- Email: [email protected]
74P STEREOTACTIC BODY IRRADIATION IN PATIENTS WITH T1-T2 NSCLC OR LUNG METASTASES FROM DIFFERENT PRIMARY SITES: PRELIMINARY RESULTS
S38 Disclosure: M. Zielinski: The author gets grant from GlaxoSmithKline Biologicals and is member of the Steering Committee MAGRIT. H. Hoffmann: Work Under Consideration for Publication: Grant & Support for travel to meetings for the study or other purposes and Relevant financial activities outside the submitted work: Grants (BMBF) & several Payment for lectures from GSK Bio. T. Mitsudomi: Work under Consideration for Publication: grant from GSK Bio Relevant financial activities outside the submitted work: consultancy and lecturer fees from several pharma companies (a.o. Pfizer, AstraZeneca, Lilly,...). C. Debruyne: The author is employed by GlaxoSmithKline Biologicals. All other authors have declared no conflicts of interest. 73PD STEREOTACTIC BODY RADIOTHERAPY FOR PRIMARY LUNG CANCER: A NON INVASIVE TREATMENT APPROACH IN MEDICALLY INOPERABLE PATIENTS G. Beltramo1 , L.C. Bianchi1 , A. Bergantin1 , A.S. Martinotti1 , P. Bonfanti2 , C. Gerosa3 , F. Varoli3 , P. Mariani4 , M.C. Locatelli5 1 Cyberknif Unit, Centro Diagnostico Italiano, Milan, Italy, 2 Medical Physics, School of Specialization University of Milan, Milan, Italy, 3 Surgery, San Carlo Hospital, Milan, Italy, 4 Radiology, San Carlo Hospital, Milan, Italy, 5 Oncology, San Carlo Hospital, Milan, Italy Introduction: Although surgical resection remains the mainstay of therapy for early stage non-small cell lung cancer (NSCLC), many patients with resectable early stage disease are unable to tolerate pulmonary resection because of compromised cardiopulmonary function We evaluate the efficacy and feasibility of Cyberknife image-guide stereotactic body radiation therapy in patients with early-stage (Stage IA IB) NSCLC. Materials and Methods: Between April 2006 to April 2010 34 patients, 2 female, 32 male with a median age of 74 years (range 55 89 years) with pathologically proven NSCLC diagnosed as 16 stage IA and 18 Stage Ib were referred to our Radiotherapy Department for Cyberknife treatment. Before study enrollment, patients underwent physical examination, computed tomography (CT) of the chest and upper abdomen, pulmonary function testing, and whole-body 18F-FDG PET/CT study. In all patients one or three gold fiducial seeds were implanted in or next to the lung cancer and to allow fiducials stabilization, CT simulation was performed one week later. Multiplan (Accuray, USA) was employed. The planning target volume (PTV) included the GTV expanded by 5 mm isotropic margin. CK stereotactic radiosurgery protocol provide a prescribed PTV dose of 45 60 Gy given in 3 daily fractions of 15 20 Gy, with >95% of the PTV encompassed within the prescription isodose. Patients were followed with CT and PET scan to detect disease recurrence. Local recurrence was defined as an increase in size of tumor as most tumors shrunk following radiation. Results: Median follow-up was 19 months (range 4 48 months). At 1 and 2 years Kaplan Meier local control was 84.9% and 84.9% respectively, overall survival (OS) was 89.8% and 83.4%, disease free Survival (DFS) was 84.9% and 78%. We detected a late radiationinduced local fibrosis using CT imaging in most patients, but, till today, none of patients had any chronic symptoms. Conclusions: CyberKnife-based SRT is a feasible approach for primary lung cancer, offering excellent in-field tumor control and low toxicity profile. Further experience and longer follow-up are needed to evaluate the role of CK and to identify patients most likely to benefit from it. Disclosure: All authors have declared no conflicts of interest.
Early stage NSCLC 74P STEREOTACTIC BODY IRRADIATION IN PATIENTS WITH T1 T2 NSCLC OR LUNG METASTASES FROM DIFFERENT PRIMARY SITES: PRELIMINARY RESULTS M. Marcenaro1 , L. Belgioia2 , E. Mantero2 , D. Doino2 , D. Agnese2 , o2 S. Vagge1 , F. Cavagnetto3 , M. Gusinu3 , M. Zeverino3 , R. Corv` 1 Radiation Oncology, National Institute of Cancer Research, Genoa, Italy, 2 Radiotherapy School, University of Genoa, Genoa, Italy, 3 Medical Physics, National Institute of Cancer Research, Genoa, Italy Purpose: To evaluate preliminary results of SBRT in pts with T1 2 NSCLC tumor or lung mts from other primaries. Materials and Methods: From March 2009 to September 2010, 38 T1 T2a pts or with<4 mts from other sites underwent lung SBRT at our Institution with Tomotherapy or Siemens Primus with Moduleaf device. SBRT fractionation was chosen depending on T stage, T chest location (central/peripheral), lung primary or mts disease, receiving a planned Biologic Effective Dose (BED)> 100 Gy10 . In the first 9 SBRT pts BED<100 Gy10 were allowed in order to check pts tolerance. We prescribed T1 and T2 peripheral tumors with 48 Gy/4 fx, 52 Gy/4 fx respectively, T1 2 central tumors with 50 Gy/5 fx, mts and pts with previous RT with 60 Gy/8 fx. In 9/38 pts a simulation CT/PET was performed. In 34/38 pts a diagnostic CT/PET was available. Results: Median pts age was 70 yrs (range 55 86). Median follow up was 8 mns (range 2 18). Pts stage was as follow: 20 pts (53%) T1 NSCLC, 2 pts (5%) T2a NSCLC, 10 pts (26%) local recurrence from NSCLC, 6 pts (16%) with lung mts from NSCLC or other primaries. 20 and 14 pts had peripheral and central lesions, respectively. 14 pts had both central and peripheral disease. 8/38 pts have had previous chest RT. Histology was available in 21/31 pts with lung primary: 13 (42%) had adk, 7 (22.5%) SCC and 1 (3.5%) undifferentiated carcinoma. In the remaining 10 pts (32%) diagnosis of cancer was based on CT or CT/PET findings. Of the 33 pts treated with Tomotherapy, 15 (45.5%), 1 (3%), 7 (21.2%), 6 (18.2%), 4 (12.1%) were given 60 Gy/8 fx, 52 Gy/4 fx, 50 Gy/5 fx, 48 Gy/4 fx and 48 Gy/8 fx, respectively. Pts treated with Primus received 16 Gy, 24 Gy or 28 Gy in 4 fx. SBRT was well tolerated in all pts. No acute toxicity (dysphagia, dyspnoea, fatigue) was recorded. In 3/38 pts (8%) lung fibrosis were detected on CT scan. 5/38 pts (13.2%), 11 pts (29%) and 16 pts (42%) had complete or partial response and stable disease, respectively. One (2.6%) pt had local progression and in 5 pts (13.2%) radiologic outcome was not assessable. Conclusions: This preliminary data seem to confirm that SBRT for pts with T1 2 NSCLC or few lung mts is well tolerated and give good local control rates. More pts and a longer f-up are needed to confirm these findings. Disclosure: All authors have declared no conflicts of interest. 75P STEREOTACTIC RADIOTHERAPY FOR LUNG CANCER: EARLY EFFICACY AND TOXICITY EVALUATION OF A NON-INVASIVE REAL-TIME TUMOR TRACKING SYSTEM J. Bibault1 , B. Prevost1 , E. Dansin2 , X. Mirabel1 , T. Lacornerie1 , F. Dubus1 , E. Lartigau1 1 Academic Radiation Oncology Department, Centre Oscar Lambret, Lille, France, 2 General Oncology Department, Centre Oscar Lambret, Lille, France Purpose: Several methods are currently available for stereotactic lung cancer treatment with the CyberKnife: one of them requires the use of fiducials (Synchrony®) while the other is completely fiducial-free (Xsight Lung Tracking System®). We report our initial experience with 22 treated patients. Materials: Selection criteria were as follows: inoperable patients with single pulmonary tumor, T1 or T2 stage, tumor size between 15 mm and 60 mm, N0, M0. Initial staging included CT-Scan with
Early stage NSCLC 74P STEREOTACTIC BODY IRRADIATION IN PATIENTS WITH T1 T2 NSCLC OR LUNG METASTASES FROM DIFFERENT PRIMARY SITES: PRELIMINARY RESULTS M. Marcenaro1 , L. Belgioia2 , E. Mantero2 , D. Doino2 , D. Agnese2 , o2 S. Vagge1 , F. Cavagnetto3 , M. Gusinu3 , M. Zeverino3 , R. Corv` 1 Radiation Oncology, National Institute of Cancer Research, Genoa, Italy, 2 Radiotherapy School, University of Genoa, Genoa, Italy, 3 Medical Physics, National Institute of Cancer Research, Genoa, Italy Purpose: To evaluate preliminary results of SBRT in pts with T1 2 NSCLC tumor or lung mts from other primaries. Materials and Methods: From March 2009 to September 2010, 38 T1 T2a pts or with<4 mts from other sites underwent lung SBRT at our Institution with Tomotherapy or Siemens Primus with Moduleaf device. SBRT fractionation was chosen depending on T stage, T chest location (central/peripheral), lung primary or mts disease, receiving a planned Biologic Effective Dose (BED)> 100 Gy10 . In the first 9 SBRT pts BED<100 Gy10 were allowed in order to check pts tolerance. We prescribed T1 and T2 peripheral tumors with 48 Gy/4 fx, 52 Gy/4 fx respectively, T1 2 central tumors with 50 Gy/5 fx, mts and pts with previous RT with 60 Gy/8 fx. In 9/38 pts a simulation CT/PET was performed. In 34/38 pts a diagnostic CT/PET was available. Results: Median pts age was 70 yrs (range 55 86). Median follow up was 8 mns (range 2 18). Pts stage was as follow: 20 pts (53%) T1 NSCLC, 2 pts (5%) T2a NSCLC, 10 pts (26%) local recurrence from NSCLC, 6 pts (16%) with lung mts from NSCLC or other primaries. 20 and 14 pts had peripheral and central lesions, respectively. 14 pts had both central and peripheral disease. 8/38 pts have had previous chest RT. Histology was available in 21/31 pts with lung primary: 13 (42%) had adk, 7 (22.5%) SCC and 1 (3.5%) undifferentiated carcinoma. In the remaining 10 pts (32%) diagnosis of cancer was based on CT or CT/PET findings. Of the 33 pts treated with Tomotherapy, 15 (45.5%), 1 (3%), 7 (21.2%), 6 (18.2%), 4 (12.1%) were given 60 Gy/8 fx, 52 Gy/4 fx, 50 Gy/5 fx, 48 Gy/4 fx and 48 Gy/8 fx, respectively. Pts treated with Primus received 16 Gy, 24 Gy or 28 Gy in 4 fx. SBRT was well tolerated in all pts. No acute toxicity (dysphagia, dyspnoea, fatigue) was recorded. In 3/38 pts (8%) lung fibrosis were detected on CT scan. 5/38 pts (13.2%), 11 pts (29%) and 16 pts (42%) had complete or partial response and stable disease, respectively. One (2.6%) pt had local progression and in 5 pts (13.2%) radiologic outcome was not assessable. Conclusions: This preliminary data seem to confirm that SBRT for pts with T1 2 NSCLC or few lung mts is well tolerated and give good local control rates. More pts and a longer f-up are needed to confirm these findings. Disclosure: All authors have declared no conflicts of interest. 75P STEREOTACTIC RADIOTHERAPY FOR LUNG CANCER: EARLY EFFICACY AND TOXICITY EVALUATION OF A NON-INVASIVE REAL-TIME TUMOR TRACKING SYSTEM J. Bibault1 , B. Prevost1 , E. Dansin2 , X. Mirabel1 , T. Lacornerie1 , F. Dubus1 , E. Lartigau1 1 Academic Radiation Oncology Department, Centre Oscar Lambret, Lille, France, 2 General Oncology Department, Centre Oscar Lambret, Lille, France Purpose: Several methods are currently available for stereotactic lung cancer treatment with the CyberKnife: one of them requires the use of fiducials (Synchrony®) while the other is completely fiducial-free (Xsight Lung Tracking System®). We report our initial experience with 22 treated patients. Materials: Selection criteria were as follows: inoperable patients with single pulmonary tumor, T1 or T2 stage, tumor size between 15 mm and 60 mm, N0, M0. Initial staging included CT-Scan with