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Clinical Outcomes of Extensive-Stage Small Cell Lung Cancer Patients Treated With Thoracic Intensive Modified Radiation Therapy (IMRT)
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Volume 93 Number 3S Supplement 2015 following threshold values were used to classify two groups: SUVMEAN Z 4, SUVMAX Z 15, MTVMEAN Z 500, and MTVMAX Z 1,500. Results: We found neither SUVMEAN (p Z 0.1155) nor SUVMAX (p Z 0.8024) to be associated with a statistically significant increase in the hazard ratio of the OS rate for the NSCLC patients who have SUVMEAN 4 or SUVMAX 15. In contrast to SUV-based prognostic assays, both MTVMEAN (p Z 0.0456) and MTVMAX (p Z 0.0376) were found to be associated with statistically significant increases in the hazard ratio of OS rate for the NSCLC patients who have MTVMEAN 500 or MTVMAX 1,500. A robust prognostic assay allows clinicians to identify responders and nonresponders to lung cancer therapy before and/or during early therapy stages. This enables lung cancer patients to be informed of their predicted treatment outcome before or during early therapy, allowing for a window of opportunity to choose a more aggressive therapy if needed. Conclusion: MTV, the product of SUV and tumor volume integrating both PET and CT information, presents statistically a significant correlation for OS for NSCLC cases while SUV presented no statistically significant correlation. Author Disclosure: Y. Kim: None. H.I. Rochford: None. M.J. TenNapel: None. J. Bai: None. B.G. Allen: None. S.K. Bhatia: None. X. Wu: None.
2999 Absolute Number of Lymph Node Metastasis Is Associated With Prognosis of Postoperative Radiation Therapy for Patients With Non-Small Cell Lung Cancer H.I. Kim,1 O.K. Noh,2 Y.T. Oh,1 M. Chun,1 O. Cho,1 J. Heo,1 M.H. Kim,1 and H.J. Park1; 1Department of Radiation Oncology, Ajou University School of Medicine, Suwon-si, South Korea, 2Ajou University School of Medicine, Suwon-si, South Korea Purpose/Objective(s): To evaluate the prognostic association of absolute number of lymph node metastasis with survival rate of post-operative radiation therapy (PORT) for patients with non-small cell lung cancer (NSCLC) at a single institution. Materials/Methods: From 1997 to 2012, 203 patients in a single institution with pathologic stage II-III NSCLC who underwent PORT were analyzed. PORT was performed with 2-dimensional (nZ67) or 3-dimensional conformal technique and total radiation dose ranged from 30.6 to 70.0 Gy (median, 54.0) with conventional fractionation. Cisplatin-based adjuvant chemotherapy was administered in 81 patients (39.9%). Mediastinal lymph node dissection was performed in 178 (87.7%). Univariate and multivariate analyses were performed to identify the factors influencing overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRFS) and distant metastasis-free survival (DMFS). Results: Median OS was 43 months. Five-year OS, DFS, LRFS and DMFS rates were 40.9%, 41.9%, 58.4% and 51.1%, respectively. In multivariate analyses decreased OS was associated with higher pathologic T-stage (p<0.001) and positive resection margin (p<0.001). Pathologic N-stage was significantly associated with OS on univariate analysis (p<0.001), but no association on multivariate analysis. Absolute number of lymph node metastasis (<4 versus 4) was associated with OS (HR Z 1.564, pZ0.012), DFS (HR Z 1.715, pZ0.005) and DMFS (HR Z 2.187, p<0.001) on multivariate analyses. Conclusion: Absolute number of lymph node metastasis is independently significant prognostic factor in NSCLC patients treated with surgery and followed by PORT.
Author Disclosure: H. Kim: None. O. Noh: None. Y. Oh: None. M. Chun: None. O. Cho: None. J. Heo: None. M. Kim: None. H. Park: None.
3000 Clinical Outcomes of Extensive-Stage Small Cell Lung Cancer Patients Treated With Thoracic Intensive Modified Radiation Therapy (IMRT) Z. Zongmei,1 W. Zhang,1 D. Xin,1 C. Dongfu,1 F. Qinfu,1 X. Zefen,1 L. Jima,1 J. Liang,1 and L. Wang2; 1Cancer Institute & Hospital Chinese Academy of Medical Sciences, Beijing, China, 2Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China Purpose/Objective(s): To determine the effect and failure pattern in extensive small cell lung cancer patients treated with thoracic IMRT. Materials/Methods: A retrospective review was conducted on SCLC patients treated between January 2007 and December 2012. 138 Patients with ES-SCLC who received thoracic IMRT were identified, 38 of them received PCI. The median thoracic radiation dose was 56 Gy (32Gyw67Gy), 1.8w2Gy per fractions. The schedules for cranial irradiation were including 25 Gy in 10 fractions. The cumulative local-regional failure rate, distant failure rates and brain metastases rate were calculated. Overall survival was estimated by the KaplaneMeier method and compared by means of log-rank tests. Fisher’s exact test was used to compare brain metastases rate between subgroup. Results: The median follow-up times was 37 months (6w66 months). In addition, the follow-up rate was 93.67% (11 patients lost). 132 of 138 patients had completed the treatment plan. The rates of CR, PR, SD, and PD over thoracic radiation were 5%, 72.7%, 5.8% and 18% respectively. Five patients (3.6%) didn’t have enough data to evaluate tumor response. The acute toxicity was relatively mild. Grade 2 hematological toxicity and Grade 2 acute esophagitis were occurred in 22.3% and 22.2% of the patients. Ten patients developed Grade 2 radiation pneumonitis after radiation while 2 of them died for pneumonitis and primary disease progression. Median survival time was 14 months. The 1-year rate and 2-year overall survival rate were 63.4% and 21.6% respectively. The cumulative rate was 25.2% (35pts) for local-regional failure and 64% (89pts) for distant failure. Twenty-six patients experienced local-regional failure inside radiation field and 2 patients experienced failure outside. Two patients experienced localregional failure both inside and outside radiation field. 123 of 138 patients originally diagnosed without brain metastases. For patients received PCI ,the 18.42% and 7.89%，for patients received thoracic radiation only, the cumulative brain metastases rate and 1-year brain metastases rate were 42.35% (pZ0.01) and 35.29% (pZ0.003). PCI group also achieved better overall survival (HRZ2.248，pZ0.003). Thoracic radiation dose < 50Gy prognosis poor overall survival (HRZ0.376, pZ0.001), while there is no significant difference in overall survival between dose 50Gy and dose>50Gy. Conclusion: Thoracic radiation by IMRT in ES-SCLC may improve localregional control and overall survival, high dose (>50Gy) radiation seems unnecessary. Prophylactic cranial irradiation can notably prolong survival and reduce brain metastases. Author Disclosure: Z. Zongmei: None. W. Zhang: None. D. Xin: None. C. Dongfu: None. F. Qinfu: None. X. Zefen: None. L. Jima: None. J. Liang: None. L. Wang: None.
Volume 93 Number 3S Supplement 2015 following threshold values were used to classify two groups: SUVMEAN Z 4, SUVMAX Z 15, MTVMEAN Z 500, and MTVMAX Z 1,500. Results: We found neither SUVMEAN (p Z 0.1155) nor SUVMAX (p Z 0.8024) to be associated with a statistically significant increase in the hazard ratio of the OS rate for the NSCLC patients who have SUVMEAN 4 or SUVMAX 15. In contrast to SUV-based prognostic assays, both MTVMEAN (p Z 0.0456) and MTVMAX (p Z 0.0376) were found to be associated with statistically significant increases in the hazard ratio of OS rate for the NSCLC patients who have MTVMEAN 500 or MTVMAX 1,500. A robust prognostic assay allows clinicians to identify responders and nonresponders to lung cancer therapy before and/or during early therapy stages. This enables lung cancer patients to be informed of their predicted treatment outcome before or during early therapy, allowing for a window of opportunity to choose a more aggressive therapy if needed. Conclusion: MTV, the product of SUV and tumor volume integrating both PET and CT information, presents statistically a significant correlation for OS for NSCLC cases while SUV presented no statistically significant correlation. Author Disclosure: Y. Kim: None. H.I. Rochford: None. M.J. TenNapel: None. J. Bai: None. B.G. Allen: None. S.K. Bhatia: None. X. Wu: None.
2999 Absolute Number of Lymph Node Metastasis Is Associated With Prognosis of Postoperative Radiation Therapy for Patients With Non-Small Cell Lung Cancer H.I. Kim,1 O.K. Noh,2 Y.T. Oh,1 M. Chun,1 O. Cho,1 J. Heo,1 M.H. Kim,1 and H.J. Park1; 1Department of Radiation Oncology, Ajou University School of Medicine, Suwon-si, South Korea, 2Ajou University School of Medicine, Suwon-si, South Korea Purpose/Objective(s): To evaluate the prognostic association of absolute number of lymph node metastasis with survival rate of post-operative radiation therapy (PORT) for patients with non-small cell lung cancer (NSCLC) at a single institution. Materials/Methods: From 1997 to 2012, 203 patients in a single institution with pathologic stage II-III NSCLC who underwent PORT were analyzed. PORT was performed with 2-dimensional (nZ67) or 3-dimensional conformal technique and total radiation dose ranged from 30.6 to 70.0 Gy (median, 54.0) with conventional fractionation. Cisplatin-based adjuvant chemotherapy was administered in 81 patients (39.9%). Mediastinal lymph node dissection was performed in 178 (87.7%). Univariate and multivariate analyses were performed to identify the factors influencing overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRFS) and distant metastasis-free survival (DMFS). Results: Median OS was 43 months. Five-year OS, DFS, LRFS and DMFS rates were 40.9%, 41.9%, 58.4% and 51.1%, respectively. In multivariate analyses decreased OS was associated with higher pathologic T-stage (p<0.001) and positive resection margin (p<0.001). Pathologic N-stage was significantly associated with OS on univariate analysis (p<0.001), but no association on multivariate analysis. Absolute number of lymph node metastasis (<4 versus 4) was associated with OS (HR Z 1.564, pZ0.012), DFS (HR Z 1.715, pZ0.005) and DMFS (HR Z 2.187, p<0.001) on multivariate analyses. Conclusion: Absolute number of lymph node metastasis is independently significant prognostic factor in NSCLC patients treated with surgery and followed by PORT.
Author Disclosure: H. Kim: None. O. Noh: None. Y. Oh: None. M. Chun: None. O. Cho: None. J. Heo: None. M. Kim: None. H. Park: None.
3000 Clinical Outcomes of Extensive-Stage Small Cell Lung Cancer Patients Treated With Thoracic Intensive Modified Radiation Therapy (IMRT) Z. Zongmei,1 W. Zhang,1 D. Xin,1 C. Dongfu,1 F. Qinfu,1 X. Zefen,1 L. Jima,1 J. Liang,1 and L. Wang2; 1Cancer Institute & Hospital Chinese Academy of Medical Sciences, Beijing, China, 2Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China Purpose/Objective(s): To determine the effect and failure pattern in extensive small cell lung cancer patients treated with thoracic IMRT. Materials/Methods: A retrospective review was conducted on SCLC patients treated between January 2007 and December 2012. 138 Patients with ES-SCLC who received thoracic IMRT were identified, 38 of them received PCI. The median thoracic radiation dose was 56 Gy (32Gyw67Gy), 1.8w2Gy per fractions. The schedules for cranial irradiation were including 25 Gy in 10 fractions. The cumulative local-regional failure rate, distant failure rates and brain metastases rate were calculated. Overall survival was estimated by the KaplaneMeier method and compared by means of log-rank tests. Fisher’s exact test was used to compare brain metastases rate between subgroup. Results: The median follow-up times was 37 months (6w66 months). In addition, the follow-up rate was 93.67% (11 patients lost). 132 of 138 patients had completed the treatment plan. The rates of CR, PR, SD, and PD over thoracic radiation were 5%, 72.7%, 5.8% and 18% respectively. Five patients (3.6%) didn’t have enough data to evaluate tumor response. The acute toxicity was relatively mild. Grade 2 hematological toxicity and Grade 2 acute esophagitis were occurred in 22.3% and 22.2% of the patients. Ten patients developed Grade 2 radiation pneumonitis after radiation while 2 of them died for pneumonitis and primary disease progression. Median survival time was 14 months. The 1-year rate and 2-year overall survival rate were 63.4% and 21.6% respectively. The cumulative rate was 25.2% (35pts) for local-regional failure and 64% (89pts) for distant failure. Twenty-six patients experienced local-regional failure inside radiation field and 2 patients experienced failure outside. Two patients experienced localregional failure both inside and outside radiation field. 123 of 138 patients originally diagnosed without brain metastases. For patients received PCI ,the 18.42% and 7.89%，for patients received thoracic radiation only, the cumulative brain metastases rate and 1-year brain metastases rate were 42.35% (pZ0.01) and 35.29% (pZ0.003). PCI group also achieved better overall survival (HRZ2.248，pZ0.003). Thoracic radiation dose < 50Gy prognosis poor overall survival (HRZ0.376, pZ0.001), while there is no significant difference in overall survival between dose 50Gy and dose>50Gy. Conclusion: Thoracic radiation by IMRT in ES-SCLC may improve localregional control and overall survival, high dose (>50Gy) radiation seems unnecessary. Prophylactic cranial irradiation can notably prolong survival and reduce brain metastases. Author Disclosure: Z. Zongmei: None. W. Zhang: None. D. Xin: None. C. Dongfu: None. F. Qinfu: None. X. Zefen: None. L. Jima: None. J. Liang: None. L. Wang: None.