Virtual Library
Start Your Search
Marta Scorsetti
Author of
-
+
P3.08 - Oligometastatic NSCLC (Not CME Accredited Session) (ID 974)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 2
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
-
+
P3.08-02 - Oligometastatic Non Small Cell Lung Cancer Patients Treated with Stereotactic Body Radiotherapy (SBRT), a Single Institution Experience (ID 12932)
12:00 - 13:30 | Author(s): Marta Scorsetti
- Abstract
Background
Oligometastatic disease is an intermediate state between localized and widespread diffuse disease. By definition, this state is amenable to local ablative approaches, like Stereotactic Body Radiation Therapy (SBRT), with curative intent.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients treated with SBRT for oligometastatic NSCLC (max 5 active lesions in max 3 different organs) between January 2014 and December 2015 in the Radiotherapy and Radiosurgery department of the Humanitas Clinical and Research Hospital were retrospectively analyzed. Primary endpoint of the study was local contro (LC)l; overall survival (OS), disease metastases free survival (DMFS) and progression free survival (PFS) were analyzed as well. LC and survival times were calculated from the first day of SBRT. Best local response (BLR) was defined according to RECIST criteria.
4c3880bb027f159e801041b1021e88e8 Result
83 patients were included in the study. Patients received different RT schedules according to number, site and size of the metastases. Treatment was generally well tolerated, no acute or late G3-4 toxicity was recorded.
Complete response, partial response or stable disease were recorded in 30 (35%), 40 (47%) and 14 (16%) patients respectively. One patient had a local progression at first evaluation, while other 16 (19%) patients experienced local relapse during follow up. Actuarial local control time at 6, 12 and 24 months was 91.73%, 84.95% and 77.82% respectively. Distant progression was recorded in 64 patients (75%), in most cases (54 patients, 84%) patients progressed again in a oligometastatic way. Actuarial DMFS at 6, 12 and 24 months was 60.97%, 36.9% and 23.36% respectively. Actuarial PFS at 6, 12 and 24 months was 60.1%, 37% and 22.% respectively.
With a median follow up time of 20 months (range 4.9-49.9), 33 patients (39%) were still alive, in 8 cases with no evidence of disease. Actuarial median overall survival (OS) was 24.5 months, OS at 6, 12 and 24 months was 97.6%, 81.6% and 50.2%.
At univariable analysis type of oligometastases (p=0.015) and BLR (p=0.000) were found to be correlated with LC. Previous local ablative treatments (p=0.04, p=0.033), site of the irradiated lesion(s) (p=0.0016, p=0.0026), “adjuvant” medical therapies (p=0.0278, p=0.023) and BLR (p=0.011, p=0.018) correlated with DMFS and PFS. Site of irradiated lesion (p=0.000), RT BED (p=0.0019) and BLR (p=0.000) were statistically correlated with OS.
8eea62084ca7e541d918e823422bd82e Conclusion
SBRT for oligometastatic NSCLC is safe and effective. Local response is strongly correlated with patients’ prognosis, underlying the relevance of local control also in a metastatic setting.
6f8b794f3246b0c1e1780bb4d4d5dc53 -
+
P3.08-04 - OMEGA, A Randomized Trial of Local Ablative Therapy Vs. Conventional Treatment in Oligometastatic NSCLC – Trial in Progress (ID 13971)
12:00 - 13:30 | Author(s): Marta Scorsetti
- Abstract
Background
A recent randomized phase 2 study has shown that local ablative therapy in addition to systemic treatment was superior to maintenance therapy in prolonging disease-free survival in NSCLC patients harboring up to three metastatic sites.
Oligometastatic lung cancer (OM-NSCLC) seems thus to be associated with a better prognosis than usual Stage IV non-small cell lung cancer when radical local therapy of all metastatic sites is administered but the impact of such an approach on overall survival and quality of life remains unclear
a9ded1e5ce5d75814730bb4caaf49419 Method
A consortium of tertiary referral centres involved in Lung Cancer management at the national level was established with the aim of setting up a randomized trial addressing this issue
4c3880bb027f159e801041b1021e88e8 Result
A randomized trial of local ablative therapy in OM-NSCLC patients with potentially resectable or locally controlled primary tumors has been designed and 7 tertiary referral centers agreed to participate
Patients with synchronous or metachronous oligometastatic lung cancer (1-3 metastatic lesions) will be randomized to local ablative therapy + standard treatment Vs. standard treatment.
Balancing between study arms will be performed according to synchronous vs. metachronous presentation, Number of oligometastases, Nodal status and Oncogene-addiction or PDL-1 expression.
Primary outcome will be Overall Survival (OS) from randomization. The sample size is set to 195 patients.
Inclusion criteria include adequate performance status, primary tumor controlled or controllable staging with whole-body FDG PET scan and brain MRI, fit to receive at least 3 cycles of platinum-based doublet chemotherapy, or immunotherapy or targeted agents according to molecular profile.
Exclusion criteria include cerebral oligometastasis alone (will receive local therapy in any case),
metastasis in sites where normal radiotherapy constraints cannot be met, multiple subsolid nodules in the absence of extrapulmonary metastasis, prior malignant tumor with some exceptions, relevant co-morbidities that would significantly reduce life expectancy on their own,
Disease state and life status assessed on a 2-monthly basis by physical examination, whole-body CT scan plus repeat PET-scan if needed and Brain MRI if brain metastasis at enrolment. Toxicity and adverse events will be assessed according to NCI-Common Terminology Criteria. Quality of life will be assessed at randomization and after six months by the SF36/LCSS.
8eea62084ca7e541d918e823422bd82e Conclusion
There is a clear need for randomized controlled trials with overall survival as their main endpoint to confirm whether local ablative therapy indeed has a role in the management of oligometastatic lung cancer. The Omega trial will try to respond to such a need.
6f8b794f3246b0c1e1780bb4d4d5dc53
-
+
PC08 - The Great Oligometastatic Debates (ID 847)
- Event: WCLC 2018
- Type: Pro-Con Session
- Track: Oligometastatic NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 13:30 - 15:00, Room 105
-
+
PC08.08 - Debate #3: Brain Metastases with a Driver Mutation Should Be Treated with Systemic Therapy First (CON) (ID 11638)
14:40 - 14:50 | Presenting Author(s): Marta Scorsetti
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
