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N. Farré
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P2.01 - Advanced NSCLC (ID 618)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:00 - 16:00, Exhibit Hall (Hall B + C)
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P2.01-072 - Local Management of Oligometastasis in Non-Small Cell Lung Cancer (NSCLC) (ID 10104)
09:00 - 16:00 | Author(s): N. Farré
- Abstract
Background:
Stage IV NSCLC patients with oligometastasis may experience long-term survival when macroscopic tumour sites are treated radically. The aim of this abstract is to analyse our experience in local management of oligometastasis in NSCLC.
Method:
We retrospectively analysed 38 patients with oligometastatic NSCLC in terms of overall survival (OS), progression-free survival from diagnosis (SLP) and treatment (SLPT) of oligometastatic disease and the association with clinical features such as age, gender, histology, molecular profile, stage at diagnosis and metastatic sites. Kaplan Meier method was used.
Result:
We analysed 38 patients (25 men, 13 women). Mean age: 61 years (40-82). Histology: 60% adenocarcinoma, 8% squamous carcinoma, 13% large cell carcinoma, 19% NOS. 2 EGFR and 1 BRAF mutations. 60% patients (23/38) presented oligometastatic NSCLC at diagnosis, 34% after progression of early disease and 6% after response to initial systemic treatment for advanced disease. Mean number of metastasis: 1 (1-3). Most frequent location: brain (80%). 35% of patients (8/23) oligometastatic at diagnosis received local treatment for the primary tumour: 75% surgery, 25% radiotherapy. Systemic therapy was administrated in 65% of patients (15/23): 93% platinum-based chemotherapy, 7% EGFR-TKI. Table 1 shows local treatment for oligometastasis at diagnosis. No severe complications were observed.
With a median follow up of 23 months (95%CI 0.9-78.2m), median SLPT was 8.5 months (95%CI 5.3-11.7m), median SLP was 8.7 months (95%CI 6.1 – 11.3m) and median OS was 9.9 months (95%CI 0-32). Median OS of brain metastasis was 9.7 months (95%CI 6.5-12m) vs not reached in patients without brain metastasis (p 0.019). Median OS patients with oligometastatic NSCLC at diagnosis was 8.7 months (95%CI 5'9-11) vs not reached in the rest of patients (p 0.025).Table 1 Brain (n=30, 80%) Adrenal gland (n=4, 10%) Lung (n=3, 8%) Liver (n=1, 2%) Surgery + Radiotherapy 87% (26/30) Surgery 10% (3/30) 50% (2/4) 67% (2/3) Radiotherapy 33% (1/3) No local treatment 3% (1/30) 50% (2/4) 100% (1/1)
Conclusion:
Data collected demonstrate that survival rate in patients with oligometastatic NSCLC is similar to that reported in literature. Cerebral metastasis significantly worsen the prognosis.
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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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P2.05-007 - Sterotactic-Body-Radiotherapy for Early-Lung Cancer: Is FDG-PET/TC a Predictor of Outcome? (ID 10045)
09:30 - 16:00 | Author(s): N. Farré
- Abstract
Background:
Follow-up recommendations after stereotactic body radiation therapy (SBRT) for early non–small cell lung cancer (NSCLC) patients are not well defined. We analyzed the prognostic value of early response evaluated by FDG-PET/TC scan.
Method:
Between April 2012 and September 2016, 63 primary lung lesions in unfit patients or who refused surgery were treated with SBRT. Three risk-adapted fractionation schemes that ensure DBE>100Gy were considered: 3x18Gy, 5x11Gy and 8x7.5Gy. In all patients two FDG-PET/TC scans were performed: one before the SBRT treatment and another one a month after the completion of the treatment. Changes in FDG-uptake were evaluated. We considered complete response (CR) when the FDG-uptake was normalized, partial response (PR) when there was a decrease and stable disease (SD) when no modification was observed. Local control (LC), cause-specific survival (CSS) and overall survival (OS) were analyzed according to response.
Result:
With a median follow-up of 16 months; LC, CSS, and OS at 2 years were 100%, 91% and 64%, respectively. We correlated the FDG-PET/TC response at one month with LC and OS at 2 years. The FDG-PET/CT response at one month was not related to LC at 2 years, which was above 95% for all patients. For patients who achieved CR at one moth, OS and CSS at 2 years was both 100% while patients with PR was 49% and 86% respectively and for those with SD were 63% and 92% respectively (Figure 1). Figure 1
Conclusion:
Our results suggest that an early complete response on FDG-PET/TC may be a good predictor factor of survival. Based on the grade of early PET-CT response, patients for stricter monitoring could be selected. Longer follow-up to confirm these findings is necessary.
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P3.14 - Radiotherapy (ID 730)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiotherapy
- Presentations: 2
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.14-014 - Lung Stereotactic Body Radiotherapy (SBRT): Patient's Outcome and Prognostic Factors (ID 9866)
09:30 - 16:00 | Author(s): N. Farré
- Abstract
Background:
Stereotactic body radiotherapy (SBRT) is the standard of care in patients with medically inoperable early stage NSCLC and an effective method of treatment of lung metastases (LM) in oligometastatic patient.We evaluated local control (LC), overall survival (OS), cause-specific survival (CSS), and related toxicity in the both group of patients treated in our center.
Method:
Between April 2012 and September 2016, 107 lung lesions were treated with SBRT; 62 early NSCLC(58%) and 45 LM(42%). Three risk-adapted fractionation schemes that ensure DBE>100Gy were considered: 3x18Gy, 5x11Gy and 8x7.5Gy. Kaplan-Meier(KM) curves were used to evaluate LC,OS and CSS. We analyzed toxicity and predictive factors.
Result:
The median follow-up was 16 months(range 6-44). For primary NSCLC: LC,CSS, and OS at 2 years were 100%,91% and 64%, respectively.19 patients died, 5 because of a lung cancer and 14 due to concurrent disease. Regional relapse was observed in five patients(7.6%).Six patients(9.2%) developed distant metastases. There was no statistically significant difference in OS and CSS when comparing peripheral-central tumors or T1-T2 tumors. However, T2 and central tumors showed lower survival rates. For lung metastatic lesions: LC,CSS, and OS at 2 years were 69%, 66% and 66%, respectively.The primary tumors were:colorectal 17(38%), lung 15(33%) and others 13(29%).There was no statistically signficant difference in survival among primary tumor or 1-3 metastatic lesions, but colorectal primary tumors and more than one lung metastases had lower survival.We compared LC and CSS in both group of patients. There was a statistically significant difference in local control(p=0.002) and CSS(p=0.027) among the primary tumors or lung metastases(Figure 1).According to RTOG,≤G2 lung and skin acute toxicity was 5% and 3% respectively.Lung late toxicity ≤G2 was 22.4%. No patients developed >G2 toxicities. Figure 1
Conclusion:
With a 2-year LC rate >95% with limited toxicity, SBRT confirms as state-of-the-art treatment for medically inoperable early stage NSCLC and effective options for oligometastatic patients.
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P3.14-017 - Dosimetric Evaluation of Lung SBRT Treatment (ID 10204)
09:30 - 16:00 | Author(s): N. Farré
- Abstract
Background:
To analyse the relation between clinical outcomes and dosimetric indices for SBRT lung treatments.
Method:
96 lung lesions were treated with SBRT(6MV photons 3DCRT). Planning CT included whole lung. 4DCT of tumor area was used to obtain a MIP-based ITV, with three risk-adapted fractionation schemes [3x18Gy, 5x11Gy, 8x7.5Gy(BED>100Gy)]. In treatment delivery the tumor was centered online using CBCT and its movement validated by fluoroscopy adjusting the gating limits to the breathing amplitude. Toxicity and dosimetric indices for PTV and OAR were evaluated and correlated with the clinical outcomes 6 months after radiotherapy
Result:
Table1 shows the dose constraints as well as the results of the dosimetric indices. It was found that 95%/75% of the patients developed G=0 acute/late toxicity, 3%/0% G=2 acute lung/skin toxicity, 3% G=2 late lung toxicity and no patients developed G>2 toxicities. Figure 1 displays the correlation between V~100~, V~90~, CI and the clinical outcomes after 6 months of radiotherapy. Only the CI was statistically significant(t-test p=0.017) as an indicator of the ratio between complete/partial responses(mean CI=1.1/1.05) Figure 1 Figure 2
Conclusion:
The lung SBRT technique is safe(no G> 2 toxicity has been reported) even for cases with OAR compromise. The CI has been statistically significant as a predictor of complete tumor remission at 6 months.
