- Email: [email protected]
177 Clinical implementation of stereotactic ablative radiotherapy (SABR) for NSCLC in the UK
Poster abstracts, 11th Annual British Thoracic Oncology Group Conference, 2013: Radiotherapy 177 Clinical implementation of stereotactic ablative radiotherapy (SABR) for NSCLC in the UK A. Baker2 *, C. Clark3 , L. Ciurlionis6 , G. Distefano4 , M. Hatton1 , P. Jain2 , J. Lilley5 , H. Mayles2 , E. Miles6 , A. Scott2 , G. Webster7 . 1 Weston Park Hospital, Sheffield, UK, 2 Clatterbridge Cancer Centre, Wirral, UK, 3 National Physical Laboratory, Teddington, Middlese, UK, 4 Royal Surrey County Hospital, Guildford, UK, 5 St. James’s Institute of Oncology, Leeds, UK, 6 RTTQA, Mount Vernon Hospital, Middlesex, UK, 7 Queen Elizabeth Hospital, Birmingham, UK Introduction: The UK SABR Consortium was established in early 2007 with the aim of achieving a consensus on how best to develop, implement and research SABR (Stereotactic Ablative Radiotherapy) in the UK and the first treatments were in 2009. The 2011 NRIG report (SBRT: Guidelines for Commissioners, Providers and Clinicians in England 2011) acknowledges that SABR has become a standard of care for the management of early stage medically inoperable peripheral NSCLC. Methods: There are significant risks associated with introducing SABR as a routine treatment for NSCLC, with the non-standard method of dose prescription, and the complex nature of both planning and delivery of high dose fractions. In August 2012 a questionnaire was sent to all centres to ascertain the progress being made towards the implementation of SABR treatment and obtain details of current issues in centres with an active treatment program. Results: Currently treatment is available in only 15 out of 62 UK centres with a further 19 centres indicating they are planning to implement the technique in the next 2 years. About 450 NSCLC patients are being treated annually following the UK SABR Consortium guidelines. This number is predicted to rise to 1150 by the end of 2014. 1400 No. of projected paents per year end 2014
1200
No. of paents per year in 2012
1000
800
600
S61
178 Stereotactic ablative radiotherapy (SABR) for early stage, medically inoperable NSCLC: initial outcomes from 3 years experience at James Cook University Hospital (JCUH), Middlesbrough R. Carr *, D. Shakespeare, E. Aynsley, S. Lawless, P. Summers, J. Green, K. Pilling, N. Richmond, C. Walker, C. Peedell. James Cook University Hospital, UK Background: JCUH Cancer Centre serves a population of 1.1 million in North-East England. SABR is an internationally accepted standard treatment option for medically inoperable, peripheral, early stage NSCLC. We have established a SABR programme based on guidance from the UK SABR Consortium. The first patient was treated in September 2009. To date, 72 patients have been treated, 50 of whom have had an initial assessment of response at least 6 months out from treatment. Methods: Patients are selected via lung MDT using strict eligibility criteria based on UK SABR Consortium national guidelines. Eligibility: Peripheral tumour <5 cm, node negative Histologically proven or growing PET +ve lesion Performance Status 0 3 Able to lie supine with arms raised behind head Immobilisation with BodyFix system. Tumour motion assessed fluoroscopically. Abdominal compression applied if tumour motion >1 cm. Gross Tumour Volume (GTV) outlined on 3 CT data-sets: freebreathing and inspiration/expiration breath-holding. The Internal Target Volume (ITV) encompasses compound GTVs with 5 mm margin for Planning Target Volume (PTV). Dose regimens: 54 Gy in 3 fractions and 55 Gy in 5 fractions prescribed to 80% isodose. Collapsed cone algorithm with 6MV photons and 7 field co-planar technique is used. All patients treated using Elekta Synergy with Cone beam CT guidance (2 mm tolerance) Data collected prospectively. Results: 1 year and 2 yr overall survival are 83% and 60% respectively 3/50 in-field recurrences, giving local control rate of 94% No G3 or 4 toxicities. Conclusion: Implementation of a SABR programme in a nonacademic UK radiotherapy centre is feasible and now part of our routine clinical practice. Early outcome data are comparable to internationally published studies, but longer term follow up data is needed to confirm this. SABR for medically inoperable NSCLC can and should become part of routine practice throughout the UK. 179 Early outcome in patients with early stage non-small cell lung cancer treated with stereotactic body radiotherapy (Cyberknife): Mount Vernon Cancer Centre experience S. Dubash *, J. Wang, A. Martin, A. Aitken, P. Ostler, N. Shah, P. Hoskin. Mount Vernon Cancer Centre, UK
400 200
0 Lung
Non-lung
Progress in these centres has been limited and many centres have indicated a need for external support with 29 requests going directly to the UK SABR Consortium. Conclusion: In response the UK SABR Consortium appointed an experienced multidisciplinary QA group in collaboration with the NCRI Radiotherapy Trials QA group and the National Physical Laboratory. This group proposes a mentoring scheme to offer expert guidance and to provide independent verification of SABR programmes and is currently seeking funding for this program.
Introduction: Stereotactic body radiotherapy (SBRT) is an effective and recommended treatment for patients with inoperable early stage non-small cell lung cancer (NSCLC). We present our experience in establishing a stereotactic service. Method: Data was recorded between September 2010 and August 2012. Histology, tumour stage, location and lung function were recorded with prescribed tumour doses and calculated BED (biological effective dose). Protocol included treating tumours up to 5 cm. All patients underwent 18 FDG-PET Scan within 4 weeks of treatment. Toxicity was recorded using CTC 3.0 criteria at 6 weeks, 3, 12, and 24 months. CT restaging was 3 monthly. Results: 22 patients were included (36% male; 64% female). Median age was 71 years. Tumour stage breakdown: 45% T1, 27% T2, and 23% T3 ranging from 1.0 to 5.5 cm. Breakdown included 9 adenocarcinomas and 13 squamous cell carcinomas. Radiation dose delivered was 45 60 Gy in 3 5 fractions. Median follow up is 4.5 months range (2 15 months).
1200
No. of paents per year in 2012
1000
800
600
S61
178 Stereotactic ablative radiotherapy (SABR) for early stage, medically inoperable NSCLC: initial outcomes from 3 years experience at James Cook University Hospital (JCUH), Middlesbrough R. Carr *, D. Shakespeare, E. Aynsley, S. Lawless, P. Summers, J. Green, K. Pilling, N. Richmond, C. Walker, C. Peedell. James Cook University Hospital, UK Background: JCUH Cancer Centre serves a population of 1.1 million in North-East England. SABR is an internationally accepted standard treatment option for medically inoperable, peripheral, early stage NSCLC. We have established a SABR programme based on guidance from the UK SABR Consortium. The first patient was treated in September 2009. To date, 72 patients have been treated, 50 of whom have had an initial assessment of response at least 6 months out from treatment. Methods: Patients are selected via lung MDT using strict eligibility criteria based on UK SABR Consortium national guidelines. Eligibility: Peripheral tumour <5 cm, node negative Histologically proven or growing PET +ve lesion Performance Status 0 3 Able to lie supine with arms raised behind head Immobilisation with BodyFix system. Tumour motion assessed fluoroscopically. Abdominal compression applied if tumour motion >1 cm. Gross Tumour Volume (GTV) outlined on 3 CT data-sets: freebreathing and inspiration/expiration breath-holding. The Internal Target Volume (ITV) encompasses compound GTVs with 5 mm margin for Planning Target Volume (PTV). Dose regimens: 54 Gy in 3 fractions and 55 Gy in 5 fractions prescribed to 80% isodose. Collapsed cone algorithm with 6MV photons and 7 field co-planar technique is used. All patients treated using Elekta Synergy with Cone beam CT guidance (2 mm tolerance) Data collected prospectively. Results: 1 year and 2 yr overall survival are 83% and 60% respectively 3/50 in-field recurrences, giving local control rate of 94% No G3 or 4 toxicities. Conclusion: Implementation of a SABR programme in a nonacademic UK radiotherapy centre is feasible and now part of our routine clinical practice. Early outcome data are comparable to internationally published studies, but longer term follow up data is needed to confirm this. SABR for medically inoperable NSCLC can and should become part of routine practice throughout the UK. 179 Early outcome in patients with early stage non-small cell lung cancer treated with stereotactic body radiotherapy (Cyberknife): Mount Vernon Cancer Centre experience S. Dubash *, J. Wang, A. Martin, A. Aitken, P. Ostler, N. Shah, P. Hoskin. Mount Vernon Cancer Centre, UK
400 200
0 Lung
Non-lung
Progress in these centres has been limited and many centres have indicated a need for external support with 29 requests going directly to the UK SABR Consortium. Conclusion: In response the UK SABR Consortium appointed an experienced multidisciplinary QA group in collaboration with the NCRI Radiotherapy Trials QA group and the National Physical Laboratory. This group proposes a mentoring scheme to offer expert guidance and to provide independent verification of SABR programmes and is currently seeking funding for this program.
Introduction: Stereotactic body radiotherapy (SBRT) is an effective and recommended treatment for patients with inoperable early stage non-small cell lung cancer (NSCLC). We present our experience in establishing a stereotactic service. Method: Data was recorded between September 2010 and August 2012. Histology, tumour stage, location and lung function were recorded with prescribed tumour doses and calculated BED (biological effective dose). Protocol included treating tumours up to 5 cm. All patients underwent 18 FDG-PET Scan within 4 weeks of treatment. Toxicity was recorded using CTC 3.0 criteria at 6 weeks, 3, 12, and 24 months. CT restaging was 3 monthly. Results: 22 patients were included (36% male; 64% female). Median age was 71 years. Tumour stage breakdown: 45% T1, 27% T2, and 23% T3 ranging from 1.0 to 5.5 cm. Breakdown included 9 adenocarcinomas and 13 squamous cell carcinomas. Radiation dose delivered was 45 60 Gy in 3 5 fractions. Median follow up is 4.5 months range (2 15 months).