Virtual Library
Start Your Search
Stephen James Harrow
Author of
-
+
MA09 - Lung Cancer Surgical and Molecular Pathology (ID 908)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Pathology
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 15:15 - 16:45, Room 202 BD
-
+
MA09.01 - Correlation of Pre-Operative Cancer Imaging Techniques with Post-Operative Macro and Microscopic Lung Pathology Images (ID 13181)
15:15 - 15:20 | Presenting Author(s): Stephen James Harrow
- Abstract
- Presentation
Background
This research project aims to investigate the performance of several PET radiotracers in lung cancer by aligning PET-CT and pathology imagery acquired from the same patients at different points in time. The discrimination of tumour substructures is of great importance in therapy planning, as a given treatment may be better adapted depending on the local characteristics of the carcinoma.
a9ded1e5ce5d75814730bb4caaf49419 Method
Due to the high deformability of lung tissue, several intermediate steps must be used for merging pathology and pre-operative PET-CT in a coherent manner. Firstly, the tumour volume is reconstructed from the macroscopic images taken during dissection. For this purpose, an enhanced dissection protocol is used, where the lung specimen is placed in a bespoke slicing rig and embedded in agar to hold it in place. Using a threaded plunger, the specimen is pushed upwards in 5mm steps, sliced and photographed. This procedure allows us to obtain slices of uniform thickness. Secondly, microscopic digital slides of the cancerous tissue are merged with the macroscopic 3D model. Finally, the whole volume is fused with the pre-operative PET-CT scan, using a non-linear deformable model.
4c3880bb027f159e801041b1021e88e8 Result
Preliminary results obtained with a synthetic phantom allowed us to analyse the accuracy of the tumour 3D reconstruction algorithm from planar macroscopic slices. Using these findings, we could optimise the interpolation and segmentation routines for building an accurate 3D model of the tumour mass. During our first trial with lung tissue (on-going work), each cross-sectional slice was photographed, the tumour boundary was delineated in each image by a pathologist (CD), and from these contours a high-resolution 3D tumour model was built. Next, the corresponding microscopic digitised slices were merged. To date, ten patients have been identified and consented, therefore allowing us to test our algorithm on different cases and assess its performance.
8eea62084ca7e541d918e823422bd82e Conclusion
We demonstrate a novel set of methods for co-registration of pre-operative PET-CT to macro and microscopically defined lung tumours. This proof of principle now allows interrogation of the raw data from PET-CTs using a range of tracers and the development of algorithms that identify substructure detail within a tumour mass, which could lead to tailored radiotherapy for individual tumours based on tracer patterns and uptake.
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.
-
+
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
-
+
P1.16-26 - Safety of SABR (Stereotactic Ablative Body Radiotherapy) for Central Non-Small Cell Lung Cancers (cNSCLC) with 50 Gray in 5 Fractions (50Gy/5f) (ID 12732)
16:45 - 18:00 | Author(s): Stephen James Harrow
- Abstract
Background
SABR using 60Gy/3f (or equivalent) caused high toxicity when used for cNSCLC. To determine a safe SABR dose for cNSCLC, the phase I/II RTOG 0813 trial used 50Gy/5f as a baseline. From 2013, 50Gy/5f was adopted for inoperable early-stage cNSCLC at the West of Scotland Cancer Centre, a tertiary-level oncology unit. We report our prospectively collected toxicity and efficacy data.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients with cNSCLC were identified from the radiotherapy database. cNSCLC was defined as lung cancers within 2cm of the proximal bronchial tree, or the planning target volume (PTV) abutting the mediastinal pleura/pericardium. Patient and treatment characteristics were obtained from electronic medical records. All patients received 50Gy/5f on alternate days with a volumetric arc therapy plan using TrueBeam linear accelerators. Toxicity was assessed in a centralised follow-up clinic 2 weeks, 6 weeks, 3 months, 6 months, 1 and 2 years after treatment using Common Toxicity Criteria Adverse Events version 3. Patients had a CT scan at 3 months post-treatment. Subsequent CT scans were at the discretion of the treating clinician.
4c3880bb027f159e801041b1021e88e8 Result
50 patients (31 females, 19 males, median age 75.1 years old) were identified with T1-2N0M0 cNSCLC. 84% were medically unfit for surgery. 40% had biopsy-proven NSCLC. All patients completed treatment on schedule. Two patients died within 90 days of treatment, one from a chest infection, the other cause of death was unknown. Table 1 describes the early and late toxicity. Over a median follow-up of 24 months, there were 20 deaths, 8 unrelated to cancer, and 12 due to cancer recurrence. The median progression free survival and overall survival are 26.0 months (95% confidence interval: 16.4, 35.6 months) and 28.6 months (95% confidence interval: 21.3, 35.8 months) respectively.
8eea62084ca7e541d918e823422bd82e Conclusion
This study has demonstrated that 50Gy/5f is a safe dose and fractionation for early-stage inoperable cNSCLC, with outcomes comparable to other series.
6f8b794f3246b0c1e1780bb4d4d5dc53
-
+
P2.10 - Prevention and Tobacco Control (Not CME Accredited Session) (ID 959)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
-
+
P2.10-03 - Feasibility and Acceptability of E-Cigarettes as an Aid to Quitting Smoking in Lung Cancer Patients: A Pilot Study (ID 13193)
16:45 - 18:00 | Presenting Author(s): Stephen James Harrow
- Abstract
Background
Many patients diagnosed with lung cancer continue to smoke even though this can make treatment less effective and increase side effects. E-cigarettes form part of the UK’s tobacco harm reduction policy landscape and are smokers’ most popular quit attempt method. This pilot study explores feasibility and acceptability of e-cigarettes to aid smoking cessation among lung cancer patients with advanced disease undergoing chemotherapy.
a9ded1e5ce5d75814730bb4caaf49419 Method
mokers with Stage IV lung cancer were recruited in NHS Greater Glasgow and Clyde and NHS Lanarkshire. Participants were provided with a 2nd generation e-cigarette device and a four week supply of e-liquid. Abaseline home visit was conducted by a researcher and an experienced e-cigarette user. Participants were followed-up over 16 weeks. We explored participants' experiences of using e-cigarettes including CO validated smoking cessation at 4 and 16 weeks. Qualitative interviews were conducted with participants (n=13), their significant others (n=6) and health professionals (n=8) engaged with lung cancer patients to obtain their views on the study.
4c3880bb027f159e801041b1021e88e8 Result
Twenty-nine patients were recruited and completed baseline data collection. Three patients died during the study. Of the 26 remaining, 35% (n=9) were CO validated as having stopped smoking at four weeks and 15% (n=4) at 16 weeks. Study procedures were viewed as feasible and acceptable. Patients’ experiences of using e-cigarettes were mixed. Some felt unwell during treatment making stopping smoking more challenging. Those who managed to quit were very positive about e-cigarettes as were their significant others. Health professionals expressed concern about longer term e-cigarette safety but welcomed the study.
8eea62084ca7e541d918e823422bd82e Conclusion
Smoking cessation should be offered to patients who have incurable disease. It is feasible and acceptable to offer e-cigarettes for smoking cessation to lung cancer patients during treatment. Cessation outcomes were positive and comparable with local cessation services. Future research involving a pilot randomised controlled trial is warranted but should include patients with less advanced cancer and assessment of longer term outcomes
6f8b794f3246b0c1e1780bb4d4d5dc53
-
+
P2.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 965)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
-
+
P2.16-22 - Comparing Two Common Radiotherapy Regimens in Non-Small Cell Lung Cancer - A Retrospective Study (ID 13462)
16:45 - 18:00 | Presenting Author(s): Stephen James Harrow
- Abstract
Background
In patients with inoperable non-small cell lung cancer (NSCLC), a variety of radiotherapy regimens are used as potentially curative treatments. At the Beatson West of Scotland Cancer Centre (BWoSCC), continuous hyperfractionated accelerated radiotherapy (CHART: 54 Gy in 36 fractions over 12 days) and hypofractionated radiotherapy (55 Gy in 20 fractions over 4 weeks) are the standard fractionations. The aim of this study was to review the clinical outcomes.
a9ded1e5ce5d75814730bb4caaf49419 Method
A retrospective study was performed assessing clinical and dosimetric records of all radically treated NSCLC patients at the BWoSCC in 2010 and 2015. We excluded all patients who had received chemotherapy sequentially or concurrently. Patient demographics, tumour characteristics, radiotherapy and survival data were collected and analysed.
4c3880bb027f159e801041b1021e88e8 Result
A total of 254 patients received radical radiotherapy: 113 were treated in 2010 (52 CHART and 61 with 55/20); 141 were treated in 2015 (43 CHART and 98 with 55/20).
Median age for CHART patients was 76 IQR (70-81), and for 55/20 patients 74 (68-79).
Overall, CHART patients had poorer performance status (PS). 32% of CHART patients had a PS 2/3 compared to 19.5% of 55/20 patients (p<0.01). In 2010, 68% of CHART patients were PS 0/1 and 32% were PS 2/3. In 2015, 53% were PS 0/1 and 47% were PS 2 (p<0.01).
In 2010, more CHART patients had unknown staging compared with the 55/20 patients (28% versus 4%). By 2015, there was no statistically significant difference.
The max planning target volumes (PTV) were on average larger in 2015 than 2010. The PTV of CHART patients increased by 19.8%. The PTV of the 55/20 patients increased by 3.4%.
Median progression free survival (progression or death) was 14.3 months 95%CI (11.0 to 18.0) for 55/20 patients and 14.6 months 95%CI (11.0 to 18.7) for CHART patients. Median overall survival was 23.2 months 95%CI (16.2 to 30.2) for 55/20 patients and 22.2 months 95%CI (14.5 to 29.2) for CHART patients.
8eea62084ca7e541d918e823422bd82e Conclusion
In this single centre study, we present a series of patients treated with 2 different radical radiotherapy regimens. Despite PTV volumes on average increasing from 2010 to 2015, the median survival has decreased for CHART. In our centre we introduced Stereotactic ablative radiotherapy as a new option for patients with stage I and II disease. Many patients who previously received CHART or 55/20 will now be eligible for SABR. It may be that this has changed selection criteria, with more advanced patients being put forward for CHART.
6f8b794f3246b0c1e1780bb4d4d5dc53
