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Sunita Ghosh



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    MA22 - New Therapeutics, Pathology, and Brain Metastases for Small Cell and Neuroendocrine Tumour (ID 925)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Small Cell Lung Cancer/NET
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 15:15 - 16:45, Room 206 BD
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      MA22.09 - Should Stereotactic Radiosurgery be Considered for Salvage of Intracranial Recurrence in Small Cell Lung Cancer? (ID 14092)

      16:15 - 16:20  |  Author(s): Sunita Ghosh

      • Abstract
      • Presentation
      • Slides

      Background

      Prophylactic cranial irradiation (PCI) remains a standard of care for small cell lung cancer (SCLC) to improve overall survival (OS) and prevent recurrence in limited (LS) and extensive stage (ES) disease. Intracranial recurrence (IC) after PCI affects 12-33%. Limited published data describe outcomes of salvage reirradiation (ReRT). Our purpose was to review outcomes after IC post-PCI or therapeutic whole brain radiotherapy (WBRT).

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Consecutive patients with pathologically-confirmed SCLC assessed (01/2013-12/2015) at a tertiary cancer centre (catchment 1.5M) were retrospectively reviewed. Demographics, treatment and outcomes were abstracted and summary statistics calculated. Kaplan-Meier estimates and univariate and multivariate analysis (MVA) via the Cox proportional hazard model were performed.

      4c3880bb027f159e801041b1021e88e8 Result

      Median age was 66.1yrs, 53% female, and 80% ECOG 0-2 (N =372). Median survival (MS) was 24 months (95%CI 18.3-29.7 mos) for 103 LS, and 7 months (95%CI 6.1-7.9 mos) for 269 ES patients. 72/103 LS received PCI (69.9%), 84.7% of whom had radical thoracic radiotherapy (RT). 54/269 ES patients presented with brain metastases (BM); 98/215 of the remaining received PCI, and 72 of those thoracic RT (84.7% 25-30Gy/10). PCI dose was 25Gy/10 in 95.9%. PCI patients had better performance status (PS), and were more likely to receive chemotherapy (CT) and thoracic RT (all p<0.013). 18.8% (32/170) recurred post-PCI (13 LS; 19 ES) at a median of 11.5 mos. 45/54 presenting with BM received WBRT (83.3% 20Gy/5), 14 of whom recurred. MS after PCI was 28 mos vs 12 mos for LS and ES, respectively. For LS patients with IC post-PCI, MS was 20 mos vs 38 mos without IC (p=0.03). On MVA, interval between brain RT predicted OS after PCI (HR 0.87; p<0.001), while stage (HR 3.56; p=0.008) and cranial RT dose predicted IC (HR 0.65; p=0.047). At IC, 56.5% (26/46) had <5 BM, median 1.7cm (range 0.5-5cm), 39.1% had no extracranial disease, 6 were asymptomatic, and 50% had ECOG 0-2. 30/46 had ReRT: 27 WBRT and 3 stereotactic radiosurgery (SRS). In retrospect, 17/46 would have been candidates for salvage SRS: 5 LS post-PCI; 8 ES post-PCI; and 4 ES post-WBRT.

      8eea62084ca7e541d918e823422bd82e Conclusion

      This cohort seems to challenge the belief that in-brain progression is always: diffuse; associated with clinical deterioration; and synchronous with systemic failure. With potential for OS >6 months, repeat WBRT risks meaningful neurocognitive toxicity. Further data are required; however, approximately 1 in 3 SCLC patients who recur after PCI or WBRT appear clinically appropriate for salvage SRS.

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    P2.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 966)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.17-28 - Real-World Data: Survival Outcomes of Chemotherapy Regimens Given Concurrently with Radiotherapy for Locally Advanced NSCLC (ID 12013)

      16:45 - 18:00  |  Author(s): Sunita Ghosh

      • Abstract
      • Slides

      Background

      Initial management for inoperable Stage III non-small cell lung cancer (NSCLC) treated for curative intent is platinum-based chemotherapy with concurrent thoracic radiotherapy (TRT). However, a lack of consensus on the optimal chemotherapy regimen administered with TRT remains. In Alberta, Canada, cisplatin/etoposide (EP), given Days 1-5 + 8 of a 28-day cycle, and cisplatin/vinorelbine (VP), given Days 1 +8 of a 21-day cycle, have been the two regimens used preferentially. Weekly carboplatin/paclitaxel (CP) has historically been used as an alternative in patients (pts) with borderline performance status or contraindication to cisplatin. Here, we retrospectively compare survival outcomes of these chemotherapy regimens.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The Alberta Cancer Registry identified pts diagnosed with locally advanced NSCLC between 2010 and 2015 and treated with EP, VP or CP chemotherapy with concurrent TRT. Patient and tumour characteristics were collected along with treatment parameters. Progression-free survival (PFS) and overal survival (OS) was determined for each chemotherapy regimen. Survival outcomes were compared using Kaplan-Meier analysis and Cox proportional hazard regression models adjusting for age, gender, tumour histological subtype (squamous vs. non-squamous NSCLC) and 7th edition TNM Stage (IIIA vs. IIIB).

      4c3880bb027f159e801041b1021e88e8 Result

      Of 148 pts reviewed, 44, 79, and 25 pts were treated with EP, VP, and CP, respectively, with median ages of 63, 62, and 68 years. Gender, tumour histological subtype, distribution of Stage IIIA vs. IIIB, and use of PET imaging for staging were balanced between regimens. Median PFS (EP 9.5 mo; VP 12.9 mo; CP 11.2 mo; p=0.875) and OS (EP 17.8 mo; VP 25.3 mo; CP 33.2 mo; p=0.509) were not significantly affected. Non-squamous median OS (EP 33.4 mo; VP 31.0 mo; CP 33.2 mo; p=0.997) and squamous median OS (EP 13.4 mo; VP 22.3 mo; CP not reached (N=11); p=0.406) also did not differ by regimen. Multivariate Cox regression analysis demonstrated Stage (IIIA vs. IIIB) as the only parameter that significantly altered PFS and OS.

      8eea62084ca7e541d918e823422bd82e Conclusion

      This retrospective analysis of real-word data from 2010 to 2015, in the absence of consolidation durvalumab, shows that PFS and OS in locally advanced NSCLC pts treated with concurrent chemoradiotherapy are similar for the EP, VP or CP regimens. Dose scheduling and respective toxicities will likely determine choice of chemotherapy regimen given with TRT. Further review of the CP regimen, given the small sample size in this study, and the use of next generation chemotherapy regimens such as platinum/pemetrexed for non-squamous NSCLC is warranted.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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