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Claus Belka
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Lunch & Poster Display session (ID 58)
- Event: ELCC 2019
- Type: Poster Display session
- Track:
- Presentations: 7
- Moderators:
- Coordinates: 4/11/2019, 12:30 - 13:00, Hall 1
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100P - A new PET-CT score for locally-advanced inoperable NSCLC stage III patients treated with chemoradiotherapy (ID 580)
12:30 - 13:00 | Author(s): Claus Belka
- Abstract
Background
FDG-PET/CT is an integral part of staging and radiation treatment planning for patients with stage III non-small cell lung cancer (NSCLC). In this study, we analysed the correlation between different PET parameters and survival in NSCLC patients treated with chemoradiotherapy (CRT).
a9ded1e5ce5d75814730bb4caaf49419 Methods
Ninety-nine consecutive patients with NSCLC stage IIIA-B and good performance status, who underwent FDG-PET-CT before the start of CRT were analysed. Maximum standardized uptake value of primary tumor (SUVmax_PT) and range between the two most distant PET-positive (SUV≥3) lymph nodes in two directions (cranio-caudal and transversal) were analysed for their correlation with patient survival. The cranio-caudal distance was defined as A- and the transversal as B-line. The area under the ROC curve (AUC) as well as the cut-off SUVmax, A- and B-lines were calculated.
20c51b5f4e9aeb5334c90ff072e6f928 Results
Median survival for the entire cohort was 20.8 months (95% CI: 15.3-26.3). Patients with SUVmax_PT ≥ 8 had poor overall survival (OS) (19 vs. 40 months in patients with SUVmax ≥ 8 and <8, p < 0.0001). A-line was not associated with OS, whereas B-line < 3.7 cm improved OS significantly (30 vs. 16 months in patients with B-line < 3.7 and ≥3.7cm, p = 0.001). The sum of A- and B-lines with the cut-off at 6.7cm correlated with overall survival significantly (29 vs. 18 months in patients with sum < 6.7 and ≥6.7cm, p = 0.04). The PET-CT score was generated on the basis of PET parameters correlated with OS in univariate analysis. The patients were divided into 4 subgroups. The low-risk subgroup (0 points) included patients with SUVmax_PT< 8, B-line < 3.7 cm and the sum of A- and B-lines < 6.7 cm (n = 20, 21.3%). Twenty-eight patients (29.5%) had 1 point (intermediate risk), 20 (21.3%) had 2 points (high) and 26 patients (27.7%) had 3 points (very high risk). Median OS in terms of low/intermediate/high and very high risk subgroups was 40 (95% CI: 0-83)/27 (95% CI: 15-39)/26 (95% CI: 15-37) and 14 months (95% CI: 13-14), (p = 0.0001).
fd69c5cf902969e6fb71d043085ddee6 Conclusions
A new PET-CT score was developed for patients with inoperable stage III NSCLC treated with definitive CRT. Initial SUVmax_PT < 8, B-line < 3.7 cm and PET-CT score were predictors of patient long-term outcome.
b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study
The authors.
213f68309caaa4ccc14d5f99789640ad Funding
Has not received any funding.
682889d0a1d3b50267a69346a750433d Disclosure
All authors have declared no conflicts of interest.
cffcb1a185b2d7d5c44e9dc785b6bb25 -
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33P - Prognostic value of CD8-positive tumor stroma-infiltrating lymphocytes and PD-L1 positive tumor cells at initial biopsy in patients with locally advanced NSCLC treated with chemoradiotherapy (ID 581)
12:30 - 13:00 | Author(s): Claus Belka
- Abstract
Background
According to results of PACIFIC trial, immune checkpoint inhibitors (CPIs) are an integral part of the multimodal treatment approach for inoperable locally-advanced non-small cell lung cancer (LA-NSCLC). The purpose of this single-center study was to investigate a prognostic value of CD8-positive tumor stroma-infiltrating lymphocytes (TILs) and PD-L1 positive tumor cells at initial biopsy in patients treated with definitive chemoradiotherapy (CRT).
a9ded1e5ce5d75814730bb4caaf49419 Methods
We collected initial tumor tissue samples and reviewed the clinical characteristics of 36 LA-NSCLC patients treated at our center with definitive CRT between 2000 and 2004. The analyzed tumor tissue was taken before start of multimodal treatment. An experienced pathologist performed the immunohistochemistry analysis and interpretation. Tumor cells and CD8-positive tumor stroma-infiltrating lymphocytes were analyzed separately. Based on PD-L1 expression on tumor cells, patients were divided into three subgroups (0%, 1-5%, >5%). Two patient subgroups were defined according to CD8 expression in the tumor-surrounding stroma (low and high density: 0-40% vs. 41-100%).
20c51b5f4e9aeb5334c90ff072e6f928 Results
Thirty-six patients with LA-NSCLC were treated with definitive CRT (stage II, III and IV: 2, 30 and 4 patients). 18 (50%) patients had squamosa cell carcinoma, 14 patients (39%) adenocarcinoma and 4 patients (11%) NOS. Patients with high density of CD8 positive tumor stroma-infiltrating lymphocytes (TILS) showed a significantly reduced overall survival than patients with low density (13 vs. 19 months, one-year survival 56.5 vs. 69.2% p = 0.047); Patients without (0%) and low expression (1-5%) of PD-L1 on tumor cells showed a significantly improved overall survival compared to patients with a PD-L1 expression on tumor cells over 5% (median survival: 13.8 vs. 6.6 months, 1-year survival rate: 67.7 vs. 33.3%; p = 0.039).
fd69c5cf902969e6fb71d043085ddee6 Conclusions
High density of CD8-positive tumor stroma-infiltrating lymphocytes and PDL1 expression on tumor cells over 5% at initial biopsy correlates significantly with reduced overall survival in patients with LA-NSCLC treated with CRT.
b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study
The authors.
213f68309caaa4ccc14d5f99789640ad Funding
Has not received any funding.
682889d0a1d3b50267a69346a750433d Disclosure
All authors have declared no conflicts of interest.
cffcb1a185b2d7d5c44e9dc785b6bb25 -
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62P - External validation of a survival score for limited stage small cell lung cancer treated with chemoradiotherapy (ID 570)
12:30 - 13:00 | Author(s): Claus Belka
- Abstract
Background
In 2016, a survival score for limited stage small cell lung cancer (LS-SCLC) patients was developed to characterize prognostic sub-groups who underwent multimodal treatment. Herein, we validate the score in an independent external patient cohort.
a9ded1e5ce5d75814730bb4caaf49419 Methods
We reviewed the medical charts of 78 LS-SCLC patients treated with CRT at our institution. The survival score was calculated by independent prognostic factors: gender, Karnofsky performance status (50-70% vs. 80-100%), Tumor sub-stage (very limited vs. limited disease) and hemoglobin level before the start of radiation (<12 g/dl vs. ≥12 g/dl). Scoring points were derived from 2-year survival rates divided by 10 and the individual values for each prognostic factor were tallied. Three risk subgroups were defined (high, intermediate vs. low-risk: 9-13, 14-18 vs.19-26 points).
20c51b5f4e9aeb5334c90ff072e6f928 Results
Median overall survival in the validation cohort was 17 months (range: 1-123months). The 2-year survival rates were 0% in the high, 35% in the intermediate and 43% in the low-risk subgroup, respectively (p = 0.018). The difference in 2-year survival between the high and intermediate risk subgroups was significant (p = 0.007), whereas the 2yr-OS between the intermediate and low risk was not (p = 0.602). After stratification for the concurrent treatment mode, 2-year survival rates were 0% in the high, 60% in the intermediate and 58% in the low-risk subgroups, respectively (p = 0.004).
fd69c5cf902969e6fb71d043085ddee6 Conclusions
The survival score was reproducible to estimate 2-year survival rates of patients with LS-SCLC, especially in the high and intermediate-risk subgroups. In order to better characterize the prognostic difference between intermediate and low-risk patients, the scoring system needs further optimization.
b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study
The authors.
213f68309caaa4ccc14d5f99789640ad Funding
Has not received any funding.
682889d0a1d3b50267a69346a750433d Disclosure
All authors have declared no conflicts of interest.
cffcb1a185b2d7d5c44e9dc785b6bb25 -
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93P - Heterogeneity score in inoperable stage III non-small cell lung cancer patients treated with definitive chemoradiotherapy: A single centre analysis (ID 563)
12:30 - 13:00 | Author(s): Claus Belka
- Abstract
Background
Inoperable stage-III non-small cell lung cancer (NSCLC) represents a very heterogeneous disease in terms of patient and tumor characteristics. A simple heterogeneity score may help to personlize multimodal therapy.
a9ded1e5ce5d75814730bb4caaf49419 Methods
The data of 99 patients with performance status ECOG 0-1 treated with chemoradiotherapy (CRT) for inoperable stage III NSCLC, treated between 2011 and 2016 at our hospital were analyzed. Patient- and tumor-related factors were evaluated, and factors showing a significant negative association with patient survival were scored with one point each. Three subgroups with a low, intermediate and high-risk (0-1, 2-3 and 4-5 points) score were defined. The results were validated in a prospective cohort of 35 patients.
20c51b5f4e9aeb5334c90ff072e6f928 Results
Concurrent CRT was administered in 78% (n = 78) of patients and sequential CRT in 11% (n = 11), 10 Patients were treated with radiotherapy alone. 53% (n = 53) of patients received induction chemotherapy. Median overall survival (mOS) for the entire cohort was 20.8 months. Age (p = 0.020), gender (p = 0.007), cumulative tobacco pack years (PY) (p = 0.015), tumor-associated atelectasis (p = 0.004) and histology (p = 0.011) had a significant impact on survival in univariate analysis. 12, 59 and 28 patients had low, intermediate and high-risk score. MS, 1-, 2- and 3-year survival rates were as follows: not reached, 100%, 83% and 67% in the low, 22.9 months, 80%, 47% and 24% in the intermediate and 13.7 months, 57%, 25% and 18% in the high-risk score subgroup. Prospective validation of the score demonstrated one-year survival of 100% for patients in the low-risk subgroup, 93% in the intermediate-risk subgroup, and 69% in the high-risk subgroup (p = 0.100).
fd69c5cf902969e6fb71d043085ddee6 Conclusions
This simple heterogeneity score was developed for inoperable stage III NSCLC patients with good performance status receiving multimodal therapy. The score may aid physicians to infer clinical outcomes and optimize decisions concerning treatment strategies, as well as planning of prospective studies.
b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study
The authors.
213f68309caaa4ccc14d5f99789640ad Funding
Has not received any funding.
682889d0a1d3b50267a69346a750433d Disclosure
All authors have declared no conflicts of interest.
cffcb1a185b2d7d5c44e9dc785b6bb25 -
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95P - The role of patient performance status and its changes before and after completion of multimodal treatment for inoperable stage III NSCLC (ID 584)
12:30 - 13:00 | Author(s): Claus Belka
- Abstract
Background
The Eastern Cooperative Oncology Group performance score (ECOG-PS) is used in clinical routine to quantify patients’ general condition. We evaluated ECOG-PS before, after and its changes in the course of chemoradiotherapy (CRT) in patients with inoperable stage III NSCLC.
a9ded1e5ce5d75814730bb4caaf49419 Methods
The data of ninety-nine patients with NSCLC UICC stage IIIA/B (TNM 7th edition) were evaluated. ECOG-PS before treatment, at first follow-up and the difference was examined for their impact on overall survival (OS) from initial diagnosis and event-free survival (EFS) from the first day of radiation.
20c51b5f4e9aeb5334c90ff072e6f928 Results
Median survival for the entire cohort was 20.8 (range: 15.3-26.2) months. Before the start of multimodal treatment, ECOG-PS was 0 in 48% and 1 in 52% of patients; median OS, 1- and 2-year survival rates were 26.4 months, 85% and 53% for ECOG-PS 0 and 18.9 months, 69% and 37% for ECOG-PS 1 patients (p = 0.1). After completion of CRT 65% of patients had the same or better and 35% worse ECOG-PS: 0 in 34%, 1 in 46%, 2 in 18% and 3 in 2% of patients. Median OS, 1- and 2-year survival rates were 40.3 months, 88% and 64% for ECOG-PS 0; 19.3 months, 82% and 40% for ECOG-PS 1; 11.9 months, 50% and 28% for ECOG-PS 2 and 7.6 months, 0% and 0% for ECOG-PS 3 (p < 0.001). Deterioration of ECOG-PS after multimodal treatment significantly impaired survival in the initial ECOG-PS 0 (p = 0.005, median 19.1 vs 31.4 months) and 1 (p = 0.001, median 22.9 vs 11.1 months) subgroups. Median EFS was 9.6, 9.0, 7.9 and 3.5 months for patients with ECOG-PS 0, 1, 2, 3 after completion of CRT (p = 0.018). EFS was not affected by initial ECOG-PS but was significantly impaired by deterioration of ECOG-PS after completion of multimodal therapy with a median time of 9.4 vs 7.7 months (p = 0.049), respectively.
fd69c5cf902969e6fb71d043085ddee6 Conclusions
Deterioration of ECOG-PS after completion of primary multimodal treatment is a significant negative prognostic factor.
b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study
The authors.
213f68309caaa4ccc14d5f99789640ad Funding
Has not received any funding.
682889d0a1d3b50267a69346a750433d Disclosure
All authors have declared no conflicts of interest.
cffcb1a185b2d7d5c44e9dc785b6bb25 -
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96P - Impact of thrombocytosis and neutrophil-to-lymphocyte ratio before start of chemoradiotherapy on patient survival in inoperable stage III NSCLC (ID 587)
12:30 - 13:00 | Author(s): Claus Belka
- Abstract
Background
We aimed to evaluate an impact of thrombocytosis and neutrophil-to-lymphocyte ratio (NLR) before start of multimodal treatment on survival of patients with inoperable locally advanced non-small cell lung cancer (NSCLC).
a9ded1e5ce5d75814730bb4caaf49419 Methods
Retrospective data of 99 patients (ECOG 0-1) with inoperable NSCLC stage III receiving definitive chemoradiotherapy (CRT) between 2010 and 2016 at our institute were analyzed. Complete blood count and neutrophil- to- lymphocyte ratio (NLR) before initiation of multimodal treatment were evaluated and correlated with EFS and OS.
20c51b5f4e9aeb5334c90ff072e6f928 Results
The median age was 67 years and 63 % of patients were male. Median follow-up for the entire cohort was 17 months (range: 2 – 92). Patients with initial thrombocytosis (>401 x 109/L) demontrated a significantly shorter median EFS (7 vs. 14.5 months, p < 0.001, log-rank test) and OS (11 vs. 23 months, p = 0.002, log-rank test) vs. patients with normal platelet count. Patients with NLR >3.5 before start of multimodal treatment had a significantly worse prognosis than patients with lower initial NLR (0.78 – 3.5), (17.2 vs 29.3 months, p = 0.041, log-rank test).
fd69c5cf902969e6fb71d043085ddee6 Conclusions
Initial thrombocytosis and NLR > 3.5 were associated with shorter survival in patients with inoperable stage III NSCLC treated with definitive CRT.
b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study
The authors.
213f68309caaa4ccc14d5f99789640ad Funding
Has not received any funding.
682889d0a1d3b50267a69346a750433d Disclosure
All authors have declared no conflicts of interest.
cffcb1a185b2d7d5c44e9dc785b6bb25 -
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97P - Pattern of first-site failure and salvage treatment in patients with inoperable stage III non-small cell lung cancer after chemoradiotherapy (ID 590)
12:30 - 13:00 | Author(s): Claus Belka
- Abstract
Background
The standard of care treatment for inoperable stage III NSCLC is concurrent chemoradiotherapy (CRT) followed by consolidation with durvalumab. Loco-regional and distant recurrences remain common. Herein, we examine pattern of first-site failure and salvage treatment.
a9ded1e5ce5d75814730bb4caaf49419 Methods
We analysed the medical charts of 99 patients treated with CRT. Scans from date of first-site failure were fused with the delivered treatment plans. Recurrences were identified as in-field recurrence (IFR), out-of-field recurrence (OFR) [outside 50Gy isodose line] and distant metastases (DM). Using the Kaplan-Meier method with log-rank test for univariate analysis, the effect of salvage surgery (S), radiotherapy (sRT), chemotherapy (sCT) and immunotherapy (sIO) on overall survival (OS) was evaluated.
20c51b5f4e9aeb5334c90ff072e6f928 Results
With a median follow-up of 17.2 months, the mOS for all patients was 20.8 months. 26 patients (26%) with IFR had a mOS of 19.3 months. In patients who survived at least 12 months from initial diagnosis (74%), IFR was a significant negative prognosticator (mOS 19.3 vs 40.0 months; p < 0.001). 25 (25%) patients developed OFR with no significant impact on survival (27.1 vs 20.8 months, p = 0.313). 3 (12%) patients with OFR underwent salvage surgery (p = 0.057) and were still alive at the time of this analysis. 5 (20%) patients underwent sRT with a mOS of 71.2 vs 19.1 months (p = 0.014). 13 (52%) patients with OFR received sCT; mOS 26.4 vs 32.7 mo. (p = 0.644;) and 4(16%) pts received sIO (mOS: 64.6 vs 26.4 months; p = 0.222). Distant and brain relapse were detected in 42 (42%) and 16 (16%) patients; mOS 19.1 vs. 22.9 months (p = 0.819) and 19.1 vs 20.8 mo. (p = 0.635), respectively. 15 (94%) patients with brain relapse received cranial radiotherapy: 7 (47%) whole brain irradiation and 8 (53%) stereotactic radiosurgery (mOS 15.3 vs. 37.8 mo.; p = 0.064).
fd69c5cf902969e6fb71d043085ddee6 Conclusions
IFR was a significant negative predictor of OS in patients, who survived >1 year after initial diagnosis. Patients with OFR benefit most from salvage operation and/or radiotherapy. Furthermore, we observed survival benefit in patients who received SRS vs. WBRT for brain relapse.
b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study
The authors.
213f68309caaa4ccc14d5f99789640ad Funding
Has not received any funding.
682889d0a1d3b50267a69346a750433d Disclosure
All authors have declared no conflicts of interest.
cffcb1a185b2d7d5c44e9dc785b6bb25
