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Xiaojiang Sun
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OA01 - Improving Outcomes in Locoregional NSCLC I (ID 892)
- Event: WCLC 2018
- Type: Oral Abstract Session
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 10:30 - 12:00, Room 107
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OA01.02 - The Estimate of Shrinking Field and SIB Radiotherapy Guided by 18F-FDG PET/CT in Locally Advanced NSCLC Patients: A Phase 2 Randomized Clinical (ID 14474)
10:40 - 10:50 | Author(s): Xiaojiang Sun
- Abstract
- Presentation
Background
Tumor control remains suboptimal in locally advanced lung cancer. Radiation dose acceleration has a positive effect to local tumor control, but is limited by radiation-induced lung injury (RILI). The aim of this study was to evaluate the safety and efficacy of adaptive radiation therapy guided by functional imaging 18F-FDG PET/CT in patients with locally advanced non-small lung cancer.
a9ded1e5ce5d75814730bb4caaf49419 Method
A total number of 72 patients with locally advanced NSCLC were enrolled between November 2012 and June 2017. After signing the inform consent form, 36 patients were randomized into the shrinking field and simultaneous integrated boost radiotherapy group, others were in the conventional radiotherapy group. The Objective Response rate (ORR), progression-free survival (PFS) and overall survival (OS) were compared, as well as the safety of shrinking field and simultaneous integrated boost radiotherapy (radiological dosimetry parameters and the incidence of grade 2 or higher radiotherapy-related toxicity). T-test was utilized to compare the differences between the quantitative data of two groups, while chi-square test or Fisher exact test were utilized to compare the differences between the count data of two groups. Kaplan-Meier curve was utilized to show PFS and OS, and the log-rank test analysis was utilized to compare the survival difference between two groups. P value less than 0.05 was considered statistical difference.
4c3880bb027f159e801041b1021e88e8 Result
All the patients in both two groups had completed their treatment according to the study protocol. The shrinking field and simultaneous integrated boost radiotherapy group was significantly greater than the conventional radiotherapy group in ORR (77.8% vs. 52.8%, P=0.026). The median OS and PFS in shrinking field and simultaneous integrated boost radiotherapy group was 22.0 months (95%CI：18.1~25.9) and 12.4 months (95%CI：10.4~14.3), which is significantly longer than 18.1 months (95%CI：12.4~23.8) and 8.2 months (95%CI：5.2~11.2) in the conventional radiotherapy group (P=0.045 and P=0.013). There was no significant difference between the two groups in radiological metrological parameters and organ at risk (OAR). The incidence of grade 2 or higher RILI, radiation-induced esophagitis, radiation-related myocardial damage and myelosuppression between two groups has no statistically significant difference.
8eea62084ca7e541d918e823422bd82e Conclusion
Shrinking field and simultaneous integrated boost radiotherapy guided by function imaging 18F-FDG PET/CT is a safe and operable technique in practice. It can improve ORR, OS and PFS without increasing the risk of radiotherapy-related toxicity in patients with locally advanced NSCLC.
6f8b794f3246b0c1e1780bb4d4d5dc53Only 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.
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P1.01 - Advanced NSCLC (Not CME Accredited Session) (ID 933)
- 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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P1.01-100 - Concurrent Brain Radiotherapy and EGFR-TKI Have Better Survival Benefits in Patients with Brain Metastases from EGFR-Mutant NSCLC (ID 14392)
16:45 - 18:00 | Author(s): Xiaojiang Sun
- Abstract
Background
Epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) has intracranial activity in EGFR-mutant Non-Small Cell Lung Cancer (NSCLC). The optimal timing of brain radiotherapy and appropriate patients who need early brain radiotherapy remains controversial. We performed a retrospective analysis of patients with brain metastases (BM) from EGFR-mutant NSCLC to evaluate the preferred treatment of EGFR-TKIs in this population.
a9ded1e5ce5d75814730bb4caaf49419 Method
Of 128 initial or recurrent patients diagnosed BM from EGFR-mutant NSCLC between Jan 1, 2012, and Dec 31, 2016, 68 EGFR-TKI combined with concurrent brain RT, and 60 upfront EGFR-TKI then brain RT. Disease-specific-graded prognostic assessment was similar between two groups. The Kaplan-Meier method and log-rank tests were used to compare overall survival rates and intracranial progression-free survival rates, and a bootstrapped Cox proportional hazards model was used to determine significant contributors to overall survival.
4c3880bb027f159e801041b1021e88e8 Result
Compared with upfront EGFR-TKI group, the median OS was significantly longer in EGFR-TKI combined with concurrent brain radiotherapy group (24.1 vs 17.8 months; P=0.046). According to multivariate COX analysis, KPS (≥ 70) and intracranial metastasis alone was associated with a longer OS. The median intracranial progression-free survival was significantly improved in patients receiving EGFR-TKI combined with concurrent brain radiotherapy compared with upfront EGFR-TKI (32.3 vs 10.2 months; P=0.022).
8eea62084ca7e541d918e823422bd82e Conclusion
The present study suggests that the use of EGFR-TKI combined with concurrent brain radiotherapy may result in superior OS in patients with brain metastases from EGFR-mutant NSCLC. Also, early brain radiotherapy could significantly reduce the risk of intracranial progression compared with EGFR-TKI alone. Participation in clinical trials is essential to define the indications and relative efficacy of concurrent management and EGFR-TKI alone in a selected population. We expect that further molecular biomarkers will improve estimation of prognosis and patient selection in the future.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 982)
- 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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P3.16-19 - Clinical Outcomes of Stereotactic Body Radiation Therapy for T2N0M0 Non-Small Cell Lung Cancer (ID 12543)
12:00 - 13:30 | Author(s): Xiaojiang Sun
- Abstract
Background
For patients with inoperable stage I non-small cell lung cancer (NSCLC), stereotactic body radiation therapy (SBRT) is considered standard. However, the effectiveness and safety of SBRT specifically for T2N0M0 NSCLC remains controversial. This retrospective study investigated the safety and efficacy of SBRT in T2N0M0 NSCLC.
a9ded1e5ce5d75814730bb4caaf49419 Method
The medical records of 29 patients with T2N0M0 NSCLC treated by SBRT were reviewed. The overall, progression-free, and cause-specific survival rates were determined.
4c3880bb027f159e801041b1021e88e8 Result
The mean follow-up was 20.1 months. At years 1, 2, and 3, the overall survival rates were 93.1, 93.1, and 89.7%, respectively; the corresponding cause-specific survivals were 96.6, 96.6, and 93.1%; the progression-free survivals were 75.9, 65.5, and 62.1%; the local control rates were 100, 96.6, and 96.6%; the regional control was 86.2, 79.3, and 75.9%; and distant control was 89.7, 82.8, and 79.3%. Twenty patients (69.0%) developed symptoms of grade 1 toxicity: dyspnea, chest pain, fatigue, cough, esophagitis, or pneumonia. Among these, 5 patients suffered grade ≥2 therapy-associated pneumonitis, and one patient experienced grade 4 adverse pulmonary effects.
8eea62084ca7e541d918e823422bd82e Conclusion
SBRT was efficient and safe for patients with inoperable T2N0M0 NSCLC, imposing tolerable toxicities. These results warrant a prospective study to develop the multidisciplinary criteria for SBRT in T2N0M0 NSCLC.
6f8b794f3246b0c1e1780bb4d4d5dc53
