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Tatiana Rabin El Ezra



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    MA05 - Improving Outcomes in Locoregional NSCLC II (ID 901)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 13:30 - 15:00, Room 105
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      MA05.10 - The Pathologic Response of Locally Advanced NSCLC Treated with Concomitant Chemoradiation to 60 Gy in Image Guided Radiation Therapy (IGRT) (ID 13758)

      14:35 - 14:40  |  Author(s): Tatiana Rabin El Ezra

      • Abstract
      • Presentation
      • Slides

      Background

      Neoadjuvant concomitant chemoradiation (NACCRT) was historically limited to 45 Gy. We recently published data on the safety of a higher radiation dose in this setting. Here we evaluate the pathologic response of locally advanced non small cell lung cancer (LANSCLC) treated with 60Gy NACCRT combined with modern IGRT.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Our cohort comprised patients that underwent NACCRT followed by surgery during August 2012-December 2017 at our institution. We retrospectively collected the demographic, stage, histology, and treatment details. Radiation was planned using eclipse system to deliver 2 Gy per fraction to a total of 60 Gy

      Treatment effect was determined from the pathologic specimen in accordance with College of American Pathologists recommendations, based on the modified tumor regression grading: Favorable pathologic responses included major tumor regression (MTR); we also evaluated the average percent of the residual tumor cells seen in the specimen. Statistical analysis was performed to analyze treatment effect on the pathologic response using spearman correlation and Kruskal-Wallis test with SPSS software v.24.

      4c3880bb027f159e801041b1021e88e8 Result

      Our cohort included 70 patients. Mean age was 63 years (range 45–79.7), men n=49 (70%), smoking status: never smokers n=11 (16.2%), past smokers n=10 (14.7%), current smokers n=47 (69.1%). Histology consisted adenocarcinoma n=42 (60%), squamous n=21 (30%) and other n=7 (10). Stage 2 were n=65 (78.3%) and stage 3 n=15 (21.4%). Chemotherapy consisted of platinum-doublet administered to 69 patients (98.5%). A mean radiation dose of 59 Gy (range 46-72 Gy) was delivered with IGRT prior to each fraction. Five patients received lower radiation doses due to toxicity or dose constraints. Surgery comprised of lobectomy n=50 (71.4%), chest wall resection n=9 (12.9%) or pneumonectomy n=11 (15.7%). Negative surgical margins were achieved in n=63 (90%) and positive margins in n=7 (10%). 30-day mortality was n=2 (2.8%) both cases after Right-sided pneumonectomy.

      MTR was observed in 45 cases (64.3%) including a pathological complete response in 25 (35.7%) and < 10% residual tumor in 20 cases (28.5%). The mean percent of residual tumor cells was 16% and the median 6.5%. Percent of residual tumor cells did not correlate to radiation dose (Rs=0.092), and not to the histology (p= 0.165), and not to type of chemotherapy (p=0.35).

      8eea62084ca7e541d918e823422bd82e Conclusion

      NACCRT delivered to 60 Gy with modern image-guided radiation therapy is safe. Two thirds of such patients achieve major tumor regression.

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