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Lisa Van Der Woude
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P05 - Early Stage/Localized Disease - Radiotherapy (ID 114)
- Event: WCLC 2020
- Type: Posters
- Track: Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P05.05 - Real-World Data on Patients With Stage I Non-Small Cell Lung Cancer Treated With Stereotactic Body Radiotherapy (SBRT) (ID 1837)
00:00 - 00:00 | Presenting Author(s): Lisa Van Der Woude
- Abstract
Introduction
Since the introduction of Stereotactic Body Radiotherapy (SBRT), it has firmly established its place in the management of stage I non-small cell lung cancer (NSCLC), showing better overall survival than conventional radiotherapy. In the Netherlands, the first SBRT for lung cancer was performed in 2003. For patients, real-world data is essential to balance treatment toxicity and treatment outcome. This study aims to audit SBRT in patients with stage I NSCLC in the Netherlands.
Methods
The Dutch Lung Cancer Audit-Radiotherapy (DLCA-R) started in 2013 to register patients treated with radical or curative intent radiotherapy nationally. All patients receiving SBRT with curative intent for stage I NSCLC are included in this study. Information is collected on patient, tumor, and treatment characteristics, including acute toxicity and mortality within three months after the end of radiotherapy. We analyzed the percentage stage I NSCLC treated from 2015-2019 with SBRT. We studied toxicity and mortality in patients <65 years and with increasing 5 years of age cohorts up to >80 years of age.
Results
All 19 Dutch departments of radiation oncology participate in the registry. From 2015 until 2019, a total of 4537 stage I patients were registered with SBRT for primary (97.1%) or recurrent (1.6%) NSCLC. 21.4% was ≥80 years (the elderly). Overall good performance (WHO 0-1) was 68.4% vs. 67.4% in the elderly. 85.4% had stage IA, while stage IB was found in 14.6% of all patients. In the elderly, stage IB was slightly higher with 22.5% (p<0.001). Pathological proof of NSCLC was available in 45.1% of all patients. The median GTV was 4 cm3, IQR [0.00, 11.00], and significant larger in the older cohort (7 cm3). The planned dose was not given in 0.3%; no difference appeared in cohorts of age. 3-month acute toxicity (grade ≥3) was observed in 4.2% of all patients and in 3.1% of the elderly. The 3-month mortality rate was 1.7% for patients <65 years of age and 1.5% for the patients ≥ 80 years of age.
<65 years
65-70 years
70-75 years
75-80 years
>80 years
n=865
n=729
n=1007
n=961
n=972
p-value
Age (mean [SD])
59.74 (4.32)
67.63 (1.48)
72.55 (1.44)
77.46 (1.44)
83.65 (2.81)
<0.001
Year of treatment
2015
77 (8.9)
61 (8.4)
99 (9.8)
97 (10.1)
88 (9.1)
0.351
2016
99 (11.4)
84 (11.5)
100 (9.9)
99 (10.3)
128 (13.2)
2017
200 (23.1)
153 (21.0)
235 (23.3)
225 (23.4)
217 (22.3)
2018
271 (31.3)
252 (34.6)
345 (34.3)
294 (30.6)
286 (29.4)
2019 *
218 (25.2)
179 (24.6)
228 (22.6)
246 (25.6)
253 (26.0)
Gender
male
336 (38.8)
344 (47.2)
530 (52.6)
546 (56.8)
631 (64.9)
<0.001
female
528 (61.0)
385 (52.8)
477 (47.4)
414 (43.1)
340 (35.0)
Unknown
1 (0.1)
0 (0.0)
0 (0.0)
1 (0.1)
1 (0.1)
WHO performance status
0
233 (26.9)
164 (22.5)
209 (20.8)
199 (20.7)
184 (18.9)
<0.001
1
408 (47.2)
329 (45.1)
437 (43.4)
468 (48.7)
471 (48.5)
≥2
143 (16.5)
158 (21.7)
271 (26.9)
209 (21.7)
234 (24.1)
Unknown
81 (9.4)
78 (10.7)
90 (8.9)
85 (8.8)
83 (8.5)
Pathologically proven disease
NSCLC (tissue diagnosis)
395 (45.7)
325 (44.6)
441 (43.8)
454 (47.2)
429 (44.1)
0.553
Suspicion of NSCLC (clinical diagnosis)
470 (54.3)
404 (55.4)
566 (56.2)
507 (52.8)
543 (55.9)
Clinical stage (TNM-7/8 ^)
Stage IA
775 (89.6)
645 (88.5)
875 (86.9)
825 (85.8)
753 (77.5)
<0.001
Stage IB
90 (10.4)
84 (11.5)
132 (13.1)
136 (14.2)
219 (22.5)
Tumor
Primary
842 (97.3)
710 (97.4)
975 (96.8)
935 (97.3)
942 (96.9)
0.958
Recurrence
13 (1.5)
9 (1.2)
16 (1.6)
17 (1.8)
16 (1.6)
Unknown
10 (1.1)
10 (1.3)
16 (1.6)
9 (0.9)
14 (1.4)
Median GTV tumor volume [IQR, p25-p75]
3.00 [1.00, 8.00]
4.00 [1.00, 9.00]
4.00 [2.00, 11.00]
5.00 [2.00, 11.00]
7.00 [3.00, 16.00]
<0.001
Median cumulative dose[range]
55.00 [44.00, 75.00]
55.00 [40.00, 75.00]
55.00 [40.00, 75.00]
55.00 [42.00, 75.00]
55.00 [40.00, 75.00]
<0.001
Cumulative dose as planned
No
2 (0.2)
3 (0.4)
4 (0.4)
1 (0.1)
2 (0.2)
0.320
Yes
743 (85.9)
599 (82.2)
864 (85.8)
832 (86.6)
827 (85.1)
Unknown
120 (13.9)
127 (17.4)
139 (13.8)
128 (13.3)
143 (14.7)
Toxicity
None or < grade 3
763 (88.2)
645 (88.5)
887 (88.1)
845 (87.9)
874 (89.9)
0.474
Yes, grade ≥3
32 (3.7)
37 (5.1)
45 (4.5)
46 (4.8)
30 (3.1)
Unknown
70 (8.1)
47 (6.4)
75 (7.4)
70 (7.3)
68 (7.0)
Mortality within 90 days after finishing radiotherapy
No
788 (91.1)
678 (93.0)
926 (92.0)
885 (92.1)
895 (92.1)
0.683
Yes
15 (1.7)
9 (1.2)
15 (1.5)
22 (2.3)
15 (1.5)
Unknown
62 (7.2)
42 (5.8)
66 (6.6)
54 (5.6)
62 (6.4)
Table 1. Patient-, tumor-, and treatment characteristics of stage 1A/1B NSCLC patients treated with SBRT.
* 2019: not complete
^ TNM-7 2015-2016, TNM-8 2017-2019
Conclusion
This Dutch audit provides real-world data for stage I NSCLC patients treated with SBRT. The acute toxicity was low and identical in all age cohorts, while the elderly had significantly larger tumors. The 90 days mortality was overall 1.7% and not significantly different between the different age cohorts.
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P21 - Locoregional and Oligometastatic Disease - Treatment of Locally Advanced NSCLC (ID 131)
- Event: WCLC 2020
- Type: Posters
- Track: Locoregional and Oligometastatic Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P21.03 - Dutch Lung Cancer Audit-Radiotherapy: Real-World Data on Stage III Non-Small Cell Lung Cancer Treated With Radiotherapy Only (ID 1526)
00:00 - 00:00 | Author(s): Lisa Van Der Woude
- Abstract
Introduction
Around 9,500 patients are yearly diagnosed with non-small cell lung cancer (NSCLC) in the Netherlands. The Dutch Lung Cancer Audit-Radiotherapy (DLCA-R) is a national registry for lung cancer patients irradiated with curative/radical intent. The standard treatment for inoperable stage III NSCLC (III-NSCLC) is concurrent chemoradiation and adjuvant immunotherapy in responders. In some cases, chemotherapy is withheld for several reasons. The aim of this study is to describe the real-world data of radical radiotherapy only in patients with III-NSCLC and to analyse toxicity and mortality within 3 months post radiation in patients ≤75 years and >75 years of age.
Methods
Between January 2015 and December 2018, 543 patients with III-NSCLC registered within the DLCA-R were treated with radical radiotherapy only.
Descriptive statistics were used to assess toxicity and mortality within 3 months in patients ≤75 years and >75 years of age. (Table1) Co-morbidities were scored as cardiac, vascular, diabetic, pulmonary or malignant.
ResultsTable 1. Patient characteristics
N = 543
N
N(%)
Age (yrs)
≤75
>75
296
247
54.5
45.5
Gender
Male
Female
345
198
63.5
36.5
WHO PS
0
1
≥2
Unknown
64
269
183
27
11.8
49.5
33.7
5.0
Co-morbidity
None
Yes
Unknown
55
432
56
10.1
79.6
10.3
Toxicity (3 months)
None or < grade III
≥ grade III
Unknown
425
87
31
78.3
16.0
5.7
Mortality (3 months)
No
Yes
Unknown
472
55
16
86.9
10.1
2.9
Median dose
63 Gy
Range: 40-87 Gy
Acute 3-month toxicity (grade ≥3) and mortality data are summarized in Table 2.
Table 2. Three-months toxicity and mortality
≥ grade III toxicity*
Mortality*
Missing (%)
Age
All
87 (16%)
55 (10%)
0
≤ 75 years
45 (16%)
24 (8%)
> 75 years
42 (18%)
31 (13%)
WHO Performance Status
0-1
48 (15%)
25 (8%)
27 (5%)
≥2
34 (20%)
24 (13%)
Co-morbidity
No
07 (13%)
06 (11%)
56 (10%)
Yes
71 (17%)
41 (10%)
≥ grade III toxicity*
All
-
19 (22%)
31 (6%)
≤ 75 years
-
06 (13%)
> 75 years
-
13 (31%)
Mortality*
All
19 (38%)
-
16 (3%)
≤ 75 years
06 (29%)
-
> 75 years
13 (45%)
-
Missing
(% in whole population)
31 (6%)
16 (3%)
*<3-months after end of treatment
The 3-month mortality rate was 8.1% in patients ≤75 years and 12.6% in patients> 75 years (p=0.144). The 3-month mortality rate in patients with grade ≥3 toxicity was 13.3% in patients ≤75 years and 31.0% for the patients aged > 75 years (p<0.001). Significantly more grade III toxicity was observed in patients > 75 years and all age, who died within 3 months after treatment (p<0.001). This association could not be found in the group of patients ≤75 years. Most frequent reasons for withholding chemotherapy were co-morbidity, WHO Performance Status and age (survey, data not shown).
Real-world data on inoperable III-NSCLC patients selected for radical radiotherapy only revealed grade ≥3 toxicity in 16%, irrespective of age group. In an exploratory subgroup analysis, patients aged >75 years with grade III toxicity have a higher mortality-rate.