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or Mediastinal Lymph Node Metastases After Stereotactic Body Radiation Therapy for Stage I Non–small Cell Lung Cancer: 5-Year Results
E478
International Journal of Radiation Oncology Biology Physics
3134
Purpose/Objective(s): Two randomized Phase II trials with primary endpoints of toxicity showed single fraction SBRT for early stage peripheral non-small cell lung cancer in medically inoperable patients (pts) to be the optimal schedule after meeting pre-specified criteria for both toxicity and efficacy compared to fractionated schedules. These trials did not stratify by distance of tumor to chest wall (CW). Therefore, we sought to determine CW toxicity (CWT) rates for single fraction SBRT by location in pts treated with 30 Gy or 34 Gy. Materials/Methods: An IRB-approved prospective SBRT registry was used to identify pts treated with 30 Gy or 34 Gy in one fraction, on or off relevant protocols. Tumors were 5 cm, node-negative, and 2 cm from the proximal tracheo-bronchial tree. GTV was measured as abutting, 1 cm, or > 1 cm from the CW. CWT and pneumonitis were graded according to CTCAE 3.0 criteria. Chi-square test or unpaired t-test was used to assess differences in pt and disease characteristics between the two dose groups. Overall survival (OS) was calculated using the Kaplan Meier method and compared using the log-rank test. Rates of disease failure and toxicity were calculated using the cumulative incidence method and compared using Gray’s test. Results: This study included 140 pts treated with single fraction SBRT to 147 lesions. 81 lesions (55.1%) were treated to 30 Gy and 66 lesions (44.9%) to 34 Gy. Median follow-up was 23.7 months (30.2 months for living pts). Pt and tumor factors were balanced between groups, except for more active smokers (34.8% vs. 19.8%; pZ0.04), higher median body mass index (26.9 vs. 24.5; pZ 0.01), and shorter follow up (19.2 months vs. 27.0 months) in the 34 Gy cohort. The rate of pneumonitis (any grade, 6.2% vs. 8.9%; pZ 0.74) and CWT (any grade, 7.5% vs. 15.6%; pZ0.17) at 2 years was not significantly different between 30 Gy and 34 Gy. CWT was 30.6% for lesions abutting the CW, 6.0% for lesions 1 cm from the CW, and 3.3% for lesions > 1 cm from the CW. Abutment was significantly associated with CWT (p <0.0001) on UVA. Grade 3 CWT was modest for the entire cohort (1.4%). For the 30 Gy and 34 Gy subsets, rates of local failure (7.6% vs. 12.8%; pZ 0.55), distant metastasis (16.2% vs. 20.4%; pZ 0.54), and OS (64.6% vs. 65.8%; pZ 0.40) at 2 years were not significantly different, respectively. Conclusion: With single fraction lung SBRT, rates of local control, CWT, and pneumonitis do not significantly vary with prescription dose. The rate of CWT is associated with distance from the CW. The overall rate of CWT for single fraction SBRT appears similar to that reported for fractionated SBRT in randomized trials. Even when considering only lesions adjacent to the CW, the rate of CWT in this series (30.6%) does not appear to exceed the rates in the published fractionated SBRT literature (20-33%). Our results suggest location adjacent to the CW should not be a contraindication to single fraction SBRT. Author Disclosure: B. Manyam: None. G.M. Videtic: Member, Lung cancer steering CommitteeLiaison for Lung Committee to the Advanced Technology Integration Committee; RTOG. ; ASTRO, IASLC. draft and review treatment guidelines in lung cancer; ASTRO. C.A. Reddy: None. N.M. Woody: None. K.L. Stephans: None.
Definitive Radiation Therapy for Hilar and/or Mediastinal Lymph Node Metastases After Stereotactic Body Radiation Therapy for Stage I Nonesmall Cell Lung Cancer: 5-Year Results Y. Manabe,1 Y. Shibamoto,1 F. Baba,2 R. Murata,3 T. Yanagi,1 C. Hashizume,4 H. Iwata,5 K. Kosaki,6 A. Miyakawa,7 and T. Murai1; 1 Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan, 2Department of Radiotherapy, Nagoya City West Medical Center, Nagoya, Japan, 3Department of Radiation Oncology, Suzuka Chuo General Hospital, Suzuka, Japan, 4Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Japan, 5 Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan, 6Department of Radiology, Kasugai Municipal Hospital, Kasugai, Japan, 7Department of Radiation Oncology, Nanbu Tokushukai Hospital, Okinawa, Japan Purpose/Objective(s): In 2011, we reported the clinical outcome of radiotherapy for hilar and/or mediastinal lymph node (LN) metastases developing after stereotactic body radiotherapy (SBRT) for stage I nonsmall cell lung cancer (NSCLC), in comparison with that for postoperative LN metastases. The aim of this study is to evaluate 5-year results for these patients. Materials/Methods: Between 2004 and 2014, 27 patients with hilar and/or mediastinal LN metastases without local recurrence and distant metastasis after SBRT (n Z 14) or surgery (n Z 13) were treated with definitive conventional radiotherapy. The median follow-up period was 11 months (range, 4-92) in the post-SBRT group and 25 months (range, 5-126) in the post-surgery group. Twelve of the 14 patients (86%) in the post-SBRT group were judged medically inoperable at the time of SBRT. Prior to radiotherapy for LN metastases, absence of local recurrence and distant metastases was confirmed by FDG-PET and/or other imaging modalities in both groups of patients. Both groups were treated conventionally with 2Gy daily fractions using 10-MV photons. The median total dose for treating metastatic lymph nodes was 60 Gy (range, 54-66) for the postSBRT group and 66 Gy (range, 60-66) for the post-surgery group. Only 1 of the 14 post-SBRT patients and 9 of the 12 post-surgery patients received chemotherapy. Survival and local control rates were calculated by KaplanMeier method, and differences between the curves were examined by logrank test. Toxicities were evaluated with the Common Terminology Criteria for Adverse Events version 4.0. Results: Overall survival, cause-specific survival, progression-free survival, and local control rates at 3 years after mediastinal irradiation were 21%, 45%, 21%, and 64%, respectively, for the 14 patients in the postSBRT group. These rates were 54%, 54%, 39%, and 92%, respectively for the post-surgery group (P Z .066, .64, .38, and .71, respectively). Four in the post-SBRT group lived 3 or more years (range, 36-92 months) after mediastinal irradiation. A grade 5 pulmonary toxicity was observed in 1 of the post-SBRT patients. The other toxicities were all grade 2. There was no significant difference in the incidence of grade 2 pulmonary toxicity (43% for the post-SBRT group vs 31% for the post-surgery group, PZ .80; chi-square test). Conclusion: A proportion of patients achieved long-term survival by conventional radiotherapy. The probability of long-term survival did not seem to differ significantly from that in postoperative recurrent cases. Radiotherapy in this setting appears reasonably well tolerated. Author Disclosure: Y. Manabe: None. Y. Shibamoto: None. F. Baba: None. R. Murata: None. T. Yanagi: None. C. Hashizume: None. H. Iwata: None. K. Kosaki: None. A. Miyakawa: None. T. Murai: None.
3135 Single Fraction SBRT for Stage I NoneSmall Cell Lung Cancer: Treatment Outcomes and Effect of Tumor Location on Chest Wall Toxicity B. Manyam, G.M. Videtic, C.A. Reddy, N.M. Woody, and K.L. Stephans; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
3136 Central3D: A Clinical Tool for Robust Characterization of Centrally Located Nonesmall Cell Lung Cancer D. Mathieu,1 V. Cousineau Daoust,1 L. Bilodeau,1 S. Bedwani,1 E. Filion,1 A. Lenglet,2 H. Bahig,1 T. Vu,1 D. Roberge,1 and M.P. Campeau1; 1Centre hospitalier de l’Universite de Montreal, Montreal, QC, Canada, 2Centre Hospitalier Universaitaire de Montre´al, Montre´al, QC, Canada Purpose/Objective(s): The aim of this study is to evaluate inter observer variability in the proper identification of centrally located lung tumors and to evaluate the clinical applications of an anatomy visualization tool. Central3D is a software which uses available treatment planning contours to allow clinicians to visualize the gross tumor volume (GTV) in an interactive 3D environment and appreciate its relationship to organ at risks (OARs). This algorithm precisely calculates the minimal GTV distance to any structure of interest and displays volume relations through a user-
International Journal of Radiation Oncology Biology Physics
3134
Purpose/Objective(s): Two randomized Phase II trials with primary endpoints of toxicity showed single fraction SBRT for early stage peripheral non-small cell lung cancer in medically inoperable patients (pts) to be the optimal schedule after meeting pre-specified criteria for both toxicity and efficacy compared to fractionated schedules. These trials did not stratify by distance of tumor to chest wall (CW). Therefore, we sought to determine CW toxicity (CWT) rates for single fraction SBRT by location in pts treated with 30 Gy or 34 Gy. Materials/Methods: An IRB-approved prospective SBRT registry was used to identify pts treated with 30 Gy or 34 Gy in one fraction, on or off relevant protocols. Tumors were 5 cm, node-negative, and 2 cm from the proximal tracheo-bronchial tree. GTV was measured as abutting, 1 cm, or > 1 cm from the CW. CWT and pneumonitis were graded according to CTCAE 3.0 criteria. Chi-square test or unpaired t-test was used to assess differences in pt and disease characteristics between the two dose groups. Overall survival (OS) was calculated using the Kaplan Meier method and compared using the log-rank test. Rates of disease failure and toxicity were calculated using the cumulative incidence method and compared using Gray’s test. Results: This study included 140 pts treated with single fraction SBRT to 147 lesions. 81 lesions (55.1%) were treated to 30 Gy and 66 lesions (44.9%) to 34 Gy. Median follow-up was 23.7 months (30.2 months for living pts). Pt and tumor factors were balanced between groups, except for more active smokers (34.8% vs. 19.8%; pZ0.04), higher median body mass index (26.9 vs. 24.5; pZ 0.01), and shorter follow up (19.2 months vs. 27.0 months) in the 34 Gy cohort. The rate of pneumonitis (any grade, 6.2% vs. 8.9%; pZ 0.74) and CWT (any grade, 7.5% vs. 15.6%; pZ0.17) at 2 years was not significantly different between 30 Gy and 34 Gy. CWT was 30.6% for lesions abutting the CW, 6.0% for lesions 1 cm from the CW, and 3.3% for lesions > 1 cm from the CW. Abutment was significantly associated with CWT (p <0.0001) on UVA. Grade 3 CWT was modest for the entire cohort (1.4%). For the 30 Gy and 34 Gy subsets, rates of local failure (7.6% vs. 12.8%; pZ 0.55), distant metastasis (16.2% vs. 20.4%; pZ 0.54), and OS (64.6% vs. 65.8%; pZ 0.40) at 2 years were not significantly different, respectively. Conclusion: With single fraction lung SBRT, rates of local control, CWT, and pneumonitis do not significantly vary with prescription dose. The rate of CWT is associated with distance from the CW. The overall rate of CWT for single fraction SBRT appears similar to that reported for fractionated SBRT in randomized trials. Even when considering only lesions adjacent to the CW, the rate of CWT in this series (30.6%) does not appear to exceed the rates in the published fractionated SBRT literature (20-33%). Our results suggest location adjacent to the CW should not be a contraindication to single fraction SBRT. Author Disclosure: B. Manyam: None. G.M. Videtic: Member, Lung cancer steering CommitteeLiaison for Lung Committee to the Advanced Technology Integration Committee; RTOG. ; ASTRO, IASLC. draft and review treatment guidelines in lung cancer; ASTRO. C.A. Reddy: None. N.M. Woody: None. K.L. Stephans: None.
Definitive Radiation Therapy for Hilar and/or Mediastinal Lymph Node Metastases After Stereotactic Body Radiation Therapy for Stage I Nonesmall Cell Lung Cancer: 5-Year Results Y. Manabe,1 Y. Shibamoto,1 F. Baba,2 R. Murata,3 T. Yanagi,1 C. Hashizume,4 H. Iwata,5 K. Kosaki,6 A. Miyakawa,7 and T. Murai1; 1 Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan, 2Department of Radiotherapy, Nagoya City West Medical Center, Nagoya, Japan, 3Department of Radiation Oncology, Suzuka Chuo General Hospital, Suzuka, Japan, 4Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Japan, 5 Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan, 6Department of Radiology, Kasugai Municipal Hospital, Kasugai, Japan, 7Department of Radiation Oncology, Nanbu Tokushukai Hospital, Okinawa, Japan Purpose/Objective(s): In 2011, we reported the clinical outcome of radiotherapy for hilar and/or mediastinal lymph node (LN) metastases developing after stereotactic body radiotherapy (SBRT) for stage I nonsmall cell lung cancer (NSCLC), in comparison with that for postoperative LN metastases. The aim of this study is to evaluate 5-year results for these patients. Materials/Methods: Between 2004 and 2014, 27 patients with hilar and/or mediastinal LN metastases without local recurrence and distant metastasis after SBRT (n Z 14) or surgery (n Z 13) were treated with definitive conventional radiotherapy. The median follow-up period was 11 months (range, 4-92) in the post-SBRT group and 25 months (range, 5-126) in the post-surgery group. Twelve of the 14 patients (86%) in the post-SBRT group were judged medically inoperable at the time of SBRT. Prior to radiotherapy for LN metastases, absence of local recurrence and distant metastases was confirmed by FDG-PET and/or other imaging modalities in both groups of patients. Both groups were treated conventionally with 2Gy daily fractions using 10-MV photons. The median total dose for treating metastatic lymph nodes was 60 Gy (range, 54-66) for the postSBRT group and 66 Gy (range, 60-66) for the post-surgery group. Only 1 of the 14 post-SBRT patients and 9 of the 12 post-surgery patients received chemotherapy. Survival and local control rates were calculated by KaplanMeier method, and differences between the curves were examined by logrank test. Toxicities were evaluated with the Common Terminology Criteria for Adverse Events version 4.0. Results: Overall survival, cause-specific survival, progression-free survival, and local control rates at 3 years after mediastinal irradiation were 21%, 45%, 21%, and 64%, respectively, for the 14 patients in the postSBRT group. These rates were 54%, 54%, 39%, and 92%, respectively for the post-surgery group (P Z .066, .64, .38, and .71, respectively). Four in the post-SBRT group lived 3 or more years (range, 36-92 months) after mediastinal irradiation. A grade 5 pulmonary toxicity was observed in 1 of the post-SBRT patients. The other toxicities were all grade 2. There was no significant difference in the incidence of grade 2 pulmonary toxicity (43% for the post-SBRT group vs 31% for the post-surgery group, PZ .80; chi-square test). Conclusion: A proportion of patients achieved long-term survival by conventional radiotherapy. The probability of long-term survival did not seem to differ significantly from that in postoperative recurrent cases. Radiotherapy in this setting appears reasonably well tolerated. Author Disclosure: Y. Manabe: None. Y. Shibamoto: None. F. Baba: None. R. Murata: None. T. Yanagi: None. C. Hashizume: None. H. Iwata: None. K. Kosaki: None. A. Miyakawa: None. T. Murai: None.
3135 Single Fraction SBRT for Stage I NoneSmall Cell Lung Cancer: Treatment Outcomes and Effect of Tumor Location on Chest Wall Toxicity B. Manyam, G.M. Videtic, C.A. Reddy, N.M. Woody, and K.L. Stephans; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
3136 Central3D: A Clinical Tool for Robust Characterization of Centrally Located Nonesmall Cell Lung Cancer D. Mathieu,1 V. Cousineau Daoust,1 L. Bilodeau,1 S. Bedwani,1 E. Filion,1 A. Lenglet,2 H. Bahig,1 T. Vu,1 D. Roberge,1 and M.P. Campeau1; 1Centre hospitalier de l’Universite de Montreal, Montreal, QC, Canada, 2Centre Hospitalier Universaitaire de Montre´al, Montre´al, QC, Canada Purpose/Objective(s): The aim of this study is to evaluate inter observer variability in the proper identification of centrally located lung tumors and to evaluate the clinical applications of an anatomy visualization tool. Central3D is a software which uses available treatment planning contours to allow clinicians to visualize the gross tumor volume (GTV) in an interactive 3D environment and appreciate its relationship to organ at risks (OARs). This algorithm precisely calculates the minimal GTV distance to any structure of interest and displays volume relations through a user-