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C. Eze
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Poster Display session (Friday) (ID 65)
- Event: ELCC 2018
- Type: Poster Display session
- Track:
- Presentations: 4
- Moderators:
- Coordinates: 4/13/2018, 12:30 - 13:00, Hall 1
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114P - Evaluation of pulmonary function parameters after moderate hypofractionated image-guided thoracic irradiation in locally advanced node-positive non-small cell lung cancer patients with very limited lung function (ID 633)
12:30 - 13:00 | Author(s): C. Eze
- Abstract
Background:
To evaluate the changes in pulmonary function parameters (PFT) after moderate hypofractionated image-guided thoracic irradiation (Hypo-IGRT) in locally advanced node-positive non-small cell lung cancer patients with very limited lung function.
Methods:
PFT was measured in 8 patients with NSCLC UICC stage IIIA, IIIB and IIIC (UICC 8[th] Edition) and very limited PFT (FEV1 ≤ 1 L and/or DLCO ≤ 40% and/or long-term oxygen therapy) prior to as well as 3 and 6 months after Hypo-IGRT. Vital capacity (VC), forced expiratory volume in 1s (FEV1), and single-breath diffusing capacity of the lung for CO (DLCO-SB) as PFT parameters were analyzed. Hypo-IGRT was delivered to a total dose of 45 Gy (ICRU) in 15 fractions under daily image-guidance.
Results:
Eight patients (5 men/3 women) were treated with Hypo-IGRT. The median follow-up was 20 months. COPD GOLD III and IV was diagnosed in 2 (25%) and 4(50%) patients, respectively. Five (63%) patients were on long-term oxygen treatment. The median initial VC, FEV1 and DLCO-SB was 1.69L/64.8% predicted (range: 1.36–2.66/33–80%), 1L/39.4% predicted (range: 0.78–1.26/28–60%) and 33.3% (range: 13.3–54), respectively. The median value for VC, FEV1 and DLCO-SB 3 months after Hypo-IGRT was 2.05L/56.35% predicted (range: 1.34–2.33/47–81.5%), 1.08L/47.5% predicted (range: 0.74–1.60/30.8–59.59%) and 38.55% (range: 24–68), respectively. At 6 months post-treatment, the mean value for VC, FEV1 and DLCO-SB was 1.64L/66% predicted (range: 1.41–2.79/35.5–75.5%), 1.0L/47% predicted (range: 0.65–1.28/24.5–54.10%) and 31% (range: 27–43%), respectively. The estimated median overall survival (OS) was not reached for the entire cohort.
Conclusions:
No significant decrease in all tested parameters was found until 6 months after Hypo-IGRT. In this small study, Hypo-IGRT was safely delivered in locally advanced node-positive NSCLC patients with very limited lung function who were not suitable candidates for conventional treatment.
Clinical trial identification:
Legal entity responsible for the study:
University Hospital, LMU Munich
Funding:
Has not received any funding
Disclosure:
All authors have declared no conflicts of interest.
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117P - Feasibility of moderate hypofractionated image-guided thoracic irradiation for locally advanced node-positive non-small cell lung cancer patients with very limited lung function (ID 626)
12:30 - 13:00 | Author(s): C. Eze
- Abstract
Background:
To determine the feasibility of moderate hypofractionated image-guided thoracic irradiation (Hypo-IGRT) in locally advanced node-positive non-small cell lung cancer patients with very limited pulmonary function.
Methods:
Eight patients with NSCLC stage IIIA-C and highly diminished pulmonary function (FEV1 ≤ 1.0 L and/or DLCO-SB ≤ 40% and/or long-term oxygen therapy) were treated with Hypo-IGRT. Planning was based on 18F-FDG-PET/CT and 4-D computed tomography (4D-CT). GTV included primary tumor and involved lymph nodes (short-axis ≥1 cm and/or PET-positive). CTV was not generated. ITV was defined through the overlap of GTVs on 10 phases of 4D-CT. Isotropic margin of 5 mm was added to ITV to generate the PTV. Hypo-IGRT was delivered to a total dose of 45 Gy (ICRU) in 15 fractions under daily image-guidance.
Results:
Eight patients completed Hypo-IGRT. The median follow-up was 20 months. The median age was 64 years. Two (25%), 4 (50%) and 2 (25%) patients presented with NSCLC stage IIIA, IIIB and IIIC, respectively. There were 7 (88%) patients with ECOG 2 and 1 (12%) patient with ECOG 3. Three patients received chemotherapy prior to Hypo-IGRT. Median initial DLCO-SB was 33.3% (range: 13.3–54) and the median initial FEV1 was 1L/39% predicted (range: 0.78–1.26L/28–60%). The median PTV was 226.9 cm³ (range: 100.17–379.80). The median overall survival (OS), progression-free survival (PFS) and distant metastasis-free survival (DMFS) for the entire cohort were not reached. Mean OS was 42 months (95% CI: 31.7–52.6). Mean PFS was 38 months (95% CI: 17.8–45.7). The 1- and 2-year OS rates were 100% and 87.5%. The 6- and 12- months PFS rates were 100% and 62.5%. Three patients developed local failure. Median mean lung dose was 9.4 Gy (range: 5.3–11.6). V15 and V20 for both lungs were 22% (range: 10–25) and 15% (range: 6–19). Median mean esophageal dose was 12.76 Gy (range: 2.1–26.7). There was no case of radiation pneumonitis. Four patients developed grade 2 acute radiation esophagitis.
Conclusions:
This analysis shows that Hypo-IGRT can be considered in locally advanced node-positive NSCLC patients with very limited pulmonary function who are inadequate for conventional therapy.
Clinical trial identification:
Legal entity responsible for the study:
University Hospital, LMU Munich
Funding:
Has not received any funding
Disclosure:
All authors have declared no conflicts of interest.
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84P - Patterns of care for patients with small cell lung cancer: A survey of German radiation oncology institutions on recommendations for prophylactic cranial irradiation (ID 471)
12:30 - 13:00 | Presenting Author(s): C. Eze
- Abstract
Background:
Prophylactic cranial irradiation in SCLC was first proposed in 1973 and is recommended for patients demonstrating good response to initial therapy. The general pattern of care amongst radiation oncologists in Germany has not been previously evaluated. We conceptualized and conducted this survey to assess patterns of care.
Methods:
We surveyed radiation oncology institutions in Germany via an online questionnaire sent by e-mail to member institutions of the German Society for Radiation Oncology (DEGRO e.V.). The questions were based on respondent and treatment characteristics with emphasis on prophylactic cranial irradiation in limited- and extensive-stage SCLC.
Results:
We received a total of 95 responses (29% response rate). Of which 64 were completed and returned and hence eligible for evaluation. Sixty-one percent of respondents were between the ages of 50–59, 88% with over 15 years of experience in the management of lung malignancies. Sixty-seven percent of the institutions stage their patients initially with 18F-FDG-PET/CT. Of the 64 responses, 97% recommended delivery of PCI in therapy responders with LS-SCLC compared to 67% with ES-SCLC. Interestingly, a quarter of respondents offered hippocampal-avoidance PCI with only 38% following their patients with serial brain imaging following PCI. Neuropsychological testing was generally not routinely performed.
Conclusions:
German radiation oncology institutions showed interesting variations in certain aspects yet in general congruence in SCLC management and PCI delivery in accordance with the updated national and international guidelines. Future randomized clinical trials will further reduce discrepancies regarding delivery of PCI especially in ES-SCLC.
Clinical trial identification:
Legal entity responsible for the study:
University Hospital, LMU Munich
Funding:
Has not received any funding
Disclosure:
All authors have declared no conflicts of interest.
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86P - Prophylactic cranial irradiation in SCLC: A survey of German radiation oncology institutions on recommendations for brain imaging (ID 573)
12:30 - 13:00 | Presenting Author(s): C. Eze
- Abstract
Background:
Prophylactic cranial irradiation in SCLC is recommended in therapy responders to primary treatment. The landmark PCI trials largely took place in the pre-MRI era. Recently, the role of brain imaging in PCI has come under increased scrutiny. We conducted this survey to gauge the patterns of brain imaging in PCI amongst radiation oncologists in Germany.
Methods:
We surveyed radiation oncology institutions in Germany via an online questionnaire sent by e-mail to member institutions in the online directory of the German Society for Radiation Oncology (DEGRO e.V.). The questions covered aspects of brain imaging in limited- and extensive-stage SCLC.
Results:
We received a total of 39 responses. Of which 34 were completed and eligible for further evaluation. 97% and 92% of respondents recommended brain imaging prior to initial treatment in LS- and ES-SCLC, respectively with contrast-enhanced MRI being the preferred modality in 86% of cases. Ninety-one percent of respondents recommended brain imaging not older than 4 weeks prior to PCI delivery with 71% recommending commencing PCI <4 weeks after primary treatment. Of all responses, 38% followed their patients regularly with serial brain imaging following PCI with the absolute majority preferring image acquisition only in symptomatic patients. On detection of brain metastases (BMs), 59% recommended stereotactic radiosurgery (SRS) or repeat whole brain radiotherapy depending on the number of BMs.
Conclusions:
Patterns of brain imaging in Germany are in general consistent with the guidelines with contrast-enhanced MRI being the preferred modality for brain staging prior to primary treatment and especially after multimodality treatment and before PCI delivery.
Clinical trial identification:
Legal entity responsible for the study:
University Hospital, LMU Munich
Funding:
Has not received any funding
Disclosure:
All authors have declared no conflicts of interest.
