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153: Outcome of stage III inoperable non-small cell lung cancer (NSCLC) treated with radical intent
Poster abstracts, 13th Annual British Thoracic Oncology Group Conference, 2015: Radiotherapy overall survival of 5 to 14 months. To assess the usage of thoracic re-irradiation, we conducted a web based survey of UK thoracic clinical oncologists. Methods: A questionnaire was developed and circulated to 152 Oncologists. Questions included details on consultant demographics and their current thoracic radiotherapy practice. With regards to re-irradiation, respondents were asked how frequently they re-irradiate in locally relapsed lung cancers, criteria used to select patients for re-irradiation, treatment intent, re-irradiation techniques and the dose/fractionation schedules used. Statistical support was provided by the NWORTH Team at Bangor University. Results: Sixty-nine responses were received from 45 centres. 93% and 35% of respondents re-irradiate lung cancers with palliative and radical intent respectively. 79%, 81% and 92% would reirradiate after patients had a radical (>40 Gy), high dose palliative (30 39 Gy) or low dose palliative (<30 Gy) primary radiotherapy course respectively. 59% of re-irradiating oncologists allow at least 6 months between 1st and 2nd courses of radiotherapy. Of the re-irradiating oncologists, 71% would re-irradiate asymptomatic relapses if the intent of re-irradiation was radical. When reirradiating with palliative intent, 74% of oncologists re-irradiate patients with local relapse and oligometastases elsewhere. The most common dose-fractionation schemes were 20 Gy/5 fractions, 20 Gy/ 10 fractions, 30 Gy/10 fractions in descending order of frequency. Only 20% had access to any audit data on re-irradiation and 76% indicated they would be supportive of phase I/II trials in this area (see Table 1). Table 1. Support for a trial to determine a safe dose-fractionation regime for re-treatment How supportive would you be of a phase I/II trial to determine a safe fractionation regimen for re-irradiation?
Respondents N %
Not supportive at all Not very supportive Neutral Fairly supportive Completely supportive
0 6 10 23 30
0 9 14 33 43
Conclusion: Palliative and radical re-irradiation of locally relapsed lung cancer is commonly practiced in UK. Prospective trial is warranted to investigate this further. Disclosure: All authors have declared no conflicts of interest. 152 25 Gy in 5 fractions in one week as palliative radiotherapy in NSCLC S. Jones1 *, A. Pope1 , V. Kelly2 , J. Maguire2 . 1 Radiotherapy, Clatterbridge Cancer Centre, Liverpool, United Kingdom, 2 Research Department, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom Introduction: Survival in advanced NSCLC is influenced by systemic treatment but palliative RT remains important for symptom control and quality of life. Several treatment schedules are available; local tumour control, treatment time and toxicity are all important. 25 Gy/5f/1 week was previously used for NSCLC but discontinued because of occasional instances of myelopathy in patients treated with large AP fields on Cobalt machines. This treatment schedule is equivalent to 40 42 Gy in conventional fractionation (similar to 30 Gy/10f) and with modern radiotherapy equipment and treatment techniques is tolerable for even large pelvic volumes. Methods: We have treated 85 patients with 25 Gy/5f/1week using conformal planning to ensure a max cord dose of 22.5 Gy and V12.5 <30 35% depending on patient’s lung function, with no constraints on oesophageal dose. 52% of patients had stage IV disease, 30% stage III and 13% stage II. 68% of patients were PS 3 and 26% PS 2 at start of treatment.
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Results: Symptomatic response was assessed 2 4 weeks after RT. Compared to pre-treatment symptoms, pain improved in 71%, haemoptysis resolved in 57%, cough resolved in 33% and improved in 22% and dypsnoea improved in 54% of cases. The median duration of symptom control was 195 days (range 137 470), and symptom control continued until death in 17% of patients. CT scan at 8 weeks confirmed PR in 41% and SD in 34%. 69% of patients reported no toxicity from radiotherapy. Grade 2 oesophagitis occured in 8.5%. There was no grade 3 oesophagitis. Median survival for this group of patients was 7.7 months with 38% alive at one year. Conclusion: 25 Gy/5f in 1 week is a safe and effective regimen for palliative RT in NSCLC. This schedule is well tolerated by patients and has significant logistic and cost effectiveness benefits compared to longer treatment schedules in advanced disease. Disclosure: All authors have declared no conflicts of interest. 153 Outcome of stage III inoperable non-small cell lung cancer (NSCLC) treated with radical intent M. Shahid Iqbal *, M. Usman Saleem, C. Peedell. Clinical Oncology, The James Cook University Hospital, Middlesbrough, United Kingdom Introduction: A vast majority of NSCLC patients present at advanced stage. Stage III represent a heterogenous group of patients and (chemo)radiotherapy has become an established standard of care in these surgically inoperable patients though head to head randomised control trials are lacking. We have reviewed our clinical practice of treating these patients. Methods: The patients with a diagnosis of stage III NSCLC from January 2005 to December 2011 were identified from the local database and those who completed their radical treatment were included in the study. The data were collected retrospectively. Results: A total of 145 patients were identified (M/F: 83/62). Their median age was 69 (range: 36 87). As expected, majority of them were smokers or ex-smokers. In 82% of cases, WHO performance status was 0 or 1. Majority of patients were of stage IIIa (66%) vs. IIIb (36%). Most common subtype was T4N2 (28%) followed by T2N2 (21%) and T4N0 (20%). Squamous cell carcinoma was the most common histology (61%). 77% of patients received sequential chemoradiotherapy, gemcitabine/carboplatin being the most common regime. All but 13 patients managed to complete all prescribed 4 cycles of chemotherapy. Various dose/fractionation of radical radiotherapy were used, 55 Gy in 20 fractions being the most common (80%), followed by 60 Gy in 20 fractions (17%). In 57% patients, the disease recurred. Majority of the patients (76%) have died. Two year overall survival (OS) was 46%, 3 year OS was 30% and a median OS of 23 months was recorded with a range of 2 105 months. Conclusion: Stage III NSCLC is a heterogenous group of patients and the best management option remains a therapeutic challenge. Concurrent chemoradiotherapy is the accepted standard of care, but is only suitable for selected patients of good performance status. Sequential chemotherapy and radical radiotherapy can also provide very reasonable outcomes in those unsuitable for concurrent treatment. Disclosure: All authors have declared no conflicts of interest. 154 Positron emission tomography derived parameters as predictive factors for doubling time of tumour & survival in non-small cell lung cancer patients treated with radical radiotherapy M.H. Khan *, A. Chetiyawardana, R. Amir, V. Harrop, K. Sharma Sharma. Oncology, University Hospitals of Birmingham NHS Trust, United Kingdom Introduction: We evaluated Positron emission tomography derived parameters as predictive factors for tumour doubling time & survival
Respondents N %
Not supportive at all Not very supportive Neutral Fairly supportive Completely supportive
0 6 10 23 30
0 9 14 33 43
Conclusion: Palliative and radical re-irradiation of locally relapsed lung cancer is commonly practiced in UK. Prospective trial is warranted to investigate this further. Disclosure: All authors have declared no conflicts of interest. 152 25 Gy in 5 fractions in one week as palliative radiotherapy in NSCLC S. Jones1 *, A. Pope1 , V. Kelly2 , J. Maguire2 . 1 Radiotherapy, Clatterbridge Cancer Centre, Liverpool, United Kingdom, 2 Research Department, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom Introduction: Survival in advanced NSCLC is influenced by systemic treatment but palliative RT remains important for symptom control and quality of life. Several treatment schedules are available; local tumour control, treatment time and toxicity are all important. 25 Gy/5f/1 week was previously used for NSCLC but discontinued because of occasional instances of myelopathy in patients treated with large AP fields on Cobalt machines. This treatment schedule is equivalent to 40 42 Gy in conventional fractionation (similar to 30 Gy/10f) and with modern radiotherapy equipment and treatment techniques is tolerable for even large pelvic volumes. Methods: We have treated 85 patients with 25 Gy/5f/1week using conformal planning to ensure a max cord dose of 22.5 Gy and V12.5 <30 35% depending on patient’s lung function, with no constraints on oesophageal dose. 52% of patients had stage IV disease, 30% stage III and 13% stage II. 68% of patients were PS 3 and 26% PS 2 at start of treatment.
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Results: Symptomatic response was assessed 2 4 weeks after RT. Compared to pre-treatment symptoms, pain improved in 71%, haemoptysis resolved in 57%, cough resolved in 33% and improved in 22% and dypsnoea improved in 54% of cases. The median duration of symptom control was 195 days (range 137 470), and symptom control continued until death in 17% of patients. CT scan at 8 weeks confirmed PR in 41% and SD in 34%. 69% of patients reported no toxicity from radiotherapy. Grade 2 oesophagitis occured in 8.5%. There was no grade 3 oesophagitis. Median survival for this group of patients was 7.7 months with 38% alive at one year. Conclusion: 25 Gy/5f in 1 week is a safe and effective regimen for palliative RT in NSCLC. This schedule is well tolerated by patients and has significant logistic and cost effectiveness benefits compared to longer treatment schedules in advanced disease. Disclosure: All authors have declared no conflicts of interest. 153 Outcome of stage III inoperable non-small cell lung cancer (NSCLC) treated with radical intent M. Shahid Iqbal *, M. Usman Saleem, C. Peedell. Clinical Oncology, The James Cook University Hospital, Middlesbrough, United Kingdom Introduction: A vast majority of NSCLC patients present at advanced stage. Stage III represent a heterogenous group of patients and (chemo)radiotherapy has become an established standard of care in these surgically inoperable patients though head to head randomised control trials are lacking. We have reviewed our clinical practice of treating these patients. Methods: The patients with a diagnosis of stage III NSCLC from January 2005 to December 2011 were identified from the local database and those who completed their radical treatment were included in the study. The data were collected retrospectively. Results: A total of 145 patients were identified (M/F: 83/62). Their median age was 69 (range: 36 87). As expected, majority of them were smokers or ex-smokers. In 82% of cases, WHO performance status was 0 or 1. Majority of patients were of stage IIIa (66%) vs. IIIb (36%). Most common subtype was T4N2 (28%) followed by T2N2 (21%) and T4N0 (20%). Squamous cell carcinoma was the most common histology (61%). 77% of patients received sequential chemoradiotherapy, gemcitabine/carboplatin being the most common regime. All but 13 patients managed to complete all prescribed 4 cycles of chemotherapy. Various dose/fractionation of radical radiotherapy were used, 55 Gy in 20 fractions being the most common (80%), followed by 60 Gy in 20 fractions (17%). In 57% patients, the disease recurred. Majority of the patients (76%) have died. Two year overall survival (OS) was 46%, 3 year OS was 30% and a median OS of 23 months was recorded with a range of 2 105 months. Conclusion: Stage III NSCLC is a heterogenous group of patients and the best management option remains a therapeutic challenge. Concurrent chemoradiotherapy is the accepted standard of care, but is only suitable for selected patients of good performance status. Sequential chemotherapy and radical radiotherapy can also provide very reasonable outcomes in those unsuitable for concurrent treatment. Disclosure: All authors have declared no conflicts of interest. 154 Positron emission tomography derived parameters as predictive factors for doubling time of tumour & survival in non-small cell lung cancer patients treated with radical radiotherapy M.H. Khan *, A. Chetiyawardana, R. Amir, V. Harrop, K. Sharma Sharma. Oncology, University Hospitals of Birmingham NHS Trust, United Kingdom Introduction: We evaluated Positron emission tomography derived parameters as predictive factors for tumour doubling time & survival