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Gaurav Marwaha



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    P1 - Poster Viewing (ID 5)

    • Event: NACLC 2019
    • Type: Poster Session
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 10/11/2019, 16:45 - 18:00, Exhibit Hall
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      P1.02 - Chemotherapy with VMAT (Volumetric Modulated Arc Therapy) Radiation Therapy for Poor Risk Stage IIIA-C NSCLC Patients (ID 40)

      16:45 - 18:00  |  Author(s): Gaurav Marwaha

      • Abstract

      Background:
      Concurrent chemoradiation (CRT) for treatment of locally advanced lung cancer often leads to adverse events and discontinuation of therapy, even in healthy patients. Poor risk and/or elderly patients are often offered palliative doses of radiation and/or chemotherapy, with little chance for cure. In this single institution retrospective analysis, we examine a unique approach of curative, concurrent chemoradiation for these poor risk (defined as ECOG performance status of 2) and/or elderly patients (?80yo). Specifically, we examine the tolerability, compliance and efficacy of the regimen in a modernly treated patient population.


      Method:
      Consecutive patients treated at a single institution with the diagnosis of locally advanced (i.e. stage IIIA-C) non-small cell lung cancer (NSCLC) who were treated with four-phase concurrent chemoradiotherapy (CRT) from January 2016 to May of 2018 were included in this IRB-approved retrospective analysis. Chemoradiation was administered in four phases of 1.5 weeks each, with 1.5 week breaks in between each phase (total treatment duration of 12 weeks). All patients were treated with modern IMRT (intensity modulated radiation therapy), specifically VMAT. The primary end points were compliance (defined as completion of curative dosing of both radiation and chemotherapy), one-year overall survival, and one-year progression free survival. Survivals calculated with Kaplan Meier analyses). Analyses of adverse toxicities (CTCAE v.4) were also included in the study.


      Results:
      Twenty-seven (27) consecutive patients with median age of 74 (range: 48-84) were analyzed for this study. 36% of the patients had an ECOG score of 2. There were no ECOG 3 or 4 patients who underwent treatment. There was a 100% completion rate for patients treated with split-course CRT. The overall median survival for all patients was 13.7 months. Progression free survival was 10.7 months; and metastasis-free survival was 14.8 months. 18.5% of patient experienced grade 2 toxicities (pneumonitis, dyspnea, dermatitis, dysphagia) during treatment and there was no grade three or higher toxicities observed.


      Conclusion:
      Initial findings suggest that this unique 4-phase CRT regimen employing VMAT and interdigitated treatment breaks has an inordinately low toxicity profile (zero grade 3+ toxicities), a 100% completion rate, and favorable outcomes in a patient population who otherwise would not necessarily have curative therapy options. Prospective study of this treatment course is warranted, in addition to investigation of the adjuvant utilization of immunotherapy to maximize long-term cure rate in this patient population.