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Josef Karner



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    Lunch & Poster Display session (ID 58)

    • Event: ELCC 2019
    • Type: Poster Display session
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 4/11/2019, 12:30 - 13:00, Hall 1
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      174P - NSCLC stages IIa-IIIc: Tumor related IGRT yields better local control than kV-guidance to anatomic structures (ID 173)

      12:30 - 13:00  |  Author(s): Josef Karner

      • Abstract
      • Slides

      Background

      The prognosis for patients with LA-NSCLC (UICC stages IIa - IIIc) is still very limited with 5-year overall survival rates (OS) of approximately 20%. The meta-analysis published by Auperin et al. published in 2010 gives evidence that improved local control (LC) translates into better OS.Concurrent chemoradiotherapy – the standard of care treatment regimen – achieves LC around 65% at two years. The aim of the current single centre analysis was a comparison of LC after tumor related image guided radiotherapy (IGRT) versus kV-IGRT to central anatomic structures.

      a9ded1e5ce5d75814730bb4caaf49419 Methods

      122 patients with LA-NSCLC treated between January 2010 and December 2014 were eligible. After induction chemotherapy patients were treated with dose-differentiated accelerated radiotherapy (DART-bid) with total doses ranging between 73.8 and 90.0 Gy. In group A (69 patients) image guidance was either performed by matching to the tumor (with cone beam CT or fiducials) whereas in group B (53 patients) two orthogonal kV-images were acquired for subsequent matching to central mediastinal structures. With respect to baseline characteristics patients in group B had a higher ECOG, more loss of weight and a higher probability of a centrally located tumor. KV-imaging was used more frequently in the years 2010 and 2011, with a shift towards tumor related IGRT thereafter. Irradiation techniques changed from 3D target splitting to IMRT by the end of 2013.

      20c51b5f4e9aeb5334c90ff072e6f928 Results

      With a minimum follow-up of 3.5 years LC for all patients amounted to 73% and 59% at year 1 and 2 respectively. The difference between group A and B was insignificant (log-rank p-value = 0.080). Yet in the subgroup of 81 patients with peripheral lung cancer, tumor related IGRT led to a significantly better 1- and 2-year LC compared to kV-imaging: 84% and 72% versus 70% and 35% respectively (log-rank p-value: 0.010). Multivariate analysis (Cox regression, forward stepwise) showed that tumor related image guidance was the only significant prognosticator (p = 0.017, HR 0.279; 95%-CI 0.097 – 0.798) for LC.

      fd69c5cf902969e6fb71d043085ddee6 Conclusions

      Tumor related image guidance is the IGRT method of choice for patients with peripherally located tumors in order to improve local control.

      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.

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