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Chukwuka Eze



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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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      P2.17-18 - A Prognostic Score for Patients Receiving Multimodal Treatment for Locally-Advanced Non-Small Cell Lung Cancer (ID 14198)

      16:45 - 18:00  |  Author(s): Chukwuka Eze

      • Abstract
      • Slides

      Background

      Background:

      Locally-advanced non-small cell lung cancer (LA-NSCLC) represents a heterogeneous entity, distinct regarding patient- and primary tumor features. Introduction of a simple prognostic score can lead to personalized decision-making in clinical routine. The present study aimed to create a prognostic score for LA-NSCLC patients treated with multimodal therapy.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Patients and methods:

      Data were collated on a total of 100 patients treated with curative-intent multimodal therapy for LA-NSCLC (UICC stage III) . Several prognostic factors including gender, age, ECOG performance status, comorbidity, tobacco consumption, atelectasis before irradiation, COPD, emphysema and histology were analyzed for impact on overall survival (OS). Factors showing a significant negative association with OS on univariate analysis were included and scored with one point. A prognostic score was defined by the following 4 subgroups: low risk (0-1 points), medium risk (2 points), high risk (3 points) and very high risk (4-5 points).

      4c3880bb027f159e801041b1021e88e8 Result

      Results:

      Chemoradiotherapy (CRT) was completed by 96 (96%) patients with a total dose range of 50-70Gy. The absolute majority (81%) was treated with a total dose ≥ 60Gy. Intensity-modulated radiotherapy (IMRT) was delivered in 40 (40%) cases. 10 (10%) patients were treated with radiotherapy alone, 11 (11%) with sequential and 79 (79%) patients with concurrent CRT. 13 (13%) patients underwent surgery after completion of radiotherapy. Median OS for the entire cohort was 20.8 months (95% CI: 16.229–25.371). Impact on overall survival was found for age (negative in >60 vs. ≤60 years, p=0.038), gender (negative in male vs. female, p=0.016), pack years (PY) (negative in >21 PY vs. ≤20 PY, p=0.017), presence of atelectasis before irradiation (negative in yes vs. no, p=0.019) and tumor histology (negative in squamous cell carcinoma and NOS vs. adenocarcinoma, p=0.027).

      Per definition, 11 (11%), 26 (26%), 37 (37%) and 26 (26%) patients were in the low, medium, high and very high risk subgroups, respectively. Median OS was not reached for those with low risk, was 26.4 for medium, 22.0 for high and 13.7 months for patients with very high risk, respectively (p<0.001).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Conclusion:

      The simple prognostic score we developed for patients receiving multimodal treatment for stage III NSCLC may aid physicians in making individual therapeutic decisions and personalizing treatment by defining patients with compromised survival outcomes.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)

    • 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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      P3.01-25 - Feasibility of Moderate Hypofractionated Thoracic Irradiation for Non-Small Cell Lung Cancer Patients with Very Limited Lung Function (ID 13457)

      12:00 - 13:30  |  Author(s): Chukwuka Eze

      • Abstract
      • Slides

      Background

      To determine the feasibility of moderate hypofractionated image-guided thoracic irradiation (modHypo-IGRT) in locally advanced node-positive non-small cell lung cancer patients with very limited pulmonary function.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Eight selected patients with highly diminished pulmonary function (FEV1 ≤ 1.0L and/or DLCO ≤ 40% and/or long-term oxygen therapy) were treated with modHypo-IGRT. Planning was based on 18F-FDG-PET/CT and 4D-CT. Gross tumor volume (GTV) included primary tumor and involved lymph nodes. Internal target volume (ITV) was defined through the overlap of GTVs on 10 phases of 4D-CT. An isotropic margin of 5 mm was added to ITV to generate the planning target volume (PTV). modHypo-IGRT was delivered to a total dose of 45 Gy (ICRU) in 15 daily fractions under strict image-guidance. Vital capacity (VC), forced expiratory volume in 1s (FEV1), and single-breath diffusing capacity of the lung for CO (DLCO-SB) were analyzed prior to, 3 and 6 months after modHypo-IGRT.

      4c3880bb027f159e801041b1021e88e8 Result

      Eight patients completed modHypo-IGRT. The median follow-up was 20 months. The median age was 64 years. Two, 4 and 2 patients presented with stage IIIA, IIIB, and IIIC. Seven patients were with performance status ECOG 2 and 1 with ECOG 3. Five patients (63%) were on long-term oxygen. Three patients received chemotherapy prior to modHypo-IGRT. The median PTV was 226.9 cm³ (range: 100.17 - 379.80). The median overall (OS) and progression-free survival (PFS) for the entire cohort were not reached. The 1- and 2-year OS rates were 100% and 87.5%. The 6- and 12- months PFS rates were 100% and 63%. Three patients developed local failure. Median mean lung dose was 9.4 Gy (range: 5.3 -11.6). V15 and V20 for both lungs were 22% (range: 10-25) and 15% (range: 6-19). Median mean esophageal dose was 12.76 Gy (range: 2.1-26.7). There was no case of radiation pneumonitis. Four patients developed grade 2 radiation esophagitis. Median initial VC, FEV1 and DLCO-SB was 1.69L/64.8% predicted (range: 1.36-2.66/33-80%), 1L/39.4% predicted (range:0.78-1.26/28-60%) and 33.3% (range: 13.3-54), respectively. Median value for VC, FEV1 and DLCO-SB 3 months after modHypo-IGRT was 2.05L/56.35% predicted (range: 1.34-2.33/47-81.5%), 1.08L/47.5% predicted (range: 0.74-1.60/30.8-59.59%) and 38.55% (range: 24-68). At 6 months post-treatment, the median value for VC, FEV1 and DLCO-SB was 1.64L/66% predicted (range: 1.41-2.79/35.5-75.5%), 1.0L/47% predicted (range: 0.65-1.28/24.5-54.10%) and 31% (range: 27-43%).

      8eea62084ca7e541d918e823422bd82e Conclusion

      modHypo-IGRT can be considered for individual patients with locally advanced node-positive NSCLC patients with very limited pulmonary function hence inadequate for conventional treatment. This protocol is being assessed in an ongoing single-center prospective study.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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