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Maddalena Rossi
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P1.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 949)
- 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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P1.17-07 - The Prognostic Value of Volumetric Changes of the GTV Measured on CBCT During Radiotherapy for CCRT in NSCLC Patients (ID 13159)
16:45 - 18:00 | Author(s): Maddalena Rossi
- Abstract
Background
To pursue personalized cancer care, it is important to determine tumor response during treatment and associate these with outcomes. Previously published literature reported that adenocarcinoma and squamous cell carcinoma have different treatment response and outcome. Therefore, the aim of this study is to examine the prognostic value of volumetric changes of the primary tumor measured on Cone Beam-CT (CBCT) during radiotherapy for locally advanced NSCLC patients treated with concurrent chemoradiation (CCRT).
a9ded1e5ce5d75814730bb4caaf49419 Method
394 NSCLC-patients treated with CCRT between 2007-2013 were included. To determine GTV during treatment, deformable image registration of the planning-CT to all CBCTs was performed. To assess the association of volumetric changes of the gross tumor volume (GTV) with overall survival (OS), progression free survival (PFS) and local regional control (LRC), multivariate cox regression analyses were performed, accounting for potential confounders. Furthermore, the entire group was stratified based on adenocarcinoma and non-adenocarcinoma and an additional log rank and multivariate cox regression analysis based on pathology was performed.
4c3880bb027f159e801041b1021e88e8 Result
In patients with adenocarcinoma, GTV reduction during CCRT was significantly associated with worse OS (HR=1.55, Figure 1). GTV reduction was not significantly associated with PFS and LRC in either subgroup. For the entire group no significant association was found between GTV volume change and OS, PFS or LRC.
8eea62084ca7e541d918e823422bd82e Conclusion
Surprisingly, no associations between GTV changes and outcomes were found for the entire treatment group. In patients with adenocarcinoma, GTV changes during concurrent chemoradiaton measured on CBCT were a significant predictor for OS.
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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P3.16-17 - Cardiac Sparing in Stereotactic Body Radiotherapy of Early Stage NSCLC Patients (ID 13855)
12:00 - 13:30 | Author(s): Maddalena Rossi
- Abstract
Background
In NSCLC patients who receive radiotherapy, cardiac toxicity was not well established as a possible factor until the results of the RTOG 0617 showed associations between cardiac dose and survival. These associations have been confirmed both in early and in locally advanced stage NSCLC patients. Cardiac sparing is not yet systematically pursued, and there is currently no agreement on cardiac constraints to be used. We investigated the feasibility of cardiac sparing in early stage NSCLC patients who receive SBRT.
a9ded1e5ce5d75814730bb4caaf49419 Method
Ten patients with early stage NSCLC in a middle or lower lobe, treated to 3x18 Gy between 2015 and 2017 using a dual arc VMAT technique were randomly selected. Retrospectively, clinical plans were adapted to minimize the maximum heart dose, while clinical constraints were respected. Mean Lung Dose (MLD) and cardiac doses Dmax, Dmean and V5Gy were compared between clinical and cardiac spared plans using a paired t-test.
4c3880bb027f159e801041b1021e88e8 Result
Median GTV was 3.05cc (range 0.54-23.2cc), 7 left sided tumors, 3 right sided. All cardiac spared plans fulfilled the clinical constraints on tumor coverage, conformity and organs at risk. All cardiac parameters were significantly decreased; a reduction in max heart dose of 8.2 Gy, reduction in mean heart dose of 1.0 Gy, and reduction in heart V5Gy of 10.3%, with p-values <0.001, 0.008 and 0.014 respectively. MLD was increased by a mean of 0.51 Gy (p-value 0.002). Results are shown in table 1.
8eea62084ca7e541d918e823422bd82e ConclusionDifference in cardiac and lung doses between clinical plans and cardiac spared plans. Patient Difference Heart_Dmax (Gy) Difference Heart_Dmean (Gy) Difference Heart_V5 (%) Difference MLD (Gy) 1
-6.1
-0.2
-2.5
0.2
2
-6.6
-0.9
-6.8
0.5
3
-2.8
0
-0.1
0.1
4
-8
-0.5
-3.7
0.8
5
-8
-0.2
-1.9
0.7
6
-8.6
-1.8
-13.4
0.2
7
-12.8
-2.9
-34.9
1.3
8
-12.4
-0.4
-5.6
0.2
9
-7.4
-1.4
-14.8
0.6
10
-9.4
-1.9
-19.5
1
Average
-8.21
-1.02
-10.32
0.56
Cardiac sparing is feasible for early stage NSCLC patients treated with SBRT, without compromising target coverage, and with minimal increase in mean lung dose. As cardiac exposure is associated with increased mortality, cardiac sparing has the potential to increase survival, and should be considered for all early stage NSCLC patients treated with radiotherapy. These data will need to be confirmed in a larger, prospective cohort.
6f8b794f3246b0c1e1780bb4d4d5dc53