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Deniz Yalman
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P2.01 - Advanced NSCLC (ID 159)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.01-47 - Ipsilateral Lung Dose Constraints Predict Radiation Pneumonitis Better Than Conventional Ones in NSCLC Patients Treated with RCT (Now Available) (ID 337)
10:15 - 18:15 | Presenting Author(s): Deniz Yalman
- Abstract
Background
Mean lung dose (MLD) and percent of total lung volume that receive a dose greater than 20 Gy (V20) have been mostly validated parameters in prediction of radiation pneumonitis (RP). But these parameters present mean values of total lung parenchyme and predict the right and the left lung as a unique functional organ unit, not take into account the difference in function, dose density and radiosensitivity between the lungs. Also, there has been very limited data evaluating ipsilateral lung dosimetric constraints in addition to total lung parameters to predict RP in NSCLC-patients treated with radiochemotherapy (RCT).
Method
Between 2010-2017, clinical-radiological findings of NSCLC-patients treated with RCT were evaluated in terms of RP, retrospectively. The right and the left lung were contoured separately.The total lung was created by extracting PTV. Ipsilateral lung was described as the lung containing more than 50% of PTV and was created by extracting PTV from ipsilateral lung.
Pulmonary toxicity was graded according to RTOG/EORTC.Clinicaly important RP was defined as ≥ grade 2 lung morbidity.
The primary end point was to asses the relation between ipsilateral lung dose constraints and RP risk.The secondary end-point was to evaluate the predictive value of ipsilateral dose constraints in case of a relationship.
There were 75 patients.There was ≥ grade 2 RP in 33 cases (%44).Median age at diagnosis was 59.The median follow-up was 21 months.The median RT dose was 63 Gy.There was ≥ grade 2 RP in 33 cases(%44).RP risk was 75% if the tumor was located in upper lobe(p:0.012).
Univariate analysis was carried on clinical and dosimetric variables.The most significant ones were;ipsilateral MLD(p<0.001), ipsilateral V20(p<0.001), ipsilateral V30(p<0.001) and total lung V30(p<0.001).
Ipsilateral MLDp<0.001(OR:1.34)(%95CI:1.16-1.55) and PTV p:0.039(OR:1.002)(%95CI:1.000-1.004) were found to be the independent risk factors for RP.
The diagram of ROC curve analysis is shown in Figure 1.AUC values for ipsilateral MLD, ipsilateralV20, ipsilateralV30, MLD, V20 and V30 were 0.84, 0.80, 0.81, 0.64, 0.69 and 0.77, respectively.Threshold values for ipsilateral MLD, ipsilateral V20 and ipsilateral V30 were selected by ROC curve analysis and was determined as 18 Gy. 35% and 28% respectively.
Conclusion
In NSCLC-patients treated with CRT, MLD, V20 and V30 values of ipsilateral lung parameters might increase the predictablity of RP risk in addition to total lung parameters or even better. RT plannings might be improved by simply adding ipsilateral dose volume constraints witthout any additional test or effort to the patient
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P2.18 - Treatment of Locoregional Disease - NSCLC (ID 191)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.18-07 - Prognostic Factors Affecting Brain Metastasis-Free Survival in Non-Small Cell Lung Cancer Patients (Now Available) (ID 2249)
10:15 - 18:15 | Presenting Author(s): Deniz Yalman
- Abstract
Background
Brain metastasis is a poor prognostic factor for survival in all cancer types.Prophylactic cranial irradiation(PCI)has been considered standard of care for patients with small-cell lung cancer because of its favorable effects on survival, however there is no identifiable effect of PCI on survival in non-small cell lung cancer(NSCLC).The aim of this study is to define the factors which may be related to brain metastasis in patients with NSCLC who developed brain metastases after their definitive treatment.
Method
Two-hundred-eight patients with NSCLC,without brain metastases who received definitive radiotherapy or radiochemotherapy between January 2005 and January 2016 were evaluated retrospectively.Hematological parameters [platelet, neutrophil, lymphocyte counts, LDH, CRP, hemoglobin(Hb)levels,neutrophil-lymphocyte ratio(NLR)and platelet-lymphocyte ratio(PLR)],andFDG-PET/CT parameters(SUVmax values for the primary tumor and mediastinal lymph nodes),and patient characteristics were evaluated for brain-metastasis-free survival(BMFS).Cut-off values were determined byROC analysis.
Result
Patient and treatment characteristics were indicated in Figure 1. Median follow-up duration was 25 months.Cut-off values for platelet, NLR, PLR, LDH, CRP, and Hb were 290x103/µL, 2.6, 198, 468 IU/L, 2.5 mg/dL, and 11.5 g/dl. We defined each parameter as low or high according to the cut-off values. Fifty six patients(26.9%) developed brain metastases during follow-up.Median BMFS for the whole group was 21 months. In univariate analysis high NLR(71 vs 80months;p=0.001), PLR(71 vs 74months;p=0.037), LDH (65 vs 85months;p=0.028), CRP(47 vs 95months;p=0.002) values, SUVmax value ≥7.5 for lymph nodes(47 vs 79months;p=0.005) were poor prognostic factors for BMFS. In multivariate analysis high NLR(p=0.022), PLR(p=0.017), CRP(p=0.006), stage ≥IIIA disease(p<0.001), multi-stational N2 disease(p=0.036), adenocarcinoma histology(p<0.001) and SUVmax value ≥7.5(p=0.035) were poor prognostic factors for BMFS. Median survival duration after brain metastases was 6.5 months.
Conclusion
Development of brain metastases after definitive treatment of NSCLC is a serious problem affecting survival unfavorably. High NLR, PLR, LDH, CRP values and high SUVmax values for lymph nodes were additional prognostic factors besides stage, histology, and lymph node status.