Virtual Library

Start Your Search

Saskia Anne Cooke



Author of

  • +

    OA02 - Updates in Locally Advanced NSCLC (ID 125)

    • Event: WCLC 2020
    • Type: Oral
    • Track: Locoregional and Oligometastatic Disease
    • Presentations: 1
    • +

      OA02.05 - Local, Regional and Pulmonary Failures in the Randomised PET-Boost Trial for NSCLC Patients (ID 2266)

      09:15 - 10:15  |  Presenting Author(s): Saskia Anne Cooke

      • Abstract
      • Presentation
      • Slides

      Introduction

      In the phase II PET-Boost trial (NCT01024829), patients with stage II-III non-small cell lung cancer (NSCLC) were treated with hypofractionated dose escalation to either the primary tumour (PT) as a whole (armA) or the high FDG-uptake region inside the PT (>50%SUVmax) (armB). Results on Freedom From Local Failure at 1-year (primary endpoint), and overall survival (a secondary endpoint) were reported previously (Cooke et al,ESTRO,2020). Here we report on local and regional failure.

      Methods

      Patients with stage II-III NSCLC were randomised to armA or armB, after a treatment plan was made for both arms that were normalized to the mean lung dose. Concurrent/sequential/no chemotherapy was allowed. Follow-up chest CT-scans - scheduled at 3/6/12/18 months - were centrally reviewed by a thoracic radiologist. Definitions: local failure (LF): 20% growth of PT. Regional failure (RF): lymph node (LN) failure either in-field (IF) or out-of-field (OF) on CT-scan. Kaplan Meier analysis was performed to assess LF and RF rates at 2 years. Analysis of distant metastases is on-going.

      Results

      Between April 2010 and Sep 2017, 107 patients were randomised. 82% had stage III disease and 80% had N≥1 disease. Most patients received concurrent-chemoradiotherapy (72%). In arms A and B, median GTV-PT was 100 and 115cm3, median GTV-LN was 18 and 20cm3, median fraction dose was 3.25Gy to PTVwhole PT and 3.50Gy to PTV50%SUVmax, resulting in total planned physical dose 78.0 and 84.0 Gy, in 24 fractions (median OTT 34 days in both arms). Median follow-up for CT-scans in central review was 12.6months.

      In armsA and B respectively, loco-regional failure occurred in 12 and 15 patients, of which 2 and 4 had LF-without-RF, while 9 and 10 had RF-without-LF. One patient in armA had LF with synchronous RF, while in armB one patient had non-synchronous LF and RF.

      Analysis of all RF’s (10 and 11 total) showed 3 and 4 IF, 3 and 5 OF, 3 and 0 IF as well as OF (missing n=3). In arms A and B respectively, the 2-year cumulative incidence of LF was 11% and 18%, and for RF 28% and 25% (fig1).

      wclc cooke figure 1.png

      Conclusion

      In this randomised, phase II trial dose escalation to the whole PT or 50%SUVmax in NSCLC patients led to excellent local control rates in both treatment arms. The 2-year local failure rate was below 20% and regional failures rate about 27%. In future trials, dose escalation on the PT, sparing central structures as much as possible, may be considered.

      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.