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Andrea Bezjak

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    IBS19 - Novel Approaches in Radiation Oncology for Small Cell and Neuroendocrine Cancers (Ticketed Session) (ID 50)

    • Event: WCLC 2019
    • Type: Interactive Breakfast Session
    • Track: Small Cell Lung Cancer/NET
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 07:00 - 08:00, Seoul (2007)
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      IBS19.01 - Novel Radiotherapy Approaches in Small Cell Lung Carcinoma – Applications to Thoracic, Oligometastatic and Cranial Tumor Control (Now Available) (ID 3372)

      07:00 - 08:00  |  Presenting Author(s): Andrea Bezjak

      • Abstract
      • Presentation
      • Slides


      Novel Radiotherapy Approaches in Small Cell Lung Carcinoma –

      Applications to Thoracic, Oligometastatic and Cranial Tumor Control

      Prof Andrea Bezjak, MDCM, MSc, FRCPC

      Radiotherapy (RT) plays a very important role in the management of Small cell Lung Cancer (SCLC), and jointly with chemotherapy can lead to cures in locally advanced SCLC1. Advances in RT techniques and understanding of its impact on tumor control are paving the way for a number of novel RT approached in the management of thoracic disease, as well as metastatic disease and brain control in SCLC.

      Thoracic radiation currently plays a role in extensive stage SCLC2, particularly in terms of reduction of symptomatic progression of intrathoracic disease. There is room to optimizing the indications, techniques, volumes and perhaps even dose of RT in that setting, and timing with respect to other treatments is worth exploring3-5.

      Whether there is an “oligometastatic” state in SCLC is not clear. One randomized trial of consolidative RT for patients with 1-3 extrathoracic metastases6 showed worse outcomes if all sites were treated with RT, so at this time we cannot recommend such an approach. However, immunotherapy is now part of systemic management of SCLC and studies have documented an important synergy of RT and immunotherapy7. Thus, the question of consolidative RT to areas of either residual disease, or to areas of oligo-progression, should be explored further, particularly if there are improved biological markers to differentiate patients with a lower burden of cancer, or slower natural history of disease.

      Prophylactic cranial irradiation (PCI) has been more controversial given some mixed evidence of its impact on survival from randomized controlled trials8,9, but all trials agree that PCI does reduce the risk of brain metastases in patients with SCLC. There are two current approaches to minimizing the risks of PCI – hippocampal sparing10 and omission of PCI, with MRI surveillance, and perhaps utilization of stereotactic RT if patients present with one or few brain metastases11. This approach, which has been of great benefit in reducing the negative impact of brain radiation while maximizing brain tumor control in non-small cell lung cancer, is emerging as a new paradigm in the management of patients with SCLC, although its applicability may be limited.


      1. Faivre-Finn C, Snee M, Ashcroft L, et al. Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an open-label, phase 3, randomised, superiority trial. Lancet Oncol. 2017;18(8):1116–1125.

      2. Slotman BJ, van Tinteren H, Praag JO, et al. Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial. Lancet 2015; 385: 36–42.

      3. Slotman BJ, Faivre-Finn C, van Tinteren H, et al. Which patients with ES-SCLC are most likely to benefit from more aggressive radiotherapy: A secondary analysis of the Phase III CREST trial. Lung Cancer 108 (2017) 150–153.

      4. Palmer DA, Warner A, Louie AV et al. Thoracic Radiotherapy for Extensive Stage Small-Cell Lung Cancer: A Meta-Analysis. Clinical Lung Cancer, 2015, Vol. 17, No. 4, 239-44.

      5. Rathod S, Jeremic B, Dubey A. et al. Role of thoracic consolidation radiation in extensive stage small cell lung cancer: A systematic review and meta-analysis of randomised controlled trials. European Journal of Cancer 110 (2019) 110-119.

      6. Gore EM, Hu C, Sun AY, et al. NRG Randomized Phase II Study Comparing Prophylactic Cranial Irradiation Alone To Prophylactic Cranial Irradiation And Consolidative Extra-Cranial Irradiation For Extensive Disease Small Cell Lung Cancer (ED-SCLC): NRG Oncology RTOG 093. J Thorac Oncol. 2017 October ; 12(10): 1561–1570.

      7. Bang A, Schoenfeld JD. “Immunotherapy and radiotherapy for metastatic disease”. Ann Palliat Med. 2018; (in press)

      8. Slotman B, Faivre-Finn C, Kramer G, et al. EORTC Radiation Oncology Group and Lung Cancer Group. Prophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med. (2007), 357(7):664-72.

      9. Takahashi T, Takeharu Y, Takashi S, et al. Prophylactic cranial irradiation versus observation in patients with extensive-disease small-cell lung cancer: a multicenter, randomized, open-label, phase 3 trial. The Lancet Oncology 2017, 18: 663-71.

      10. Gondi V, Pugh SL, Tome WA, et al.Preservation of Memory With Conformal Avoidance of the Hippocampal Neural Stem-Cell Compartment During Whole-Brain Radiotherapy for Brain Metastases (RTOG 0933): A Phase II Multi-Institutional Trial J Clin Oncol. 2014 Dec 1; 32(34): 3810–3816.

      11. Robin TP, Jones BL, Amini A, et al. Radiosurgery alone is associated with favorable outcomes for brain metastases from small-cell lung cancer. Lung cancer (2018), 120, 88-90

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    P1.10 - Prevention and Tobacco Control (ID 175)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Prevention and Tobacco Control
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.10-05 - Tobacco Retail Availability and Tobacco Cessation Among Lung Cancer Survivors (ID 1089)

      09:45 - 18:00  |  Author(s): Andrea Bezjak

      • Abstract


      Continued smoking after a lung cancer diagnosis is associated with poorer outcomes. Tobacco retail availability is negatively associated with cessation in non-cancer patients but this has not been explored in cancer survivors. We evaluated the impact of tobacco retail availability on tobacco cessation in lung cancer survivors.


      Lung cancer survivors from Princess Margaret Cancer Centre (Toronto, Canada) completed questionnaires at diagnosis and follow-up evaluating changes in tobacco use with a median of 26 months apart. Validated tobacco retail location data were obtained from Ministry of Health and patient home addresses were geocoded using ArcGIS 10.6.1, which calculated walking time/distance to nearest vendor, and vendor density within 250 meters (m) and 500m from patient residences. Multivariable logistic regression and Cox proportional hazard models evaluated the impact of vendor availability on cessation and time to quitting after diagnosis respectively, adjusting for significant clinico-demographic and tobacco covariates.


      242/721 lung cancer survivors smoked at diagnosis; subsequent overall quit rate after diagnosis was 66%. Mean distance and walking time to a vendor was 0.8 km (range 0-13) and 10 min (range 0-157). On average, there was one vendor (range 0-19) within 250m and five vendors (range 0-36) within 500m from pts; 40% and 64% of pts lived within 250m and 500m from at least one vendor respectively. Greater distance (aOR 1.28 per 1000m [95% CI 0.97-1.70] p = 0.08) and increased walking time (aOR 1.02 per minute [1.00-1.05] p = 0.08) to a tobacco vendor had a non-significant trend towards increased chances of quitting at one year. Living within 250m (aOR 0.43 [0.25-0.74] p = 0.003) or 500m (aOR 0.50 [0.28-0.88] p = 0.02) to at least one vendor reduced quitting at one year. Living near more vendors within 500m had a non-significant trend towards having an increasing dose effect on reducing cessation rates at one year (aOR 0.97 per vendor [0.94-1.00] p = 0.08). Living within 500m to a vendor reduced chance of quitting at any time (aHR 0.70 [0.50-1.00] p = 0.05).


      Close proximity to tobacco retail outlets is associated with reduced cessation rates for lung cancer survivors. Reducing density of tobacco vendors is a cessation strategy that could positively impact lung cancer patient outcomes.