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J.D. Ruben



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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 01.01 - 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): J.D. Ruben

      • Abstract
      • Presentation
      • Slides

      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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    P1.05 - Early Stage NSCLC (ID 691)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Early Stage NSCLC
    • Presentations: 1
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      P1.05-022c - Screening for Psychosocial Distress in Lung Cancer: Defining the Unmet Gaps (ID 8412)

      09:30 - 16:00  |  Author(s): J.D. Ruben

      • Abstract

      Background:
      Objective: The evaluation of supportive care needs in lung cancer patients may be enhanced by engaging systematic screening using a validated distress screening tool, the distress thermometer (DT). We aimed to identify the extent of use of the screening tool, levels of distress and psychosocial problems identified by the tool and to determine associations with distress and the impacts of distress screening on patient outcomes in an Australian university teaching hospital.

      Method:
      We recruited all new lung cancer diagnoses recruited via the Victorian Lung Cancer Registry at the Alfred Hospital, Melbourne, Australia, during the period 14 July 2011 to 24 September 2016. We evaluated the presence of documented supportive care screening using the distress thermometer and demographic, clinical, treatment and outcome measures.

      Result:
      Levels of screening were very low (15.2%) amongst this cohort and yet 49.2% respondents described high levels of distress (median DT 3.5; IQR 1-6). High levels of distress (DT≥4) were associated with higher levels of practical, family, emotional and physical problems. Patients reporting higher levels of distress experienced an accelerated rate of decline in physical component of quality of life and had increased risk of death.

      Conclusion:
      The identification of the supportive care needs for lung cancer patients may be augmented by the use of a systematic screening tool. This study identifies significant gap in supportive care screening, high levels of distress amongst screened subjects and poorer patient related outcomes for distressed patients. This study provides an important platform for institutional supportive care screening strategy planning.

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    P2.13 - Radiology/Staging/Screening (ID 714)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Radiology/Staging/Screening
    • Presentations: 1
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      P2.13-026c - Impact of Lung Cancer Multidisciplinary Meeting Presentation on Quality of Life and Survival: A Victorian Retrospective Cohort Study (ID 8633)

      09:30 - 16:00  |  Author(s): J.D. Ruben

      • Abstract

      Background:
      The creation of an effective management plan for non-small cell lung cancer (NSCLC) requires clinical and functional evaluation, a series of diagnostic and staging investigations and an evaluation of suitability for treatment. This process requires diverse multidisciplinary input and modern clinical guidelines therefore recommend presentation of all new lung cancer diagnoses to a multidisciplinary meeting (MDM) to facilitate evaluation and the development of an informed multidisciplinary management plan

      Method:
      We sought to evaluate the characteristics of patients presented to the lung cancer MDM and to evaluate the impact of MDM presentation on (i) management related outcomes including timeliness, supportive care screening, receipt of treatment and clinical trial participation, and (ii) patient related outcomes including survival and quality of life (QoL) in a metropolitan university teaching hospital.

      Result:
      In this cohort of cancer patients we found that just 59.6% of all new cancer diagnoses were presented to the lung cancer multidisciplinary meeting for clinical assessment and treatment planning despite the recommendation that all patients with lung cancer receive treatment in the context of a multidisciplinary setting. The likelihood of presentation was doubled for those with early clinical stage IA and halved for those with stage IV. Measures of quality of life (vitality and role emotion domain scores from the SF12v2) improved for those presented to the MDM between 3 and 12 months following presentation compared to those not presented. Advanced clinical stage was a strong predictor of mortality for all patients. MDM presentation conferred a significant crude protective effect on mortality for all patients (HR 0.63, 0.49-0.81; p<0.001) which was diminished when adjusted for confounding factors (0.79, 0.56-1.10;p=0.16), although this benefit was sustained for those with clinical stage IIIA (adjusted HR 0.31 0.12—0.79; p=0.01). The referral source for MDM presented patients were approximately one third from respiratory medicine, one third from lung cancer specialities and one third from medical and surgical specialty units with mortality risk increased for those referred by general medicine and surgical specialties.

      Conclusion:
      We found significant disparities in the utilisation of lung multidisciplinary meeting presentation which was associated with significant differences in uptake of active cancer therapy and ultimately survival. This study identifies significant benefit to those being presented to a lung cancer MDM and provides evidence to support multidisciplinary evaluation.