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J. Ruben
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P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.01-067 - Quality in Lung Cancer Care: The Victorian Lung Cancer Registry Pilot Initial Report (ID 1296)
09:30 - 17:00 | Author(s): J. Ruben
- Abstract
Background:
The Victorian Lung Cancer Registry is a clinical quality registry designed with the aim of improving the quality of care delivered to Victorians with lung cancer by collecting and assessing management, treatment and outcome data on all new cases of lung cancer.
Methods:
The establishment of the Victorian Lung Cancer Registry Pilot Project commenced with the appointment of a Steering Committee to provide project governance. Review of current literature and evidence-based national and international clinical practice guidelines was undertaken by an expert working group. Included data items were epidemiologically sound, reproducible and valid. The data set enables the capture of identified quality indicators designed to describe the structural quality, process quality and indicators of outcome in lung cancer management. Case ascertainment is derived from institutional ICD-10 coding and participant consent occurs via an “opt-off” system. Follow up and outcome measures are collected at baseline, 6 and 12 months after diagnosis capturing survival, treatment and quality of life. Institutional recruitment was designed to sample from metropolitan public, metropolitan private and regional hospitals.
Results:
Data was collected on 690 patients from 1 July 2012 to 31 June 2013 from 8 Victorian Hospitals (3 public and 3 private metropolitan and 2 regional). Evidence of distress screening was available for 27% of subjects. Diagnosis was confirmed < 28 days from referral in 66% of cases across institutions. A statement of ECOG status was available in 45% of cases and clinical TNM staging in 49% prior to treatment. A record of multidisciplinary team meeting presentation was available in 59% of cases. First treatment was initiated < 42 days from diagnosis in 76% of cases. Curative surgery was provided for 28% of subjects, curative chemotherapy <5% and curative radiotherapy < 5%.
Conclusion:
The evaluation of registry outcomes at governance, administrative and clinical levels may identify targets for quality and service improvement and further define safety measures. The comparison of performance outcomes across institutions and sectors may drive competitive recruitment to improve measures on a longitudinal basis.
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P2.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 213)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.03-026 - Assessing the Risk of Cardiac Toxicity with Esophageal-Sparing Intensity Modulated Radiotherapy for Locally Advanced Lung Cancers (ID 2646)
09:30 - 17:00 | Author(s): J. Ruben
- Abstract
Background:
Intensity-modulated radiotherapy (IMRT) can be used to reduce high doses to the esophagus for locally advanced non-small cell lung cancer (NSCLC), at the cost of increasing low to intermediate doses to adjacent healthy organs. Care is generally taken to ensure dose to healthy lung is minimized, resulting in IMRT not increasing lung toxicity. Such measures are not normally taken for the heart. Recently, a trial evaluating dose-escalated radiotherapy (RTOG 0617) found that overall survival was impacted by increased low (5Gy) and intermediate (30Gy) cardiac doses. We evaluated the impact of esophageal-sparing IMRT on cardiac doses and predicted toxicity compared to conventional radiotherapy (CRT).
Methods:
Ten consecutive patients with N2 Stage III NSCLC treated to 60Gy in 30 fractions, between February 2012 and September 2014, were evaluated. For each patient, CRT and esophageal-sparing IMRT plans were generated (Eclipse, Anisotropic Analytical Algorithm v11.0.31). For IMRT, treatments were planned such that no radiotherapy beams entered the contralateral lung or heart whenever possible. To compare CRT and IMRT plans, the dose delivered to more than 95% of the target (D~95%~) was compared. Doses to the esophagus, lung and heart were compared by determining the volume receiving X dose (V~XGy~) and the normal tissue complication probability (NTCP).
Results:
Seven patients had Stage IIIA disease, while three had Stage IIIB. The median PTV size was 435.5cc (range 175.0-1309.5). CRT treatment plans used 3-4 fields. IMRT plans had the same (30%), one additional (50%) or two additional fields (20%). Dosimetric and NTCP results are summarized in the table below. IMRT resulted in satisfactory target coverage in 90% of patients. In the one patient with unsatisfactory coverage, the target was adjacent to the spinal cord and IMRT improved the D~95% ~from 42.6Gy to 54.3Gy. Esophageal-sparing was achieved in every patient at all dose levels. There were statistically significant reductions in V~40Gy~ and V~50Gy~ and the NTCP for grade 2 or higher toxicity. IMRT decreased low and intermediate heart doses significantly compared to CRT. This translated into a significantly lower NTCP for cardiac mortality. The cost of this was increased low dose (5Gy) lung exposure, however this did not reach statistical significance, nor did it worsen NTCP for grade 2 pneumonitis.CRT IMRT p-value Mean Dose (Gy) Target D~95%~ 55.9 57.5 0.20 Esophagus V~60Gy~ 3.5 0 0.17 Esophagus V~50Gy~ 32 22.9 <0.01 Esophagus V~40Gy~ 36.4 27.4 <0.01 Heart V~30Gy~ 21.2 15.8 0.03 Heart V~5Gy~ 45.7 39.1 0.01 Lung V~20Gy~ 22 21.9 0.95 Lung V~5Gy~ 45.5 48 0.28 NTCP (%) Esophagus 15.4 9.9 <0.01 Heart 5.7 2.8 0.01 Lung 10.0 8.5 0.02
Conclusion:
Esophageal-sparing IMRT for locally advanced NSCLC can additionally achieve cardiac-sparing and reduce the theoretical risk of cardiac death. With careful consideration this can be achieved without compromising target coverage or increasing the risk of radiation pneumonitis.
