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Jian Zhu



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    P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)

    • 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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      P2.01-124 - SIB-IMRT in Symptomatic Brain Metastases for NSCLC: A Randomized Controlled Study of WBRT Comparing 25Gy and 30Gy (ID 11955)

      16:45 - 18:00  |  Presenting Author(s): Jian Zhu

      • Abstract
      • Slides

      Background

      Intensity Modulated Radiation Therapy with Simultaneous Integrated Boost (SIB-IMRT) can better control intracranial local control rate and even prolong overall survival in non-small cell lung cancer (NSCLC) patients with brain metastases. However, some patients suffer severe neurocognitive dysfunction largely due to whole brain radiation. The purpose of this study is to explore the appropriate dose of whole brain RT when SIB-IMRT is applied.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A total of 75 patients with symptomatic brain metastases in NSCLC were randomly divided into 25Gy and 30Gy groups with 10 fraction whole brain radiation therapy (WBRT). The tumor beds with 3 mm expansion (PGTV) were synchronously boosted to 50Gy in both groups. The primary endpoint of the study was intracranial progression-free survival (iPFS) and neurocognitive dysfunction. Secondary endpoints objective response ratio (ORR) of 1 month after treatment and overall survival (OS) were included.

      Trial registration number: ChiCTR-INR-17013204.

      4c3880bb027f159e801041b1021e88e8 Result

      There were 38 and 37 patients in 25Gy and 30 Gy groups, respectively. There was not significant differences in age, gender, performance status and number of brain metastasis between these groups (all Ps>0.05). The median follow-up is 15 (range 2-39) months. The median iPFS was 11 months (95%CI:8.7-13.3) in the 25Gy Group and 8 months (95%CI:4.4-11.6) in the 30Gy Group (P=0.104). The median OS was 13 (95%CI:11.4-14.6) months in the 25Gy Group, which is significantly better than 8 (95%CI:4.4-11.6) months in the 30Gy Group (P=0.025). The mini-mental state examination(MMSE)of neurocognitive dysfunction found significant differences in the 25Gy Group vs. 30Gy Groups, 27.4±1.26 vs. 26.4±2.03 (P=0.027) at 12 months after radiotherapy (Table 1).

      Table 1. MMSE score statement

      Treatment arms

      P value

      25Gy group

      30Gy group

      Before radiotherapy

      28.03±1.57

      27.56±2.55

      0.322

      1-month After radiotherapy

      28.29±1.33

      27.92±2.13

      0.228

      3-monthAfter radiotherapy

      28.12±1.01

      27.98±1.24

      0.323

      6-month After radiotherapy

      27.47±1.55

      27.29±1.49

      0.061

      12-month After radiotherapy

      27.40±1.26

      26.37±2.03

      0.027

      Abbreviations: MMSE = mini mental state examination.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Based on this small randomized study, the 25Gy group with SIB did not reduce iPFS, but significantly improved OS and decreased toxicity of neurocognitive dysfunction at 12 months after radiotherapy, compared to the 30Gy group with 10 fractions SIB-IMRT in patients with NSCLC with symptomatic brain metastases.

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