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Stefan Starup Jeppesen



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    OA 01 - The New Aspect of Radiation Therapy (ID 652)

    • Event: WCLC 2017
    • Type: Oral
    • Track: Radiotherapy
    • Presentations: 1
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      OA 01.02 - Stereotactic Radiotherapy as Salvage Treatment After Surgery and Curative Intended Radiotherapy for Patients with NSCLC (ID 9618)

      11:00 - 12:30  |  Author(s): Stefan Starup Jeppesen

      • Abstract
      • Presentation
      • Slides

      Background:
      Stereotactic radiotherapy (SBRT) is an efficient treatment for early stages of inoperable NSCLC. SBRT may, however, also be used as salvage treatment for recurrent disease. This retrospective study reports and compares the outcome of patients initially treated with surgery and patients initially treated with curative radiotherapy (RT).

      Method:
      All cases of NSCLC treated with RT with curative intent at our institution are prospectively recorded. We here report the results of 114 cases treated at our institution July 2009 to June 2016 with SBRT as salvage therapy. The doses used for peripheral located tumors have been 45-66 Gy (central doses) in 3 fractions (F) while centrally located tumors have been treated with 50-78.4 Gy/ 5-8 F. The patients have been treated with IMRT or VMAT. A group of 80 patients had surgery initially (Surg-Grp): Resection 19 (24%), lobectomy 56 (70%), bi-lobectomy 1 (1%), and pneumonectomy 4 (5%). Another group of 34 patients was initially treated with RT (RT-Grp): SBRT 30 (88%) and conformal chemo-RT 4 (12%). All patients had more than 1 year of potential follow-up.

      Result:

      The patient characteristics
      Surg-Grp RT-Grp p-value
      Age (yr.) 72.6 (55.1; 89.3) 71.7 (53.5; 87.1) 0.56
      Female /Male 45 / 35 18 /16 0.91
      PS 0-1 55 (69%) 15 (44%)
      PS 2 21 (26%) 15 (44%)
      PS 3 4 (5%) 4 (12%)
      Median FEV1 (L/sec) 1.54 (.39-2.72) 1.37 (.42-2.75) 0.59
      Time from initial treatment to salvage treatment (mo) 22.4 (0.6; 272) 20.7 (4.4; 100)
      Salvage RT
      45 Gy/3 F 10 (13%) 9 (26%)
      66 Gy/3 F 54 (68%) 18 (53%)
      50 Gy /5 F 3 (4%) 0
      78.4 Gy /8 F 13 (16%) 7 (21%)
      The median, 1, 2, 3, and 4 year overall survival was 50.5 mo, 85%, 72%, 59%, and 59 % in the Surg-Grp and 31.3 mo., 71%, 55%, 46%, and 46% in the RT-Grp, (p=.13).

      Conclusion:
      SBRT gives excellent survival used as salvage therapy after surgery and curative intended radiotherapy.

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    P2.05 - Early Stage NSCLC (ID 706)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Early Stage NSCLC
    • Presentations: 1
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      P2.05-001 - Does CGA Impact QoL and Overall Survival in NSCLC Patients Treated with SBRT - Results of a Randomized Pilot Study (ID 7970)

      09:30 - 16:00  |  Presenting Author(s): Stefan Starup Jeppesen

      • Abstract
      • Slides

      Background:
      Overall survival ﴾OS﴿ for medically inoperable patients with localized non‐small cell lung cancer ﴾NSCLC﴿ treated with stereotactic body radiotherapy ﴾SBRT﴿ is poorer than for patients undergoing surgery. A possible explanation is contribution of comorbidities to the mortality. Klement et al. demonstrated that comorbidity did not predict the risk of early death for patients with localized NSCLC treated with SBRT. However, it was suggested that a comprehensive geriatric assessment (CGA) could improve OS. We have performed a randomized study to investigate whether CGA added to SBRT impact quality of life ﴾QoL﴿ and OS.

      Method:
      From January 2015 to June 2016 51 patients diagnosed T1‐2N0M0 NSCLC were enrolled. The patients were randomized 1:1 to receive SBRT +/‐CGA. EQ‐5D QoL health-index and VAS-scores were assessed at start of SBRT, at 5 weeks, and every third months for a year after SBRT. Repeated measures ANOVA compared EQ‐5D overall scores and changes from baseline. OS was analyzed by Kaplan‐Meier methods and compared with log‐rank test.

      Result:
      26 vs. 25 patients were randomized in the groups +/-CGA, respectively. 4 patients dropped out. There were no differences in patient characteristics between groups. In both groups QoL decreased from baseline but with no differences between groups. VAS scores decreased significantly in the no-CGA group (Table 1). The 1-year and potential 2-year OS was 92% vs. 73% and 72% vs. 57% for the groups +/-CGA, respectively (p=0.24). Figure 1



      Conclusion:
      In patients treated with SBRT for a localized NSCLC, a CGA did improve the subjective opinion (VAS-score) of QoL at 12 months follow up. A CGA did not statistically improve the health index of QoL and OS. However, more patients deceased within the first 12 months after SBRT in the group without a CGA performed. This study suggests that CGA may prevent early death and improve the patients’ subjective opinion of QoL after SBRT.

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