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Poster abstracts of the 14th Annual British Thoracic Oncology Group Conference 2016 / Lung Cancer 91, Suppl. 1 (2016) S1–S71

3 due to resection of metastases; 1 partial brain irradiation and 1 WBRT planned but not given. 48% presented with brain metastases and metachronous metastases developed up to 4 years from diagnosis. All received 20Gy in 5# over 1 week except one patient who had treatment on alternate days (reason unknown). The median time from diagnosis of brain metastases to WBRT was 22 days. Conclusion: Overall median survival of 14.7 weeks is comparable to published data. Survival was better in PS 0–1 patients but less than a third went on to receive systemic treatment, and of those half only received one cycle of treatment. The QUARTZ trial data may help us better identify those patients who will significantly benefit from WBRT. Disclosure: All authors have declared no conflicts of interest. 145

Documentation of DVLA guidance provision for patients with brain metastases

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tient characteristics were studied using multivariate analysis to identify impact on patient survival after PTRT. The statistical significance for survival by PS was calculated by log rank comparison. Survival was calculated at 01.05.15. Results: 72 patients: 74% NSCLC, 14% SCLC, 11% mesothelioma, 1% radiological. Overall median survival was 162 days (range 7–822), with 179 days and 71 days for NSCLC and SCLC respectively. 30 day mortality was 6%. 30 day mortality with PS 0–1, 2, 3–4 was 0%, 5%, 15% respectively. Multivariate analysis showed that PS was a predictor of poor survival (p=0.030). 43% received PTRT as the first treatment. 61% received 20Gy in 5f, 11% received 8Gy in 1f with median survival of 180 days and 71 days respectively. 8/72 (11%) patients had a 3D conformal plan (5–15f) and 3/72 (4%) had parallel opposed fields (10f, all Pancoast tumours) with median survival of 393 days and 154 days respectively.

P. Patel, L. Welsh, N. Hopkins, F. Mcdonald. Radiotherapy, Royal Marsden Hospital, London, United Kingdom Introduction: Lung cancer accounts for over 20% of all cases of brain metastases diagnosed. Following a diagnosis of brain metastases, clinicians are required to inform the patient of the risks of driving as per the Driver, Vehicle and Licensing agency (DVLA) guidelines. It is however the patients’ responsibility to declare their medical condition to the DVLA and stop driving. This audit reviews the proportion of patients’ with documented discussion of DVLA guidance and provision of a DVLA patient information sheet (PIS), to compare against the standard of 100% compliance with DVLA regulations. Methods: Patients receiving palliative whole brain radiotherapy (WBRT) across all tumour sites between January and May 2014 at the Royal Marsden Hospital (RMH) were identified. Electronic Patient Records (EPR), radiotherapy consent and booking forms were reviewed for evidence of discussion of DVLA guidance and provision of PIS. Results: 23 patients in total were identified. Two consent forms were in use, 57% and 39% were consented using a neuro-oncology and palliative radiotherapy forms respectively. 70% of patients were documented as receiving the radiotherapy PIS, 0% patients were documented as receiving the DVLA PIS. 17% of patients had a documented discussion of the DVLA regulations. 1 patient was documented to still be driving. 2 professional drivers were documented to have stopped. Conclusion: This audit demonstrates poor documentation of the provision of DVLA guidance following diagnosis of brain metastases and importantly no patients had documented evidence of receiving the recommended DVLA PIS. The results of the audit have led to amendments to the consent forms, PIS and booking forms to facilitate delivery and documentation of information. A re-audit is currently underway, the results of which will be presented at the meeting. Disclosure: All authors have declared no conflicts of interest. 146

Retrospective audit of treatment outcomes from palliative thoracic radiotherapy – a single centre experience

Z. Aladili, D.J. Kearns, O. Chan. Oncology, Southend University Hospital, Southend on Sea, United Kingdom Introduction: Palliative thoracic radiotherapy (PTRT) is an effective treatment modality for patients with advanced lung cancer. However, PTRT can be associated with toxicity which can last for several weeks to months, therefore it is important to select appropriate patients. RCR has recommended less than 20% 30 day mortality following palliative radiotherapy. The aim of this audit was to assess 30 day mortality, overall survival and to identify predictors for poor survival. Methods: A retrospective review of electronic records identified patients with a diagnosis of thoracic malignancy (NSCLC, SCLC, mesothelioma, radiological) who received palliative radiotherapy to the chest area between Jan 2013-Mar 2014 at Southend Hospital. Pa-

Conclusion: The RCR recommendation of less than 20% 30 day mortality was met. Median survival was comparable to published data for PTRT. Poor PS was a predictor for poor survival. Hypofractionated regimes are appropriate for patients with poor PS and nearing end of life. Disclosure: All authors have declared no conflicts of interest. 147

Palliative thoracic radiotherapy in locally advanced/ metastatic non-small cell lung cancer (NSCLC)

K. Maclennan, S. Campbell, F. Little, S. Erridge, T. Evans, A. Price. Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom Introduction: Randomised controlled trials suggest high dose (HD) palliative thoracic radiotherapy improves overall survival for good performance status (PS) patients. 39 Gy in 13 daily fractions and 20– 30 Gy in 5–10 daily fractions were compared with 17 Gy in 2 weekly fractions and 10 Gy single fractions respectively, but not head to head. We studied the outcomes of locally advanced/metastatic NSCLC in a single centre receiving these treatments over 2 years. Methods: Retrospective review of 176 patients who received palliative thoracic radiotherapy 2011–2012. Data collected included age, stage, PS, dose/fractionation, additional treatments and outcome. Results: 36 patients received HD thoracic radiotherapy (36–40 Gy in 12–15 fractions) and 140 received a lower dose (LD), 20 Gy in 5 fractions. Median overall survival (OS) with HD radiotherapy was 8.5 months and 5.5 months with LD radiotherapy (p=0.0026) HD RT 12 patients (33%) received chemotherapy with median OS 12 months vs 6.5 months with radiotherapy alone. 20 patients (55%) had Stage IV disease; median OS was 8 months vs 9.6 months in stage II–III disease. 34 patients (94%) had PS 0–2; median OS was 9 months vs 1 month in PS 3. LD RT 25 patients (22%) received chemotherapy with median OS 7 month vs 4 months without chemotherapy. 100 patients (71%) had Stage IV disease; median OS was 5 months vs 6 months in stage III disease. 120 patients (86%) had PS 0–2; median OS was 6 months vs 3 months for the 20 PS 3 patients.

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Poster abstracts of the 14th Annual British Thoracic Oncology Group Conference 2016 / Lung Cancer 91, Suppl. 1 (2016) S1–S71

Conclusion: This audit of contemporary practice suggests that the survival benefit of HD palliative radiotherapy reported by Macbeth and colleagues persists with modern staging and chemotherapy practices, and may extend to patients with small volume stage IV disease excluded from that trial. As expected, those with higher PS, lower TNM stage and receiving systemic treatment had better outcomes in either group. Disclosure: All authors have declared no conflicts of interest. 148

Lung toxicity and patient outcomes correlated to V5 , V20 , lung and PTV volume in patients treated radically for non-small cell lung cancer at the Beatson West of Scotland Cancer Centre

identified by clinicians at referral to receive a 4DCT planning scan. Patients were immobilised as per departmental protocol and received CBCT imaging with or without back up gating under pilot protocol. A core group of radiographers reviewed the CBCT images alongside clinicians. Data was collected on the daily treatment set up, imaging and performance status of the patient. Retrospectively the data was collated for further analysis. Results: All 20 patients completed the course of radiotherapy treatment as prescribed. All presented at different clinical stages with varying co-morbidities contributing to variance in results. Results confirmed that current immobilisation is reproducible for the majority of patients; however, most required additional verification.

R. Harrand 1 , S. Smith 1 , Y. Flanagan 2 . 1 Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; 2 Physics Treatment Planning, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom Introduction: The correlation between V20 and pneumonitis risk for patients treated with radical radiotherapy for non-small cell lung cancer (NSCLC) is well established, V20 over 35% carrying a much higher risk. Recent attention has fallen on the V5 level where there is less agreement on interpretation and its correlation with risk of pneumonitis and lung toxicity. We decided to look at patients treated radically for NSCLC to see if any link between V5 , V20 , lung and PTV volumes and recorded lung toxicity or outcome could be identified. Methods: Data for 150 NSCLC patients treated radically in 2014 was obtained from the Aria v13.6 system including rates on treatment of short to medium term toxicity, date and cause of death. Both Static and Arc techniques were included. Each plan was reviewed on Eclipse v13.6 planning system. The V20, V5 , PTVcc, Lung cc and mean lung doses (MLD) were recorded and analysed for evidence of correlation between the data sets. Results: Doses ranged from 54Gy in 36 to 70Gy in 30 fractions. Of the150 patients included, 73 have died at time of writing the abstract. The V5 ranged from 15.3% to 87.2% with initial findings suggesting no link between these values and lung toxicity in the form of SOB/cough or pneumonitis. The V20 ranged from 3.4% to 37.2% and showed no correlation with lung toxcity which is in line with published data. The average PTVcc was 28% higher in patients who died. Conversley V20 , V5 and mean lung dose showed only an approximate 10% increase in this same set of patients. Conclusion: Neither V5 or V20 was found to correlate with risk of lung toxicity or death, PTVcc did not correlate with lung toxicity directly but did appear to link with patient outcome. Other factors need to be taken into account e.g. patients lung function and position of tumour within the lung. Disclosure: All authors have declared no conflicts of interest. 149

A review of the accuracy and efficacy of immobilisation used for patients receiving radical radiotherapy for lung cancer

L. Todd, D. Brown, K. Perkins. Radiotherapy, Imperial College Healthcare NHS Trust, London, United Kingdom Introduction: Radiotherapy is improving at a rapid rate and the need for accurate treatment delivery is vital. Radical radiotherapy aims to deliver a high dose to the tumour whilst minimising dose delivered to normal tissues; reducing damage and long term side effects. During 4DCT planning, lung and tumour movement are accounted for, improving dose conformity and reducing planning margins. Immobilisation plays an integral part in ensuring treatment position reproducibility. This review examines both accuracy and efficacy of using the CIVCO wing board to immobilise these patients. Methods: A sample of 20 patients with a primary lung diagnosis was

Conclusion: The results identify a need to reduce current set up error and evidence in literature supports our findings. Further departmental research and development is required using a more precise method of immobilisation in combination with 4DCT and image guided radiotherapy. A plan to re-audit with improved set up is underway. Disclosure: All authors have declared no conflicts of interest. 150

Ninety-day mortality following radical radiotherapy for lung cancer

E. Nolan 1 , L. Pemberton 2 , J. Coote 2 , M. Harris 2 , L. Lee 2 , C. Faivre-Finn 2 , H. Sheikh 2 , C. O’Hara 2 , P. Burt 2 , N. Bayman 2 . 1 Medical School, University of Manchester, Manchester, United Kingdom; 2 Clinical Oncology, Christie NHS Foundation Trust, Manchester, United Kingdom Introduction: The Cancer reform Strategy 2011 recommends reporting 90-day mortality for all radically irradiated cancer patients due to delayed onset of benefit and slower presentation of toxicity following radiotherapy. Methods: Consecutive lung cancer patients treated radically between January and April 2014 were identified using a radiotherapy database (Mosaiq). Patient, tumour, Adult co-morbidity evaluation (ACE27) and treatment-related data was obtained from patient electronic records. Overall survival was calculated from diagnosis and 90day survival from final radiotherapy treatment. Results: 143 patients were identified: 58% male, 87% non-small cell, 13% small cell. Patients were staged 1, 2, 3, 4, unknown in 26%, 20%, 43%, 4% and 7% respectively. WHO performance status (PS) was ≥2 in 40% with an ACE 27 score of ≥2 in 46%. Median overall survival was 27.5 months (CI 17.8–49.3) and 90-day mortality was 10% (CI 0.83–0.93) for the whole group: with 7% (1 patient) being small cell. No correlation was seen between 90-day mortality and age, PS, comorbidity or stage. Although small numbers, there was a difference between deaths within 90 days and survivors beyond 90 days according to increasing PTV (median 513 versus 278, p=0.004) and V20 categories (V20 median 26 versus 19, p=0.012). In all, but one patient who died of a confirmed pulmonary embolus, the cause of death could not be accurately established. Conclusion: To our knowledge, this is the largest series reporting specifically on 90-day mortality in lung cancer. This large series demonstrates real-life practice and includes a significant proportion of patients with poor PS and high co-morbidity. However, further work is vital to clearly establish the cause of death in patients dying within 90 days to improve patient selection and treatment safety