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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
      • Slides

      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
      • Slides

      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.

      Table 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

      Results

      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).

      Conclusion

      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.

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