145 Continuous hyperfractionated accelerated radiotherapy in non-small cell lung cancer: the West of Scotland experience

Posters, 10th Annual British Thoracic Oncology Group Conference, 2012: Radiotherapy has not gained universal acceptance in UK centres. We audited the outcome, patterns of recurrence and survival of patients treated with CHART from 2004 2009, in our district general hospital, and evaluated its benefit across difference age groups. Method: The data of all patients who received CHART from 2004 2009 was collected from the electronic data system of Derby Hospitals. Age at diagnosis, gender, date of diagnostic biopsy, histology, site of primary tumour, stage of tumour time to disease recurrence, time to death or last clinic visit from the end of CHART and site of disease recurrence were noted. The results were tabulated and analysed using SPSS statistical programme. Results: 37 patients were treated with CHART between January 2004 and January 2009. 67% of patients were male and 33% were female. 94% of patients were more than 60 years old, older than the cohort treated in the CHART study. Only 21% of patients had stage III disease. Median survival of patients was 21 months, which met the standards of 16.5 months set by the CHART trial. The benefit of survival in squamous cell lung cancer was not seen in our study. Estimated 2 year survival is 46.5% at Derby, within this cohort, compared to 29% in the CHART study. 43% patients had recurrence of disease during the follow up period, and 30% of disease recurred locally. 11% developed brain secondaries and 3% developed malignant pleural effusion. Male patients had a slightly poorer prognosis. There was also a trend for poorer short-term survival, if over 70 years although not statistically significant (p = 0.7). Conclusions: CHART radiotherapy continues to demonstrate the survival benefit seen in the pivotal CHART study. Significant proportion of patients had developed systemic disease recurrence suggesting the role of systemic therapy in these patients. Irrespective of treating an older cohort of patients, the survival benefit is still demonstrated. Further studies are needed to demonstrate benefits in integrating systemic therapy with CHART. radiotherapy. 144 Prospective data of continuous hyperfractionated accelerated radiotherapy (CHART): does performance status have an impact on radiation acute toxicities and resources? R. Pickles *, P. Mulvenna, R. McMenemin, P. Atherton, F. Mcdonald, M. Kagzi, C. McFetrich. Northern Centre for Cancer Care, Newcastle Upon tyne, UK Introduction: The Northern Centre for Cancer Care implemented CHART in 2005 and has treated 186 patients to date. We prospectively collect data for all CHART patients and have demonstrated CHART is a clinically effective treatment with manageable toxicities. As some patients referred for CHART were outside the protocol for the inclusion criteria of Performance Status (PS) 0 or 1, we commenced the formal recording of ECOG performance status in March 2009. We wanted to assess whether there were significant differences in acute toxicities relevant to PS and if this made a difference in required resources Method: Data on 72 patients consented for CHART between March 2009 and November 2011 was analysed from a prospective database. Data included performance status, length of oesophagus within the treatment field and results of on treatment review. In addition it was recorded whether the patient stayed in a self caring flat, travelled as an outpatient or elected to be admitted as an inpatient at commencement of treatment. Results: 96% of patients completed the full course of CHART. The results showed no significant difference between performance status and radiation acute toxicities. The remaining 4% did not complete or did not start due to comorbidities. These were all PS 3 patients, therefore only half of patients completing

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All PS 2 patients successfully completed CHART. Elective admission to the ward was the most popular at 53% followed by 36% of patients self caring in the flat. The largest group was PS 1 (46%) followed by PS 2 (24%), PS 0 (22%) and PS 3 (8%). Conclusions: This prospective data confirms the feasibility of delivering CHART to a wider group of patients than that indicated in current protocols and should include PS 2 patients, as there is no difference in toxicities. Additional resources would be required as 82% of this group elected for formal hospital admission. The results of PS 3 group demonstrate that this group needs careful consideration prior to being consented for CHART. Regardless of performance status, the CHART service has continued to be flexible and efficient complying with the national cancer waiting time targets. Information from 2 patient surveys over the 2-year period showed a good level of satisfaction from all patients. 145 Continuous hyperfractionated accelerated radiotherapy in non-small cell lung cancer: the West of Scotland experience S. Nowicki, K. Graham, B. Clark, V. Maclaren *. Beatson West of Scotland Cancer Centre, Glasgow, UK Introduction: The management of non-small cell lung cancer (NSCLC) has changed in recent years, with the introduction of continuous hyperfractionated accelerated radiotherapy (CHART). We present the results of a retrospective review in the West of Scotland Cancer Network. Method: A retrospective case note review was conducted for all NSCLC patients treated with (CHART) at the Beatson West of Scotland Cancer Centre over four years, from 2006 to 2009. Results: 126 patients were treated with CHART at our centre, of which 23 did not have a confirmed pathological diagnosis of NSCLC. These patients were excluded from the data analysis. Squamous cancer was the predominant pathological type (54.4%), followed by adenocarcinoma (20.4%). The median age of treatment was 75 years of age (range 46 to 90), with 59.2% male. 52.4% of patients had a PET prior to treatment. The majority of patients had early stage disease with 18.4% stage IA, 37.9% stage IB, 1.9% stage IIA, 20.4% stage IIB, 11.7% stage IIIA and 9.7% stage IIIB. Most patients had a performance status (PS) of 0 or 1 prior to treatment (PS0 24.3%, PS1 52.4%, PS2 22.4%, PS3 1%). After radiotherapy, 4.9% had a complete response, 64.1% had a partial response, 21.4% had stable disease, and 6.8% had progressive disease. 60 patients developed acute toxicity with radiotherapy treatment. Oesophagitis rates were 16.5% grade 1, 13.6% grade 2, and 1% grade 3. Pneumonitis rates were 3% grade 1, 6.8% grade 2, and 1% grade 3. 62% of patients with a recorded mean lung dose of greater than 20 Gy developed pneumonitis. Median overall survival time was 20.9 months (95% CI 15.3 26.4).

Parameters

Mean 3

Gross Tumour Volume, cm 96.46 Planning Target Volume (PTV), cm3 516.21 Length of the PTV, cm 13.53 Whole Lung Volume, cm3 3466.1 PTV/Whole lung Volume, % 16.37 Mean lung dose, Gy 16.92 V-20, % 27.36 V-10, % 53.74 V-5, % 68.27 Max dose to spinal cord, Gy 39.74

Range 6.47 638.5 135.53 1112.92 6.5 22.2 1847.99 5964.26 6.06 48.33 5.23 23.08 0 35.29 11.64 76.67 22.34 95 12.07 48.58

Conclusions: Our experience shows that CHART is well tolerated and our centre shows slightly improved survival rates compared to the published data.