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365 poster workshop Hypofractionated conformal radiotherapy with concomitant boost for locally advanced NSCLC — A new way for speeding?
$164
Wednesday, October 27, 2004
Poster workshops
363 poster workshop
Intensity Modulated Radiation Therapy (IMRT) may improve treatment conformity in dose per fraction dose escalation in patients with unresectable Non-Small-Cell Lung Cancer (NSCLC)
P. Thirion, C. Kelly, J. Armstrong St Luke's Hospital, Clinical Trials Unit, Dublin, Ireland Background: In a clinical trial conducted in St Luke's Hospital, radiotherapy intensification by the mean of dose per fraction dose escalation in patients (pts) with unresectable NSCLC shows promising results. The purpose of this study was to assess the potential role of IMRT and its level of compliance with the treatment planning objectives of ICRU 50. Materials and Methods: 10 patients included in the trial and treated by 3DCRT to a dose of 72Gy in 24 fractions (3Gy/fraction) were also planned for "step and shoot" IMRT. The recommendations of ICRU 50 in relation to dose prescription and homogeneity within the PTV were applied together with trial dose volume constraints to the organs at risk (OAR). For IMRT planning a class solution was developed incorporating a 5-field arrangement and a system for assigning relative importance values for the OAR. The plans were evaluated in terms of (1) a modified conformity index (Treated Volume (TV)/PTV) to include cases where the PTV is no__tt completely enclosed by the TV (2) a Coverage Index (CI) defined as the % of PTV encompassed by the 95% isodose, and (3) an estimate of dose homogeneity across the PTV (expressed as the dose range and DSO/ovolume of the PTV). The Tumour Control Probability (TCP) was calculated for each individual plan using standard radiobiological values obtained from the literature. Results: The median PTV for the 10 patients was 308.5 cm 3 (164-1308). A significant reduction in TV was demonstrated for IMRT (p=0.008). The median results are summarised below: °................................................................~................... i"......................... 3DCRT I M a T iW coxon Test T V (cm 3)
628
M o d Conformity Index 2
~,. .............................
i509
iP< 0.05
1.6
ie< 0.05
,~ .......................
,.~. .......................................................
Coverage ndex 1 0....................... 0 9 ~:iP< 0 05 i ........................................................................ ~-~ ~9............... .................................... :Dose ............................................................................................. range 12.8 2 5 . 3 /~._
:O0oo .............................
105
D107. P=.S i
..............
o TC~,.Range (yo) ............ 8#-#2 {85-g0: P=NS
Conclusions: IMRT planning results in significant reduction in TV and dramatically more conformal distributions surrounding the PTV. Although the IMRT plans are seen to be ICRU 50 noncompliant both in terms of PTV coverage and homogeneity, the TCP analysis indicate broadly similar values. 364 poster workshop
Early versus late chest radiotherapy for limited stage small cell lung cancer: a systematic review and meta-analysis
M. Piils-Johannesma 1, D. de Ruysscher ~, I. Rutten 2, J. Vansteenkiste 3, P. Lambin 1 I MAASTRO clinic, Radiation Oncology, Maastricht, The Netherlands 2University Hospital Liege, Radiotherapy, Liege, Belgium 3University Hospital Leuven, Pneumonology, Louvain, Belgium Background: The best way to integrate chest radiotherapy with chemotherapy in patients suffering from limited stage small cell lung cancer (LS-SCLC) is still unclear. We therefore performed a systematic review and meta-analysis.
Methods: Search Strategy: The electronic databases MEDLINE, EMBASE, Cancerlit and the Cochrane Central Register of Controlled Trials, reference lists, hand searching of journals and conference proceedings, and discussion with experts were used to identify potentially eligible trials, published and unpublished.
Selection Criteria: Data collection and analysis: Results: When platinum-etoposide chemotherapy was delivered concurrently with chest radiotherapy, survival Was significantly in favor of beginning thoracic radiation within 30 days after the start of chemotherapy (2-year survival: 5 1 . 1 % vs. 41.8 %; OR: 0.63, 95 % CI: 0.48-0.84; p=0. 003001 014 017 000 006 33 32 Conclusions: Long-term survival of patients with limited stage small cell lung cancer improves significantly by beginning chest radiotherapy within 30 days after the start of cisplatin-etoposide chemotherapy. The overall treatment time of thoracic radiation should be less than 30 days. 365 poster workshop
Hypofractionated conformal radiotherapy with concomitant b o o s t for locally advanced NSCLC - A new way for speeding?
L." Kepka 1, K. Bujko 1, A. Zolciak 1, J. Fijuth 1, A. Zawadzka z, D. Blatkiewic2 1M.Sklodowska-Curie Memorial Cancer Center - Institute of Oncology, Radiation Oncology, Warsaw, Poland 2M.Sklodowska-Curie Cancer Center- Institute of Oncology, Medical Physics, Warsaw, Poland Background/Purpose: Shortening of treatment time for lung cancer is promising approach and the best way to obtain this aim is not clearly established. Our goal is to evaluate the toxicity and efficacy of hypofractionated conformal radiotherapy (HCRT) using dose per fraction escalation by concomitant boost technique (CBT) for locally advanced NSCLC. Material/Methods: Between 1999-2002, 52 patients (pts) with III stage NSCLC received HCRT delivered with CBT. 70% received neoadjuvant platinum-based chemotherapy. The limited elective irradiation area (PTV1) was treated to 39.9 Gy in 21 fractions of 1.9 Gy, simultaneously the tumor and involved lymph nodes (PTV2) were boosted to 56.7 Gy in 21 fractions of 2.7 Gy. Overall treatment time was 26 days. Dose homogeneity within PTV met criteria of ICRU Report 50 for conformal techniques. Mean lung dose had to be < 20 Gy, maximum dose for spinal cord - 45 Gy. Toxicity was scored according to EORTC/RTOG criteria. Results: Compliance to treatment protocol was good, all but 1 patient received prescribed dose. Treatment time exceeded 30 days in 3 pts (5%). Mean lung dose exceeded 20 Gy in 4 pts (6%) (21-25 Gy). There were no other protocol violations. Severe acute esophageal toxicity (111grade) was observed in 3 pts (5%). Radiation pneumonitis did not exceed grade I1. There was no grade Ill or higher late toxicity. With the f/u ranging for alive pts from 12 to 57 months, actuarial 2-years overall survival was 37% with a median of 17 months. First site of failure was located within PTV2 in 72% pts. Conclusions: HCRT with CBT is feasible for NSCLC. High rate of local failure within concomitant boost area and low toxicity warrant further studies on dose escalation in this region.
Wednesday, October 27, 2004
Poster workshops
363 poster workshop
Intensity Modulated Radiation Therapy (IMRT) may improve treatment conformity in dose per fraction dose escalation in patients with unresectable Non-Small-Cell Lung Cancer (NSCLC)
P. Thirion, C. Kelly, J. Armstrong St Luke's Hospital, Clinical Trials Unit, Dublin, Ireland Background: In a clinical trial conducted in St Luke's Hospital, radiotherapy intensification by the mean of dose per fraction dose escalation in patients (pts) with unresectable NSCLC shows promising results. The purpose of this study was to assess the potential role of IMRT and its level of compliance with the treatment planning objectives of ICRU 50. Materials and Methods: 10 patients included in the trial and treated by 3DCRT to a dose of 72Gy in 24 fractions (3Gy/fraction) were also planned for "step and shoot" IMRT. The recommendations of ICRU 50 in relation to dose prescription and homogeneity within the PTV were applied together with trial dose volume constraints to the organs at risk (OAR). For IMRT planning a class solution was developed incorporating a 5-field arrangement and a system for assigning relative importance values for the OAR. The plans were evaluated in terms of (1) a modified conformity index (Treated Volume (TV)/PTV) to include cases where the PTV is no__tt completely enclosed by the TV (2) a Coverage Index (CI) defined as the % of PTV encompassed by the 95% isodose, and (3) an estimate of dose homogeneity across the PTV (expressed as the dose range and DSO/ovolume of the PTV). The Tumour Control Probability (TCP) was calculated for each individual plan using standard radiobiological values obtained from the literature. Results: The median PTV for the 10 patients was 308.5 cm 3 (164-1308). A significant reduction in TV was demonstrated for IMRT (p=0.008). The median results are summarised below: °................................................................~................... i"......................... 3DCRT I M a T iW coxon Test T V (cm 3)
628
M o d Conformity Index 2
~,. .............................
i509
iP< 0.05
1.6
ie< 0.05
,~ .......................
,.~. .......................................................
Coverage ndex 1 0....................... 0 9 ~:iP< 0 05 i ........................................................................ ~-~ ~9............... .................................... :Dose ............................................................................................. range 12.8 2 5 . 3 /~._
:O0oo .............................
105
D107. P=.S i
..............
o TC~,.Range (yo) ............ 8#-#2 {85-g0: P=NS
Conclusions: IMRT planning results in significant reduction in TV and dramatically more conformal distributions surrounding the PTV. Although the IMRT plans are seen to be ICRU 50 noncompliant both in terms of PTV coverage and homogeneity, the TCP analysis indicate broadly similar values. 364 poster workshop
Early versus late chest radiotherapy for limited stage small cell lung cancer: a systematic review and meta-analysis
M. Piils-Johannesma 1, D. de Ruysscher ~, I. Rutten 2, J. Vansteenkiste 3, P. Lambin 1 I MAASTRO clinic, Radiation Oncology, Maastricht, The Netherlands 2University Hospital Liege, Radiotherapy, Liege, Belgium 3University Hospital Leuven, Pneumonology, Louvain, Belgium Background: The best way to integrate chest radiotherapy with chemotherapy in patients suffering from limited stage small cell lung cancer (LS-SCLC) is still unclear. We therefore performed a systematic review and meta-analysis.
Methods: Search Strategy: The electronic databases MEDLINE, EMBASE, Cancerlit and the Cochrane Central Register of Controlled Trials, reference lists, hand searching of journals and conference proceedings, and discussion with experts were used to identify potentially eligible trials, published and unpublished.
Selection Criteria: Data collection and analysis: Results: When platinum-etoposide chemotherapy was delivered concurrently with chest radiotherapy, survival Was significantly in favor of beginning thoracic radiation within 30 days after the start of chemotherapy (2-year survival: 5 1 . 1 % vs. 41.8 %; OR: 0.63, 95 % CI: 0.48-0.84; p=0. 003001 014 017 000 006 33 32 Conclusions: Long-term survival of patients with limited stage small cell lung cancer improves significantly by beginning chest radiotherapy within 30 days after the start of cisplatin-etoposide chemotherapy. The overall treatment time of thoracic radiation should be less than 30 days. 365 poster workshop
Hypofractionated conformal radiotherapy with concomitant b o o s t for locally advanced NSCLC - A new way for speeding?
L." Kepka 1, K. Bujko 1, A. Zolciak 1, J. Fijuth 1, A. Zawadzka z, D. Blatkiewic2 1M.Sklodowska-Curie Memorial Cancer Center - Institute of Oncology, Radiation Oncology, Warsaw, Poland 2M.Sklodowska-Curie Cancer Center- Institute of Oncology, Medical Physics, Warsaw, Poland Background/Purpose: Shortening of treatment time for lung cancer is promising approach and the best way to obtain this aim is not clearly established. Our goal is to evaluate the toxicity and efficacy of hypofractionated conformal radiotherapy (HCRT) using dose per fraction escalation by concomitant boost technique (CBT) for locally advanced NSCLC. Material/Methods: Between 1999-2002, 52 patients (pts) with III stage NSCLC received HCRT delivered with CBT. 70% received neoadjuvant platinum-based chemotherapy. The limited elective irradiation area (PTV1) was treated to 39.9 Gy in 21 fractions of 1.9 Gy, simultaneously the tumor and involved lymph nodes (PTV2) were boosted to 56.7 Gy in 21 fractions of 2.7 Gy. Overall treatment time was 26 days. Dose homogeneity within PTV met criteria of ICRU Report 50 for conformal techniques. Mean lung dose had to be < 20 Gy, maximum dose for spinal cord - 45 Gy. Toxicity was scored according to EORTC/RTOG criteria. Results: Compliance to treatment protocol was good, all but 1 patient received prescribed dose. Treatment time exceeded 30 days in 3 pts (5%). Mean lung dose exceeded 20 Gy in 4 pts (6%) (21-25 Gy). There were no other protocol violations. Severe acute esophageal toxicity (111grade) was observed in 3 pts (5%). Radiation pneumonitis did not exceed grade I1. There was no grade Ill or higher late toxicity. With the f/u ranging for alive pts from 12 to 57 months, actuarial 2-years overall survival was 37% with a median of 17 months. First site of failure was located within PTV2 in 72% pts. Conclusions: HCRT with CBT is feasible for NSCLC. High rate of local failure within concomitant boost area and low toxicity warrant further studies on dose escalation in this region.