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A. Nishikawa
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MA 09 - The Current Status of Radiation Oncology (ID 666)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:Tomoki Kimura, Yong Chan Ahn
- Coordinates: 10/17/2017, 11:00 - 12:30, Room 316
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MA 09.06 - Pulmonary Oligometastases Treated by Stereotactic Body Radiation Therapy (SBRT): A Nationwide Survey of 1,378 Patients (ID 8014)
11:00 - 12:30 | Author(s): A. Nishikawa
- Abstract
- Presentation
Background:
The treatment outcomes of patients with pulmonary oligometastases treated by SBRT were evaluated; the oligometastases were classified into three groups (oligo-recurrence, sync-oligometastases, and unclassified oligometastases) and the outcomes compared.
Method:
This study was limited to patients who had a BED10 ≥75 Gy. Oligo-recurrence was defined as a primary lesion that was controlled, the number of metastases or recurrences in the lung was one to five, and the disease-free interval (DFI), the interval between initial therapy of the primary lesion and the date of recurrence in the lung, was ≥6 months. Sync-oligometastases were defined as: the primary lesion was active; the number of metastases or recurrences in the lung and the active primary lesion was one to five; and the DFI was zero. The definition of unclassified oligometastases was similar to that of oligo-recurrence, but the DFI was <6 months. All oligomtastases in this study were treated by local therapy for all active lesions including primary and metastatic lesions.
Result:
Between 2004 and 2015, 1378 patients (male/female = 893/485; PS 0/1/2/3 = 746/474/85/17) meeting the study definition of pulmonary oligometastases were treated by SBRT in 68 institutions in Japan. Their median age was 72 years (16-93 years). The primary region was lung in 421, colorectal in 348, head and neck in 113, and others in 618. Histopathology showed adenocarcinoma in 761, squamous cell carcinoma in 358, and others in 186. Oligostatus was oligo-recurrence in 1013, sync-oligometastases in 118, and unclassified oligometastases in 122. The median maximum tumor diameter (MTD) was 1.5 cm (0.3-6.5 cm). The number of target tumors was solitary in 1037 and multiple in 341. The median BED10 was 105.6 Gy (75-289.6 Gy). The median DFI was 17.9 months (0-424 months). The median follow-up time was 24.3 months (0.1-143.7 months). The 3-year overall survival (OS), relapse-free survival, and local control rates were 60.3% (95%CI: 57.1-63.3%), 32.6% (95%CI: 29.7-35.5%), and 81.4% (95%CI: 78.8-83.7%). Univariate analysis showed only oligostatus, sex, PS, DFI, MTD, primary region, and histopathology were significant. The 3-year OS was 64.0% (95%CI: 60.4-67.5%) for oligo-recurrence and 50.6% (95%CI: 42.9-57.8%; p<0.001) for the others. Multivariate analysis of OS showed that only oligostatus (others/oligo-recurrence: HR 1.43), MTD (>2 cm/<2 cm, HR 1.45), histopathology (others/adenocarcinoma: HR: 1.47), and sex (male/female: HR 1.38) were significant.
Conclusion:
Pulmonary oligometastases, oligo-recurrence, female sex, adenocarcinoma, and small-sized tumor could be factors associated with longer 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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P2.05-009 - Outcome of Stereotactic Body Radiotherapy for Clinical Stage I Non Small Cell Lung Cancer and CT Findings: Comparison with Surgical Resection (ID 9964)
09:30 - 16:00 | Author(s): A. Nishikawa
- Abstract
Background:
The standard care for Stage I non small cell lung cancer (NSCLC) is surgical resection, but stereotactic body radiotherapy (SBRT) can be an alternative treatment option, especially for patients with comorbidities. However, it is difficult to compare the outcomes of SBRT with surgical resection because their characteristics are so different, and the risk factors for recurrence after SBRT are not fully understood. In this study, we report pretreatment clinical characteristics and CT findings in patients treated with SBRT, and reviewed patients underwent surgery with similar tumors.
Method:
Between January 2012 and December 2015, patients treated with SBRT for cT1-2N0M0 NSCLC and 218 patients who underwent surgery for cT1b-2N0M0 NSCLC in our institution were analyzed.
Result:
During the study period, 88 patients were treated with SBRT. The 3-year disease free survival (3-year DFS) for all patients was 81.2%. There were 15 cases of recurrences (9 cases of lymph node recurrences, 8 cases of distant metastases and 2 cases of local recurrence. 4 cases were both lymph node and distant metastases). There was no recurrence among the patients with no more than 1cm of consolidation (cT1a or less according to the 8th edition of the Union for International Cancer Control TNM classification) and all recurrent cases were with solid pattern predominant tumors (maximum consolidation diameters were more than 50% of tumor diameters) based on CT findings. Then we evaluated outcomes and clinical characteristics of patients who were treated with SBRT or underwent surgery for cStage I, cT1b or more and solid predominant NSCLC during the same period. 61 patients were treated with SBRT and 218 underwent surgery (190 cases of lobectomy, 21 secmentectomy and 7 wedge resection). Among clinical characteristics, smaller tumor sizes tend to be treated with SBRT (average sizes were 2.25 and 2.57 cm respectively, p=0.055). The mean age was significantly higher in SBRT group (78.5 vs 68.0, p<0.001). Surgical resection was associated with improved DFS (3-year DFS 84.4% vs 73.4%, p=0.004) and lymph node metastasis was found in 34 cases (15.6%) pathologically in patients underwent surgery, suggesting they are incurable with SBRT.
Conclusion:
The main limitations of this study are the small number of cases and different patient characteristics. Taken together, our data suggesting SBRT is acceptable for patients with cT1a or less, cStage I NSCLC, and surgical resection is recommended for patients with more advanced NSCLC.
