Virtual Library

Start Your Search

Iris Walraven



Author of

  • +

    MA08 - Pawing the Way to Improve Outcomes in Stage III NSCLC (ID 127)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Now Available
    • +

      MA08.07 - The Concordance Between Patient Reported Outcomes and Clinician Reported Outcomes During Radiotherapy in Lung Cancer Patients  (Now Available) (ID 2507)

      15:15 - 16:45  |  Author(s): Iris Walraven

      • Abstract
      • Presentation
      • Slides

      Background

      Capturing information on toxicity in (non-)small cell lung cancer patients receiving radiotherapy or chemoradiotherapy, is crucial for optimal symptom management. Patient Reported Outcomes (PROs) have the potential to improve toxicity detection by adding direct information from the patient perspective. The aim of this study is therefore to determine the predictive and additional value of PROs on prospectively scored clinician reported toxicity.

      Method

      An observational study was performed in lung cancer patients (n=111) treated with (chemo)radiation with curative intent. The EORTC QLQ-C30 and the EORTC LC-13 questionnaires were used to score PROs on a scale of 0-100 for a selection of commonly occurring toxicities (i.e. dysphagia, dyspnea, anorexia, fatigue, cough and nausea). Clinicians prospectively scored the maximum toxicity during, and at the end of treatment using the Common Toxicity Criteria for Adverse Events (CTCAE) version 4.0. Receiver operating characteristic (ROC) curves were constructed to evaluate the performance (i.e. discrimination) of PROs on predicting clinician scored CTCAE toxicity (grade ≥2). Furthermore, cut-off points were determined from the ROC-curve on the basis of the best trade‐off values between sensitivity and specificity (0,5). Validity of the model was assessed with the ability to predict the number of grade ≥2 toxicities (calibration).

      Result

      roc-curve for predictive ability of six pro toxicities for ctcae based toxicity.png

      Assessment of predictive performance in our cohort demonstrated a good fit for anorexia (AUC: 0,810 95% CI 0,699 to 0,921) and dysphagia (AUC: 0,828 95% CI 0,743 to 0,914) with sensitivity scores of 85,7%, 67,4% and specificity scores of 74,0% and 92,6% respectively. Both dyspnoea (AUC: 0,765 95% CI 0,60 to 0,910) and nausea (AUC: 0,745, 95% CI 0,548 to 0,942) showed a fair fit with sensitivity score of 74,1% for both toxicities and specificity of 69,1% and 68,3% respectively. A poor fit was found for cough (AUC: 0,667 95% CI 0,495-0,839) with a sensitivity of 55,6% and specificity of 30,4%. The model failed to discriminate for fatigue (AUC: 0,507 95% CI 0,368-0,645). Calibration showed that clinician based CTCAE toxicities substantially underestimated all PRO-based toxicities.

      Conclusion

      This study has identified that patient reported toxicities and clinician reported toxicities do not always concord. Only anorexia and dysphagia showed good agreement, while for the other toxicities, the agreement was only fair to poor. Furthermore, we showed that clinicians substancially underreport the existence of toxicities. This study adds to the growing body of evidence indicating the potential beneficial role of using PRO-based toxicity reporting in clinical cancer care for lung cancer.

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    P1.01 - Advanced NSCLC (ID 158)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
    • +

      P1.01-115 - Long-Term Effects of Concurrent Chemoradiotherapy on Quality of Life in Locally Advanced Non-Small Cell Lung Cancer Patients (ID 1780)

      09:45 - 18:00  |  Author(s): Iris Walraven

      • Abstract

      Background

      Concurrent chemoradiotherapy imposes beneficial effects on overall survival (OS) in patients with locally advanced non-small cell lung cancer (NSCLC). Currently, it is unknown what the effects on long-term health-related quality of life (HRQOL) are. Therefore, we investigated long-term HRQOL in locally advanced NSCLC patients treated with concurrent chemoradiotherapy, using an accelerated fractionation scheme of 24 x 2.75 Gy +/- Cetuximab.

      Method

      A 2-armed phase II, multi-center study (NTR2230) was performed with the initial aim to assess the effect of additional Cetuximab to concurrent chemoradiotherapy in locally advanced NSCLC patients. Arm A received high dose accelerated radiotherapy (24 x 2.75 Gy) and concurrent daily low-dose cisplatin (6 mg/m2). Arm B additionally received weekly Cetuximab (400 mg/m2 one-week pre-treatment followed by weekly 250 mg/m2). HRQOL was assessed using the EORTC QLQ-C30 at baseline, 3 months post treatment and after 1 year. The primary endpoints included dyspnea, pain, physical functioning, cognitive functioning and the QLQ-C30 summary score. Following the EORTC guidelines, the scores of the endpoints were linearly transformed to 0–100 scales. Higher scores correspond to improved functioning for the functioning scales and for the summary score while for symptom scales (pain and dyspnea), higher scores indicate more symptoms. Linear mixed-modeling was used to assess differences over time. Standardized effect sizes based on the t-test statistic were calculated: (2*t)/(√degrees of freedom). Effect sizes of 0.2 were considered small, 0.5 moderate and clinically relevant, and 0.8 large.

      Result

      Between February 2009 and May 2011, 102 patients were randomly allocated in two arms; 51 patients (50%) in arm A and 51 patients (50%) in arm B. Of those, 79 (77%) patients had at least one evaluable questionnaire. Figure 1 shows the development of the HRQOL endpoints over time. Over time, physical functioning (ES 0.48, P-value 0.003), cognitive functioning (ES 0.37, P-value 0.020), dyspnea complaints (ES 0.67, P-value <0.001) and the summary score (ES 0.44, P-value 0.006) significantly worsened. Only pain showed a reversing pattern in which pain was less present at 1 year (ES 0.37, P-value 0.021). No differences between the two arms were found. figure1.jpg

      Conclusion

      In this randomized study of locally advanced NSCLC patients treated with concurrent chemoradiotherapy with or without Cetuximab, a clinically meaningful and long-term decline for all HRQOL endpoints except pain was observed. This analysis suggests that although concurrent chemoradiotherapy improves OS in NSCLC patients, efforts should also be taken to improve long-term HRQOL.

  • +

    P1.18 - Treatment of Locoregional Disease - NSCLC (ID 190)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
    • +

      P1.18-18 - Feasibility of Hypofractionated Chemoradiation for Patients with Stage III Non-Small Cell Lung Cancer (Now Available) (ID 2598)

      09:45 - 18:00  |  Author(s): Iris Walraven

      • Abstract
      • Slides

      Background

      The standard treatment for fit patients with stage III non-small cell lung cancer (NSCLC) is concurrent chemoradiation often consisting of a platinum doublet and 60-66Gy. In the Netherlands an alternative is mildly hypofractionated radiotherapie (66Gy in 24 fractions of 2.75 Gy) combined with daily low dose Cisplatinum. This schedule aims to improve local tumor controle and overall survival by reducing overall treatment time. We investigated the feasibility of three weekly full dose platinum doublet chemotherapy combined with hypofractionated radiotherapy. The rational for full dose platinum doublet chemotherapy is to reduce the incidence of distant metastases.

      Method

      A retrospective observational study was performed including patients with stage III NSCLC (<70 years old, WHO performance score 0-1, estimated length of the oesophagus receiving 66Gy ≤12cm) who were treated with full dose platinum doublet chemotherapy and 66Gy/24 fractions. All patients were staged with a PET-scan and brain MRI. Chemotherapy generally consisted of 1 cycle of Cisplatin/Alimta or Cisplatin/Gemcitabine followed by 2-3 cycles of Cisplatin/Etoposide. Radiotherapy mostly started on day two of the second cycle of chemotherapy. Patients with a single mediastinal lymphnode metastasis who were selected for surgery after chemoradiation are not included in this analysis. Toxicity was scored using the common criteria for adverse events (CTCAE v4.0): acute if it occurred ≤90 days, late >90 days.

      Result

      Between 2012-2019, 40 patients were treated with hypofractionated radiotherapy and platinum doublet chemotherapy. The median age was 58 years (SD 8.9), all had a WHO 0-1, and 58% were male. The median follow-up was 3.3 years (IQR 1.7 – 3.9). The median overall survival was 1.6 years (IQR 0.6-3.2). The rate of distant metastases was 30% at two years, and the median progression free survival was 0.9 years. Grade ≥3 acute oesophageal toxicity occurred in 14 patients (35%) and late oesophageal toxicity in 7 patients (17.5%). Five patients died: all due to oesophagus perforation or broncho-oesophageal fistula.

      Conclusion

      In selected fit patients with locally advanced stage III NSCLC hypofractionated radiotherapy with concurrent full dose Cisplatin based chemotherapy resulted in an unexpected high rate of severe acute and late esophageal toxicity.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.