers. Twenty-three tumors (35%) had exon 19 deletion, 23 (35%) L858R exon 21 mutation, 10 (15%) T790M mutation. Median number of previous lines was 2 [1–7], and 19 pts (29%) had additional intrathecal treatment. 2[nd] line TKI was given to 36 pts (55%): 19 (53%) received erlotinib, 10 (28%) high dose (HD) erlotinib (300 mg daily), 3 osimertinib, 4 other 1[st]/2[nd] generation TKI (3 gefitinib, 1 afatinib). Median PFS and OS from LM progression were 3 months (m) [CI95% 2–3] and 7 m [CI95% 3–16], respectively. CRR and DCR for 2nd-line TKI were 43% and 77%. Nine pts (25%) were alive at 10 m (6 erlotinib, 1 HD erlotinib, 2 osimertinib). Median OS for erlotinib, HD erlotinib, osimertinib and other 1[st]/2[nd] generation TKI were 8 m (CI 95% 7–16), 3 m (CI 95% 2-not reached (NR)), NR (CI 95% NR-NR), and 2.5 m (CI 95% 0-NR), respectively. Patients treated with erlotinib, of whom 79% received prior afatinib or gefitinib, had better OS compared to patients treated with other 1[st]/2[nd] generation TKI (8 m vs. 2.5 m, P = 0.04). CRR and DCR in patients with HD erlotinib were 40% and 60%, respectively, of whom 80% received prior erlotinib.
Conclusions:
2[nd]-line TKI can increase survival in LM+ EGFRm NSCLC previously treated with TKI. Sequential erlotinib after prior gefitinib or afatinib seems to be a suitable strategy. Increasing erlotinib dose has demonstrated clinical benefit.
Clinical trial identification:
Legal entity responsible for the study:
Gustave Roussy
Funding:
Has not received any funding
Disclosure:
All authors have declared no conflicts of interest.
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Limitations and advances of thoracic radiotherapy (ID 58)
- Event: ELCC 2018
- Type: Proffered Paper session
- Track:
- Presentations: 1
- Moderators:C. Le Pechoux, S. Senan
- Coordinates: 4/12/2018, 15:00 - 16:00, Room B
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Invited Discussant 110O, 111O and 131O (ID 688)
15:00 - 16:00 | Presenting Author(s): C. Le Pechoux
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
