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Conformal radiotherapy as an alternative to surgery for respiratory inoperable stage I non-small cell lung cancer (NSCLC)
Radiation
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of QOL score. Patients received chemotherapy lost QOL score after radiation therapy. In five categories, score of physical condition had less improvement. Conclusion: It was suggested that radiation therapy could be completed without losing QOL of lung cancer patients, including elder patients. However, patients receiving chemotherapy are possible to lose their QOL, therefore, it is needed to treat such patients carefully.
• 5Brain7 metastases - 5 from 1 NSCLC E Barata, A. Figueiredo, P. Alves, L. Pedro, R. Rate. CentreHospitalar de Coimbra, Departmentof Pneumology Service, Coimbra, Portuga/ Purpose: To determine the median survival of patients with metastatic brain cancer from non-small cell lung cancer (NSCLC) and to evaluate some factors involved in survival. Patients and Methods: A total of 48 patients (39 males, 9 females) with a median age of 62.4 years (41-81), all with brain metastases (BM) from NSCLC, were studied. The histologic patterns were: 52% adenocarcinoma; 37.5% squamous cell cercinom; 10.5% large cell carcinoma. The most frequent basal clinical symptom was headache in 62.5%. Diagnosis of BM was obtained by CT scan in 70.8% of the patients and MRI in the remaining 29.2%. All patients but 6, with single brain metastasis, had multiple metastases. The therapeutic option was surgery plus radiotherapy in 8.4% of the patients; radiotherapy (30 Gy in 15 fractions) in 41.6%. In the remaining 50%, the only option was to provide the best supportive therapy. Results: The overall survival post NSCLC diagnosis was 216 days to the 48 patients. 29 patients didn't show BM at the time of diagnosis; the mean time to BM was 137.5 days. In 19 patients, the presence of BM was simultaneous with diagnosis of NSCLC. The mean survival after BM diagnosis was 146 days. After BM diagnosis, a performance status (PS) value of 1-2 was associated with better survival (164 days) than a PS value of 3-4 (112 days). The survival of patients with BM treated with radiotherapy is significantly longer than one of those receiving best supportive care (215 days vs. 62 days; p < 0.001). There was no significant difference between patients with adenocarcinoma and squamous cell carcinoma. Conclusions: The survival of patients with BM from NSCLC is poor. The survival was better for patients with PS values of 1-2 and on those eligible for radiotherapy versus best supportive care, probably reflecting a bias on the patient selection for radiotherapy. radiotherapy as an alternative to surgery for [57-6-]Conformal respiratory inoperable stage I non-small cell lung cancer (NSCLC) S. Hominal, I. MarteI-Lafay, M. Perol, C. Ginestet, J.C. Guerin, C. Carrie. Croix-Rousse Hospital Lyon; Centre Leon Berard, Lyon,
France The published results of conventional radiotherapy for stage I NSCLC as an alternative to surgery in patients with severe underlying pulmonary disease, indicate that local control remains unsatisfactory. This retrospective study was conducted to investigate whether conformal radiotherapy could be given without major pulmonary toxicity and if a better local control would be obtained. Materials and Methods: From 1996 to 1997, patients with stage I NSCLC received conformal radiotherapy. An immobilisation device with a polyurethane foam mould was made before the dosimetric scan performed in the treatment position. The plannifled target volume (PTV) encompassed the gross tumor volume (GTV) (macroscopic tumor mass) with 1 cm margin. Complex fields were obtained from a multileaf collimator. Dose volume histograms (DHV) were calculated for the tumor and the normal tissues. The prescribed dose was 60-66 GY on the P'IV in 18 MV photons with 6 to 12 fields using a conventional fractionation. Lung functions were assessed prior to irradiation, 6 weeks and 6 months follow-up by forced expiratory volume in 1 second (FEV 1), forced vital capacity (FVC), total lung capacity (TLC), diffusion capacity to carbon monoxide (DLCO) and blood gaz tests. Pneumonitis
was graded according to the SOMA-LENT scale. Local disease free survival (LDFS) was our primary objective because of the high rate of intercurrent death in these patients. Results: 10 patients (6 T1 and 4 T2 tumors). Median age = 67 years. Median Karnofsky performance score = 90%. Median FEV1 = 1280 ml (42.5% of theory). Median FVC = 2780 ml (74%). Median TLC = 6040 (91%). Median DLCO = 52%. Median PO2 = 69 mmHg. Pneumonitis: 6 weeks = 3 grade 1, 3 grade 2/6 months = 7 grade 1, 3 grade 2. No grade 3-4. No fatal complication. End point (1 January 2000): 6 patients alive with disease; 4 died of cancer; local recurrence for 8 patients. Median LDFS is 15 months. Two years LDFS rate is 17.5%. Median survival time is 35.8 months. Two years overall survival rate is 78%. Discussion-Conclusion: The high local relapse could be explained by the difficulties in delivering treatment with a high degree of precision because of respiratory movements. Further studies are necessary to evaluate the different methods to control breathing during radiotherapy, to determine the optimal radiation dose and to develop a mathematical model which could estimate the risk of radiation pneumonitis, considering DHV, baseline pulmonary function and biological factors (cytokines).
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Patterns of tumor recurrence following induction chemotherapy and involved-field" radiotherapy (RT) to 70 Gy in stage 3 non-small cell lung cancer (NSCLC)
J.P. van Meerbeeck, S.A. Burgers, J. van Sornsen de Koste, R.J. van Klaveren, M.J. Samson, S.S. eel, M.J.A. de Jonge, T.A.W. Splinter, S. Senan. ROTS, Rotterdam, the Netherlands Background: With conventional RT techniques and doses, a high incidence of local and distant failure is observed in locally advanced NSCLC. Omitting RT to uninvolved mediastinal nodes (i.e. "involvedfield" RT) could reduce toxicity, while not increasing the incidence of isolated regional failure. Methods: In an ongoing phase II study, 39 patients (pt) with medicelly or surgically inoperable stage III non-small cell lung cancer were treated with either 2 or 4 cycles of cerboplatin (AUC 6) and paclitaxel (200 mg/m2). Pt whose primary tumors had a diameter > 6 cm and/or supraclavicular metastases were ineligible. Tumor response was evaluated 2 weeks after the second cycle of chemotherapy. If at least a partial response was obtained, 2 additional cycles of chemotherapy were administered, followed by "involved-field" RT to 70 Gy using 3-dimensional treatment planning. Only the tumor and mediastinal nodes with a short axis diameter equal to, or greater than, 1 cm were contoured in the gross tumor volume. At 3 and 6 months following RT, pt were reevaluated by means of bronchoscopy and CT scan. Local tumor control was also reevaluated when distant recurrences were detected. Elective nodal failure was defined as a recurrence in an initially uninvolved regional node in the absence of local failure. Results: The majority of pt had stage 3B disease. At the time of writing, 12 pt have died of progressive lung cancer. 23 pt received only 2 cycles of induction chemotherapy and 8 pt are still undergoing chemotherapy. 5 pt underwent only palliative RT. A total of 19 pt received a dose of 70 Gy and have also completed >3 months of followup post-RT. After 70 Gy, a complete response was achieved in 11/19 pt, 8 of whom remain in complete remission, while 3 later developed exclusively extrathoracic metastases. Of the 7 pt showing a partial response, 3 subsequently developed exclusively local progression. No elective nodal failures were observed. No pt developed > grade 1 esophagitis, while grade 2 acute radiation pneumonitis (SWOG scale) developed in 6 pt. No grade 3-5 radiation-induced toxicities were observed. Conclusion: In locally advanced NSCLC, [a] local failure is uncommon when a complete remission is achieved after 70 Gy, and [b] "involved-field" RT did not appear to increase isolated regional failures. No unacceptable toxicity was observed and local tumor control may be improved with the "involved field" technique and concurrent chemo-RT and/or accelerated RT.
170
of QOL score. Patients received chemotherapy lost QOL score after radiation therapy. In five categories, score of physical condition had less improvement. Conclusion: It was suggested that radiation therapy could be completed without losing QOL of lung cancer patients, including elder patients. However, patients receiving chemotherapy are possible to lose their QOL, therefore, it is needed to treat such patients carefully.
• 5Brain7 metastases - 5 from 1 NSCLC E Barata, A. Figueiredo, P. Alves, L. Pedro, R. Rate. CentreHospitalar de Coimbra, Departmentof Pneumology Service, Coimbra, Portuga/ Purpose: To determine the median survival of patients with metastatic brain cancer from non-small cell lung cancer (NSCLC) and to evaluate some factors involved in survival. Patients and Methods: A total of 48 patients (39 males, 9 females) with a median age of 62.4 years (41-81), all with brain metastases (BM) from NSCLC, were studied. The histologic patterns were: 52% adenocarcinoma; 37.5% squamous cell cercinom; 10.5% large cell carcinoma. The most frequent basal clinical symptom was headache in 62.5%. Diagnosis of BM was obtained by CT scan in 70.8% of the patients and MRI in the remaining 29.2%. All patients but 6, with single brain metastasis, had multiple metastases. The therapeutic option was surgery plus radiotherapy in 8.4% of the patients; radiotherapy (30 Gy in 15 fractions) in 41.6%. In the remaining 50%, the only option was to provide the best supportive therapy. Results: The overall survival post NSCLC diagnosis was 216 days to the 48 patients. 29 patients didn't show BM at the time of diagnosis; the mean time to BM was 137.5 days. In 19 patients, the presence of BM was simultaneous with diagnosis of NSCLC. The mean survival after BM diagnosis was 146 days. After BM diagnosis, a performance status (PS) value of 1-2 was associated with better survival (164 days) than a PS value of 3-4 (112 days). The survival of patients with BM treated with radiotherapy is significantly longer than one of those receiving best supportive care (215 days vs. 62 days; p < 0.001). There was no significant difference between patients with adenocarcinoma and squamous cell carcinoma. Conclusions: The survival of patients with BM from NSCLC is poor. The survival was better for patients with PS values of 1-2 and on those eligible for radiotherapy versus best supportive care, probably reflecting a bias on the patient selection for radiotherapy. radiotherapy as an alternative to surgery for [57-6-]Conformal respiratory inoperable stage I non-small cell lung cancer (NSCLC) S. Hominal, I. MarteI-Lafay, M. Perol, C. Ginestet, J.C. Guerin, C. Carrie. Croix-Rousse Hospital Lyon; Centre Leon Berard, Lyon,
France The published results of conventional radiotherapy for stage I NSCLC as an alternative to surgery in patients with severe underlying pulmonary disease, indicate that local control remains unsatisfactory. This retrospective study was conducted to investigate whether conformal radiotherapy could be given without major pulmonary toxicity and if a better local control would be obtained. Materials and Methods: From 1996 to 1997, patients with stage I NSCLC received conformal radiotherapy. An immobilisation device with a polyurethane foam mould was made before the dosimetric scan performed in the treatment position. The plannifled target volume (PTV) encompassed the gross tumor volume (GTV) (macroscopic tumor mass) with 1 cm margin. Complex fields were obtained from a multileaf collimator. Dose volume histograms (DHV) were calculated for the tumor and the normal tissues. The prescribed dose was 60-66 GY on the P'IV in 18 MV photons with 6 to 12 fields using a conventional fractionation. Lung functions were assessed prior to irradiation, 6 weeks and 6 months follow-up by forced expiratory volume in 1 second (FEV 1), forced vital capacity (FVC), total lung capacity (TLC), diffusion capacity to carbon monoxide (DLCO) and blood gaz tests. Pneumonitis
was graded according to the SOMA-LENT scale. Local disease free survival (LDFS) was our primary objective because of the high rate of intercurrent death in these patients. Results: 10 patients (6 T1 and 4 T2 tumors). Median age = 67 years. Median Karnofsky performance score = 90%. Median FEV1 = 1280 ml (42.5% of theory). Median FVC = 2780 ml (74%). Median TLC = 6040 (91%). Median DLCO = 52%. Median PO2 = 69 mmHg. Pneumonitis: 6 weeks = 3 grade 1, 3 grade 2/6 months = 7 grade 1, 3 grade 2. No grade 3-4. No fatal complication. End point (1 January 2000): 6 patients alive with disease; 4 died of cancer; local recurrence for 8 patients. Median LDFS is 15 months. Two years LDFS rate is 17.5%. Median survival time is 35.8 months. Two years overall survival rate is 78%. Discussion-Conclusion: The high local relapse could be explained by the difficulties in delivering treatment with a high degree of precision because of respiratory movements. Further studies are necessary to evaluate the different methods to control breathing during radiotherapy, to determine the optimal radiation dose and to develop a mathematical model which could estimate the risk of radiation pneumonitis, considering DHV, baseline pulmonary function and biological factors (cytokines).
•]
Patterns of tumor recurrence following induction chemotherapy and involved-field" radiotherapy (RT) to 70 Gy in stage 3 non-small cell lung cancer (NSCLC)
J.P. van Meerbeeck, S.A. Burgers, J. van Sornsen de Koste, R.J. van Klaveren, M.J. Samson, S.S. eel, M.J.A. de Jonge, T.A.W. Splinter, S. Senan. ROTS, Rotterdam, the Netherlands Background: With conventional RT techniques and doses, a high incidence of local and distant failure is observed in locally advanced NSCLC. Omitting RT to uninvolved mediastinal nodes (i.e. "involvedfield" RT) could reduce toxicity, while not increasing the incidence of isolated regional failure. Methods: In an ongoing phase II study, 39 patients (pt) with medicelly or surgically inoperable stage III non-small cell lung cancer were treated with either 2 or 4 cycles of cerboplatin (AUC 6) and paclitaxel (200 mg/m2). Pt whose primary tumors had a diameter > 6 cm and/or supraclavicular metastases were ineligible. Tumor response was evaluated 2 weeks after the second cycle of chemotherapy. If at least a partial response was obtained, 2 additional cycles of chemotherapy were administered, followed by "involved-field" RT to 70 Gy using 3-dimensional treatment planning. Only the tumor and mediastinal nodes with a short axis diameter equal to, or greater than, 1 cm were contoured in the gross tumor volume. At 3 and 6 months following RT, pt were reevaluated by means of bronchoscopy and CT scan. Local tumor control was also reevaluated when distant recurrences were detected. Elective nodal failure was defined as a recurrence in an initially uninvolved regional node in the absence of local failure. Results: The majority of pt had stage 3B disease. At the time of writing, 12 pt have died of progressive lung cancer. 23 pt received only 2 cycles of induction chemotherapy and 8 pt are still undergoing chemotherapy. 5 pt underwent only palliative RT. A total of 19 pt received a dose of 70 Gy and have also completed >3 months of followup post-RT. After 70 Gy, a complete response was achieved in 11/19 pt, 8 of whom remain in complete remission, while 3 later developed exclusively extrathoracic metastases. Of the 7 pt showing a partial response, 3 subsequently developed exclusively local progression. No elective nodal failures were observed. No pt developed > grade 1 esophagitis, while grade 2 acute radiation pneumonitis (SWOG scale) developed in 6 pt. No grade 3-5 radiation-induced toxicities were observed. Conclusion: In locally advanced NSCLC, [a] local failure is uncommon when a complete remission is achieved after 70 Gy, and [b] "involved-field" RT did not appear to increase isolated regional failures. No unacceptable toxicity was observed and local tumor control may be improved with the "involved field" technique and concurrent chemo-RT and/or accelerated RT.