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864 Poster Exclusive high dose rate (HDR) brachytherapy for early stage bronchial carcinomas
$256 Friday/Saturday, 20-21 September 2002
vivat in irradiated pts [Celia 1998; Frommhold 1998; Lee 1998; Grogan 1999; Glaser 2001]. Despite this, the prevalence of anemia at presentation and during radiation therapy (RT) remains poorly characterized. Aims: To define the prevalence, severity, patterns, and factors contributing to the development of anemia (Hb <12 g/dL) in pts undergoing curative-intent RT + chemotherapy for bronchopulmonary cancer (BPCa). Methods: 110 BPCa pts irradiated in our department between 10/97 and 12/00 underwent prospective serial CBCs at consistent intervals relative to the start of RT (median time preRT=l day; median time intraRT=14 days). Hb levels were analyzed by pt age, sex, tumor stage, time, radiation dose, and chemotherapy use. All were treated to standard radiation portals and doses; 61 (56%) received concomitant chemotherapy. Results: Overall, 56 patients (51%) had anemia before RT and 88 (80%) had anemia during RT. Of the 54 (49%) pts without anemia at presentation, 15 (28%) experienced an Hb decrease of 1-2 g/dL and 18 (33%) had an Hb decrease of >2 g/dL, with 35 (65%) becoming anemic during RT. Of the 56 pts with anemia at presentation, 12 (21%) experienced an Hb decrease of 1-2 g/dL and 7 (13%) had an Hb decrease >2 g/dL, with 53 (95%) remaining anemic throughout RT. Mean Hb levels for all pts decreased significantly (P<.001) from baseline regardless of preRT anemia status (1.6 g/dL in pts with no anemia and 0.8 g/dL in those with anemia at presentation). IntraRT Hb decreases worsened (P<.01) with continued RT as shown by the lower Hb values observed during the final >5 weeks of RT compared with earlier values (2.2 g/dL in pts with no anemia and 1.7 g/dL in those with anemia at presentation). Multivariate analysis showed that preRT Hb (P<.0001) and concomitant chemotherapy (P=.067) were the most signific=ant factors associated with peri-RT anemia. Conclusions: A high proportion of pts with BPCa undergoing curative RT present with and develop anemia. A cumulative radiationdose effect on Hb is observed, with a significant correlation noted between presenting Hb level and decrease in Hb during treatment. Ongoing research seeks to prospectively characterize the relationship between extent and rate of Hb decline and QOL and tumor control, 863
Poster
Quality of life impact of endobronchial brachytherapy in non curable bronchogenic tumors N. Stas. L. Rocha, L. Trigo, M.J. Bento Depto. Radioterapia - Instituto Portugues Oncologia - Porto, Portugal Purpose: to use a simple but reliable score to determine the impact of palliative endobronchial HDR brachytherapy (EBBT) on the quality of life of patients with non curable bronchial carcinomas, Material and methods: from January 2000 to January 2002, 19 patients with non surgical and non potentially curable T3-T4, N0-N2 bronchial squamous cell carcinomas or adenocarcinomas, and 1 patient with a bronchial metastasis of an extrapulmonary carcinoma, had 1 to 7 palliative EBBT fractions as unique treatment or associated with external beam. All the 20 patients answeredthe EORTC QLQ-C30-LC13 quality of life questionnaires prior to each EBBT fraction, after the conclusion of all the EBBT treatments, and in some cases during the follow-up time (15 days to 18 months) (2 to 9 questionnaires per patient). The resultant data was correlated to the WHO Performance Status, the Speiser Symptomatic Score, the body weight, the clinical fiberoptic bronchoscopic and radiological data, for each patient and each questionnaire. At different times of their treatment, 4 patients answered the questionnaires alone, with their family, with a nurse, or with their physician. Results: 8/20 patients gave QLQ-C30-LC13 answers that correlated with their objective clinical situation. Emotional external factors such as the family, the nurse, and above all the physician dramatically influenced the given answers. Objective measurements such as the Speiser Score, the Performance Status, and the clinical data are not specific enough to judge the impact of palliative EBBT on the quality of life. Only bronchoscopy shows clearly the tumoral response and the therapeutic sequelae, but these do not correlate to the quality of life felt by the patient in oe third of the cases. The numeric QLQ-C30 score (questions 29 and 30) is often misunderstood by the patient. The number of choices is excessive and appears to disturb the aptient. The whole of this data was correlated in order to try to establish guidelines that could help the physician in the decision to go on or to stop the palliative treatment, Conclusions: palliative treatments for non curable bronchial cancers include therapeutic strategies sometimes aggressive, aimed at the patient comfort by lessening the symptoms and increasing the quality of life. Up to this moment there is not a reliable score that allows for the objective evaluation of these two factors,
Posters
864
Poster
Exclusive high dose rate (HDR) brachytherapy for early stage bronchial carcinomas M. Mahe 1, M. Merio~, L. Campion 1, M. Boeffard 1"2, O. Thomas 1, E. Bardet 1, L. Cellerin2, A. Le Groumellec 3, T. Francois 1, J.Y. Douillard 1 1Centre Ren~ Gauducheau, Radiotherapy, St Herblain, France 2CHU, Pneumology, Nantes, France 3CH, Pneumology, Vannes, France Introduction: HDR brachytherapy is considered standard treatment of inoperable endobronchial carcinomas. Objective: This retrospective study was to evaluate local control, survival, complications and parameters affecting these latter. Patients and methods: Criteria for selection from the Centre Rene Gauducheau database were as follow: non small-cell histology, no extrabronchial involvement on CT, contre indication to surgery and external radiation therapy. Comparisons of groups of interest were done with the Chi2 or Fisher's tests. Survival curves were assessed using the Kaplan-Meier's method and compared with the log-rank test. Results: Between 11/1994 and 12/2001, 29 males (mean age : 64.5, extremes 44-79 years) met criteria including 16 in situ and 13 invasive squamous ceil carcinomas. Previous local treatment consisted of surgery in 11 patients and external radiation therapy in 3. First 18 patients received 5 fractions of 6 Gy each at 1 cm radius and last 11 had 6 fractions of 5 Gy each. Median follow-up was 30 months (range 4-75 months). Oncologic results were as follow: 2-months histologic control: 92%, median survival 20.6 months, 2-year overall, specific and local relapse-free survival namely 47, 63 and 59%. Life-threatening complications included 2 fatal hemoptysis, 1 bronchial stenosis requiring pneumonectomy and 1 bronchial necrosis (13%). At the time of analysis, 10 patients were alive with no evolutive disease and 19 dead. Causes of death were local failure: 5, local failure + metastases: 4, metastases: 1, intercurrent: 7, complications: 2. The only factor affecting oncologic results was histology with 2-year local relapsefree survival of 77% for in situ versus only 41% for invasive tumors (p=0.03). No parameter was observed to statistically influence frequency of complications, despite a trend for a higher frequency of hemoptysis with 6 fractions vs 5 (p=0.08). Conclusion: This series confirmed value of HDR brachytherapy as an alternative to surgery in inoperable endobronchial carcinomas. The use of CT and techniques to decrease dose to normal bronchial mucosa are now under investigation in our department to improve local control and decrease frequency of complications. 865
Poster
Interrupted phase II trial of adjuvant docetaxel and radiothera p y in resected stage III non-small cell lung cancer (NSCLC)
V. Beckendorf 1, D. Spaeth 1, E. Luporsi 1, M. Untereinet2, J. Froment 3, Oncolor Radiotherapie, College Lorrain de Pathologie Thoracique 1Centre alexis vautrin, Radiotherapy, Vandoeuvre les Nancy, France 2Centre Francois Baclesse, Rradiotherapy, Esch/Alzette, Luxembourg 3Centre Hospitalier, Medecine, Bar le Duc, France Aim of the study: As poor survival in stage III NSCLC results from both local and distant failure, a double approach was planned with Docetaxel chemotherapy first at high dose and secondly at low dose in combination with reduced field mediastinal irradiation. Design of the study: Thirty five patients were planned to receive 3 infusions of docetaxel 100 mg/m = -. premedication with corticosteroids on D1, D22, D43 beginning between 35 and 50 days after complete surgical resection. Three weeks later, involved and immediately next node levels had to receive 50 Gy / 25 fractions with weekly 20 mg/m 2 docetaxel infusion. Results: From January 2000 to march 2002, 27 patients, men and women were enrolled. Chemotherapy courses were complete in xx (xx%) patients: dose reduction occurred in x because of haematologic toxicity, x stopped after D1 because of an hypersensibility reaction, one after 2 courses for dermatologic intolerance, one after metastatic progression. Radiotherapy delivered 50 Gy in xx patients, xx in association with 5 Docetaxel infusions: one patient stopped at 36 Gy with an invasive aspergillose, one after Tow patients developed slowly between the third infusion of docetaxel and the end of the radiochemotherapy a refractory diffuse lethal interstitial pneumonitis. Both have been received amiodarone since the surgical resection. Late oesophageal stricture occurred in one patient at 6 months and needed 2 dilatations with good results. Conclusion: For this selected population of stage III resected NSCLC, the
vivat in irradiated pts [Celia 1998; Frommhold 1998; Lee 1998; Grogan 1999; Glaser 2001]. Despite this, the prevalence of anemia at presentation and during radiation therapy (RT) remains poorly characterized. Aims: To define the prevalence, severity, patterns, and factors contributing to the development of anemia (Hb <12 g/dL) in pts undergoing curative-intent RT + chemotherapy for bronchopulmonary cancer (BPCa). Methods: 110 BPCa pts irradiated in our department between 10/97 and 12/00 underwent prospective serial CBCs at consistent intervals relative to the start of RT (median time preRT=l day; median time intraRT=14 days). Hb levels were analyzed by pt age, sex, tumor stage, time, radiation dose, and chemotherapy use. All were treated to standard radiation portals and doses; 61 (56%) received concomitant chemotherapy. Results: Overall, 56 patients (51%) had anemia before RT and 88 (80%) had anemia during RT. Of the 54 (49%) pts without anemia at presentation, 15 (28%) experienced an Hb decrease of 1-2 g/dL and 18 (33%) had an Hb decrease of >2 g/dL, with 35 (65%) becoming anemic during RT. Of the 56 pts with anemia at presentation, 12 (21%) experienced an Hb decrease of 1-2 g/dL and 7 (13%) had an Hb decrease >2 g/dL, with 53 (95%) remaining anemic throughout RT. Mean Hb levels for all pts decreased significantly (P<.001) from baseline regardless of preRT anemia status (1.6 g/dL in pts with no anemia and 0.8 g/dL in those with anemia at presentation). IntraRT Hb decreases worsened (P<.01) with continued RT as shown by the lower Hb values observed during the final >5 weeks of RT compared with earlier values (2.2 g/dL in pts with no anemia and 1.7 g/dL in those with anemia at presentation). Multivariate analysis showed that preRT Hb (P<.0001) and concomitant chemotherapy (P=.067) were the most signific=ant factors associated with peri-RT anemia. Conclusions: A high proportion of pts with BPCa undergoing curative RT present with and develop anemia. A cumulative radiationdose effect on Hb is observed, with a significant correlation noted between presenting Hb level and decrease in Hb during treatment. Ongoing research seeks to prospectively characterize the relationship between extent and rate of Hb decline and QOL and tumor control, 863
Poster
Quality of life impact of endobronchial brachytherapy in non curable bronchogenic tumors N. Stas. L. Rocha, L. Trigo, M.J. Bento Depto. Radioterapia - Instituto Portugues Oncologia - Porto, Portugal Purpose: to use a simple but reliable score to determine the impact of palliative endobronchial HDR brachytherapy (EBBT) on the quality of life of patients with non curable bronchial carcinomas, Material and methods: from January 2000 to January 2002, 19 patients with non surgical and non potentially curable T3-T4, N0-N2 bronchial squamous cell carcinomas or adenocarcinomas, and 1 patient with a bronchial metastasis of an extrapulmonary carcinoma, had 1 to 7 palliative EBBT fractions as unique treatment or associated with external beam. All the 20 patients answeredthe EORTC QLQ-C30-LC13 quality of life questionnaires prior to each EBBT fraction, after the conclusion of all the EBBT treatments, and in some cases during the follow-up time (15 days to 18 months) (2 to 9 questionnaires per patient). The resultant data was correlated to the WHO Performance Status, the Speiser Symptomatic Score, the body weight, the clinical fiberoptic bronchoscopic and radiological data, for each patient and each questionnaire. At different times of their treatment, 4 patients answered the questionnaires alone, with their family, with a nurse, or with their physician. Results: 8/20 patients gave QLQ-C30-LC13 answers that correlated with their objective clinical situation. Emotional external factors such as the family, the nurse, and above all the physician dramatically influenced the given answers. Objective measurements such as the Speiser Score, the Performance Status, and the clinical data are not specific enough to judge the impact of palliative EBBT on the quality of life. Only bronchoscopy shows clearly the tumoral response and the therapeutic sequelae, but these do not correlate to the quality of life felt by the patient in oe third of the cases. The numeric QLQ-C30 score (questions 29 and 30) is often misunderstood by the patient. The number of choices is excessive and appears to disturb the aptient. The whole of this data was correlated in order to try to establish guidelines that could help the physician in the decision to go on or to stop the palliative treatment, Conclusions: palliative treatments for non curable bronchial cancers include therapeutic strategies sometimes aggressive, aimed at the patient comfort by lessening the symptoms and increasing the quality of life. Up to this moment there is not a reliable score that allows for the objective evaluation of these two factors,
Posters
864
Poster
Exclusive high dose rate (HDR) brachytherapy for early stage bronchial carcinomas M. Mahe 1, M. Merio~, L. Campion 1, M. Boeffard 1"2, O. Thomas 1, E. Bardet 1, L. Cellerin2, A. Le Groumellec 3, T. Francois 1, J.Y. Douillard 1 1Centre Ren~ Gauducheau, Radiotherapy, St Herblain, France 2CHU, Pneumology, Nantes, France 3CH, Pneumology, Vannes, France Introduction: HDR brachytherapy is considered standard treatment of inoperable endobronchial carcinomas. Objective: This retrospective study was to evaluate local control, survival, complications and parameters affecting these latter. Patients and methods: Criteria for selection from the Centre Rene Gauducheau database were as follow: non small-cell histology, no extrabronchial involvement on CT, contre indication to surgery and external radiation therapy. Comparisons of groups of interest were done with the Chi2 or Fisher's tests. Survival curves were assessed using the Kaplan-Meier's method and compared with the log-rank test. Results: Between 11/1994 and 12/2001, 29 males (mean age : 64.5, extremes 44-79 years) met criteria including 16 in situ and 13 invasive squamous ceil carcinomas. Previous local treatment consisted of surgery in 11 patients and external radiation therapy in 3. First 18 patients received 5 fractions of 6 Gy each at 1 cm radius and last 11 had 6 fractions of 5 Gy each. Median follow-up was 30 months (range 4-75 months). Oncologic results were as follow: 2-months histologic control: 92%, median survival 20.6 months, 2-year overall, specific and local relapse-free survival namely 47, 63 and 59%. Life-threatening complications included 2 fatal hemoptysis, 1 bronchial stenosis requiring pneumonectomy and 1 bronchial necrosis (13%). At the time of analysis, 10 patients were alive with no evolutive disease and 19 dead. Causes of death were local failure: 5, local failure + metastases: 4, metastases: 1, intercurrent: 7, complications: 2. The only factor affecting oncologic results was histology with 2-year local relapsefree survival of 77% for in situ versus only 41% for invasive tumors (p=0.03). No parameter was observed to statistically influence frequency of complications, despite a trend for a higher frequency of hemoptysis with 6 fractions vs 5 (p=0.08). Conclusion: This series confirmed value of HDR brachytherapy as an alternative to surgery in inoperable endobronchial carcinomas. The use of CT and techniques to decrease dose to normal bronchial mucosa are now under investigation in our department to improve local control and decrease frequency of complications. 865
Poster
Interrupted phase II trial of adjuvant docetaxel and radiothera p y in resected stage III non-small cell lung cancer (NSCLC)
V. Beckendorf 1, D. Spaeth 1, E. Luporsi 1, M. Untereinet2, J. Froment 3, Oncolor Radiotherapie, College Lorrain de Pathologie Thoracique 1Centre alexis vautrin, Radiotherapy, Vandoeuvre les Nancy, France 2Centre Francois Baclesse, Rradiotherapy, Esch/Alzette, Luxembourg 3Centre Hospitalier, Medecine, Bar le Duc, France Aim of the study: As poor survival in stage III NSCLC results from both local and distant failure, a double approach was planned with Docetaxel chemotherapy first at high dose and secondly at low dose in combination with reduced field mediastinal irradiation. Design of the study: Thirty five patients were planned to receive 3 infusions of docetaxel 100 mg/m = -. premedication with corticosteroids on D1, D22, D43 beginning between 35 and 50 days after complete surgical resection. Three weeks later, involved and immediately next node levels had to receive 50 Gy / 25 fractions with weekly 20 mg/m 2 docetaxel infusion. Results: From January 2000 to march 2002, 27 patients, men and women were enrolled. Chemotherapy courses were complete in xx (xx%) patients: dose reduction occurred in x because of haematologic toxicity, x stopped after D1 because of an hypersensibility reaction, one after 2 courses for dermatologic intolerance, one after metastatic progression. Radiotherapy delivered 50 Gy in xx patients, xx in association with 5 Docetaxel infusions: one patient stopped at 36 Gy with an invasive aspergillose, one after Tow patients developed slowly between the third infusion of docetaxel and the end of the radiochemotherapy a refractory diffuse lethal interstitial pneumonitis. Both have been received amiodarone since the surgical resection. Late oesophageal stricture occurred in one patient at 6 months and needed 2 dilatations with good results. Conclusion: For this selected population of stage III resected NSCLC, the