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Y. Zheng



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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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      P1.08-023 - How to Minimize the Uncertainties of Internal Target Volume in 4DCT Scans for Stereotactic Body Radiation Therapy of Early Stage Non-small Cell Lung Cancer (ID 2832)

      09:30 - 16:30  |  Author(s): Y. Zheng

      • Abstract

      Background
      Precise definition of the target volume is one of crucial factors in the management of early stage non-small cell lung cancer (NSCLC) with stereotactic body radiation therapy (SBRT). Recent studies have shown that individualized planning margins are required to account for the variability and unpredictability of lung tumor motion. The spatial and temporal information on tumor motion can be derived with respiration-correlated 4DCT scans. In this study, we investigated how these uncertainties may be individually minimized for SBRT of NSCLC.

      Methods
      Twelve patients with early stage NSCLC who were undergoing SBRT were imaged with free-breathing 3-dimensional computed tomography (3DCT) and 10-phase 4-dimensional CT (4DCT) for delineating gross tumor volume (GTV)3D and ITV10Phase (ITV2). The maximum intensity projection (MIP) CT was also calculated from 10-phase 4DCT for contouring ITVMIP (ITV1). Then, ITVCOMB (ITV3), and ITV10Phase+GTV3D (ITV4), were generated by combining ITVMIP, ITV0% phase and ITV50% phase, ITV10phase and GTV3D, respectively. All 5 volumes (GTV3D and ITV1 to ITV4) were delineated in the same lung window by the same radiation oncologist.

      Results
      The mean (range) tumor motion (RSI, RAP, RML, and R3D ) were 6 mm (2-11 mm), 3 mm (1-4 mm), 4 mm (0-6 mm), and 7 mm (3-12 mm), respectively. The trend of volume variation was GTV3D < ITV1 < ITV2 < ITV3 ≈ ITV4 . The means ± SDs of these volumes were 10 ± 7 cc, 10 ±8 cc, 12 ± 7 cc, 11 ± 8 cc, and 12 ± 8 cc, respectively. All comparisons between the target volumes showed statistical significance ( P<0.05), except for ITV3 and ITV4 (P= 0.732). The volume of the combining ITVMIP, ITV0% phase and ITV50% phase was closed to ITV10phase plus GTV3D.

      Conclusion
      Uncertainties in individualized ITVs for SBRT of early stage NSCLC could effectively be minimized by combining information from free-breathing 3DCT and 10-phase 4DCT. If these images cannot be efficiently contoured, a combination of ITVMIP, ITV0% phase and ITV50% phase could be an effective alternative.

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    P2.06 - Poster Session 2 - Prognostic and Predictive Biomarkers (ID 165)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Biology
    • Presentations: 1
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      P2.06-039 - The Status of Epidermal Growth Factor Rceptor (EGFR) Mutation, Protein Overexpression and Gene Amplification in Esophageal Squamous Cell Carcinomas (ID 2848)

      09:30 - 16:30  |  Author(s): Y. Zheng

      • Abstract

      Background
      Epidermal growth factor receptor (EGFR) is widely distributed in human epithelial cell membrane, including esophageal squamous cell carcinoma (ESCC). The purpose of this study was to evaluate the relationship between malignant biological behavior and EGFR status in ESCC.

      Methods
      We investigated tumor specimens from 56 patients with surgically resected ESCC from 2004 through 2008. Immunohistochemistry (IHC) was performed to analyze the expression of EGFR. Fluorescence in situ hybridization (FISH) was performed to assess the EGFR gene amplification. EGFR mutations in exons 19-21 were detected by pyrosequencing technology. A chi-square test or Fisher exact test for independence was used to examine the correlation among the status of EGFR protein, gene and the several clinicopathological factors. Overall survival and disease-free survival were constructed using the Kaplan-Meier method, and the log-rank test was used to evaluate the statistical significance of differences. Multivariate analysis was performed using the Cox proportional hazard method.

      Results
      EGFR was overexpressed in 30 of 56 ESCC (53.6%) and was correlated with tumor differentiation (p=0.047) (Figure 1.). EGFR gene amplification was found in 13(23.2%) cases and was correlated with the presence of lymph node metastasis (p=0.001) and higher pathological tumor-node-metastasis (pTNM) stage (p=0.042). There was no EGFR mutation in the clinical samples of 56 patients with ESCC. In univariate analysis, there was no correlation between the prognosis and EGFR protein expression, but EGFR gene amplification was a significant predictor of better prognosis (p=0.031). The multivariate analysis revealed that EGFR gene amplification was significantly correlated with better disease-free survival (p=0.037) and overall survival (OS) (p=0.026). However, patients with EGFR gene amplification did more likely receive aggressive treatment in clinical practice.Figure 1

      Conclusion
      EGFR protein overexpression and gene amplification in ESCC were correlated with the malignant biological behavior, including tumor differentiation and lymph node metastasis. Further studies should be conducted to analyze the prognostic value of EGFR protein overexpression and gene amplification in patients with ESCC.

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    P2.09 - Poster Session 2 - Combined Modality (ID 213)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
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      P2.09-014 - Concomitant Chemoradiotherapy Using Docetaxel and Cisplatin for Unresectable Stage III Lung Squamous Cell Carcinoma (ID 2846)

      09:30 - 16:30  |  Author(s): Y. Zheng

      • Abstract

      Background
      Concomitant chemoradiotherapy is the standard treatment of unresectable stage III non-small cell lung cancer (NSCLC). However, the optimal chemotherapy regimen is still controversial, particularly in lung squamous cell carcinoma. We have conducted a phase II clinical trial in a Chinese population to evaluate concomitant treatment using docetaxel/cisplatin chemotherapy and thoracic radiotherapy followed by docetaxel/cisplatin consolidation chemotherapy in unresectable stage III lung squamous cell carcinoma. The purpose of this study is to evaluate the feasibility and activity, and also assess its impact on progression-free survival (PFS).

      Methods
      A total of 32 patients were enrolled between January 2011 and January 2013. Patients received concomitant docetaxel 30mg/m[2] on day 1 and day 8, cisplatin 25mg/m[2] on day 1 to day 3 repeated every 3 weeks for 2 cycles and thoracic radiotherapy, followed by docetaxel/cisplatin for 2 cycles as consolidation therapy (docetaxel 60mg/m[2] on day 1, cisplatin 25mg/m[2] on day 1 to day 3 repeated every 3 weeks). Objective response rate according to the RECIST criteria was recorded and toxicity was evaluated using the NCI Common Toxicity Criteria. The Kaplan–Meier method was used to evaluate patient survival. Univariate analysis of patient characteristics and tumor responses was conducted using the Chi-square and Fisher’s exact test.

      Results
      Eight (25.0%) and 20 patients (62.5%) had a complete or partial response, respectively, while 3 patient’s disease remained stable and 1 patient had progression of the disease. The overall response rate (87.2%, 95% confidence interval (CI): 63–97%) exceeded the goal per study design. The median PFS was 11.0 months (95% CI: 5.6–16.4 months). This approach obtained likely better effects than history control group. Main toxicity (grade 3 or greater, %): neutropenia 10 (31.3%); thrombocytopenia 7 (21.9%); anaemia 8 (25.0%); nausea/vomiting 5 (15.6%); anorexia 7 (21.9%), dysphagia 4 (12.5%), radiation pneumonitis 3 (9.4%) and fatigue 4 (12.5%).

      Conclusion
      This data suggests that concomitant treatment with docetaxel/cisplatin and thoracic radiotherapy was well tolerated, with promising activity in a Chinese population with unresectable stage III lung squamous cell carcinoma. Although the data presented herewith appears promising, this study is relatively small, and more data from randomized trials are needed to further validate this regimen.

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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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      P3.24-017 - The Impact of Local Radiotherapy to the Primary Site for Patients with stage IV Non-Small Cell Lung Cancer (ID 1192)

      09:30 - 16:30  |  Author(s): Y. Zheng

      • Abstract

      Background
      The prognosis of patients with non-small cell lung cancer and distant metastasis is poor. The aim of this study was to evaluate the value of local treatment to the primary site for patients with stage IV non-small cell lung cancer and oligometastatic disease at diagnosis, particularly the influence of local treatment to the primary site on prognosis.

      Methods
      From January 2004 to December 2011, 69 consecutive patients with stage IV non-small cell lung cancer treated with local palliative radiotherapy to the primary site were enrolled in this retrospective study. The prognosis factors including the patients’ general condition, disease characteristics and treatment factors were analysed. Patients were divided into two groups based on the number of distant metastases (Oligometastasis, OMT, 1-4 metastases; Polymetastasis, PMT, > 5 metastases). The relationship between the prognosis and treatment factors was explored. Overall survival was estimated using the Kaplan-Meier method, and prognostic factors were identified by univariate and multivariate analyses.

      Results
      The median overall survival was 14.1 (95%CI:7.3-20.8) months and the 1, 3-year overall survival rates were 53.0% and 9.0% , respectively. Gender, smoking index and performance status of Zubrod-ECOG-WHO were significantly associated with prognosis under univariate analysis. There was marginally significant associated with prognosis for those patients who received chemotherapy(P = 0.054) and received a sufficient dose of local palliative radiation to the primary site (at least 60Gy) (P = 0.063). On multiplicity analysis, chemotherapy and performance status retained significance. In the hierarchical analysis, patients who received at least 60 Gy of local radiotherapy to the primary site(P=0.048)(Fig 1.) and received chemotherapy (P= 0.041) achieved better overall survival in the OMT group.Figure 1

      Conclusion
      For non-small cell lung cancer with OMT, local aggressive treatment to the primary site may improve overall survival. Our results suggest that the selected non-small cell lung cancer patients with distant metastasis may benefit from aggressive local therapy.