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S.K. Vinod
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OA 01 - The New Aspect of Radiation Therapy (ID 652)
- Event: WCLC 2017
- Type: Oral
- Track: Radiotherapy
- Presentations: 1
- Moderators:M. Hiraoka, S.H. Kim
- Coordinates: 10/16/2017, 11:00 - 12:30, F201 + F202 (Annex Hall)
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OA 01.01 - A Randomized Trial of SABR vs Conventional Radiotherapy for Inoperable Stage I Non-Small Cell Lung Cancer: TROG 09.02 (CHISEL) (ID 8628)
11:00 - 12:30 | Author(s): S.K. Vinod
- Abstract
- Presentation
Background:
Although stereotactic ablative body radiotherapy (SABR) is now well established as a treatment for stage I non-small cell lung cancer (NSCLC), there is limited evidence that it is as or more effective than conventional fully fractionated radiotherapy (CRT). We conducted a randomized trial to determine if SABR results in longer time to local failure than CRT.
Method:
This was a multicentre trial of the Trans-Tasman Radiation Oncology Group (TROG) and Australasian Lung Cancer Trials Group, registration number NCT01014130. Patients were eligible if they had biopsy proven stage I (T1- T2a N0M0) NSCLC based on PET and were medically inoperable or refused surgery. Patients had to be performance status ECOG 0 or 1, and the tumor had to be at least 2 cm or more from the bifurcation of the lobar bronchus. Patients were randomized 2:1 to SABR (54 Gy in 3 fractions, or 48 Gy in 4 fractions, depending on proximity to the chest wall, to the isodose covering the PTV) or to CRT (66 Gy in 33 fractions or 50 Gy in 20 fractions). The primary objective was to compare time to local failure between arms. Assuming that the rate of local failure at 2 years would be 10% in patients randomized to SABR versus 30% in patients randomized to CRT, 100 patients were required. All living patients were followed for a minimum of 2 years. Analysis was based on the intention to treat principle. Funding: In Australia: Grant #1060822 was awarded through Cancer Australia. In New Zealand, The Cancer Society of New Zealand and the Genesis Oncology Trust.
Result:
Between 12/09 and 6/15, 101 patients were enrolled. There were 56 males and 45 females with a median age of 74 years (range 55-89), ECOG performance status – 28 were 0, 71 were 1 and 1 was 2. TNM stage was T1N0M0 in 71 and T2aN0M0 in 30. Sixty six patients were randomized to SABR and 35 patients to CRT. Patients randomized to SABR had superior freedom from local failure (HR = 0.29, 95% CI 0.130, 0.662, P=0.002) and longer overall survival (HR = 0.51, 95% CI 0.51, 0.911, P=0.020). Worst toxicities by arm were: CRT grade 3, 2 patients; SABR grade 4, 1 patient and grade 3, 9 patients.
Conclusion:
In patients with inoperable stage I NSCLC, compared with CRT, SABR resulted in superior freedom from local failure and was associated with an improvement in overall survival.
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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
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.05-004 - Radiotherapy Patterns of Care for Stage I and II Non-small-cell Lung Cancer in Sydney, Australia (ID 8424)
09:30 - 16:00 | Author(s): S.K. Vinod
- Abstract
Background:
Radiotherapy is an alternative to surgery for patients with Stage I and II non-small cell lung cancer (NSCLC) who are medically inoperable or refuse surgery. However, the use of curative radiotherapy in these patients is variable. The aim of this study is to document radiotherapy patterns of care in Stage I and II NSCLC patients at three institutions in Sydney, Australia and evaluate reasons for palliative rather than curative treatment. Stereotactic ablative body radiotherapy (SABR) is a newer treatment technique. However, eligibility for this depends on tumour size and location. A secondary aim is to identify the proportion of patients who would be suitable for SABR treatment.
Method:
Electronic oncology databases at three institutions were queried to retrieve data on patients with Stage I or II NSCLC, who did not undergo surgery and were seen in a radiation oncology clinic between 1/1/2008 to 31/12/2014. Curative radiotherapy was defined as a minimum dose of 50Gy for conventional and 48Gy for SABR. Suitability for SABR was defined as peripheral tumours less than 5cm in size. Factors associated with curative treatment were determined using univariate and multivariate analyses and variables were compared using Chi-square and t-test.
Result:
There were 315 patients, with a median age of 77 years (30-93). Two-hundred-and-five (65%) had Stage I and 110 (35%) Stage II NSCLC. Eastern Cooperative Oncology Group performance status (ECOG PS) at first clinic visit was 0-2 in 252 (80%) patients. Two-hundred-and-six (65%) and 151 (48%) had pulmonary and cardiovascular comorbidities, respectively. Seventy-six (24%) patients received no radiotherapy, 58 (18%) palliative radiotherapy and 178 (56%) curative radiotherapy. Use of curative radiotherapy varied from 43% to 81% between the three institutions and increased from 51% during 2008-2011 to 64% during 2012-2014. The main reasons for receiving palliative or no radiotherapy were chronic obstructive pulmonary disease (COPD) or poor pulmonary function (26%) and comorbidities other than COPD or cardiovascular comorbidities (22%). Excluding patients with N1 disease, 25% who received palliative radiotherapy, 42% of patients who received no treatment and 37% of patients who received conventional radiotherapy were suitable for SABR treatment. ECOG PS (p=0.011), FEV1% (p=0.025) and institution (p=0.001) were significantly associated with use of curative radiotherapy in both univariate and multivariate analyses.
Conclusion:
Use of curative radiotherapy varied among cancer institutions. Patient factors were the predominant reason for palliative treatment. A significant proportion of patients who underwent palliative or no radiotherapy were potential candidates for SABR treatment.
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P3.13 - Radiology/Staging/Screening (ID 729)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.13-038 - The RoaDmaP Study: Feasibility of Implementing a Primary Care Intervention for Referral of Potential Lung Cancer Cases to Specialist Care (ID 9875)
09:30 - 16:00 | Author(s): S.K. Vinod
- Abstract
Background:
Pathways to lung cancer diagnosis are complex. General Practitioners (GPs) play a vital role in ensuring that people diagnosed with lung cancer receive timely access to appropriate specialist care. Australian guidelines recommend that the first specialist appointment should take place within two weeks of the initial GP referral. However, local data indicate that up to 60% of patients are not referred within two weeks, while state-based data shows that 11% of patients in New South Wales (NSW), Australia, do not see a lung cancer specialist at all; these patients may be missing out on curative and palliative treatments. We designed a primary care intervention to address these gaps and conducted a feasibility study in three sites across NSW. The RoaDmaP pilot study aimed to develop, implement and evaluate the Referral Decision Prompt (RDP), an intervention that supports GPs to refer patients with a suspicious lung lesion on CT scan for specialist care. Specific objectives were to evaluate feasibility and acceptability with GPs, radiologists and radiology practice staff.
Method:
The RDP intervention was developed with key stakeholder input and was tailored for three participating radiology practices. Eligibility criteria included any patient aged over 18 attending for a chest CT scan. Recruitment and consent procedures were tested to enable collection of patient’s medical data from GPs and hospitals to confirm lung cancer diagnoses. The RDP template was integrated into CT scan reports for patients with a suspicious lung lesion. A process evaluation with GPs, radiologists and radiology staff was undertaken through brief surveys and qualitative focus groups.
Result:
Over seven months, 445 patients had a GP-referred chest CT scan; 400 were given study documents; 293 consented (73%). Twelve patients had a suspicious lesion, eight of whom received a confirmed lung cancer diagnosis. Sixty-six percent had a specialist appointment within two weeks. The intervention was rated as highly acceptable by radiologists, radiographers and practice staff; four GPs participated in the evaluation, three recalled the RDP and two used it to change their referral practices.
Conclusion:
The RoaDmaP study presents an innovative approach to identifying lung cancer patients prior to diagnosis and has the potential to improve timely and appropriate specialist referral. The process evaluation findings indicate that this simple, low-cost intervention is feasible and can be easily integrated into radiology reporting practices. It is highly acceptable to radiologists and practice staff, and may positively influence GP referral practices.
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P3.14 - Radiotherapy (ID 730)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.14-003 - Patterns of Follow-Up Care After Curative Radiotherapy for Stage I-III Non-Small Cell Lung Cancer (ID 9707)
09:30 - 16:00 | Author(s): S.K. Vinod
- Abstract
Background:
Evidence regarding optimal follow-up (FU) strategies for patients after curative radiotherapy for NSCLC is limited, resulting in variable FU practice. The aim of this study was to describe the patterns of FU care for patients undergoing curative radiotherapy +/- chemotherapy.
Method:
A retrospective study was conducted of patients with Stage I-III NSCLC, undergoing a course of curative radiotherapy (a minimum dose of 50Gy), between 1/1/2007-31/12/2011 at three institutions. Data was collected from oncology records, including patient demographics, tumour characteristics, treatment and follow-up. At each FU, the reason for FU (routine or symptomatic), specialist seen and imaging performed were recorded, until an event (recurrence or new primary) was diagnosed. The censor date was 31/12/2016. Analysis of FU included univariate chi-square tests for categorical variables, t-tests for continuous variables, multivariate logistic regression analyses, and Kaplan Meier survival curves.
Result:
Two-hundred-and-eighty-three patients (183 males, 100 females) were identified with a median age of 72(36-91) years. Eighty-four (29.7%) were Stage I, 47 (16.6%) were Stage II, and 152 (53.7%) were Stage III. Pathology was large cell in 91 patients (32.2%), squamous cell in 100 (35.3%), adenocarcinoma in 68 (24.0%), and NSCLC NOS in 24 (8.5%). One-hundred-and-sixty-five (56.5%) patients received radiotherapy alone and the remaining 123(43.5%) received chemoradiotherapy. The average frequency of FU visits per year was 5.12, median number of FU visits to first event was 6, and median time to first event was 11 months. 73.7% of FU were routine, while only 16.2% were symptomatic. 1641 imaging tests were performed, equating to an average of 5.8 scans per patient, with only 98 resulting in a diagnosis of an event. Overall, recurrences were diagnosed in 175 patients of whom 85 were symptomatic and 90 diagnosed on routine imaging. New primaries were diagnosed in 23 patients, 15 with symptoms and 8 on routine imaging. Subsequent treatment was curative in 25 (14.3%) patients with recurrent disease and 18 (85.7%) with new primaries. Univariate and multivariate analysis determined that the method of diagnosis of an event (symptomatic vs routine) had no statistically significant impact on the intent of further treatment (curative treatment 13.8% v 7.7%, p=0.089) or on overall survival (2y OS 49.5% vs 51.6%, p=0.772).
Conclusion:
Following curative radiotherapy, patients undergo frequent FU with regular imaging. Despite this only a minority of patients who develop recurrence are suitable for curative treatment. The use of routine imaging did not impact on further curative treatment or improve overall survival.
