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Matthew Hatton
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FP04 - Locoregional and Oligometastatic Disease (ID 126)
- Event: WCLC 2020
- Type: Posters (Featured)
- Track: Locoregional and Oligometastatic Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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FP04.02 - Feasibility of Radiotherapy Planning in the First 50 Patients Recruited to the ADSCaN Clinical Trial (ID 1884)
00:00 - 00:00 | Author(s): Matthew Hatton
- Abstract
Introduction
The ADSCaN clinical trial (ISRCTN47674500) randomizes patients with unresectable stage III NSCLC suitable for sequential chemo-radiotherapy to one of four accelerated dose-escalated experimental radiotherapy regimens (CHART-ED, IDEAL, I-START, and Isotoxic IMRT) or a standard radiotherapy regimen of 55Gy in 20 fractions. We present feasibility of radiotherapy planning in the first 50 patients.
Methods
ADSCaN was data locked and presented to the data monitoring committee (DMC) in November 2019. Dosimetric data: GTV volume (cc), PTV volume (cc), radiotherapy planning objectives, and dose to organs at risk (OAR) were recorded against the respective OAR constraints for each arm. Linear regression analysis examined the relationship between PTV volume and radiotherapy dose to the respective OAR. Adverse events (AEs) are reported for the first 50 patients.
Results
46 radiotherapy plans were available for review; 16 standard arm, 11 CHART-ED, 5 IDEAL, 7 I-START, and 7 Isotoxic IMRT. One of the first fifty recruited patients did not receive radiotherapy. Median GTV volume was 61.96 (cc) (IQR 36.22–91.41); median PTV volume was 285.86cc (IQR 216.65–385.45). The largest PTV volume was 1590.60cc. Radiotherapy delivery was 1-2 full arcs for 7 patients, 2-3 half arcs for 26 patients, and 4-7 static IMRT fields for 13 patients. PTV coverage achieved the mandatory planning objectives of V95% >90% and V90% >98% in all but one case in the I-START arm where the PTV spanned the hemi-thorax and mediastinum. The OAR constraints were achieved in all cases.
Dose to respective OAR were plotted against PTV volume (figure); there was a positive correlation between lung and heart constraints and PTV volume. There was a negative correlation between PTV volume and D0.1cc oesophagus.
The strength of the correlation between PTV volume and OAR dose were weak to moderate: lung–GTV V20Gy R2=0.15944, D33% heart R2=0.14634, D67% heart R2=0.33828, D100% heart R2=0.58477, D0.1cc oesophagus R2=0.01195, indicating it is feasible to radically plan accelerated dose-escalated radiotherapy over a range of PTV and planning techniques. The overall CTCAE v4.0 grade 2 and 3 toxicity rate was 54% and 28%; specific grade 3 AE were dysphagia 2%, dyspnea 12%, fatigue 4%, oesophagitis 6%, pneumonitis 2%, and upper respiratory infection 2%. One patient developed bronchopneumonia as the sole grade 5 AE.
Conclusion
The recruiting ADSCaN clinical trial demonstrates feasibility of accelerated dose-escalated radiotherapy planning across treatment arms, dose objectives, and planning techniques, with no appreciable increase in AEs when compared to the contemporary NSCLC radical radiotherapy evidence base.
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P09 - Health Services Research/Health Economics - Real World Outcomes (ID 121)
- Event: WCLC 2020
- Type: Posters
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P09.17 - Changes in the Management of Patients Having Radical Radiotherapy in the UK During the COVID-19 Pandemic (COVID-RT Lung) (ID 3488)
00:00 - 00:00 | Author(s): Matthew Hatton
- Abstract
Introduction
In response to the COVID-19 pandemic, guidelines on reduced fractionation schedules for patients with lung cancer treated with curative-intent radiotherapy were published (Faivre-Finn et al, Clin Oncol) aiming to reduce the number of hospital attendances and potential exposure of vulnerable patients to COVID-19. There is now a need to understand the changes that have taken place and their clinical impact. Here we give a descriptive analysis of the first 425 patients in the UK COVID-RT Lung database
Methods
COVID-RT Lung is a multicentre UK audit. Inclusion criteria are: patients with stage 1 – 3 lung cancer referred for and/or treated with radical RT after 2nd April 2020. Patients who have a change in their management during the COVID-19 pandemic and those who continue with standard management are included in the audit. Data on demographics, COVID-19 diagnosis, diagnostic work-up, RT and systemic treatment, treatment-related toxicity, disease/patient status are collected. Each participating centre obtains approval from their local Caldicott Guardian to collect data. Anonymised data is collected on a central, cloud-based Research Electronic Data Capture system. Currently, 17 of the UK’s 62 radiotherapy centres are contributing patients and the audit continues to accept new sites.
Results
There were 425 records available for analysis on 17th August 2020. Median age 72 years (42-90), 213 (50%) female. 6 patients had been diagnosed with COVID-19, 4 prior to starting RT. 43 patients (10%) had a change in their diagnostic work-up for lung cancer as a result of the COVID-19 pandemic. 183 patients (43%) had their treatment changed from the treating centre’s standard of care. 50 (12%) patients had radiotherapy instead of surgery, 89 (21%) patients had a change in their radiotherapy dose/fractionation schedule from their centre’s usual practice and 70 (16%) patients had systemic treatment omitted or altered.
Table 1 shows the radiotherapy delivered to patients with stage 1-3 lung cancer who had data on completed treatment at the time of initial analysis (n=411). A large proportion of the patients who had their treatment changed received hypofractionated radiotherapy or stereotactic ablative body radiotherapy in fewer fractions.
Radiotherapy schedule
All patients (n=411)
Treatment changed (n=177)
No change to treatment (n=234)
SABR
Single fraction SABR
5 (1%)
5 (3%)
0
3 fraction SABR
48 (12%)
26 (15%)
22 (9%)
5 fraction SABR
74 (18%)
17 (10%)
57 (24%)
8 fraction SABR
24 (6%)
9 (5%)
15 (6%)
15 fractions
15 fractions with concurrent chemotherapy
6 (1%)
4 (2%)
2 (1%)
15 fractions after chemotherapy
30 (7%)
26 (15%)
4 (2%)
15 fractions RT alone
28 (7%)
20 (11%)
8 (3%)
20 fractions
20 fractions with concurrent chemotherapy
25 (6%)
11 (6%)
14 (6%)
20 fractions after chemotherapy
52 (13%)
19 (11%)
33 (14%)
20 fractions RT alone
88 (21%)
33 (19%)
55 (24%)
Other regimens
Concurrent chemoRT 2Gy/fraction
8 (2%)
1
7 (3%)
CHART
7 (2%)
0
7 (3%)
Palliative RT
7 (2%)
4 (2%)
3 (2%)
Other
9 (2%)
2 (1%)
7 (3%)
Conclusion
Initial analysis of this nationwide audit shows that clinicians are changing patient management in line with the UK guidelines on reduced fractionation schedules. The main change is an increase in hypofractionated and ultra-hypofractionated radiotherapy. The data presented will be updated as more patients are entered into the database and changes in management will be linked with patients’ outcome.
