- Email: [email protected]
86P EFFICACY OF CONCURRENT CHEMORADIOTHERAPY IN LOCALLY ADVANCED NON-SMALL-CELL LUNG CANCER
S42 cord and esophagus. The total dose in small cell tumors was 60 Gy in 30 fractions. In all other histologies 68 70 Gy in 34 35 fractions. Results: It was used technique of IMRT, inverse planning, step and shoot, 6 Mv energy, with 7 and 9 angles of gantry. The mean CTV of the primary lesion is 162 cc (20 706), the average of abnormal nodal CTV is 54 cc (6 160) the average total PTV results from 610 (330 1603) In terms of acute toxicity, have been presented esofagitis GII 50% of patients and in no case has been required to suspend radiotherapy. One case of chronic pneumonitis and died secondary of pneumonia. Conclusions: The experience of using IMRT is positive, because there are cases where the 3D planning is not fulfilled a PTV coverage and does not respect the OARs tolerance, this would force to reduce the dose and change the intent of treatment to a palliative radiation therapy, or to not treat, without giving the opportunity of this treatment to these patients although the prognosis is poor. Nevertheless, these results are preliminary and need more experience. Disclosure: All authors have declared no conflicts of interest. 84P VALUE OF CURATIVE TREATMENT CHEMOTHERAPY AND RADIOTHERAPY VERSUS PALLIATIVE RADIOTHERAPY ALONE IN THE PATIENTS WITH ADVANCED NON-SMALL CELL LUNG CANCER M. Dzhugashvili1 , A. Fondevilla1 , L. Bregu1 , F. Mata2 , V. Puchades2 , D. Ramos2 , H. Marsiglia1,3,4 , P.P. Escolar1 1 Department of Radiation Oncology, Instituto Madrile˜ no de Oncologia (Grupo Imo), Madrid, Spain, 2 Department of Physics, Instituto Madrile˜ no de Oncologia (Grupo Imo), Madrid, Spain, 3 University of Florence, Florence, Italy, 4 Breast Cancer Pathology, Radiotherapy Department, Institut Gustave Roussy, Villejuif, France Purpose: It is known from numerous clinical trials that patients with advanced non-small cell lung cancer have poor prognosis. The standard of treatment of such patients is chemotherapy and radiotherapy. At our institution we have experience of treatment over 300 patients with NSCLC since 2005, but in the given study we have chosen two groups of patients and aimed to answer a question does curative intent radiotherapy treatment really prolong the overall survival rate in comparison with palliative treatment in identical groups of patients? Methods and Materials: 60 patients (treated between 2005 and 2007), with non-small cell lung cancer were randomly assigned to either of the two regimes. All patients presented inoperable locoregionally advanced disease (Stage IIIb 80%, IIIa 20%). The median age of patients was 62 years (range: 42 84). The first treatment regime consisted in palliative radiotherapy alone, 30 Gy given in 10 fractions, 300 cGy per fraction, treated volume included only macroscopic tumor with Planning Target Volume (PTV) margin. The second treatment regime consisted in combined cisplatinbased curative chemotherapy and radiotherapy, 66 Gy given in 33 fractions, 200 cGy per fraction and treated volume included macroscopic tumor with involved lymph nodes and mediastinum. Results: The median of control time was 16 months (range: 1.2 64). Survival probabilities at 5 years were considered as the endpoint of interest. The overall survival rate in the palliative treatment regime group was 3.6% and in the curative treatment regime group 28.6%. The maximum control time in the palliative treatment group was 6 months. Conclusions: These results clearly show the value of combined cisplatin-based chemotherapy and radiotherapy, applicable with curative intent in the NSCLC patients with advanced stages, frequently treated only with palliative regime radiotherapy. Disclosure: All authors have declared no conflicts of interest.
Locally advanced NSCLC 85P INOPERABLE NON SMALL CELL LUNG CANCER TREATED WITH CHEMOTHERAPY AND SEQUENTIAL RADIOTHERAPY USING HELICAL TOMOTHERAPY M. Cianciulli, A. Monaco, C. Caruso, C. Chiostrini, M. Nicoletti, M. Crescenzi, V. Donato Radioterapia, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy Aim: To investigate the impact of Helical Tomotherapy in the treatment of inoperable non small cell lung cancer. Materials and Methods: From February to January 2010, 30 consecutive patients with diagnosis of stage IIIA or IIIB NSCLC were treated with Helical Tomotherapy. Platinum-based chemotherapy was administered before radiotherapy. FDG-PET was performed, in order to stage the disease and to define CTV in planning radiation treatment. Mean radiation prescription dose ranged from 64.5 to 68.4 Gy in 30 fractions with 2.15 2.28 Gy per fraction. Results: Median follow-up was 10 months (6 20). Toxicity was evaluated using EORTC/RTOG scoring system: 21 patients experienced G1 and 7 G2 acute oesophagitis; 2 patients experienced G2 pneumonitis treated with pharmacological therapy. At the first follow-up, only one patient presented progression disease because of brain metastases; 15 patients presented stable disease, 12 partial and 2 complete response. At the second one, 8 had complete local response, 13 stable disease and 8 local progression or metastatic lesions. Conclusions: Helical Tomotherapy allows to obtain good local control of disease with low toxicity in the treatment of locally advanced NSCLC. We are going to use a treatment of concomitant radiochemotherapy after induction chemotherapy, in order to improve our results. Disclosure: All authors have declared no conflicts of interest. 86P EFFICACY OF CONCURRENT CHEMORADIOTHERAPY IN LOCALLY ADVANCED NON-SMALL-CELL LUNG CANCER M. Almodovar1 , H. Ramos1 , P. Mota1 , V. Martins1 , P. Pereira2 Respiratory Department, Portuguese Cancer Institute, Lisbon, Portugal, 2 Radiotherapy, Portuguese Cancer Institute, Lisbon, Portugal
1
At the present time the most effective therapy for locally advanced non-small-cell lung cancer (NSCLC) is concurrent chemoradiotherapy (CCRT). A better efficacy of this therapy is, however associated with higher morbidity, limiting its use in clinical practice. Aims: Evaluation of survival, progression-free survival and toxicity in NSCLC patients treated with CCRT outside clinical trials. Patients and Methods: Retrospective longitudinal study with review of 83 files of patients offered CCRT in therapeutic decision meeting from 2002 to 2009. All NSCLC patients in stage III receiving CCRT were included. Patients submitted to surgery, sequential therapy, single therapy and progression before starting CCRT were excluded. The following variables were evaluated: demographic characteristics (age, sex), smoking status, performance status, comorbidities with Charlson Index, disease characteristics (histology, localization, stage), therapy toxicity, progression-free survival (PFS), posterior treatments and survival. Chemotherapy used: cisplatin/vinorrelbin (PV) or carboplatin/paclitaxel (CT), associated with radiotherapy 60 Gy. Chi-square test and Fisher’s exact test were used for group comparison. For PFS and survival analysis the real values and Kaplan Meier curves were used. Spss v 16 was used. Results: 27 patients were treated with CCRT (23 males), mean age 61±8.8 y. 85% had smoking habits. All patients had PS 0/1. According to Charlson ´Index, 89% had co-morbidities and 44% COPD. Hystologic classification: squamous in 37% and adenocarcinoma in 41%. 74% were in stage IIIB. In Patients who progressed, mean PFS
Locally advanced NSCLC was 8.1±9.5 months, mean survival was 21±20.1 month and survival rate at 12, 24 and 48 months was 52%, 22% and 7% respectively. Grade 3 and 4 toxicity affected 9 patients, neutropenia being the most frequent. There were no treatment related deaths. Conclusions: Patients had the usual characteristics such as age, good PS, smoking habits and co-morbidities, mainly COPD. PFS and survival findings were similar to those recorded in other studies. Toxicity found was acceptable. Concurrent chemoradiotherapy is possible in daily clinical practice with good results, as long as patients are carefully selected. Disclosure: All authors have declared no conflicts of interest. 87P ORAL GLUTAMINE SUPPLEMENTATION HAS NO NEGATIVE IMPACT ON SURVIVAL IN LOCALLY ADVANCED NON-SMALL CELL LUNG CANCER TREATED WITH CONCURRENT CHEMORADIOTHERAPY E. Topkan1 , O. Yuksel1 , A. Kotek1 , C. Parlak2 , B. Pehlivan3 Radiation Oncology, Baskent University, Adana, Turkey, 2 Radiation Oncology, Antalya Education and Research Hospital, Antalya, Turkey, 3 Radiation Oncology, Akdeniz University, Antalya, Turkey 1
Background: We aimed to retrospectively evaluate the survival outcome of 92 patients with stage III non-small cell lung carcinoma
S43 (NSCLC) treated with thoracic irradiation (TRT) regarding their status of oral glutamine supplementation. Patients and Methods: Ninety-two patients with stage III lung carcinoma were included. Forty-nine patients (53.3%) received prophylactic powdered glutamine orally in doses of 10 g/8 h, while remaining 43 (46.7%) did not and served as controls. Prescribed radiation dose to planning target volume was 66 Gy, in 30 fractions, 5 days/week. The primary endpoint included the progression free survival (PFS), overall survival (OS), and their correlation with status of glutamine supplementation. Results: Oral glutamine was well tolerated, except for mild nausea in 13 (27.1%) patients. Median follow-up time was 24.2 months (range: 9.2 34.4 months. Median PFS and OS for glutamine vs. no glutamine cohorts were 14.3 vs. 17.2 months (p = 0.12) and 18.3 vs. 22.2 months (p = 0.11), respectively. Conclusion: Current results suggested no tumor cell protective action for oral glutamine, in the dose and schedule utilized here. The insignificant 4 months survival benefit achieved with glutamine may be related with limited size of study population, however, regarding the possible selective radiosensitizing effect of glutamine it may worth to address validity of these interesting results in a future prospectively randomized study. Disclosure: All authors have declared no conflicts of interest.
Locally advanced NSCLC 85P INOPERABLE NON SMALL CELL LUNG CANCER TREATED WITH CHEMOTHERAPY AND SEQUENTIAL RADIOTHERAPY USING HELICAL TOMOTHERAPY M. Cianciulli, A. Monaco, C. Caruso, C. Chiostrini, M. Nicoletti, M. Crescenzi, V. Donato Radioterapia, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy Aim: To investigate the impact of Helical Tomotherapy in the treatment of inoperable non small cell lung cancer. Materials and Methods: From February to January 2010, 30 consecutive patients with diagnosis of stage IIIA or IIIB NSCLC were treated with Helical Tomotherapy. Platinum-based chemotherapy was administered before radiotherapy. FDG-PET was performed, in order to stage the disease and to define CTV in planning radiation treatment. Mean radiation prescription dose ranged from 64.5 to 68.4 Gy in 30 fractions with 2.15 2.28 Gy per fraction. Results: Median follow-up was 10 months (6 20). Toxicity was evaluated using EORTC/RTOG scoring system: 21 patients experienced G1 and 7 G2 acute oesophagitis; 2 patients experienced G2 pneumonitis treated with pharmacological therapy. At the first follow-up, only one patient presented progression disease because of brain metastases; 15 patients presented stable disease, 12 partial and 2 complete response. At the second one, 8 had complete local response, 13 stable disease and 8 local progression or metastatic lesions. Conclusions: Helical Tomotherapy allows to obtain good local control of disease with low toxicity in the treatment of locally advanced NSCLC. We are going to use a treatment of concomitant radiochemotherapy after induction chemotherapy, in order to improve our results. Disclosure: All authors have declared no conflicts of interest. 86P EFFICACY OF CONCURRENT CHEMORADIOTHERAPY IN LOCALLY ADVANCED NON-SMALL-CELL LUNG CANCER M. Almodovar1 , H. Ramos1 , P. Mota1 , V. Martins1 , P. Pereira2 Respiratory Department, Portuguese Cancer Institute, Lisbon, Portugal, 2 Radiotherapy, Portuguese Cancer Institute, Lisbon, Portugal
1
At the present time the most effective therapy for locally advanced non-small-cell lung cancer (NSCLC) is concurrent chemoradiotherapy (CCRT). A better efficacy of this therapy is, however associated with higher morbidity, limiting its use in clinical practice. Aims: Evaluation of survival, progression-free survival and toxicity in NSCLC patients treated with CCRT outside clinical trials. Patients and Methods: Retrospective longitudinal study with review of 83 files of patients offered CCRT in therapeutic decision meeting from 2002 to 2009. All NSCLC patients in stage III receiving CCRT were included. Patients submitted to surgery, sequential therapy, single therapy and progression before starting CCRT were excluded. The following variables were evaluated: demographic characteristics (age, sex), smoking status, performance status, comorbidities with Charlson Index, disease characteristics (histology, localization, stage), therapy toxicity, progression-free survival (PFS), posterior treatments and survival. Chemotherapy used: cisplatin/vinorrelbin (PV) or carboplatin/paclitaxel (CT), associated with radiotherapy 60 Gy. Chi-square test and Fisher’s exact test were used for group comparison. For PFS and survival analysis the real values and Kaplan Meier curves were used. Spss v 16 was used. Results: 27 patients were treated with CCRT (23 males), mean age 61±8.8 y. 85% had smoking habits. All patients had PS 0/1. According to Charlson ´Index, 89% had co-morbidities and 44% COPD. Hystologic classification: squamous in 37% and adenocarcinoma in 41%. 74% were in stage IIIB. In Patients who progressed, mean PFS
Locally advanced NSCLC was 8.1±9.5 months, mean survival was 21±20.1 month and survival rate at 12, 24 and 48 months was 52%, 22% and 7% respectively. Grade 3 and 4 toxicity affected 9 patients, neutropenia being the most frequent. There were no treatment related deaths. Conclusions: Patients had the usual characteristics such as age, good PS, smoking habits and co-morbidities, mainly COPD. PFS and survival findings were similar to those recorded in other studies. Toxicity found was acceptable. Concurrent chemoradiotherapy is possible in daily clinical practice with good results, as long as patients are carefully selected. Disclosure: All authors have declared no conflicts of interest. 87P ORAL GLUTAMINE SUPPLEMENTATION HAS NO NEGATIVE IMPACT ON SURVIVAL IN LOCALLY ADVANCED NON-SMALL CELL LUNG CANCER TREATED WITH CONCURRENT CHEMORADIOTHERAPY E. Topkan1 , O. Yuksel1 , A. Kotek1 , C. Parlak2 , B. Pehlivan3 Radiation Oncology, Baskent University, Adana, Turkey, 2 Radiation Oncology, Antalya Education and Research Hospital, Antalya, Turkey, 3 Radiation Oncology, Akdeniz University, Antalya, Turkey 1
Background: We aimed to retrospectively evaluate the survival outcome of 92 patients with stage III non-small cell lung carcinoma
S43 (NSCLC) treated with thoracic irradiation (TRT) regarding their status of oral glutamine supplementation. Patients and Methods: Ninety-two patients with stage III lung carcinoma were included. Forty-nine patients (53.3%) received prophylactic powdered glutamine orally in doses of 10 g/8 h, while remaining 43 (46.7%) did not and served as controls. Prescribed radiation dose to planning target volume was 66 Gy, in 30 fractions, 5 days/week. The primary endpoint included the progression free survival (PFS), overall survival (OS), and their correlation with status of glutamine supplementation. Results: Oral glutamine was well tolerated, except for mild nausea in 13 (27.1%) patients. Median follow-up time was 24.2 months (range: 9.2 34.4 months. Median PFS and OS for glutamine vs. no glutamine cohorts were 14.3 vs. 17.2 months (p = 0.12) and 18.3 vs. 22.2 months (p = 0.11), respectively. Conclusion: Current results suggested no tumor cell protective action for oral glutamine, in the dose and schedule utilized here. The insignificant 4 months survival benefit achieved with glutamine may be related with limited size of study population, however, regarding the possible selective radiosensitizing effect of glutamine it may worth to address validity of these interesting results in a future prospectively randomized study. Disclosure: All authors have declared no conflicts of interest.