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J. Wang



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    P2.02 - Poster Session with Presenters Present (ID 462)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Locally Advanced NSCLC
    • Presentations: 1
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      P2.02-003 - Increased Circulating Cytokeratin-19 (Cyfra 21-1) is Predictive of Poor Outcome of Locally Advanced Squamous Cell Carcinoma in Lung (ID 4344)

      14:30 - 15:45  |  Author(s): J. Wang

      • Abstract

      Background:
      Our goal was to evaluate the prognostic significance of circulating tumour markers in locally advanced squamous cell carcinoma of lung (LA-SCCL).

      Methods:
      Eligible patients included those with histologically proven LA-SCCL, available baseline tumour marker panel analysis (carcino-embryonic antigen [CEA], carcinoma antigen 125 [CA125], squamous cell carcinoma antigen [SCC], cytokeratin-19 [Cyfra 21-1] and neuron-specific enolase [NSE]) and receiving definitive radiotherapy. Age, gender, radiation dose, baseline KPS, smoking history, weightless, TNM stage, PET staging, RT technique and treatment modality (radiotherapy alone vs. sequential chemoradiotherapy vs. concurrent chemoradiotherapy) were also retrospectively collected. To dichotomise the continuous values of tumour markers into categorical variables, ROC analysis was adopted to identify the optimal cutoff values using the progression within 2 years after diagnosis as the endpoint. Cox regression based multivariate analyses were used to select independent factors correlated with various survival endpoints. Overall survival (OS), local regional progression free survival (LRPFS) and distant metastasis free survival (DMFS) were defined as the time from diagnosis until the first occurrence of specific event: death, local-regional recurrence or distant metastasis, respectively. Progression free survival (PFS) was defined as the duration between the cancer diagnosis and the date of any progression or cancer related death.

      Results:
      A total of 216 patients with LA-SCCL were analyzed. The optimal discriminative values for CEA, CA125, SCC, Cyfra 21-1 and NSE in predicting 2-y progression were 5.3 ng/ml, 17.0 U/ml, 2.5 ng/ml, 5.2 ng/ml and 17.8 ng/ml, respectively. Univariate analyses showed that increased Cyfra 21-1 was associated with inferior OS, LRPFS, DMFS and PFS. Increased NSE was predictive of poor OS, DMFS and PFS. CEA also presented significant correlation with OS. Under multivariate analysis involving all clinical and tumour markers, IIIA stage, better performance status, CEA ≤ 5.3 ng/ml and Cyfra 21-1 ≤ 5.2 ng/ml were independently associated with improved OS. IMRT technique, RT dose ≥ 60Gy and Cyfra 21-1 ≤ 5.2 ng/ml were correlated with better LRPFS. None-smoker, IIIA stage, NES ≤ 17.8 ng/ml were favourable predictors for DMFS. IIIA stage, KPS ≥ 80 and Cyfra 21-1 ≤ 5.2 ng/ml were advantageous factors related with favourable PFS.

      Conclusion:
      Baseline tumour marker panel including Cyfra 21-1, NSE and CEA can be prognostic of OS, local and distant tumor control for LA-SCCL, and should be recommended for baseline evaluation of tumour burden.

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    SC09 - Radiotherapy for a Global Cancer (ID 333)

    • Event: WCLC 2016
    • Type: Science Session
    • Track: Radiotherapy
    • Presentations: 1
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      SC09.04 - Radiotherapy in China (ID 6636)

      16:00 - 17:30  |  Author(s): J. Wang

      • Abstract
      • Presentation
      • Slides

      Abstract:
      Cancer incidence and mortality have been increasing in mainland China, making cancer the leading cause of death since 2010 and a major public health problem in the country. Much of the rising burden is attributable to population growth and ageing and to socio-demographic changes. According to the National Central Cancer Registry of China (NCCR), an estimated 4292,000 new cancer cases and 2814,000 cancer deaths would occur in mainland China in 2015, with lung, stomach, esophageal, liver and colorectal cancer being the most five common incident cancers and the leading cause of cancer death, for which radiotherapy always plays an important role in the comprehensive therapy. The earliest record of radiation therapy for cancer in China dates back to the early 1930s. The establishment of the Sino-Belgian Radium Institute in 1931 signified the initiation of modern radiation oncology in China. However, the development of cancer treatment has been hampered by several major wars and political turmoil in the following decades until the late 1970s and early 1980s: the era of national economical reform in mainland China. It was at this point when the academic and research bodies started to focus on the availability of radiation oncology service and their access by cancer patients. In the next over 30 years, China has undergone a period of incredible economic growth and radiation oncology, has clearly improved in terms of equipment and its utilization, although the shortage of facilities and workforce remain to be improved. The Chinese Society of Radiation Oncology (CSTRO) started its survey of the personnel and equipment in radiation oncology in mainland China since 1986. The updated survey results of 2015 were recently compiled and analyzed. Comparison of these crucial data clearly demonstrates the increase in the number of the facilities as well as advances in the quality of service (Figures 1 and 2). Based on the report of the third survey (of 1997) (first English-vision survey published in the International Journal of Radiation Oncology * Biology * Physics), there were 453 radiation oncology centers equipped with 286 linear accelerators, 381 cobalt units, 179 deep X-ray machines, and 302 brachytherapy units. These facilities were staffed with 3,440 physicians, 423 physicists, and 2,245 radiation therapists. It is important to note that less than 1,200 physicians were trained at major cancer centers within the radiation oncology specialty. The rest were of other specialties (e.g., surgeons) and received only several months of “practical training” (i.e., mentorship by experienced radiation oncologist with customized lectures) in a few major cancer centers mostly in major cities such as Beijing, Shanghai, and Guangzhou, rather than formal residency training in radiation oncology. The ratio of medical physicists to radiation oncology centers was less than 1 as well. (Figure 1) The two decades after 1997 signifies a rapid advance in the quality of radiation therapy facilities as well. The number of linear accelerators exhibited a nearly 6-fold increase in these 20 years, and more facilities are now equipped with computerized treatment planning systems (increased from 177 to 1,921) as well. On the other hand, the registered radiation oncology centers were established in most of the major cities, increased to 1,431 (a 210% increase from the 1997 survey), which makes radiotherapy much more easily accessed by cancer patients. The number of radiation oncologists increased to 15841 (a 360% increase). Besides, medical physics, a crucial specialty for the quality and safety of the clinical application of radiotherapy, has substantially improved. The number of trained medical physicists has undergone a nearly 7-fold increase to 3,294 in total. (Figure 2) At the same time period for accelerated development regarding radiation therapy capacity, the population and cancer incidence of mainland China had also increased, which resulted in the radiotherapy remained much insufficient. According to the recently cancer statistics in mainland China, the cancer incidence was 4.29 million in 2015. Given that approximately 50% require RT as part of definitive treatment, around 2.15 million Chinese cancer patients need RT annually. This number is most likely higher, since it does not include recurrent and palliative indications (estimates put this number into the 65-75% range for all malignancies), and cover all the area in mainland China. In fact, the numbers of annual new radiotherapy consultation and daily treatment was 919,339 and 76,612 in 2015. Therefore, only 50% patients who would need radiotherapy received radiotherapy in Mainland China in 2015. The current status is caused by two main reasons. First, the ratio of tele-therapy facility (linear accelerator and Co60 combined) per million was 1.49 in 2015, which are quite low compared to 8.2 in the United States, 7.5 in France, 3.4 in the United Kingdom, and 2-3 recommended by the World Health Organization. Second, the distribution of radiotherapeutic resources is uneven by region. For example, the ratio in Beijing, Tianjin, Shanghai, and Shandong municipalities/province, where are considered regions of better economic development, is 3.07, 3.28, 2.19, and 2.28, respectively. Meanwhile, rural and/or less populous regions such as Tibet are often under 1.00. In conclusion, it is still obvious that cancer patients have limited access to radiotherapy facilities as well as qualified radiation oncologist, though remarkably robust development in all facets of radiation oncology over the last 30 years in mainland China. Clearly, much more effort should be made in regards to access to radiation oncology facilities and their service for cancer patients.Figure 1 Figure 1. The growth radiation therapy equipment in China from 1986 to 2015 based on the2015 CSTRO report by Lang et al. Figure 2 Figure 2. The changes in the configuration of radiotherapy team in China from 1986 to 2015 based on the 2015 CSTRO report by Lang et al. References 1. Gu XZH, Feng NY, Yu Y, et al. Investigation report on the composition of equipment and technical level of radiation therapy team in China. Radiat Oncol China. 1989, 3(1): 41-43. [Published in Chinese] 2. Yin WB, Chen B, Gu XZH, et al. General survey of radiation oncology in China. Chin J Radiat Oncol, 1995, 4(4):271-275. [Published in Chinese] 3. Yin WB, Tian FH, Gu XZH. Radiation Oncology in China: the third survey of personnel and equipment in radiation oncology. Int J Radiat Oncol Biol Phys, 1999, 44(2):239-241. 4. Yin WB, Tian FH. Survey report on national radiation therapy personnel and equipment in 2001. Chin J Radial Oncol, 2002, 11(3): 145-147. [Published in Chinese] 5. Chinese Society of Radiation Oncology (Yin WB, Yu Y, Chen B, et All). Fifth nationwide survey on radiation oncology of China in 2006. Chin J Radial Oncol, 2007, 16(1): 1-5. [Published in Chinese] 6. Chinese Society of Radiation Oncology (Yin WB, Chen B, Zhang CL, et al). The sixth nationwide survey on radiation oncology of continent prefecture of China in 2011. Chin J Radiat Oncol, 2011, 20(6): 453-457. [Published in Chinese] 7. Yin WB, Chen B, Tian FH, et al. The growth of radiation oncology in mainland China during the last 10 years. Int J Radiat Oncol Biol Phys, 2008, 70(3): 795-798. 8. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016, 66(2):115-132.





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