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The 5-Year Outcome for Patients Diagnosed With Locally Advanced Non-Small Cell Lung Cancer Treated With Definitive Concurrent Chemotherapy and Proton Beam Therapy
Volume 90 Number 5S Supplement 2014 Purpose/Objective(s): To determine whether the risk of radiation pneumonitis (RP) is different among patients with non-small cell lung cancer (NSCLC) treated with intensity modulated radiation therapy (IMRT) versus proton beam therapy (PBT), after taking into account differences in radiation dose to normal lung. In addition, to determine whether risk models developed to describe RP risk after 3-dimensional conformal radiation therapy (3D-CRT) are appropriate for these modalities. Materials/Methods: Plans from patients with NSCLC who received definitive chemoradiation with either IMRT (nZ305) or PBT (nZ85) were analyzed. RP was graded with the Common Terminology Criteria for Adverse Events, version 3.0; the endpoint was severe (grade 3) RP. Time to event was computed from the start of radiation therapy and was censored at last follow-up or at time of local recurrence, if any, to ensure that lung symptoms could be attributed to radiation-induced toxicity. The spatial distribution of dose to normal lung was summarized using mean lung dose (MLD) or effective dose (Deff) computed using volume parameter nZ0.41; Deff was found to describe RP risk better than MLD in an earlier study of patients receiving 3D-CRT. RP incidence after IMRT or protons was modeled as a function of MLD or Deff and compared to estimates from 3D-CRT risk models. Results: The crude incidence of grade 3 RP was 12.5% in the IMRT group and 7.1% in the proton group. After correcting for differences in MLD, no difference was found in the risk of RP for PBT versus IMRT (PZ.662, likelihood ratio test). Instead, the higher incidence of RP after IMRT was explained by significantly higher MLD values in that cohort (P<.001, Mann-Whitney test), explained in part by larger gross tumor volumes (GTVs) in the IMRT cohort (PZ.002), although MLDs were lower in proton patients than IMRT patients with similar GTV. Similar results were obtained using Deff. The models relating RP risk to MLD and Deff derived earlier from 3D-CRT data did not fit the IMRT and proton data well; although the shape of the prediction curve was similar, it was displaced upwards toward higher toxicity levels than observed here. Conclusions: PBT resulted in a lower incidence of severe RP relative to IMRT overall because of lower MLDs. However, the incidence of severe RP after PBT relative to IMRT was similar after correcting for differences in dose to normal lung. Deff or MLD could be good dosimetric parameters for describing lung exposure after protons, but incidence levels after both modalities were lower than expected based on 3D-CRT risk models. These results will be validated using the data from a prospective trial comparing IMRT vs PBT for lung cancer when the data become available. Author Disclosure: Z. Liao: None. R. Mohan: None. T. Xu: None. J.D. Cox: None. S.L. Tucker: None.
131 Comparison of Overall and Cause-Specific Survivals of Stage III Non-Small Cell Lung Cancer (NSCLC) Treated With Carboplatin- or Cisplatin-Based Concurrent Chemoradiation Therapy Using SEERMedicare Data (1992-2007) Locally Advanced Non-Small Cell Lung Cancer E. Kim,1 T. Biswas,2 A. Dowlati,2 N. Sharma,2 and M. Machtay2; 1Case Western Reserve University School of Medicine, Cleveland, OH, 2 University Hospital at Case Western Reserve University, Cleveland, OH Purpose/Objective(s): Almost one-third of lung cancers are diagnosed at stage 3. Concurrent chemoradiation therapy (CCRT) is the standard of care for unresectable locally advanced NSCLC, most commonly using cisplatin/etoposide (cis/eto), or carboplatin/paclitaxel (carb/pac). However, there has never been a trial outside of China comparing these regimens. Some studies found cis/eto had better survival than carb/pac, but poorer quality of life probably related to higher rates of toxicity. Other studies have found comparable survival and similar rates of toxicity. The hypothesis was that cis based CCRT would have slightly better survival than carb based CCRT, based on the conflicting literature results.
Poster Presentations
S19
Materials/Methods: Cases were selected from the national populationbased SEER-Medicare lung cancer database (1992-2007). Inclusion criteria included age 66-80 at diagnosis, stage III primary NSCLC as first cancer diagnosis, with carb or cis based CCRT as primary treatment without any lung surgery. Cases receiving both carb and cis were excluded. CCRT was defined as starting radiation within 2 weeks of starting carb or cis. Covariate of interest was the carb or cis based regimen. Endpoints were overall survival (OS, time from diagnosis until death) and cause specific survival (CSS, time from diagnosis until death from NSCLC). Commercially available software packages were used for case selection, descriptive statistics, Kaplan-Meier survival analysis, and log-rank tests for significance. Results: A total of 2848 cases were selected, including 2331 carb and 517 cis based CCRT. Mean age was 73 (66-80) and 59% were male. Carb and cis groups had 10.5% and 10.1% 5-yr OS, and 20.1% and 20.0% 5-yr CSS, which were not significantly different (OS PZ.18, CSS PZ.82). The most commonly used carb and cis regimens were carb/pac (72% of carb) and cis/eto (62% of cis). Carb/pac and cis/eto had 11.4% and 10.1% OS, and 20.6% and 18.9% CSS, which were not significantly different (OS PZ.29, CSS PZ.49). Conclusions: Carb and cis based CCRT had comparable OS and CSS. The most commonly used carb and cis regimens (carb/pac and cis/eto) also had comparable OS and CSS. This did not support the general belief that cis based CCRT has better outcomes than carb based CCRT, which suggests they can be used interchangeably as clinically appropriate (eg, based on comorbidities, side effects). A limitation of using Medicare claims data to determine treatment was the lack of detailed treatment information, eg, dose, fractionation, and timing of radiation, and number of cycles, spacing, and dose (systemic vs radiation-sensitizing) of drugs. Randomized trials may be helpful in confirming the results of this retrospective secondary analysis. Author Disclosure: E. Kim: None. T. Biswas: None. A. Dowlati: None. N. Sharma: None. M. Machtay: None.
132 The 5-Year Outcome for Patients Diagnosed With Locally Advanced Non-Small Cell Lung Cancer Treated With Definitive Concurrent Chemotherapy and Proton Beam Therapy Locally Advanced Non-Small Cell Lung Cancer Q. Nguyen,1 R. Komaki,1 Z. Liao,1 N. Ly,2 L. Levy,1 D. Gomez,1 J. Chang,1 and J.D. Cox1; 1University of Texas MD Anderson Cancer Center, Houston, TX, 2Tulane University School of Medicine, New Orleans, TX Purpose/Objective(s): To report 5 year survival outcomes and toxicity in stage II and stage III non-small cell lung cancer (NSCLC) patients treated with definitive concurrent chemotherapy and proton beam radiation therapy. Materials/Methods: Between 2006 and 2010, 138 primary non-small cell lung cancer (NSCLC) patients received definitive proton beam radiation therapy (PBRT) at a single tertiary institution. Patients included in this analysis were evaluated with PET/CT, EBUS, mediastinoscopy, and stage II and III. All patients received chemotherapy. There were 23 patients diagnosed with stage II and 115 patients with stage III NSCLC. The median age at diagnosis was 68.8 yrs (range 27.8 yrs-94.9 yrs), median KPS was 80 (range 60-100) and median follow up time for alive patients was 4.7 yrs (range 1.8 yrs-6.7 yrs). The median GTV volume irradiated was 70.0 cc and median proton dose delivered was 74 CGE (range 60 CGE-70 CGE). Results: The median overall survival (OS) for all patients was 32.4 mos, the 3-yr and 5-yr OS rate for all patients was 44.0% and 28%, respectively. The 5-yr local regional failure free (LRFF) rate was 54%, 5-yr distant metastasis-free survival (DMFS) rate was 46%, and 5-yr diseasefree survival (DFS) rate was 18% for all patients. For stage III patients, the 5-yr OS rate, 5-yr DFS, 5-yr LRFF, and 5 yr-DMFS rates were 29%, 18%, 55%, 43%, respectively. Patients >65 yrs old had worse 5-yr OS of 16% vs 44% for pts <65 yrs (PZ.0079). In this cohort, males had an
International Journal of Radiation Oncology Biology Physics
S20 Thoracic Abstract 132; Table Summary of Outcomes
All patients Stage II Stage III
5-YR OS
5-YR DFS
5-YR LRFF
5-YR DMFS
28% 25% 29%
18% 17.3% 28%
54% 53% 55%
46% 56% 43.3%
Summary of Toxicities Toxicity
Grade 1-2 (%)
Grade 3
Grade 4
Esophagitis Radiation pneumonitis Dermatitis
42% 54% 40%
4% 1.4% 5.7%
0.7% 0% 0%
improved 5-yr DFS rate of 25% compared to 18% for females (PZ.0301). The rate of grade 3 dermatitis was 5.7%, grade 3 radiation pneumonitis was 1.4%, and grade 3 esophagitis was 4%. The rate of grade 4 esophagitis was 0.7%, there were no grade 4 radiation pneumonitis or dermatitis observed. Conclusions: The 5 year OS rates for patients with locally advanced NSCLC treated with dose escalated PBT are improved and encouraging in combination with chemotherapy. Proton therapy is an effective treatment modality for patients with locally advanced lung cancer resulting in minimal grade 3-4 toxicity. Author Disclosure: Q. Nguyen: None. R. Komaki: None. Z. Liao: None. N. Ly: None. L. Levy: None. D. Gomez: None. J. Chang: None. J.D. Cox: None.
133 Continuous Intravenous Pumping of Recombinant Human Endostatin Combined With Concurrent Chemoradiation Therapy in Patients With Unresectable Stage III Non-Small Cell Lung Cancer: Preliminary Data of a Prospective Multicenter Phase 1/2 Clinical Trial (NCT01733589) Locally Advanced Non-Small Cell Lung Cancer Z. Hui,1 H. Ma,2 R. Wu,1 Y. Tang,1 Y. Men,1 J. Liang,1 M. Chen,2 and L. Wang1; 1Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Beijing, China, 2Zhejiang Tumor Hospital, Hangzhou, China Purpose/Objective(s): Preclinical models have shown that recombinant human endostatin can transiently normalize the tumor vasculature to make it more efficient for oxygen delivery, which provides a treatment window of enhancing tumor radiosensitivity. This study is to evaluate the safety and efficacy of continuous intravenous pumping of endostatin combined with standard concurrent chemoradiation therapy for unresectable stage III nonsmall cell lung cancer (NSCLC). Materials/Methods: In this prospective study, patients with unresectable stage IIIA or IIIB NSCLC received continuous intravenous pumping of endostatin (7.5 mg/m2/d) over 5 days at weeks 1, 3, 5, and 7. During week 2-8, patients received two 28-day cycles of etoposide 50 mg/m2 on day 1-5 and cisplatin 50 mg/m2 on day 1, 8, with concurrent thoracic radiation of 60-66 Gy in 30-33 fractions over 6-7 weeks. Acute toxicities were evaluated using CTCAE. Tumor response was evaluated using RECIST 1.1 criteria. Results: Between Nov. 2012 and Dec. 2013, 31 patients were enrolled into the study, including 28 (90.3%) male and 3 (9.7%) female, 22 (71.0%) with squamous cell carcinoma and 8 (25.8%) with adenocarcinoma, and 13 (41.9%) with stage IIIA disease and 18 (58.1%) with IIIB disease, respectively. The median age was 59 (43-69) years. One patient quit the study for the celiac lymph node metastasis, and the remaining 30 were eligible for toxicity and efficacy evaluation. All patients completed the treatment as planned, except that 1 patient missed one cycle chemotherapy for unrecovered grade 2 renal function impairment. There were 11 patients (36.7%) with grade 3/4 neutropenia, 5 (16.7%) with grade 3 anemia, and 4 (13.3%) with grade 3 thrombocytopenic. Three patients (10%) developed grade 3 nausea/vomiting. Grade 3 acute esophagitis and grade 1/2 pneumonitis were observed in 7 (23.3%) and 5
(16.7%) patients, respectively. No cardiovascular toxicity was observed. There were 19 (63.3%), 7 (23.3%), and 4 (13.3%) patients achieved partial response, stable disease, and progressive disease, respectively. Up to the last follow-up, 3 deaths were observed, including 2 died of cancer progression, and 1 died of hemoptysis 2 months after the completion of treatment who had right pulmonary artery invasion by tumor at the diagnosis. Conclusions: For patients with unresectable stage III NSCLC, continuous intravenous pumping of endostatin combined with concurrent chemoradiation therapy is tolerable and the short term outcomes are promising. Long term survival data await further follow up. Author Disclosure: Z. Hui: None. H. Ma: None. R. Wu: None. Y. Tang: None. Y. Men: None. J. Liang: None. M. Chen: None. L. Wang: None.
134 Safety and Efficacy of Stereotactic Body Radiation Therapy (SBRT) Reirradiation for New or Recurrent Pulmonary Malignancies Following Previous In-Field Conventionally Fractionated Thoracic Radiation Therapy (CFRT) Locally Advanced Non-Small Cell Lung Cancer M. Heskel,1 E.P. Xanthopoulos,2 A.T. Berman,1 W. Levin,1 A. Vachani,1 A. Haas,1 D.H. Sterman,1 A. Lanfranco,1 E. Moon,1 M.N. Corradetti,3 S.M. Hahn,1 K.A. Cengel,1 R. Rengan,4 and C.B. Simone1; 1Hospital of the University of Pennsylvania, Philadelphia, PA, 2Columbia University Medical Center, New York, NY, 3Harvard University Medical School, Boston, MA, 4University of Washington Medical Center, Seattle, WA Purpose/Objective(s): Delivering a second course of CFRT for recurrence or new malignancies can be associated with considerable toxicity. SBRT is a highly conformal therapy that has become standard treatment for medically inoperable stage I non-small cell lung cancer (NSCLC), but little data exist assessing safety and efficacy of SBRT after definitive CFRT. We assess the feasibility and safety of SBRT following prior infield CFRT, and we compare patients (pts) treated with SBRT for new primary stage I NSCLC, in-field recurrence of previous NSCLC, or lung metastasis. We hypothesized that SBRT local control (LC) would be high across cohorts but distant metastasis free survival and overall survival (OS) would be lower for pts reirradiated for lung oligometastasis (stage IV disease). Materials/Methods: In this IRB-approved study, we analyzed 40 consecutive pts with 44 lesions retreated with SBRT at our institution between 2/ 2010 and 8/2013 who previously received CFRT and had dose overlap with the SBRT course. Kaplan-Meier and chi square analysis were used to assess LC, nodal and distant failure, and OS. Results: Pts previously received CFRT to a median of 66.6/1.8 Gy (range 45.0-80 Gy/1.5-2.5 Gy) a median of 17.0 months prior to SBRT (range 0.6144.4 months). SBRT was delivered typically to 50 Gy in 4 (peripheral) or 5 (central) fractions for new stage I NSCLC (nZ23), in-field recurrence of NSCLC (nZ8; 6 former stage III, 2 former stage I), or new lung metastasis (nZ13; 8 NSCLC, 5 other primaries). Pts were predominantly female and white (both 65%). Grade 2 chest wall syndrome occurred in 9.1% and pneumonitis in 2.2%. No grade >2 acute or late toxicity was observed. At a median follow-up of 12 months for all pts and 16 months for living pts, LC for the entire cohort was 93% and did not differ according to pt groups (stage I - 91%, recurrence - 88%, stage IV - 100%; PZ.48). Nodal failure (entire cohort 14%) did not differ across groups (PZ.71). Distant failure was significantly higher in stage IV pts (54%) than in pts with stage I NSCLC (13%) or recurrence (25%) (PZ.03). Median OS after SBRT was 42 months and did not differ across cohorts (PZ.66). Conclusions: This study demonstrates SBRT can be safely administered in a high-risk pt population previously treated with in-field CFRT. This study also found that SBRT can achieve excellent LC in a variety of reirradiation settings, including for locally-recurrent tumors. Distant failure is the predominant pattern of failure after SBRT reirradiation, particularly among pts treated for stage IV disease. Pulmonary SBRT can be considered as definitive or salvage therapy in well-selected pts with new or recurrent parenchymal lung malignancies.
131 Comparison of Overall and Cause-Specific Survivals of Stage III Non-Small Cell Lung Cancer (NSCLC) Treated With Carboplatin- or Cisplatin-Based Concurrent Chemoradiation Therapy Using SEERMedicare Data (1992-2007) Locally Advanced Non-Small Cell Lung Cancer E. Kim,1 T. Biswas,2 A. Dowlati,2 N. Sharma,2 and M. Machtay2; 1Case Western Reserve University School of Medicine, Cleveland, OH, 2 University Hospital at Case Western Reserve University, Cleveland, OH Purpose/Objective(s): Almost one-third of lung cancers are diagnosed at stage 3. Concurrent chemoradiation therapy (CCRT) is the standard of care for unresectable locally advanced NSCLC, most commonly using cisplatin/etoposide (cis/eto), or carboplatin/paclitaxel (carb/pac). However, there has never been a trial outside of China comparing these regimens. Some studies found cis/eto had better survival than carb/pac, but poorer quality of life probably related to higher rates of toxicity. Other studies have found comparable survival and similar rates of toxicity. The hypothesis was that cis based CCRT would have slightly better survival than carb based CCRT, based on the conflicting literature results.
Poster Presentations
S19
Materials/Methods: Cases were selected from the national populationbased SEER-Medicare lung cancer database (1992-2007). Inclusion criteria included age 66-80 at diagnosis, stage III primary NSCLC as first cancer diagnosis, with carb or cis based CCRT as primary treatment without any lung surgery. Cases receiving both carb and cis were excluded. CCRT was defined as starting radiation within 2 weeks of starting carb or cis. Covariate of interest was the carb or cis based regimen. Endpoints were overall survival (OS, time from diagnosis until death) and cause specific survival (CSS, time from diagnosis until death from NSCLC). Commercially available software packages were used for case selection, descriptive statistics, Kaplan-Meier survival analysis, and log-rank tests for significance. Results: A total of 2848 cases were selected, including 2331 carb and 517 cis based CCRT. Mean age was 73 (66-80) and 59% were male. Carb and cis groups had 10.5% and 10.1% 5-yr OS, and 20.1% and 20.0% 5-yr CSS, which were not significantly different (OS PZ.18, CSS PZ.82). The most commonly used carb and cis regimens were carb/pac (72% of carb) and cis/eto (62% of cis). Carb/pac and cis/eto had 11.4% and 10.1% OS, and 20.6% and 18.9% CSS, which were not significantly different (OS PZ.29, CSS PZ.49). Conclusions: Carb and cis based CCRT had comparable OS and CSS. The most commonly used carb and cis regimens (carb/pac and cis/eto) also had comparable OS and CSS. This did not support the general belief that cis based CCRT has better outcomes than carb based CCRT, which suggests they can be used interchangeably as clinically appropriate (eg, based on comorbidities, side effects). A limitation of using Medicare claims data to determine treatment was the lack of detailed treatment information, eg, dose, fractionation, and timing of radiation, and number of cycles, spacing, and dose (systemic vs radiation-sensitizing) of drugs. Randomized trials may be helpful in confirming the results of this retrospective secondary analysis. Author Disclosure: E. Kim: None. T. Biswas: None. A. Dowlati: None. N. Sharma: None. M. Machtay: None.
132 The 5-Year Outcome for Patients Diagnosed With Locally Advanced Non-Small Cell Lung Cancer Treated With Definitive Concurrent Chemotherapy and Proton Beam Therapy Locally Advanced Non-Small Cell Lung Cancer Q. Nguyen,1 R. Komaki,1 Z. Liao,1 N. Ly,2 L. Levy,1 D. Gomez,1 J. Chang,1 and J.D. Cox1; 1University of Texas MD Anderson Cancer Center, Houston, TX, 2Tulane University School of Medicine, New Orleans, TX Purpose/Objective(s): To report 5 year survival outcomes and toxicity in stage II and stage III non-small cell lung cancer (NSCLC) patients treated with definitive concurrent chemotherapy and proton beam radiation therapy. Materials/Methods: Between 2006 and 2010, 138 primary non-small cell lung cancer (NSCLC) patients received definitive proton beam radiation therapy (PBRT) at a single tertiary institution. Patients included in this analysis were evaluated with PET/CT, EBUS, mediastinoscopy, and stage II and III. All patients received chemotherapy. There were 23 patients diagnosed with stage II and 115 patients with stage III NSCLC. The median age at diagnosis was 68.8 yrs (range 27.8 yrs-94.9 yrs), median KPS was 80 (range 60-100) and median follow up time for alive patients was 4.7 yrs (range 1.8 yrs-6.7 yrs). The median GTV volume irradiated was 70.0 cc and median proton dose delivered was 74 CGE (range 60 CGE-70 CGE). Results: The median overall survival (OS) for all patients was 32.4 mos, the 3-yr and 5-yr OS rate for all patients was 44.0% and 28%, respectively. The 5-yr local regional failure free (LRFF) rate was 54%, 5-yr distant metastasis-free survival (DMFS) rate was 46%, and 5-yr diseasefree survival (DFS) rate was 18% for all patients. For stage III patients, the 5-yr OS rate, 5-yr DFS, 5-yr LRFF, and 5 yr-DMFS rates were 29%, 18%, 55%, 43%, respectively. Patients >65 yrs old had worse 5-yr OS of 16% vs 44% for pts <65 yrs (PZ.0079). In this cohort, males had an
International Journal of Radiation Oncology Biology Physics
S20 Thoracic Abstract 132; Table Summary of Outcomes
All patients Stage II Stage III
5-YR OS
5-YR DFS
5-YR LRFF
5-YR DMFS
28% 25% 29%
18% 17.3% 28%
54% 53% 55%
46% 56% 43.3%
Summary of Toxicities Toxicity
Grade 1-2 (%)
Grade 3
Grade 4
Esophagitis Radiation pneumonitis Dermatitis
42% 54% 40%
4% 1.4% 5.7%
0.7% 0% 0%
improved 5-yr DFS rate of 25% compared to 18% for females (PZ.0301). The rate of grade 3 dermatitis was 5.7%, grade 3 radiation pneumonitis was 1.4%, and grade 3 esophagitis was 4%. The rate of grade 4 esophagitis was 0.7%, there were no grade 4 radiation pneumonitis or dermatitis observed. Conclusions: The 5 year OS rates for patients with locally advanced NSCLC treated with dose escalated PBT are improved and encouraging in combination with chemotherapy. Proton therapy is an effective treatment modality for patients with locally advanced lung cancer resulting in minimal grade 3-4 toxicity. Author Disclosure: Q. Nguyen: None. R. Komaki: None. Z. Liao: None. N. Ly: None. L. Levy: None. D. Gomez: None. J. Chang: None. J.D. Cox: None.
133 Continuous Intravenous Pumping of Recombinant Human Endostatin Combined With Concurrent Chemoradiation Therapy in Patients With Unresectable Stage III Non-Small Cell Lung Cancer: Preliminary Data of a Prospective Multicenter Phase 1/2 Clinical Trial (NCT01733589) Locally Advanced Non-Small Cell Lung Cancer Z. Hui,1 H. Ma,2 R. Wu,1 Y. Tang,1 Y. Men,1 J. Liang,1 M. Chen,2 and L. Wang1; 1Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Beijing, China, 2Zhejiang Tumor Hospital, Hangzhou, China Purpose/Objective(s): Preclinical models have shown that recombinant human endostatin can transiently normalize the tumor vasculature to make it more efficient for oxygen delivery, which provides a treatment window of enhancing tumor radiosensitivity. This study is to evaluate the safety and efficacy of continuous intravenous pumping of endostatin combined with standard concurrent chemoradiation therapy for unresectable stage III nonsmall cell lung cancer (NSCLC). Materials/Methods: In this prospective study, patients with unresectable stage IIIA or IIIB NSCLC received continuous intravenous pumping of endostatin (7.5 mg/m2/d) over 5 days at weeks 1, 3, 5, and 7. During week 2-8, patients received two 28-day cycles of etoposide 50 mg/m2 on day 1-5 and cisplatin 50 mg/m2 on day 1, 8, with concurrent thoracic radiation of 60-66 Gy in 30-33 fractions over 6-7 weeks. Acute toxicities were evaluated using CTCAE. Tumor response was evaluated using RECIST 1.1 criteria. Results: Between Nov. 2012 and Dec. 2013, 31 patients were enrolled into the study, including 28 (90.3%) male and 3 (9.7%) female, 22 (71.0%) with squamous cell carcinoma and 8 (25.8%) with adenocarcinoma, and 13 (41.9%) with stage IIIA disease and 18 (58.1%) with IIIB disease, respectively. The median age was 59 (43-69) years. One patient quit the study for the celiac lymph node metastasis, and the remaining 30 were eligible for toxicity and efficacy evaluation. All patients completed the treatment as planned, except that 1 patient missed one cycle chemotherapy for unrecovered grade 2 renal function impairment. There were 11 patients (36.7%) with grade 3/4 neutropenia, 5 (16.7%) with grade 3 anemia, and 4 (13.3%) with grade 3 thrombocytopenic. Three patients (10%) developed grade 3 nausea/vomiting. Grade 3 acute esophagitis and grade 1/2 pneumonitis were observed in 7 (23.3%) and 5
(16.7%) patients, respectively. No cardiovascular toxicity was observed. There were 19 (63.3%), 7 (23.3%), and 4 (13.3%) patients achieved partial response, stable disease, and progressive disease, respectively. Up to the last follow-up, 3 deaths were observed, including 2 died of cancer progression, and 1 died of hemoptysis 2 months after the completion of treatment who had right pulmonary artery invasion by tumor at the diagnosis. Conclusions: For patients with unresectable stage III NSCLC, continuous intravenous pumping of endostatin combined with concurrent chemoradiation therapy is tolerable and the short term outcomes are promising. Long term survival data await further follow up. Author Disclosure: Z. Hui: None. H. Ma: None. R. Wu: None. Y. Tang: None. Y. Men: None. J. Liang: None. M. Chen: None. L. Wang: None.
134 Safety and Efficacy of Stereotactic Body Radiation Therapy (SBRT) Reirradiation for New or Recurrent Pulmonary Malignancies Following Previous In-Field Conventionally Fractionated Thoracic Radiation Therapy (CFRT) Locally Advanced Non-Small Cell Lung Cancer M. Heskel,1 E.P. Xanthopoulos,2 A.T. Berman,1 W. Levin,1 A. Vachani,1 A. Haas,1 D.H. Sterman,1 A. Lanfranco,1 E. Moon,1 M.N. Corradetti,3 S.M. Hahn,1 K.A. Cengel,1 R. Rengan,4 and C.B. Simone1; 1Hospital of the University of Pennsylvania, Philadelphia, PA, 2Columbia University Medical Center, New York, NY, 3Harvard University Medical School, Boston, MA, 4University of Washington Medical Center, Seattle, WA Purpose/Objective(s): Delivering a second course of CFRT for recurrence or new malignancies can be associated with considerable toxicity. SBRT is a highly conformal therapy that has become standard treatment for medically inoperable stage I non-small cell lung cancer (NSCLC), but little data exist assessing safety and efficacy of SBRT after definitive CFRT. We assess the feasibility and safety of SBRT following prior infield CFRT, and we compare patients (pts) treated with SBRT for new primary stage I NSCLC, in-field recurrence of previous NSCLC, or lung metastasis. We hypothesized that SBRT local control (LC) would be high across cohorts but distant metastasis free survival and overall survival (OS) would be lower for pts reirradiated for lung oligometastasis (stage IV disease). Materials/Methods: In this IRB-approved study, we analyzed 40 consecutive pts with 44 lesions retreated with SBRT at our institution between 2/ 2010 and 8/2013 who previously received CFRT and had dose overlap with the SBRT course. Kaplan-Meier and chi square analysis were used to assess LC, nodal and distant failure, and OS. Results: Pts previously received CFRT to a median of 66.6/1.8 Gy (range 45.0-80 Gy/1.5-2.5 Gy) a median of 17.0 months prior to SBRT (range 0.6144.4 months). SBRT was delivered typically to 50 Gy in 4 (peripheral) or 5 (central) fractions for new stage I NSCLC (nZ23), in-field recurrence of NSCLC (nZ8; 6 former stage III, 2 former stage I), or new lung metastasis (nZ13; 8 NSCLC, 5 other primaries). Pts were predominantly female and white (both 65%). Grade 2 chest wall syndrome occurred in 9.1% and pneumonitis in 2.2%. No grade >2 acute or late toxicity was observed. At a median follow-up of 12 months for all pts and 16 months for living pts, LC for the entire cohort was 93% and did not differ according to pt groups (stage I - 91%, recurrence - 88%, stage IV - 100%; PZ.48). Nodal failure (entire cohort 14%) did not differ across groups (PZ.71). Distant failure was significantly higher in stage IV pts (54%) than in pts with stage I NSCLC (13%) or recurrence (25%) (PZ.03). Median OS after SBRT was 42 months and did not differ across cohorts (PZ.66). Conclusions: This study demonstrates SBRT can be safely administered in a high-risk pt population previously treated with in-field CFRT. This study also found that SBRT can achieve excellent LC in a variety of reirradiation settings, including for locally-recurrent tumors. Distant failure is the predominant pattern of failure after SBRT reirradiation, particularly among pts treated for stage IV disease. Pulmonary SBRT can be considered as definitive or salvage therapy in well-selected pts with new or recurrent parenchymal lung malignancies.