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Patrick Cheung



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    ES06 - Oligometastatic Disease (ID 774)

    • Event: WCLC 2018
    • Type: Educational Session
    • Track: Oligometastatic NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 10:30 - 12:00, Room 202 BD
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      ES06.03 - Developments in SBRT in the Oligometastatic Paradigm in NSCLC (ID 11376)

      11:10 - 11:30  |  Presenting Author(s): Patrick Cheung

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.16-29 - Accelerated Hypofractionated Radiotherapy for Central Lung Tumors Unsuitable for Stereotactic Body Radiotherapy Or Concurrent CRT (ID 12390)

      16:45 - 18:00  |  Author(s): Patrick Cheung

      • Abstract
      • Slides

      Background

      In our institution, accelerated hypofractionated radiotherapy is a treatment option for 1) stage I lung non-small cell lung cancer (NSCLC) patients whose tumors are too bulky or central for SBRT; and 2) select stage II-III NSCLC patients not candidates for concurrent CRT. The purpose of this project was to review the clinical outcomes of a large single institutional experience of treating such patients with a dose of 60 Gy in 15 fractions in an era when SBRT was routinely used in clinical practice for early stage lung cancer.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Central tumors were defined as the gross target volume being in contact with mainstem bronchi, trachea, esophagus, great vessels, or heart. All patients who received 60 Gy in 15 fractions treated between 2008 and 2017 were reviewed. Competing risk analysis was used to calculate the cumulative incidence of local failure (LF), regional failure (RF), and distant failure (DF). Kaplan-Meier methodology was used to calculate overall survival (OS). Univariate analyses were used to look for potential predictive factors.

      4c3880bb027f159e801041b1021e88e8 Result

      Eighty-nine patients were treated. Median follow-up was 24.0 months (range: 6.1-94.2 months). Median age was 79.4 years and most tumors were adenocarcinoma (n=47, 52.8%), followed by squamous cell carcinoma (n=31, 34.8%). Thirty patients (33.7%) had stage I disease, 47 patients (52.8%) had stage II-III disease, and 12 patients (13.5%) had stage 4 disease (mostly oligometastatic). Cumulative incidence of LF was 15.3% at 2 years. In those with stage I-III disease, cumulative incidence of RF and DF were 12.9%, and 28.5%, respectively at 2-years. OS was 74.9% at 2 years, with a median OS of 39.4 months for those with stage I-III disease. In the subset with stage II-III disease, median OS was 38.1 months and 2 year OS was 67.7%. Tumor stage, histology, EGFR mutation status, and location were not statistically significant predictors for any outcomes, although tumor size >3.5cm was borderline significant in predicting for a higher cumulative incidence of LF (subdistribution hazard ratio = 2.726; 95% confidence interval 0.995-7.469; p=0.051). The most common toxicity was radiation pneumonitis (n=6, 6.4%). The cumulative incidence of any grade 3 toxicity was 10.8% at ≥ 1 year. There were no deaths or hospitalizations directly attributed to treatment.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Accelerated hypofractionated radiotherapy to a dose of 60 Gy in 15 fractions resulted in favorable outcomes in NSCLC patients who were not suitable for SBRT or concurrent CRT. Patients with Stage II-III disease had good OS despite not receiving concurrent chemotherapy. Severe toxicities were uncommon.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.01-26 - A Framework for Systematic Clinical Evaluation of Technical Innovations in Lung Cancer Patients Treated on the MR-Linac (MRL) (ID 12562)

      12:00 - 13:30  |  Author(s): Patrick Cheung

      • Abstract
      • Slides

      Background

      A recent innovation in radiotherapy is the MRL developed by Elekta and Philips. The MRL combines a 1.5 T MRI with a 7 MV linac. It allows the acquisition of high resolution MR images for on treatment verification, adaption and response monitoring.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Seven cancer institutions from Europe and North America, are working within the Elekta MR-Linac Consortium to evaluate the MRL within a framework called ‘R-IDEAL’ (Radiotherapy Idea Development Exploration Assessment Long-term Evaluation) 1.

      4c3880bb027f159e801041b1021e88e8 Result

      The table below summarizes the ongoing and planned work within the Elekta MR-Linac Consortium.

      table for wlcc 3-5-2018.jpg

      Progress to date:
      Stage 0:
      We defined in 80 patients the optimal MRI sequences suitable for GTV and organ at risk (OAR) contouring: T2 Turbo Spin Echo (TSE), T2 TSE with fat sat, T1 radial gradient echo, and DIXON TSE. Two radiology-led workshops were organized and inter-observer agreement was assessed for OARs. These led to a consensus-based OAR atlas. A study is being prepared to compare the image quality of the current standard CBCT and MR images at baseline and mid-treatment for treatment verification and set-up correction.
      Stage 1: we will investigate the clinical feasibility of the MRL for standard of care radiotherapy and the scope for adaptive radiotherapy (margin reductions) and detecting changes in oxygenation during treatment on the MRL in patients with locally advanced (LA) NSCLC .
      Stage 2a/b : Based on the results from stage 1 we will design a study aiming to reduce margins around the tumour and dose escalate in patients with LA NSCLC.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The aim of this programme of work is to generate robust evidence to support the introduction of the MRL and to improve outcomes of patients with LA NSCLC.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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