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II) non small cell lung cancer treated with hyperfractionated radiation therapy alone
$161 Wednesday, October 27, 2004
Poster workshops small-cell lung cancer (NSCLC) treated with hyperfractionated radiation therapy alone.
Lung cancer 356 poster workshop Can inverse planning replace forward planning for nonIMRT conformal radiotherapy of lung cancer?
Material and Methods: A total of 116 patients were treated with tumor doses of 69.6 Gy, 1.2 Gy b.i.d, fractionation. There were 49 patients with stage I and 67 patients with stage II. Eighty patients had KPS 90-100 and 95 patients had no pronounced (< 5%) weight loss. Tumor location was equally distributed between peripheral (n=57) and central (n=59). The majority of patients had squamous histology (n=70) as well as the majority had concomitant disease prohibiting surgery (n=72).
R. Mendes 1, J. Bedford2, A. Henrys 2, M. Brada 1 1The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Academic Department of Radiotherapy, Sutton, United Kingdom 2The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Joint Department of Physics, Sutton, United Kingdom This study aimed to determine whether inverse planning could produce acceptable or improved treatment plans with reduced dosimetrists' time compared to conventionally planned treatments. The plans of ten patients with non-small cell lung cancer, who had previously undergone radical radiotherapy, were replanned using AutoPlan optimisation software. The forward plans consisted of three coplanar 6 MV fields, shaped using multileaf collimators. All plans were prescribed to 64 Gy in 32 fractions. The inverse plans consisted of three or four coplanar fields, selected to minimise volume of lung irradiated to 20 Gy .(V~0)and dose variation in the planning target volume (PTV). Spinal cord dose was constrained to 46 Gy. Plans were compared using the Pinnacle 3 treatment planning system (Philips Radiation Oncology Systems). Volume of PTV receiving 95% of the prescribed dose (V95), lung V20 and mean lung dose (MLD) were recorded. Maximum spinal cord dose and mean heart dose were also considered. In addition, to evaluate the potential of inverse planning in complex situations, a six-field non-coplanar plan was created for each patient using both forward ~and inverse planning. Plan creation times were evaluated. Mean results are shown in the table (not significant unless stated). PIn a
PTV
(%)
V9s Lung
............................... i ............................
rward 92.6
(%)
V20 MLD "G " [
iDosim
Y) (h)
time
. . . . . . . . . . . . . . . . . . . . . ~................................. "Y. . . . . . . . . . . . . . . . . . . . . . . . . .
i21.4
14.0
i2
.................... _~ ............................. ~:
Inverse 3F i92.6
21.5
13.6
0 5
Inverse 4F 92.4
21.8
13.4
i0.5
Forward 6F
22.9
114.3
12.5
22.0
13.6 (p 0.04)
194.3
Inverse 6F 92.9
I !
=iO.5 ~
:
i { I
For three or four fields, inverse planning gives comparable results to forward planning, but requires less dosimetrists' time. For six non-coplanar fields, where it is much more difficult for the human planner to visualise the dose to the PTV and lungs, inverse planning is superior, both in terms of lung toxicity and time to produce the plan. 357 poster workshop Pretreatment clinical prognostic factors in patients with early stage (1/11) non small cell lung cancer treated with hyperfractionated radiation therapy alone
B. Jeremic, B. Milicic, A. Dagovic, L. Acimovic, S. Milisavljevic, G. Radosavljevic-Asic University Hospital, Oncology, Kragujevac, Serbia Purpose: To investigate influence of various pre-treatment clinical prognostic factors in patients with early stage (I/ll) non-
Results: The median survival time for all patients was 29 months and 5-year survival was 29%. The median time to local progression was not achieved and 5-year local progression-flee survival was 50.01%%. The median time to distant metastasis was not achieved yet, while the 5-year distant metastasis-free survival was 72%. Multivariate analysis identified KPS, weight loss, location, histology and reason for not undergoing surgery as prognosticators of survival. KPS, location and histology influenced local progression-free survival, while weight loss, T stage and reason for not undergoing surgery have been of borderline significance. Finally, only KPS and weight loss influenced distant metastasis-free survival. Conclusions: Identification of prognostic factors remains an important goal in radiation therapy of technically operable, but medically inoperable early stage (I/11) NSCLC. The strongest prognosticator of treatment outcome using all three endpoints was KPS. 358 poster workshop High dose radiation therapy with 3 Gy per fraction in medically inoperable high dose radiation therapy with 3 Gy per fraction in medically inoperable stage 1/11non-small cell lung cancer
B. Kim 1, Y.C. Ahn 2, D.H. Lim 2 IDankeok University Hospital, Radiation Oncelogy, Cheonan, Chungnam, Korea 2Samsung Medical Center, Radiation Oncology, Seoul, Korea Purpose: Surgery is the treatment of choice for stage 1/11nonsmall cell lung cancer (NSCLC). High dose radiation therapy (HDRT) is usually considered as an alternative for those patients with contraindications to surgery, and the authors of this study have employed HDRT with 3.0 Gy per fraction to reduce the overall treatment duration and cost. This study is a retrospective analysis and also reports on our results of using HDRT with 3.0 Gy per fraction for those patients with stage 1/11 NSCLC who were not fit for surgery. Materials and Methods: From January 1996 till February 2001, 35 stage 1/11NSCLC patients were treated with HDRT alone at Samsung Medical Center. Twenty-two patients (62.9%) had stage I disease and 13 patients (37.1%) had stage II disease. The median age was 73 years (range: 55-84 years) and the majority were male patients (32/35; 91.4%). Squamous cell carcinoma was the most common histologic type in 23 patients (65.7%), followed by adenocarcinoma in eight (22.9%). The median radiation dose to the primary lesion was 60 Gy/20 fractions (range: 54-66 Gy) over the median duration of 27 days (range: 23-38 days). Twenty-two patients (62.9%) received the elective irradiation to the mediastinal lymphatics on an individual basis. The patterns of failure, survival, relapse-free survival and the significance of the prognostic factors were analyzed. The median follow-up period was 24 months (range: 3~72 months).
Poster workshops small-cell lung cancer (NSCLC) treated with hyperfractionated radiation therapy alone.
Lung cancer 356 poster workshop Can inverse planning replace forward planning for nonIMRT conformal radiotherapy of lung cancer?
Material and Methods: A total of 116 patients were treated with tumor doses of 69.6 Gy, 1.2 Gy b.i.d, fractionation. There were 49 patients with stage I and 67 patients with stage II. Eighty patients had KPS 90-100 and 95 patients had no pronounced (< 5%) weight loss. Tumor location was equally distributed between peripheral (n=57) and central (n=59). The majority of patients had squamous histology (n=70) as well as the majority had concomitant disease prohibiting surgery (n=72).
R. Mendes 1, J. Bedford2, A. Henrys 2, M. Brada 1 1The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Academic Department of Radiotherapy, Sutton, United Kingdom 2The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Joint Department of Physics, Sutton, United Kingdom This study aimed to determine whether inverse planning could produce acceptable or improved treatment plans with reduced dosimetrists' time compared to conventionally planned treatments. The plans of ten patients with non-small cell lung cancer, who had previously undergone radical radiotherapy, were replanned using AutoPlan optimisation software. The forward plans consisted of three coplanar 6 MV fields, shaped using multileaf collimators. All plans were prescribed to 64 Gy in 32 fractions. The inverse plans consisted of three or four coplanar fields, selected to minimise volume of lung irradiated to 20 Gy .(V~0)and dose variation in the planning target volume (PTV). Spinal cord dose was constrained to 46 Gy. Plans were compared using the Pinnacle 3 treatment planning system (Philips Radiation Oncology Systems). Volume of PTV receiving 95% of the prescribed dose (V95), lung V20 and mean lung dose (MLD) were recorded. Maximum spinal cord dose and mean heart dose were also considered. In addition, to evaluate the potential of inverse planning in complex situations, a six-field non-coplanar plan was created for each patient using both forward ~and inverse planning. Plan creation times were evaluated. Mean results are shown in the table (not significant unless stated). PIn a
PTV
(%)
V9s Lung
............................... i ............................
rward 92.6
(%)
V20 MLD "G " [
iDosim
Y) (h)
time
. . . . . . . . . . . . . . . . . . . . . ~................................. "Y. . . . . . . . . . . . . . . . . . . . . . . . . .
i21.4
14.0
i2
.................... _~ ............................. ~:
Inverse 3F i92.6
21.5
13.6
0 5
Inverse 4F 92.4
21.8
13.4
i0.5
Forward 6F
22.9
114.3
12.5
22.0
13.6 (p 0.04)
194.3
Inverse 6F 92.9
I !
=iO.5 ~
:
i { I
For three or four fields, inverse planning gives comparable results to forward planning, but requires less dosimetrists' time. For six non-coplanar fields, where it is much more difficult for the human planner to visualise the dose to the PTV and lungs, inverse planning is superior, both in terms of lung toxicity and time to produce the plan. 357 poster workshop Pretreatment clinical prognostic factors in patients with early stage (1/11) non small cell lung cancer treated with hyperfractionated radiation therapy alone
B. Jeremic, B. Milicic, A. Dagovic, L. Acimovic, S. Milisavljevic, G. Radosavljevic-Asic University Hospital, Oncology, Kragujevac, Serbia Purpose: To investigate influence of various pre-treatment clinical prognostic factors in patients with early stage (I/ll) non-
Results: The median survival time for all patients was 29 months and 5-year survival was 29%. The median time to local progression was not achieved and 5-year local progression-flee survival was 50.01%%. The median time to distant metastasis was not achieved yet, while the 5-year distant metastasis-free survival was 72%. Multivariate analysis identified KPS, weight loss, location, histology and reason for not undergoing surgery as prognosticators of survival. KPS, location and histology influenced local progression-free survival, while weight loss, T stage and reason for not undergoing surgery have been of borderline significance. Finally, only KPS and weight loss influenced distant metastasis-free survival. Conclusions: Identification of prognostic factors remains an important goal in radiation therapy of technically operable, but medically inoperable early stage (I/11) NSCLC. The strongest prognosticator of treatment outcome using all three endpoints was KPS. 358 poster workshop High dose radiation therapy with 3 Gy per fraction in medically inoperable high dose radiation therapy with 3 Gy per fraction in medically inoperable stage 1/11non-small cell lung cancer
B. Kim 1, Y.C. Ahn 2, D.H. Lim 2 IDankeok University Hospital, Radiation Oncelogy, Cheonan, Chungnam, Korea 2Samsung Medical Center, Radiation Oncology, Seoul, Korea Purpose: Surgery is the treatment of choice for stage 1/11nonsmall cell lung cancer (NSCLC). High dose radiation therapy (HDRT) is usually considered as an alternative for those patients with contraindications to surgery, and the authors of this study have employed HDRT with 3.0 Gy per fraction to reduce the overall treatment duration and cost. This study is a retrospective analysis and also reports on our results of using HDRT with 3.0 Gy per fraction for those patients with stage 1/11 NSCLC who were not fit for surgery. Materials and Methods: From January 1996 till February 2001, 35 stage 1/11NSCLC patients were treated with HDRT alone at Samsung Medical Center. Twenty-two patients (62.9%) had stage I disease and 13 patients (37.1%) had stage II disease. The median age was 73 years (range: 55-84 years) and the majority were male patients (32/35; 91.4%). Squamous cell carcinoma was the most common histologic type in 23 patients (65.7%), followed by adenocarcinoma in eight (22.9%). The median radiation dose to the primary lesion was 60 Gy/20 fractions (range: 54-66 Gy) over the median duration of 27 days (range: 23-38 days). Twenty-two patients (62.9%) received the elective irradiation to the mediastinal lymphatics on an individual basis. The patterns of failure, survival, relapse-free survival and the significance of the prognostic factors were analyzed. The median follow-up period was 24 months (range: 3~72 months).