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Intensity-Modulated Stereotactic Body Radiation Therapy for Medically Inoperable Stage I Non-Small Cell Lung Cancer
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Volume 90 Number 1S Supplement 2014 and to identify any statistically significant increases in BNP level over time. Results: The median value of the MHD was 26.5 Gy (range: 10.1–35.1 Gy). All patients had an undetectable TnI level at baseline. Two of 25 patients had TnI elevations to 0.03 and 0.07 at the end of RT, but returned to undetectable levels at the time of first follow-up. Changes in BNP at Day 1, end of RT, and first follow-up were not correlated with MHD. The mean change in BNP was significantly increased from baseline to the end of RT (95% CI: 3.4 to 46.5, P Z 0.03) and was significantly higher at first follow-up (95% CI 7.0 to 79.8, P Z 0.02) . A subset analysis on the 18 patients who received RT alone yielded no significant difference in BNP nor a correlation between BNP and MHD at any time point. Twelve patients had ECG changes, most commonly T-wave changes and poor Rwave progression, among which 7 patients (58%) had resolution of changes on future ECG. No patient experienced a cardiac event related to RT during the study. Conclusions: High-dose RT to focal areas of the heart is associated with an acute modest increase in BNP and largely non-specific ECG changes during treatment. The clinical sequelae of these findings require further investigation, including longer-term follow-up and cardiac functional evaluation in a larger cohort of patients. Author Disclosure: H. Pan: None. D.R. Grosshans: None. S.W. Yusuf: None. M. Munsell: None. J.W. Welsh: None. Z. Liao: None. S.H. Lin: None. J.Y. Chang: None. R.U. Komaki: None. J.D. Cox: None. M.F. McAleer: None. D.R. Gomez: None.
3066 Intensity-Modulated Stereotactic Body Radiation Therapy for Medically Inoperable Stage I Non-Small Cell Lung Cancer W. Jiang, J. Wang, J. Wang, J. Liang, Z. Hui, X. Wang, Z. Zhou, and L. Wang; Cancer Institute & Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, China Purpose/Objective(s): To investigate the clinical outcomes and toxicity of intensity-modulated radiation therapy (IMRT)-based stereotactic body radiation therapy (SBRT) for medically inoperable patients with stage I non-small cell lung cancer (NSCLC). Materials/Methods: Inoperable patients with stage I NSCLC, treated with hypofractionated SBRT using fixed-field IMRT (IMRT) or volumetricmodulated arc therapy (VMAT) between 2005 and 2013 at our hospital were retrospectively reviewed. The primary endpoint was tumor response, and the survival and toxicity were the secondary endpoints. Results: 68 patients with stage I NSCLC were analyzed, including 57 treated with IMRT and 11 using VMAT. 46 patients were initially treated and 22 patients were re-treated due to disease recurrence or secondary primary NSCLC. The median dose per fraction was 6 Gy (range, 4.0-12.5 Gy), multiplied by 4-17 fractions, equivalent to a median estimated biological effective dose (BED10) of 106.8 Gy (range, 67.2-124.8 Gy). An objective response (complete response and partial response) of 62.1% was achieved at 3 months and 86.8% at 12 months. At a median follow-up period of 16 months, the 1 and 2-year local control rate were 85.3% and 79.4%. The Kaplan-Meier estimates of local failure-free, progression-free, overall survival and cancer-specific survival rates at 5 year were 59.9%, 40.0%, 56.9% and 86.9%, respectively. Patients older than 75 years (p Z 0.005) and treated for recurrence (p Z 0.003) had a significantly poor progression-free survival. The rate of symptomatic acute pneumonitis was 22.06%(grade 3 in one patient). Grade 2 symptomatic late pneumonitis was observed in seven patients. Seven patients developed grade 3 late pulmonary consolidation on imaging according to LENT/SOMA scales but none had clinical symptoms. Conclusions: Moderate hypofractionated IMRT-based SBRT provided a positive therapeutic option with favorable local control and outcome without severe toxicity for inoperable patients with stage I NSCLC. Author Disclosure: W. Jiang: None. J. Wang: None. J. Wang: None. J. Liang: None. Z. Hui: None. X. Wang: None. Z. Zhou: None. L. Wang: None.
3067 Concurrent Chemoradiation Therapy in Patients With Locally Advanced NSCLC: Toxicity and Clinical Assessment Using VMAT Technique A. Ascolese, P. Navarria, F. De Rose, A. Tozzi, T. Comito, M. Campisi, A. Gaudino, E. Clerici, F. Lobefalo, C. Iftode, E. Villa, and M. Scorsetti; Humanitas Research Hospital, Milan, Italy Purpose/Objective(s): In locally advanced NSCLC (stage IIIA-IIIB) concurrent chemo-radiation therapy improves clinical outcomes compared with sequential treatments. However, patient selection and increased toxicity represent main limitation to the use of combined modalities. In this study we investigated toxicity and clinical outcomes in concurrent chemo-radiation therapy of advanced lung cancer using volumetric modulated arcs therapy (VMAT). Materials/Methods: Patients with locally advanced NSCLC, age<70 years, good performance status (PS 0-1) and minimal weight loss (< 10% within the 3 months prior to diagnosis) underwent to concurrent chemoradiation therapy. Total body computed tomography (CT) scan, FDG positron emission tomography (PET) and pathological diagnosis were performed in each patient before treatment and every three months thereafter. Patients received five cycles cisplatin and etoposide (CDDPVP16) every 21 days. The first cycle was completed prior to the radiation therapy. Total dose prescription was 60-70 Gy/30-35 fractions. Acute and late toxicity were evaluated by RTOG and CTCAE v. 4.0 score respectively. Evaluation of tumor response was defined according to the Response Evaluation Criteria in Solid Tumor (RECIST) v1.1. Results: Between May 2009 and March 2013 44 patients were treated at our Institution. Patients characteristics: IIIA(N2)/IIIB 25/19; m/f 29/15; adeno/squamous/NOS 29/10/5; age: median 62 (range 37-69). Acute Esophageal toxicity Grade 1- 2 occurred in all patients. No grade 3 toxicity occurred. Only one patient had a symptomatic pneumonia a month after the end of concurrent treatment requiring hospitalization. The median follow up was 24 months (range 4-48). Four patients had only locoregional progression and eight patients had local and systemic disease progression. The overall survival at 1, 2, 3 years was 70%, 45%, 35% respectively. Conclusions: Concurrent chemo-radiation therapy using VMAT proved to be a safe and advantageous treatment modality for locally advanced NSCLC with good toxicity profile. Clinical outcomes were satisfactory and comparable to the literature data. Author Disclosure: A. Ascolese: None. P. Navarria: None. F. De Rose: None. A. Tozzi: None. T. Comito: None. M. Campisi: None. A. Gaudino: None. E. Clerici: None. F. Lobefalo: None. C. Iftode: None. E. Villa: None. M. Scorsetti: None.
3068 Predicting Esophagitis During Radical Lung Radiation Therapy Using 18-FDG-PET Q. Mehmood, A. Sun, N. Becker, J. Higgins, A. Marshall, L. Le, P. McCloskey, V. Ford, K. Clarke, M. Yap, A. Bezjak, and J. Bissonnette; Princess Margaret Cancer Centre, Toronto, ON, Canada Purpose/Objective(s): Treatment of locally advanced non-small cell lung cancer (NSCLC) with chemo-radiation therapy (CRT) is limited by normal tissue toxicity including radiation esophagitis (RE). In the era of adaptive RT utilizing 18-FDG PET for dose escalation; one must be cognizant of the toxicities associated with such an approach. Our aim was to determine if changes in PET uptake within the esophagus during CRT can predict for the development and severity of RE. Materials/Methods: This was a secondary analysis of a prospective study in stage II-III NSCLC patients treated with CRT, which utilized serial 4DCT and 4DPET scans during CRT at weeks 0, 2, 4, and 7. All received 60-74 Gy with concurrent platinum-combination chemotherapy. RE was recorded using CTCAE v4.0. The esophagus was contoured on each exhale 4DCT scan and segmented into 2 regions. The first was the esophagus receiving <5 Gy (V0-5) which served as a baseline. The region receiving 5 Gy was analyzed excluding any region within 5 mm of the ITV
Volume 90 Number 1S Supplement 2014 and to identify any statistically significant increases in BNP level over time. Results: The median value of the MHD was 26.5 Gy (range: 10.1–35.1 Gy). All patients had an undetectable TnI level at baseline. Two of 25 patients had TnI elevations to 0.03 and 0.07 at the end of RT, but returned to undetectable levels at the time of first follow-up. Changes in BNP at Day 1, end of RT, and first follow-up were not correlated with MHD. The mean change in BNP was significantly increased from baseline to the end of RT (95% CI: 3.4 to 46.5, P Z 0.03) and was significantly higher at first follow-up (95% CI 7.0 to 79.8, P Z 0.02) . A subset analysis on the 18 patients who received RT alone yielded no significant difference in BNP nor a correlation between BNP and MHD at any time point. Twelve patients had ECG changes, most commonly T-wave changes and poor Rwave progression, among which 7 patients (58%) had resolution of changes on future ECG. No patient experienced a cardiac event related to RT during the study. Conclusions: High-dose RT to focal areas of the heart is associated with an acute modest increase in BNP and largely non-specific ECG changes during treatment. The clinical sequelae of these findings require further investigation, including longer-term follow-up and cardiac functional evaluation in a larger cohort of patients. Author Disclosure: H. Pan: None. D.R. Grosshans: None. S.W. Yusuf: None. M. Munsell: None. J.W. Welsh: None. Z. Liao: None. S.H. Lin: None. J.Y. Chang: None. R.U. Komaki: None. J.D. Cox: None. M.F. McAleer: None. D.R. Gomez: None.
3066 Intensity-Modulated Stereotactic Body Radiation Therapy for Medically Inoperable Stage I Non-Small Cell Lung Cancer W. Jiang, J. Wang, J. Wang, J. Liang, Z. Hui, X. Wang, Z. Zhou, and L. Wang; Cancer Institute & Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, China Purpose/Objective(s): To investigate the clinical outcomes and toxicity of intensity-modulated radiation therapy (IMRT)-based stereotactic body radiation therapy (SBRT) for medically inoperable patients with stage I non-small cell lung cancer (NSCLC). Materials/Methods: Inoperable patients with stage I NSCLC, treated with hypofractionated SBRT using fixed-field IMRT (IMRT) or volumetricmodulated arc therapy (VMAT) between 2005 and 2013 at our hospital were retrospectively reviewed. The primary endpoint was tumor response, and the survival and toxicity were the secondary endpoints. Results: 68 patients with stage I NSCLC were analyzed, including 57 treated with IMRT and 11 using VMAT. 46 patients were initially treated and 22 patients were re-treated due to disease recurrence or secondary primary NSCLC. The median dose per fraction was 6 Gy (range, 4.0-12.5 Gy), multiplied by 4-17 fractions, equivalent to a median estimated biological effective dose (BED10) of 106.8 Gy (range, 67.2-124.8 Gy). An objective response (complete response and partial response) of 62.1% was achieved at 3 months and 86.8% at 12 months. At a median follow-up period of 16 months, the 1 and 2-year local control rate were 85.3% and 79.4%. The Kaplan-Meier estimates of local failure-free, progression-free, overall survival and cancer-specific survival rates at 5 year were 59.9%, 40.0%, 56.9% and 86.9%, respectively. Patients older than 75 years (p Z 0.005) and treated for recurrence (p Z 0.003) had a significantly poor progression-free survival. The rate of symptomatic acute pneumonitis was 22.06%(grade 3 in one patient). Grade 2 symptomatic late pneumonitis was observed in seven patients. Seven patients developed grade 3 late pulmonary consolidation on imaging according to LENT/SOMA scales but none had clinical symptoms. Conclusions: Moderate hypofractionated IMRT-based SBRT provided a positive therapeutic option with favorable local control and outcome without severe toxicity for inoperable patients with stage I NSCLC. Author Disclosure: W. Jiang: None. J. Wang: None. J. Wang: None. J. Liang: None. Z. Hui: None. X. Wang: None. Z. Zhou: None. L. Wang: None.
3067 Concurrent Chemoradiation Therapy in Patients With Locally Advanced NSCLC: Toxicity and Clinical Assessment Using VMAT Technique A. Ascolese, P. Navarria, F. De Rose, A. Tozzi, T. Comito, M. Campisi, A. Gaudino, E. Clerici, F. Lobefalo, C. Iftode, E. Villa, and M. Scorsetti; Humanitas Research Hospital, Milan, Italy Purpose/Objective(s): In locally advanced NSCLC (stage IIIA-IIIB) concurrent chemo-radiation therapy improves clinical outcomes compared with sequential treatments. However, patient selection and increased toxicity represent main limitation to the use of combined modalities. In this study we investigated toxicity and clinical outcomes in concurrent chemo-radiation therapy of advanced lung cancer using volumetric modulated arcs therapy (VMAT). Materials/Methods: Patients with locally advanced NSCLC, age<70 years, good performance status (PS 0-1) and minimal weight loss (< 10% within the 3 months prior to diagnosis) underwent to concurrent chemoradiation therapy. Total body computed tomography (CT) scan, FDG positron emission tomography (PET) and pathological diagnosis were performed in each patient before treatment and every three months thereafter. Patients received five cycles cisplatin and etoposide (CDDPVP16) every 21 days. The first cycle was completed prior to the radiation therapy. Total dose prescription was 60-70 Gy/30-35 fractions. Acute and late toxicity were evaluated by RTOG and CTCAE v. 4.0 score respectively. Evaluation of tumor response was defined according to the Response Evaluation Criteria in Solid Tumor (RECIST) v1.1. Results: Between May 2009 and March 2013 44 patients were treated at our Institution. Patients characteristics: IIIA(N2)/IIIB 25/19; m/f 29/15; adeno/squamous/NOS 29/10/5; age: median 62 (range 37-69). Acute Esophageal toxicity Grade 1- 2 occurred in all patients. No grade 3 toxicity occurred. Only one patient had a symptomatic pneumonia a month after the end of concurrent treatment requiring hospitalization. The median follow up was 24 months (range 4-48). Four patients had only locoregional progression and eight patients had local and systemic disease progression. The overall survival at 1, 2, 3 years was 70%, 45%, 35% respectively. Conclusions: Concurrent chemo-radiation therapy using VMAT proved to be a safe and advantageous treatment modality for locally advanced NSCLC with good toxicity profile. Clinical outcomes were satisfactory and comparable to the literature data. Author Disclosure: A. Ascolese: None. P. Navarria: None. F. De Rose: None. A. Tozzi: None. T. Comito: None. M. Campisi: None. A. Gaudino: None. E. Clerici: None. F. Lobefalo: None. C. Iftode: None. E. Villa: None. M. Scorsetti: None.
3068 Predicting Esophagitis During Radical Lung Radiation Therapy Using 18-FDG-PET Q. Mehmood, A. Sun, N. Becker, J. Higgins, A. Marshall, L. Le, P. McCloskey, V. Ford, K. Clarke, M. Yap, A. Bezjak, and J. Bissonnette; Princess Margaret Cancer Centre, Toronto, ON, Canada Purpose/Objective(s): Treatment of locally advanced non-small cell lung cancer (NSCLC) with chemo-radiation therapy (CRT) is limited by normal tissue toxicity including radiation esophagitis (RE). In the era of adaptive RT utilizing 18-FDG PET for dose escalation; one must be cognizant of the toxicities associated with such an approach. Our aim was to determine if changes in PET uptake within the esophagus during CRT can predict for the development and severity of RE. Materials/Methods: This was a secondary analysis of a prospective study in stage II-III NSCLC patients treated with CRT, which utilized serial 4DCT and 4DPET scans during CRT at weeks 0, 2, 4, and 7. All received 60-74 Gy with concurrent platinum-combination chemotherapy. RE was recorded using CTCAE v4.0. The esophagus was contoured on each exhale 4DCT scan and segmented into 2 regions. The first was the esophagus receiving <5 Gy (V0-5) which served as a baseline. The region receiving 5 Gy was analyzed excluding any region within 5 mm of the ITV